Effect of Strengthening Exercise in Addition to Task-Specific Gait Training after Stroke: a Randomised Trial Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial Effects of whole-body vibration training on physical function in patients with multiple sclerosis. Coordination of Hemiparetic Locomotion after Stroke Rehabilitation Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial The effects of improved strength on obstacle negotiation in community-living older adults. Motor response to amphetamine treatment, task-specific training, and limited motor experience in a postacute animal stroke model Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Effects of task-oriented training on mobility function in children with cerebral palsy. Does Treadmill Training Improve Lower-Extremity Tasks in Parkinson Disease? A Randomized Controlled Trial Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. Cognitive rehabilitation of mildly impaired Alzheimer disease patients on cholinesterase inhibitors. Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation A task-oriented circuit training in multiple sclerosis: a feasibility study Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Effects of a Pulmonary Rehabilitation Program With Balance Training on Patients With COPD Rating the strength of scientific evidence: relevance for quality improvement programs. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Resistance training on physical performance in disabled older female cardiac patients. Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair. A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Systematic review automation technologies Effects of a postoperative strength-training program on the walking ability of children with cerebral palsy: a randomized controlled trial.
Rationale Gait deficits contribute considerably to functional disability after stroke , and the regaining of walking ability is a major goal in most stroke rehabilitation programmes . Evidence suggests that muscular strengthening exercises after stroke can improve strength and activity . Additionally , task-related practice performed at high intensities may enhance walking competency in people with stroke . However , there is insufficient evidence to conclude which approach is most effective . Aim This study will test the hypothesis that task-specific walking training plus targeted strength training is superior to task-specific walking training alone in improving strength , motor co-ordination , quality of independent walking , and participation in acute stroke patients . Design This trial is a prospect i ve , r and omised clinical trial . People after stroke who are living at home and attending outpatient clinics will be r and omly allocated into either an experimental or a control group . The experimental group will undertake task-specific walking training , plus targeted strength training three times per week over 10 weeks , while the control group will only undertake task-specific walking training . At baseline , after 10 weeks of intervention and 4 weeks after the cessation of the interventions , allocation-blinded research ers will collect outcome measures . Study outcomes Primary outcomes will be measured for levels of impairment ( strength and co-ordination ) , activity ( quality of walking ) , and participation ( quality of life ) . Secondary outcomes will be the minimal clinical ly important differences of lower limb strength , motor co-ordination , and gait speed Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 OBJECTIVE The aim of this r and omized controlled trial was to test the hypothesis that a three-week whole body vibration ( WBV ) training in addition to a st and ard rehabilitation program improves walking ability in patients with Multiple Sclerosis ( MS ) . PATIENTS AND METHOD Sixty patients with definite MS were r and omly allocated to the intervention or control group . Training sessions were performed three times per week for three weeks . Patients adopted a moderate squat position on a vibration platform . The training sessions comprised series of 3 × 60-sec exercise sets with increasing amplitude between sessions from 1 to 2 mm . During the exercise series , the vibration platform was turned on for the intervention group and switched off for the control group . A mixed factor ANOVA was used to compare sit to st and test , timed up and go test , 10-meter walk test , and 6-min walk test data between patient groups and between baseline and follow-up . RESULTS All outcome measures improved from baseline to follow-up ( P < 0.001 ) . The 6-minute walk test showed significantly greater improvements from baseline to follow-up for the intervention than for the control group ( P < 0.001 ) . CONCLUSION Determinants of walking ability in patients with MS that are specific to walking endurance tasks are most affected by vibration training design ed to improve strength endurance Objectives . Determine whether a rehabilitation program targeting functional motor recovery of persons with poststroke hemiparesis improved motor coordination . Methods . A subgroup of 20 persons with poststroke hemiparesis ( n = 11 in intervention and n = 9incontrol group ) was investigated from within a larger r and omized controlled single-blind clinical trial of 100 patients .  Motor coordination was measured using a pedaling task , and subjects in the intervention group pedaled during an intensive broad-based home exercise program that targeted flexibility , strength , balance , and endurance . Coordination variables based on paretic leg pedal forces and EMG of 4 thigh muscles were measured while pedaling pre- and postintervention . Results . Despite extensive pedaling practice , up to 30 half-hour sessions that were progressively more intense , there was no effect ( P > 0.05 ) of the intervention on percent of total work done by the paretic leg , quantitative measures of EMG , or pedaling speed . However , walking speed was improved and pedaling and walking faster were associated after the intervention . Conclusions . There is no evidence of improved locomotor coordination postintervention . The increased walking and pedaling speed was likely achieved by a more proficient use of the same impaired pattern without EMG timing changes , likely because of increased strength and endurance postintervention . A more task-specific intervention may be required to improve coordination , consistent with principles of use-dependent plasticity A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a st and ard evidence -based rehabilitation protocol . Eleven r and omized , controlled trials ( level 1 and 2 ) evaluating the effect of exercise in the treatment of impingement were identified . Data regarding demographics , methodology , and outcomes of pain , range of motion , strength , and function were recorded . Individual components of each rehabilitation program were catalogued . Effectiveness was determined by statistical and clinical significance . Although many articles had method ologic concerns , the data demonstrate that exercise has statistically and clinical ly significant effects on pain reduction and improving function , but not on range of motion or strength .  Manual therapy augments the effects of exercise  , yet supervised exercise was not different than home exercise programs . Information regarding specific components of the exercise programs was synthesized into a gold st and ard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement Background . After inpatient stroke rehabilitation , many people still can not participate in community activities because of limited walking ability . Objective . To compare the effectiveness of 2 conceptually different , early physical therapy ( PT ) interventions to usual care ( UC ) in improving walking 6 months after stroke . Methods . The Locomotor Experience Applied Post-Stroke ( LEAPS ) study was a single-blind , r and omized controlled trial conducted in 408 adults with disabling hemiparetic stroke . Participants were stratified at baseline ( 2 months ) by impairment in walking speed : severe ( < 0.4 m/s ) or moderate ( 0.4 to < 0.8 m/s ) . Between 2 and 6 months , they received either only UC ( n = 143 ) or UC plus 36 therapist-provided sessions of either ( 1 ) walking training on a treadmill using body-weight support and practice overground at clinics ( locomotor training program [ LTP ] , n = 139 ) or ( 2 ) impairment-based strength and balance exercise at home ( home exercise program [ HEP ] , n = 126 ) . Results . LTP participants were 18 % more likely to transition to a higher functional walking level : severe to > 0.4 m/s and moderate to > 0.8 m/s than UC participants ( 95 % confidence interval [ CI ] = 7%-29 % ) , and HEP participants were 17 % more likely to transition ( 95 % CI = 5%-29 % ) . Mean gain in walking speed in LTP participants was 0.13 m/s greater ( 95 % CI = 0.09 - 0.18 ) and in HEP participants , 0.10 m/s greater ( 95 % CI = 0.05 - 0.14 ) than in UC participants . Conclusions . Progressive PT , using either walking training on a treadmill and overground , conducted in a clinic , or strength and balance exercises conducted at home , was superior to UC in improving walking , regardless of severity of initial impairment Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes Poor mobility has been associated with age-related deterioration in muscle strength . While previous work has examined the effects of improved strength on level walking , we have quantified the effects of a resistance-training program on obstructed gait tasks using biomechanical-dependent measures . Forty-five community-dwelling participants aged 62 years or older were r and omised to either a control ( n=16 ) or experimental group ( n=29 ) . The experimental subjects exercised for 24 weeks on a progressive resistance-training program design ed to improve lower body strength . Dynamic strength was assessed at weeks 0 and 24 as well as specific laboratory gait kinetics and kinematics during stepping over an obstacle and negotiation of a raised surface set at 10 , 20 and 30 % of each subject 's leg length . Significant strength improvements ( P<0.05 ) , ranging between 197 and 285 % , were recorded in the experimental group . The strength gains in the experimental group were accompanied by significant increases in obstacle-crossing stride velocity ( range 5.5 - 15.5 % ) due to increases in stride length and decreases in stride duration for both gait tasks . Significant changes in the peak vertical and anterior-posterior ground reaction forces as well as in kinematic variables associated with a safe obstacle traverse such as vertical obstacle heel clearance , limb flexion at obstacle crossing , horizontal foot placement and vertical l and ing velocity result ed in an improved crossing strategy in the experimental subjects . These findings provide evidence of significant improvements in obstructed gait function of community-living older adults associated with a systematic resistance-training program Despite advances in acute treatment of ischemic cerebrovascular events , the most common clinical outcome is disabling neurological impairment . Despite experimental evidence that psychostimulant treatment can positively affect recovery rate after focal brain lesions , beyond rehabilitation therapies there are no currently accepted medical treatments indicated for diminishing neurological impairment after clinical ly established stroke . To test the effect of amphetamine , task-specific training , limiting motor experience , and their interaction on motor recovery in a postacute animal model of stroke , animals were nonaversively trained in beam walking before a unilateral photochemical sensorimotor cortex lesion and tested for 10 days after lesion . Animals were r and omized to groups receiving : a single session of motor training 24 h after lesion ; a single injection of amphetamine 2 mg/kg 24 h after lesion ; beam-walking experience limited to testing on days 1 and 10 after lesion ; and groups that received amphetamine treatment combined with training or combined with limited experience .  Motor recovery was maximally enhanced by training , delayed by amphetamine treatment , and most negatively affected by limiting beam-walking experience during the recovery period . These findings support physical training after stroke , indicating that limiting physical activity negatively affects motor recovery and raises questions about the role of stimulant treatment to enhance motor recovery in the postacute phase after stroke Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population Objective : To investigate whether gait training with treadmill improves functional tasks of lower extremities in patients with Parkinson disease ( PD ) . Design : R and omized controlled trial including two groups , the treadmill training group and the nonintervention group . Setting : University hospital . Patients : Thirty consecutive patients diagnosed with idiopathic PD , who were on stable regimens of antiparkinsonian medication , able to walk independently , and had not participated in a rehabilitation program in the previous 3 months . Patients with severe cognitive impairments or severe musculoskeletal , cardiopulmonary , neurologic , or other systemic disorders were excluded . Twenty-four patients completed the study . Interventions : Group I attended a training program on a treadmill for 6 weeks , and group II served as the control group . Both groups were instructed in home mobility exercises . Main Outcome Measurements : The primary study outcome measures were timed functional lower-extremity tasks ( walking at a corridor , U-turn , turning around a chair , stairs , st and ing on one foot , st and ing from a chair ) , and secondary outcome measures were exercise test and patient 's global assessment . Assessment s were performed at baseline and at the end of the study . Results : There were significant improvements in functional lower-extremity tests , exercise test parameters , and patients ' global assessment in group I , whereas no significant improvements were observed in group II . Conclusions : Even though long-term effects remain unknown and the study sample was small , it was concluded that  treadmill training in PD patients led to improvements in lower-extremity tasks , thus improving patients ' physical well-being in daily life QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 OBJECTIVE The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease ( AD ) patients receiving a cholinesterase inhibitor . METHODS Twenty-five participants in the Cognitive Rehabilitation ( CR ) condition participated in two 45-minute sessions twice per week for 24 total sessions . CR training included face-name association tasks , object recall training , functional tasks ( e.g. , making change , paying bills ) , orientation to time and place , visuo-motor speed of processing , and the use of a memory notebook .  Nineteen participants in the Mental Stimulation ( MS ) condition had equivalent therapist contact and number of sessions , which consisted of interactive computer games involving memory , concentration , and problem-solving skills . RESULTS Compared with the MS condition , participants in CR demonstrated improved performance on tasks that were similar to those used in training . Gains in recall of face-name associations , orientation , cognitive processing speed , and specific functional tasks were present post-intervention and at a 3-month follow-up . CONCLUSION A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in mildly impaired AD patients Background Early rehabilitation after stroke is essential to help reduce disability . Purpose To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke . Data Sources English- language search es of multiple electronic data bases from April 2009 through July 2018 ; targeted search es to December 2018 for studies of selective serotonin reuptake inhibitors ( SSRIs ) or serotonin-norepinephrine reuptake inhibitors . Study Selection 19 systematic review s and 37 r and omized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke . Data Extraction One investigator abstract ed the data , and quality and GRADE assessment were checked by a second investigator . Data Synthesis Most interventions ( for example , SSRIs , mental practice , mirror therapy ) did not improve motor function . High- quality evidence did not support use of fluoxetine to improve motor function . Moderate- quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living ( ADLs ) . Low- quality evidence supported use of robotic arm training to improve ADLs . Low- quality evidence indicated that antidepressants may reduce depression , whereas the frequency and severity of antidepressant-related adverse effects was unclear . Low- quality evidence suggested that cognitive behavioral therapy and exercise , including mind-body exercise , may reduce symptoms of depression and anxiety . Limitation Studies were of poor quality , interventions and comparators were heterogeneous , and evidence on harms was scarce . Conclusion Cardiorespiratory training , repetitive task training , and transcranial direct current stimulation may improve ADLs in adults with stroke .  Cognitive behavioral therapy , exercise , and SSRIs may reduce symptoms of poststroke depression , but use of SSRIs to prevent depression or improve motor function was not supported . Primary Funding Source U.S. Department of Veterans Affairs , Veterans Health Administration Background The aim of this study was to evaluate the safety , feasibility and preliminary effects of a high-intensity rehabilitative task-oriented circuit training ( TOCT ) in a sample of multiple sclerosis ( MS ) subjects on walking competency , mobility , fatigue and health-related quality of life ( HRQoL ) . Methods 24 MS subjects ( EDSS 4.89 ± 0.54 , 17 female and 7 male , 52.58 ± 11.21 years , MS duration 15.21 ± 8.68 years ) have been enrolled and r and omly assigned to 2 treatment groups : ( i ) experimental group received 10 TOCT sessions over 2 weeks ( 2 hours/each session ) followed by a 3 months home exercise program , whereas control group did not receive any specific rehabilitation intervention . A feasibility patient-reported question naire was administered after TOCT . Functional outcome measures were : walking endurance ( Six Minute Walk Test ) , gait speed ( 10 Meter Walk Test ) , mobility ( Timed Up and Go test ) and balance ( Dynamic Gait Index ) . Furthermore , self-reported question naire of motor fatigue ( Fatigue Severity Scale ) , walking ability ( Multiple Sclerosis Walking Scale – 12 ) and health-related quality of life ( Multiple Sclerosis Impact Scale – 29 ) were included . Subjects ’ assessment s were delivered at baseline ( T0 ) , after TOCT ( T1 ) and 3 months of home-based exercise program ( T2 ) . Results After TOCT subjects reported a positive global rating on the received treatment . At 3 months , we found a 58.33 % of adherence to the home-exercise program . After TOCT , walking ability and health-related quality of life were improved ( p < 0.05 ) with minor retention after 3 months . The control group showed no significant changes in any variables . Conclusions This two weeks high-intensity task-oriented circuit class training followed by a three months home-based exercise program seems feasible and safe in MS people with moderate mobility impairments ; moreover it might improve walking abilities . Trial registration Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov PURPOSE : Patients with chronic obstructive pulmonary disease ( COPD ) have balance impairments . However , pulmonary rehabilitation ( PR ) is associated with only minor improvements in functional balance . Therefore , there is a need to explore the role of balance training within PR . This study aim ed at assessing the effects of a PR program , with a specific component of balance training , on functional balance of patients with COPD . METHODS : Out patients with COPD ( N = 22 , age = 68.0 ± 11.8 years ; forced expiratory volume in 1 second = 72.2 ± 22.3 % predicted ) participated in a 12-week PR program including exercise training and psychosocial support and education . Exercise training sessions comprised endurance , strength , and a specific component of balance training .  The Timed Up and Go ( TUG ) test was used to assess functional balance before and after the PR . Health-related quality of life ( St George 's Respiratory Question naire ) , quadriceps muscle strength ( 10 repetition maximum ) , and exercise tolerance ( 6-minute walk test ) were also assessed . RESULTS : Patients demonstrated significant improvements in TUG scores after PR ( mean change −1.7 ± 1.4 seconds ; P = .001 ; effect size = 1.249 ) . Before PR , 9 ( 41 % ) participants and after PR only 1 ( 4.5 % ) participant had a TUG performance worse than the average performance of age-matched healthy peers ( P = .008 ) . The St George 's Respiratory Question naire symptoms score ( P = .012 ) , quadriceps muscle strength ( P = .001 ) , and exercise tolerance ( P = .001 ) were also improved . CONCLUSIONS : Pulmonary rehabilitation with a specific component of balance training had a large effect on functional balance in patients with COPD . Findings highlight the value of including balance training in PR programs . Further research is needed to determine the optimal intervention to improve balance and its specific components among patients with COPD OBJECTIVE To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence , and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available " best practice s " tools by which these steps can be accomplished . DESIGN Drawing on an extensive review of checklists , question naires , and other tools in the field of evidence -based practice , this paper discusses clinical , management , and policy rationale s for rating strength of evidence in a quality improvement context , and documents best practice s methods for these tasks . RESULTS After review of 121 systems for grading the quality of articles , 19 systems , mostly STUDY DESIGN specific , met a priori scientific st and ards for grading systematic review s , r and omized controlled trials , observational studies , and diagnostic tests ; eight systems ( of 40 review ed ) met similar st and ards for rating the overall strength of evidence . All can be used as is or adapted for particular types of evidence reports or systematic review s. CONCLUSIONS Formally grading study quality and rating overall strength of evidence , using sound instruments and procedures , can produce reasonable levels of confidence about the science base for parts of quality improvement programs . With such information , health care professionals and administrators concerned with quality improvement can underst and better the level of science ( versus only clinical consensus or opinion ) that supports practice guidelines , review criteria , and assessment s that feed into quality assurance and improvement programs . New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems , but the need for those developing systematic review s , practice guidelines , and quality or audit criteria to underst and and undertake these steps is becoming increasingly clear STUDY OBJECTIVES Low body weight in COPD patients is associated with worsening dyspnea , reduced leg strength , and poor prognosis . Classical rehabilitation strategies are then limited by reduced exercise tolerance . Thus , we proposed to evaluate whether electrostimulation ( ES ) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation . DESIGN R and omized , controlled study . SETTING Pulmonary rehabilitation center . PATIENTS Seventeen patients with severe COPD ( mean [ + /- SD ] FEV(1 ) , 30 + /- 3 % predicted ) and low body mass index ( BMI ) [ 18 + /- 2.5 kg/m(2 ) ] . METHODS Patients were r and omly assigned either to usual rehabilitation ( UR ) alone or to a UR-plus-ES program for 4 weeks . Quadriceps muscle strength , total muscle mass ( MM ) , exercise capacity , and health-related quality of life were measured before and after rehabilitation . RESULTS The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction ( MVC ) compared to UR alone ( 97 + /- 71 vs 36 + /- 34 contractions , respectively ; p = 0.03 ) and result ed in a more significant improvement in dyspnea when performing daily tasks ( decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure question naire , -1.7 + /- 1.0 vs -0.2 + /- 1.2 points , respectively ; p = 0.05 ) . There was also a significant increase in walking distance ( 63 + /- 40 m ; p = 0.01 ) and BMI ( 0.6 + /- 0.5 kg/m(2 ) ; p = 0.02 ) after training in the ES + UR group . A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group ( r = 0.94 ; p = 0.03 ) . CONCLUSIONS The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI . In this population , ES has been revealed as a useful procedure , complementing the usual pulmonary rehabilitation PURPOSE We evaluated the value of resistance training on measures of physical performance in disabled older women with coronary heart disease ( CHD ) . METHODS The study intervention consisted of a 6-month program of resistance training in a r and omized controlled trial format . Training intensity was at 80 % of the single-repetition maximal lift . Control patients performed light yoga and breathing exercises . Study participants included 42 women with CHD , all > or= 65 yr of age and community dwelling . Subjects were screened by question naire to have low self-reported physical function . The primary study measurements related to the performance of 16 household activities of the Continuous Scale Physical Functional Performance test ( CSPFP ) . These ranged from dressing , to kitchen and cleaning activities , to carrying groceries and walking onto a bus with luggage , and a 6-min walk . Activities were measured in time to complete a task , weight carried during a task , or distance walked . Other measures included body composition , measures of aerobic fitness and strength , and question naire-based measures of physical function and depression score . RESULTS Study groups were similar at baseline by age , aerobic capacity , strength , body composition , and in performing the CSPFP . After conditioning , 13 of 16 measured activities were performed more rapidly , or with increased weight carried , compared with the control group ( all P < 0.05 ) . Maximal power for activities that involved weight-bearing over a distance , increased by 40 % ( P < 0.05 ) . CONCLUSIONS Disabled older women with CHD who participate in an intense resistance-training program improve physical capacity over a wide range of household physical activities . Benefits extend beyond strength-related activities , as endurance , balance , coordination , and flexibility all improved . Strength training should be considered an important component in the rehabilitation of older women with CHD OBJECTIVES To determine the effect of a 12-week intervention to improve the ability of disabled older adults  to rise from a bed and from a chair . DESIGN Subjects were r and omly allocated to either a 12-week task-specific resistance-training intervention ( training in bed- and chair-rise subtasks , such as sliding forward to the edge of a chair with the addition of weights ) or a control flexibility intervention . SETTING Seven congregate housing facilities . PARTICIPANTS Congregate housing residents age 65 and older ( n = 161 , mean age 82 ) who reported requiring assistance ( such as from a person , equipment , or device ) in performing at least one of the following mobility-related activities of daily living : transferring , walking , bathing , and toileting . MEASUREMENTS At baseline , 6 weeks , and 12 weeks , subjects performed a series of bed- and chair-rise tasks where the rise task dem and varied according to height of the head of the bed , chair seat height , and use of h and s. Outcomes were able or unable to rise and , if able , the time taken to rise . Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise . Following log transformation of rise time , a linear effects model was used to compare rise time between tasks . RESULTS Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed , a significant training effect was seen at 12 weeks ( P = .03 ) ; the training effect decreased as the total number of tasks increased . No statistically significant training effects were noted for rise ability according to individual tasks . Bed- and chair-rise time showed a significant training effect for each rise task , with analytic models suggesting a range of approximately 11 % to 20 % rise-time ( up to 1.5 seconds ) improvement in the training group over controls . Training effects were also noted in musculoskeletal capacities , particularly in trunk range of motion , strength , and balance . CONCLUSIONS Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks . The actual rise-time improvement was clinical ly small but may be useful over the long term . Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort , such as in rehabilitation setting s. In these setting s , the less challenging rise tasks ( such as rising from an elevated chair ) and the ability to perform intermediate tasks ( such as hip bridging ) may become important intermediate rehabilitation goals Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com PURPOSE Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease ( COPD ) in the short term , but their long-term effects are not known . We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD . SUBJECTS AND METHODS One hundred patients were r and omly assigned to receive either an exercise training program that included cycling , walking , and strength training ( n = 50 ) or usual medical care ( n = 50 ) . Thirty-four patients in the training group were evaluated after 6 months ( end of training ) , and 26 were evaluated after 18 months of follow-up . In the control group , 28 patients were evaluated at 6 months and 23 after 18 months . We measured pulmonary function , 6-minute walking distance , maximal exercise capacity , peripheral and respiratory muscle strength , and quality of life ( on a 20 to 140-point scale ) , and estimated the cost-effectiveness of the program . RESULTS At 6 months , the training group showed improvement in 6-minute walking distance [ mean difference ( training - control ) of 52 m ; 95 % confidence interval ( CI ) , 15 to 89 m ] , maximal work load ( 12 W ; 95 % CI , 6 to 19 W ) , maximal oxygen uptake ( 0.26 liters/min ; 95 % CI , 0.07 to 0.45 liters/min ) , quadriceps force ( 18 Nm ; 95 % CI , 7 to 29 Nm ) , inspiratory muscle force ( 11 cm H(2)O ; 95 % CI , 3 to 20 cm H(2)O ) , and quality of life ( 14 points ; 95 % CI , 6 to 21 points ; all P < 0.05 ) . At 18 months all these differences persisted ( P < 0.05 ) , except for inspiratory muscle strength . For 6-minute walking distance and quality of life , the differences between the training group and controls at 18 months exceeded the minimal clinical ly-important difference . CONCLUSION Among patients who completed the 6-month program , outpatient training result ed in significant and clinical ly relevant changes in 6-minute walking distance , maximal exercise performance , peripheral and respiratory muscle strength , and quality of life . Most of these effects persisted 18 months after starting the program Systematic review s , a cornerstone of evidence -based medicine , are not produced quickly enough to support clinical practice . The cost of production , availability of the requisite expertise and timeliness are often quoted as major contributors for the delay . This detailed survey of the state of the art of information systems design ed to support or automate individual tasks in the systematic review , and in particular systematic review s of r and omized controlled clinical trials , reveals trends that see the convergence of several parallel research projects . We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks of the systematic review . Several projects focus on automating , simplifying and /or streamlining specific tasks of the systematic review . Some tasks are already fully automated while others are still largely manual . In this review , we describe each task and the effect that its automation would have on the entire systematic review process , summarize the existing information system support for each task , and highlight where further research is needed for realizing automation for the task . Integration of the systems that automate systematic review tasks may lead to a revised systematic review workflow . We envisage the optimized workflow will lead to system in which each systematic review is described as a computer program that automatically retrieves relevant trials , appraises them , extracts and synthesizes data , evaluates the risk of bias , performs meta- analysis calculations , and produces a report in real time OBJECTIVE To investigate the effect of a postoperative strength-training program on the walking of children with cerebral palsy ( CP ) . DESIGN R and omized controlled trial . SETTING Hospital rehabilitation department . PARTICIPANTS Thirty-nine children with CP ( age range , 6 - 16 y ) . After orthopedic surgery , the control group ( n=20 ) followed a conventional physiotherapy ( PT ) program , and the strength-training group ( n=19 ) followed a strength-training program in addition to the conventional PT .  Twenty-nine age-matched healthy children were used as references . INTERVENTION A 9-month strength-training program . MAIN OUTCOME MEASURES Spatiotemporal , kinematic , and kinetic parameters during gait analysis were analyzed before ( E0 ) and 1 year after ( E1 ) the surgery . For 22 children , a 2-year postoperative gait analysis ( E2 ) took place as well . RESULTS At E1 , several kinematic and kinetic parameters improved , although there was no significant difference between the groups . Spatiotemporal parameters showed a worsening at E1 and a recovery to preoperative values at E2 . CONCLUSIONS The examined parameters may be more substantially influenced by factors such as the surgery outcome and the variability of pathologic characteristics than by the strength-training program per se . However , a more significant effect of the strength-training may appear if more intense and short-term training protocol s are used , considering factors such as patients ' motivations , ages , and postoperative statuses
The results revealed that despite significant strength gains , many studies failed to show a significant improvement in walking capacity .
Strength testing and strengthening exercises were prioritized for the knee extensors and flexors , despite their relatively minor role in human walking .
Strengthening exercises performed in the neurologic population are not specific to the main muscle groups responsible for the power generation required for walking .
There is a predisposition for strength testing and strengthening exercises to focus on the knee flexors and extensors despite their relatively minor role during walking .
The aim of this systematic review was to investigate the task specificity of strength training programs for walking in neurologic rehabilitation .