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Journal of Perinatal Medicine Jan 2022The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical...
OBJECTIVES
The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise during pregnancy.
CONTENT
Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter. Along with their concerns regarding the potential associated risks, it contributes to the abandonment or refusal to start exercising during pregnancy. A systematic review was conducted in including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final literature review.
SUMMARY
Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depression. Exercise is not related with an increased risk of maternal or perinatal adverse outcomes. Compliance with current guidelines is sufficient to achieve the main benefits, and exercise type and intensity should be based on woman's previous fitness level.
OUTLOOK
Exercise in pregnancy is safe for both mother and fetus, contributing to prevent pregnancy related disorders. Exercise type and intensity should be adapted to woman's previous fitness level, medical history and characteristics of the ongoing pregnancy.
Topics: Exercise; Exercise Therapy; Female; Health Behavior; Health Promotion; Humans; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 34478617
DOI: 10.1515/jpm-2021-0315 -
Clinics (Sao Paulo, Brazil) 2019The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly individuals.
METHODS
Initially, ninety-two elderly individuals were included in the study and were allocated into the depression group (n=16) and nondepression group (n=14). Both groups engaged in the aquatic exercise program for 12 weeks, including two weekly sessions (45 min/session) at a low intensity (between 50% and 60% of maximal heart rate or Borg scale scores of 13 to 14) throughout the intervention. All outcomes were evaluated at baseline and 12 weeks later.
RESULTS
The patients were 63.5±8.8 years old. The following scores were decreased after training in the depressed group: depression (53%), anxiety (48%), and Timed Up & Go (33%). The following scores increased: Berg Balance Scale (9%) and flexibility (44%). Regarding the blood-based parameters, there were decreases in protein carbonylation (46%) and nitric oxide (60%) and increases in glutathione (170%) and superoxide dismutase (160%) in the depression group (p<0.005).
CONCLUSIONS
The aquatic exercise program reduces depression and anxiety, improves functional autonomy and decreases oxidative stress in depressed elderly individuals.
Topics: Aged; Aged, 80 and over; Anxiety; Exercise; Exercise Therapy; Female; Humans; Male; Mental Health; Middle Aged; Oxidative Stress; Physical Fitness; Water Sports
PubMed: 31271585
DOI: 10.6061/clinics/2019/e322 -
British Journal of Sports Medicine Nov 2020Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP).
DESIGN
Network meta-analysis (NMA).
DATA SOURCES
MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL.
ELIGIBILITY CRITERIA
Exercise training randomised controlled/clinical trials in adults with NSCLBP.
RESULTS
Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): -1.86 (-2.54 to -1.19)), resistance (SUCRA=80%; -1.14 (-1.71 to -0.56)) and stabilisation/motor control (SUCRA=80%; -1.13 (-1.53 to -0.74)) for physical function and resistance (SUCRA=80%; -1.26 (-2.10 to -0.41)) and aerobic (SUCRA=80%; -1.18 (-2.20 to -0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (-0.71 to 0.89)) and physical function (SUCRA=20%; -0.31 (-0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; -0.31 (-1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria.
SUMMARY/CONCLUSION
There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
Topics: Adult; Exercise; Exercise Movement Techniques; Exercise Therapy; Humans; Low Back Pain; Muscle Strength; Muscle Stretching Exercises; Network Meta-Analysis; Randomized Controlled Trials as Topic; Resistance Training
PubMed: 31666220
DOI: 10.1136/bjsports-2019-100886 -
ESC Heart Failure Apr 2018The present update is dedicated to the evolution of the interaction between heart failure (HF) and exercise and how the scientific community has handled it. Indeed, on... (Review)
Review
The present update is dedicated to the evolution of the interaction between heart failure (HF) and exercise and how the scientific community has handled it. Indeed, on the one hand, HF is a leading cause of morbidity and mortality with a stable prevalence from 1998 onward varying between 6.3% and 13.3%. On the other hand, exercise is seen as a diagnostic and prognostic tool as well as a therapeutic intervention in chronic HF. More precisely, the knowledge, the clinical application, and the research interest on the mutual interactions between exercise and HF have different phases in disease progression: Before HF onset (past): exercise provides protective benefit in preventing HF (primary prevention). With HF present: exercise improvement with training provides benefits in HF (secondary prevention). The prediction of future in HF patients: exercise impairment, as a leading characteristic of HF, is used as a prognostic factor.
Topics: Exercise; Exercise Therapy; Heart Failure; Humans; Prognosis
PubMed: 29235244
DOI: 10.1002/ehf2.12225 -
Cancer Immunology, Immunotherapy : CII May 2017Exercise improves functional capacity and patient-reported outcomes across a range of cancer diagnoses. The mechanisms behind this protection have been largely unknown,... (Review)
Review
Exercise improves functional capacity and patient-reported outcomes across a range of cancer diagnoses. The mechanisms behind this protection have been largely unknown, but exercise-mediated changes in body composition, sex hormone levels, systemic inflammation, and immune cell function have been suggested to play a role. We recently demonstrated that voluntary exercise leads to an influx of immune cells in tumors, and a more than 60% reduction in tumor incidence and growth across several mouse models. Given the common mechanisms of immune cell mobilization in mouse and man during exercise, we hypothesize that this link between exercise and the immune system can be exploited in cancer therapy in particular in combination with immunotherapy. Thus, we believe that exercise may not just be "healthy" but may in fact be therapeutic.
Topics: Exercise; Exercise Therapy; Humans; Neoplasms
PubMed: 28324125
DOI: 10.1007/s00262-017-1985-z -
Annual Review of Medicine Jan 2021A large and growing body of evidence suggests that physical activity (PA) may hold therapeutic promise in the management of mental health disorders. Most evidence... (Review)
Review
A large and growing body of evidence suggests that physical activity (PA) may hold therapeutic promise in the management of mental health disorders. Most evidence linking PA to mental health outcomes has focused on the effects of aerobic exercise training on depression, although a growing body of work supports the efficacy of both aerobic and resistance exercise paradigms in the treatment of anxiety and post-traumatic stress disorder. Despite abundant evidence linking PA and mental health, use of exercise training as a mental health treatment remains limited due to three important sources of uncertainty: () large individual differences in response to exercise treatment within multiple mental health domains; () the critical importance of sustained PA engagement, not always achieved, for therapeutic benefit; and () disagreement regarding the relative importance of putative therapeutic mechanisms. Our review of treatment data on exercise interventions and mental health outcomes focuses primarily on depression and anxiety within a health neuroscience framework. Within this conceptual framework, neurobiological and behavioral mechanisms may have additiveor synergistic influences on key cognitive and behavioral processes that influence mental health outcomes. We therefore highlight sources of treatment heterogeneity by integrating the critical influences of () neurobiological mechanisms enhancing neuroplasticity and () behavioral learning of self-regulatory skills. Understanding the interrelationships between dynamic neurobiological and behavioral mechanisms may help inform personalized mental health treatments and clarify why, and for whom, exercise improves mental health outcomes. The review concludes with recommendations for future studies leveraging individual differences to refine treatment approaches to optimize mental health benefits.
Topics: Exercise; Exercise Therapy; Humans; Mental Disorders; Mental Health; Psychotherapy; Quality of Life
PubMed: 33256493
DOI: 10.1146/annurev-med-060619-022943 -
BMC Psychiatry Jan 2019Although currently available evidence suggests that physical exercise can be beneficial for depressed patients and might be comparable to antidepressant treatment, the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although currently available evidence suggests that physical exercise can be beneficial for depressed patients and might be comparable to antidepressant treatment, the best way of implementing this recommendation in clinical practice is not known. This study therefore aims to ascertain the non-inferiority of supervised physical exercise to antidepressant drug treatment, in terms of reducing depressive symptoms among patients presenting with clinical criteria of a depressive episode (ICD-10), across a follow-up period of 6 months.
METHODS
It will take the form of a randomised clinical trial undertaken in a primary care setting, in which a total of 312 patients over the age of 65 years with clinically significant depression will be randomly assigned to supervised physical exercise programme, or will alternatively receive treatment with antidepressant drugs habitually used in clinical practice. Participants' physical condition will be assessed at baseline, and again at 15 days and 1, 3 and 6 months. The supervised exercise programme will consist of 2 weekly sessions in groups of 10-12 patients across a period of 6 months, in which a sports instructor will train patients to do at least 30 min of regular activity at moderate intensity on an almost daily basis, including aerobic, muscle-strengthening, flexibility, and balance-strengthening exercises. The following will be assessed at regular intervals in both groups: status of depression symptoms; level of physical activity; self-perceived health status; appearance of adverse effects; and adherence to the physical exercise programme or antidepressant treatment. The principal outcome variable will be a reduction in pre-treatment depression-symptom scale scores (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Scale).
DISCUSSION
In terms of the number of patients and duration of follow-up, this proposed clinical trial is a project which easily surpasses the few studies on this subject that have been previously conducted on the elderly. Its aim is to provide solid scientific evidence on a therapeutic resource -physical exercise- which has undeniable health benefits and can be applied to certain health problems, such as depressive disorders, which are of great magnitude and considerable socio-economic relevance, and have a significant impact on the quality of life of older adults.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03358433 (retrospectively registered on 11/25/2017).
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Depression; Exercise; Exercise Therapy; Female; Follow-Up Studies; Humans; Male; Primary Health Care; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 30642326
DOI: 10.1186/s12888-018-1982-6 -
BMC Geriatrics Jan 2019Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial.
BACKGROUND
Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence.
METHODS
The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up).
DISCUSSION
Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.
Topics: Accidental Falls; Aged; Aged, 80 and over; Exercise; Exercise Therapy; Female; Home Care Services; Humans; Male; Quality of Life; Risk Factors; Self Efficacy; Single-Blind Method; Treatment Adherence and Compliance; Treatment Outcome
PubMed: 30642252
DOI: 10.1186/s12877-018-1021-y -
The Tohoku Journal of Experimental... Jul 2020Approximately 90% of low back pain (LBP) diagnoses are non-specific (NSLBP; i.e. with unknown cause). In NSLBP patients, the hamstrings, iliopsoas, piriformis, and... (Randomized Controlled Trial)
Randomized Controlled Trial
Approximately 90% of low back pain (LBP) diagnoses are non-specific (NSLBP; i.e. with unknown cause). In NSLBP patients, the hamstrings, iliopsoas, piriformis, and tensor fasciae latae are overactive due to weak hip abductor, extensor, and core muscles. Core stability is essential for proper load balance within the pelvis, spine, and kinetic chain, and core stability exercise (CSE) is an exercise treatment regimen for LBP conditions. We investigated how core stability and hip muscle stretching exercises affected NSLBP patients' physical function and activity. Patients were randomly allocated to three groups. The Stretch group (n = 24) performed exercises for hip muscle stretching for maximal motion; the Strengthen group (n = 22) performed exercises for hip muscle strengthening while maintaining the maximal isometric contraction. The Sham group (n = 20) received gentle palpation of the skin. Therapy was conducted thrice weekly for 6 weeks. Pain intensity, lower back instability, and hip muscle flexibility were measured to assess physical function. Disability level, balance ability, and quality of life were measured to assess physical activity. Data were collected prior to intervention and at 6-week follow-up. There were significant within-group changes for all measurements (P < 0.05). The Stretch and Strengthen groups had greater improvements in pain intensity, disability level, balance ability, and quality of life than the Sham group. Lower back instability and hip muscle flexibility had the greatest improvement in the Stretch group. In conclusion, CSE and hip muscle stretching are effective at improving physical function and activity in NSLBP patients.
Topics: Adult; Aged; Disability Evaluation; Exercise; Exercise Therapy; Female; Follow-Up Studies; Hip; Humans; Isometric Contraction; Low Back Pain; Male; Middle Aged; Muscle Strength; Muscle Stretching Exercises; Muscle, Skeletal; Pain Measurement; Postural Balance; Quality of Life; Treatment Outcome
PubMed: 32669487
DOI: 10.1620/tjem.251.193 -
Journal of Affective Disorders Dec 2017There is a direct link between a variety of addictions and mood states to which exercise could be relieving. Sugar addiction has been recently counted as another... (Review)
Review
BACKGROUND
There is a direct link between a variety of addictions and mood states to which exercise could be relieving. Sugar addiction has been recently counted as another binge/compulsive/addictive eating behavior, differently induced, leading to a high-significant health problem. Regularly exercising at moderate intensity has been shown to efficiently and positively impact upon physiological imbalances caused by several morbid conditions, including affective disorders. Even in a wider set of physchiatric diseases, physical exercise has been prescribed as a complementary therapeutic strategy.
METHOD
A comprehensive literature search was carried out in the Cochrane Library and MEDLINE databases (search terms: sugar addiction, food craving, exercise therapy, training, physical fitness, physical activity, rehabilitation and aerobic).
RESULTS
Seeking high-sugar diets, also in a reward- or craving-addiction fashion, can generate drastic metabolic derangements, often interpolated with affective disorders, for which exercise may represent a valuable, universal, non-pharmachological barrier.
LIMITATIONS
More research in humans is needed to confirm potential exercise-mechanisms that may break the bond between sugar over-consumption and affective disorders.
CONCLUSIONS
The purpose of this review is to address the importance of physical exercise in reversing the gloomy scenario of unhealthy diets and sedentary lifestyles in our modern society.
Topics: Adult; Appetite Regulation; Behavior, Addictive; Compulsive Behavior; Craving; Exercise; Exercise Therapy; Humans; Physical Exertion; Physical Fitness; Sugars
PubMed: 27817910
DOI: 10.1016/j.jad.2016.10.035