Exergaming Improves Cardiac Risk Factors in Prostate Cancer Patients: A Single-Blinded Randomized Controlled Trial.

Purpose: Androgen deprivation therapy (ADT) may induce unfavorable changes in metabolic outcomes, insulin sensitivity, insulin-like growth factors (IGFs), and in serum levels of adipocyte-derived hormones. In this preplanned randomized ancillary study, we aimed to investigate the ability of exercise to counteract alterations in triglyceride, cholesterol, waist circumference, and insulin caused by ADT in men with locally advanced and metastatic prostate cancer (PCa). Materials and Methods: Forty-six PCa patients undergoing treatment were randomized to 12 weeks of 180 minutes of weekly unsupervised home-based exergaming or usual care. Blood glucose, lipids, cholesterol, adiponectin, leptin, insulin sensitivity, and the insulin growth factor axis were measured at baseline, and after 12 and 24 weeks. Biomarkers were analyzed using a linear mixed-effect model of the difference between the groups from baseline to week 24. In addition, blood pressure, body mass index, body weight, and waist circumference were measured at baseline and after 12 weeks/end of intervention and analyzed using adjusted linear regression analysis. Results: After 24 weeks, a significant difference was seen between the intervention and usual care groups in plasma triglyceride (diff: 0.5 mmol/L, P = 0.02) and high-density lipoprotein (HDL; diff: 0.2 mmol/L, P = 0.01) favoring the intervention group, whereas IGF-binding protein-3 (diff: 148 µg/L, P = 0.01) favored the usual care group. The remaining outcomes were unaffected. Conclusion: Improvement in HDL cholesterol could be used as a primary biomarker in future randomized controlled trials investigating the cardiovascular protecting properties of exergaming.

Home-based 'exergaming' was safe and significantly improved 6-min walking distance in patients with prostate cancer: a single-blinded randomised controlled trial.

OBJECTIVES: To explore the effects of 12 weeks of unsupervised home-based 'exergaming' (i.e., technology-driven exercise) compared to usual care on physical function, body composition, quality of life (QoL), and fatigue in patients with prostate cancer on androgen-deprivation therapy (ADT). PATIENTS AND METHODS: In an assessor-blinded randomised controlled trial, 46 patients with prostate cancer (aged >65 years) with locally advanced or advanced stage disease undergoing ADT were randomised to 12 weeks of unsupervised home-based exergaming or usual care from two hospitals in Denmark. The primary outcome of the study was 6-min walking test (6MWT). Secondary outcomes were leg extensor power (LEP), body composition (lean- and fat-mass), self-reported physical functioning and global health status (European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core [EORTC QLQ-C30]), QoL (Functional Assessment of Cancer Therapy - Prostate [FACT-P]) and fatigue (FACT - fatigue [FACT-F]). RESULTS: There was significant improvement in the exergaming group compared to the usual care group in the primary outcome of 6MWT (mean difference: 21.5 m; 95% confidence interval ([CI]) 3.2-39.9; P = 0.023). There were no differences between the groups for LEP (P = 0.227), lean body mass (P = 0.100), fat body mass (P = 0.092), self-reported physical functioning (P = 0.084) and global health status (P = 0.113), QoL (P = 0.614), and fatigue (P = 0.147). CONCLUSION: Unsupervised home-based exergaming for 12 weeks had an effect on the primary outcome of 6MWT in patients with prostate cancer receiving ADT. However, no significant effects were found in secondary outcomes. The exergaming intervention appeared safe and could be an alternative to traditional aerobic and resistance training in this patient group.

Patient involvement in own rehabilitation after early discharge.

BACKGROUND: A European Union Commission report in 2015 concluded that the concept of patient involvement refers specially to the right of patients to have a central position in the healthcare process (EU Commission 2012, http://ec.europa.eu/public_opinion/archives/quali/ql_5937_patient_en.pdf). Recent research suggests that patient involvement after hip replacement is a very effective strategy in older adults with regard to improving walking ability and reducing pain and thereby lessening loss of physical, mental and social aspects of the quality of life. The growing number of older adults all over the world will increase the need for hip surgery. HYPOTHESIS: Older adults' involvement in own rehabilitation improves their health and quality of life after hip replacement. AIM: To involve and coach older adults with a hip replacement to self-care after early discharge in transition between hospital and home. POPULATION: Empirical data were collected by carrying out three randomised clinical trials (RCT) focusing on self-rated health and involvement of patients undergoing total hip replacement in three Danish orthopaedic clinics. Based on power calculation, 260 patients (mean age 67.5 years) were invited to participate. In this third study in 2010-2013, patients were randomised to either an intervention group or a control group. METHODOLOGY: Randomised clinical trials (RCT). Questionnaire SF-36 a generic tool measuring patients' self-rated health status and quality of life. All patients filled out SF-36 before surgery and again 3, 6, 9 and 12 months after surgery. Patients in the intervention group had an additional follow-up 1, 3 and 7 weeks after discharge by nurses from orthopaedic clinic in hospital. The nurses used a semi-structured interview guide as intervention model to coach, counsel and involve patients to improve their self-care and planned rehabilitation after hip replacement. RESULTS: Older adults benefit through involvement based on an intervention model of expectations, measurement of self-rated health and quality of life. The results of the randomised trials one and two documented that patients' self-rated health status in the intervention group reached their habitual level 3 months after hip replacement vs. 9 months in the control group. Since our working hypothesis 'patient involvement in own rehabilitation improves health and quality of life after hip replacement' was found valid, our ambition is now based on results from this third study to contribute to further research and development within patient involvement. RELEVANCE TO CLINICAL PRACTICE: To follow new evidence-based research, results concluded that walking ability is very necessary in order to increase physical activity to benefit the health of older adults and prevent disease.

Physical health problems experienced in the early postoperative recovery period following total knee replacement.

BACKGROUND: The length of stay in hospital following total knee replacement is markedly shortened due to fast-track programmes. Patients have to be responsible for their recovery at a very early stage. The aim of this study was to investigate the prevalence of physical health problems and the level of exercising in the early recovery period after discharge from hospital following total knee replacement. METHOD: A cross-sectional survey was conducted using a questionnaire. A total of 86 patients were included following first-time elective total knee replacement. Descriptive statistics were used. RESULTS: The majority of the patients experienced leg oedema (90.7%). Secondary to this were pain (81.4%), sleeping disorders (47.7%) problems with appetite (38.4%) and bowel function (34.9%) were the most frequently identified physical health problems. In total, 69.8% of the patients indicated that they did not exercise or only partly exercise as recommended, but without associated experience of pain. CONCLUSION: Patients experienced a wide range of physical health problems following total knee replacement and deviation from recommended self-training was identified. These findings are valuable for health professionals in regard to improve treatment as well as patient education and information.

Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units--randomised controlled trial.

BACKGROUND: There are two types of bed baths: the traditional basin used with soap and water, and the disposable bath, which is prepacked in single-use units and heated before use. OBJECTIVE: To compare the traditional basin bed bath to a disposable bed bath, there are four factors that need to be considered: (1) duration and quality of the bath, (2) cost, (3) nurse satisfaction and (4) patient satisfaction. METHODS: Fifty-eight patients received bed baths on two consecutive days - a traditional bed bath on 1 day and a disposable bed bath on the other. The patients were bathed by the same nurse on both days. The baths were observed in relation to duration, use of supplies and quality. Nurses and patients were interviewed about their preferences. RESULTS: Both types of baths scored very highly in the area of quality. There was no difference in the cost of supplies. Significantly less time was used with the disposable baths (p < 0.001). In terms of total expenditure, the disposable bath cost 11.84 DKK and the basin method cost 11.87 DKK, resulting in an insignificant difference (p > 0.05). Taking the nurses salaries into account, it was much cheaper to bathe patients using the disposable bath. Most patients preferred the disposable bath, while others preferred the basin method or were equally satisfied with both types of baths. There was no significant difference in these results (p > 0.22). There were 46 cases during the trial where nurses preferred the disposable bath method. The washbasin method was preferred in six cases. And there was one case where the nurse was equally satisfied with both types of baths. The nurses rated the disposable bath significantly higher than the basin method. In most cases, patients and nurses preferred the same type of bath (70%). CONCLUSION: This study presents a comparison of the new method of bed bathing to the traditional basin method, in relation to cost, duration, quality and nurse and patient preference. In the case of disposable baths, the costs are lower as significantly less time is used. The nurses were very clear in their preference for disposable baths, and this was also the case for the majority of patients. There was consistency between the nurses and the patients in terms of their preference of bath type. When patients need assistance with personal hygiene, the nurse should inform the patient about the two methods and involve the patient in the decision.

Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial.

OBJECTIVE: We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment. DESIGN: A randomised clinical trial focusing on patients' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months postoperatively was carried out. SAMPLE: 180 patients aged 65 years and over were randomised 4 weeks preoperatively to either control or intervention groups. MEASUREMENTS: both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery. Patients were given counselling within eight main dimensions with reference to their postoperative situation. RESULTS: All patients experienced improvement in health status. The intervention significantly reduced the time patients needed to reach their habitual levels in three of eight areas of their health status: the intervention patients reached their habitual levels at 3 months whereas the control patients reached theirs after 9 months. CONCLUSION: Intervention by telephone support and counselling in the postoperative phase seems to benefit patients' improvement in health status.

Differences in health status of older people aged 65 and above after total hip replacement compared with the normal population: a cross-sectional study.

Aim. The aim of the study was to describe the health status of older patients with osteoarthrosis following total hip replacement and to compare their health status with population norms in order to analyse the need for a rehabilitation programme after total hip replacement. Background. Total hip replacement is a very efficient operation in terms of pain relief and improvement of walking ability. However, after the operation some patients still report low health status. Method. A cross-sectional study including 287 older patients aged 65-74 and 75+ years who had had total hip replacement within the previous 12 months was performed. Patients from five Danish counties received a mailed questionnaire requesting information about their health status and demographic data. The Short-Form 36 measures eight domains of importance of health. The scores related to each dimension are transformed to an interval scale ranging from 0 (worst score) to 100 (best score). Danish population norm data were used as reference point. Results. In total, 287 (91.4%) patients responded. The patients completed the questionnaire 207 (114) days after surgery within a range of 10-360 days. In all eight health domains patients reported significantly lower scores than the age specific norm population. Conclusion. Our results indicate that health status is scored lower for patients after total hip replacement. This implies that there might be a need for further postoperative rehabilitation based on the identification of problems experienced by patients in the postoperative period. Relevance to clinical practice. Patients health status is a predictor for well-being, quality of life and survival. Older people need rehabilitation after surgery to reduce dysfunction and improve perception of health. Our results demonstrate a need for further studies examining problems experienced by patients in the postoperative period. Intervention research is needed before such a programme can be implemented.