Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review.

(1) Background: Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. (2) Methods: We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords "spinal cord injury," "pain," "exercise," "disability," "paraplegia," and "tetraplegia" across the DBpia, EMBASE, PubMed, and Science Direct databases. (3) Results: From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. (4) Conclusion: Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population.

Creating a Rehabilitation Sports Public Service Information Systems Using Service Design Thinking: Physical Activity Management of the Disabled after Discharge in the Republic of Korea.

The Republic of Korea has established an institutional framework to expedite the provision of rehabilitation sports public services to individuals with disabilities post-hospital discharge (Act on Guarantee of Right to Health and Access to Health Services for People with Disabilities in December 2017). Regrettably, this service remains non-operational to date. This study employs a service design approach to identify and develop essential elements for the effective implementation of public rehabilitation sports services in Korea. Adopting the service design method, including the empathize-define-ideate-prototype phases, co-creation activities were conducted with three teams comprising people with disabilities, caregivers, rehabilitation physicians, specialized sports instructors, facility managers, and government officials, emphasizing equitable distribution. By leveraging the experiences of people with disabilities, these teams collaboratively engaged in creative activities to formulate strategies for delivering prompt and user-friendly rehabilitation sports public services post-hospital discharge. Contributions from each team were meticulously collected and organized, incorporating diverse perspectives into the development of the Korean Rehabilitation Sports Public Service Information System (KRSPSIS). Additionally, we presented a scenario illustrating the practical application of the KRSPSIS. Through this system, we anticipate providing more efficient and convenient rehabilitation sports public services to individuals with disabilities during the critical early stages following hospital discharge.

Home-Based Virtual Reality Exergame Program after Stroke Rehabilitation for Patients with Stroke: A Study Protocol for a Multicenter, Randomized Controlled Trial.

It is essential for stroke patients to maintain their therapy even after discharging inpatient rehabilitation. This is because recovery is an ongoing process that requires consistent effort. Virtual reality exergame training (VRET) is becoming widely used in stroke rehabilitation to improve physical, social, and psychological outcomes. Home-based VRET may be a more convenient and accessible option for stroke rehabilitation. This study will aim to determine the effectiveness of home-based VRET for patients with stroke who have been discharged from the hospital. This trial will randomly assign 120 participants to 8 weeks of either a VRET (intervention group) or daily life (control group). The study will measure cardiopulmonary endurance, muscular strength, functional capacity, gait, activities of daily living, and quality of life. Our main objective is to determine whether it is safe for patients to undergo VRET at home after they have been discharged from the hospital with a doctor's note. Additionally, we aim to examine whether stroke patients are capable of exercising at home after being discharged from the hospital. This study's outcome could pave the way for developing more comprehensive exercise protocols for stroke patients. Our findings will provide valuable insights into the efficacy of VRET as a therapeutic tool for stroke patients.

Protocol for Community-Based Exercise Training after Discharge from Hospital-Based Stroke Rehabilitation: A Multicenter, Randomized, Parallel-Group, Double-Blind Controlled Pilot and Feasibility Trial.

Exercise training participation of patients with stroke in the community after discharge from the hospital has many benefits for physical, social, and psychological rehabilitation and improves their quality of life. However, in the Republic of Korea, studies on stroke survivors who can participate in an exercise training program have not been conducted. This trial aims to investigate the effectiveness of exercise training programs after patients with stroke are discharged from the hospital with a doctor's note and referred to a community exercise center, as there is a lack of studies on this population. This multicenter, randomized, parallel-group, double-blind controlled pilot and feasibility trial will randomly assign 120 patients with stroke to either 8 weeks of a community-based exercise training program (experimental group) or activities of daily living (control group). The primary outcomes will be muscle strength, cardiorespiratory fitness, body composition, physical performance, and gait. The secondary outcomes will be quality of life and activities of daily living. This study's results may add new insights into the effectiveness of community-based exercise training programs after patients with stroke are discharged from the hospital with a doctor's note and referred to a community exercise center. The success of the new exercise training approach could offer valuable information for developing more inclusive protocols for patients with stroke in the future if it proves to be efficacious.

The efficacy of community-based exercise programs on circulating irisin level, muscle strength, cardiorespiratory endurance, and body composition for ischemic stroke: a randomized controlled trial.

Objective: We investigated the changes in circulating irisin levels after community-based exercise and the association of these levels with improvements in muscle strength, cardiorespiratory endurance, and body composition in people with ischemic stroke. Methods: Twenty participants were randomly assigned to either a control or an exercise group. The community-based exercise program (CEP) consisted of 8 weeks of 1 h sessions for 3 days a week. Irisin levels, muscle strength, cardiorespiratory endurance, and body composition were assessed before and after the intervention. Results: Significant improvements were observed in the leg and trunk strength, peak oxygen consumption values, and body composition of the exercise group compared with the control group. In addition, circulating irisin levels were observed to have increased in the exercise group, positively correlated with muscle strength and cardiorespiratory endurance. Conclusion: CEP might be an effective intervention to increase irisin levels and prevent a stroke-related decline in muscle function.

A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach.

BACKGROUND: Respiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications. METHODS: We examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured. RESULTS: There were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program. CONCLUSIONS: Community game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise. TRIAL REGISTRATION: KCT0005980.

Evaluation of expert views and considerations to develop rehabilitation sports public services for persons with disabilities in Republic of Korea: a Delphi study.

BACKGROUND: Physical activity is required to maintain health; however, resources needed for physical activity (e.g. facilities, instructors, and programmes) are scarce for persons with disabilities (PWD), particularly those who require rehabilitation following hospital discharge and those with severe disabilities. The Republic of Korea presently lacks a legal and administrative framework that supports the implementation of health services for PWD. Therefore, it is necessary to develop such a framework based on the perspectives of PWD, medical and physical education experts, facility managers, and government organisations. Thus, this study aimed to establish expert consensus on the development of rehabilitation sports public services (RSPS) in the Republic of Korea by reviewing previous studies and expert statements. METHODS: Using the Delphi method, we reviewed the literature to identify the critical roles and factors required for planning efficient RSPS programmes, including coordinators, physicians, facility managers, rehabilitation exercise and physical education instructors, and integrated information systems for facilities, instructors, and programmes. We developed a Delphi questionnaire with closed-ended questions, based on the factors derived from the literature review and supplementary open-ended questions, which was administered to a panel of 26 experts. RESULTS: The panel reached a consensus on most factors (i.e. coordinators, physicians, facility managers, rehabilitation exercise and physical education instructors, and integrated information systems for facilities, instructors, and programmes). However, no consensus was reached regarding 'when an applicant can continue/discontinue an RSPS programme', 'establishing information systems to manage physical fitness of PWD', and 'joint operation of the to-be-established system by the Ministry of Health and Welfare and Ministry of Culture, Sports, and Tourism', leaving room for further debate. CONCLUSIONS: By identifying the factors and roles necessary for RSPS, this study is expected to offer valuable information for state-led pilot projects and contribute to promoting physical activity and quality of life among PWD.

Comparing the effects of multicomponent exercise with or without power training on the cardiorespiratory fitness, physical function, and muscular strength of patients with stroke: a randomized controlled trial.

BACKGROUND: Literature studies concerning the effect of implementing a multicomponent program with different individual exercise intensities are insufficient. This study aimed to examine the effects of performing a multicomponent exercise program incorporating high-speed power training on cardiorespiratory fitness, physical function, and muscular strength in poststroke patients. We compared the results of two different exercise regimens: high-speed power training and traditional low-speed strength training. METHODS: Forty-five poststroke patients were randomly assigned to the high-speed, low-speed, and control groups. A 60-min multicomponent exercise program was conducted three times per week for 8 weeks in the two exercise groups, whereas static stretching was performed in the control group. Cardiorespiratory fitness, physical function, and muscular strength were assessed before and after the intervention. RESULTS: Significant improvements were observed in the peak oxygen consumption values and results of the Berg balance scale, Korean version of the Trunk Impairment Scale, and Timed Up-and-Go test. The aforementioned were evaluated as a measure of cardiorespiratory function and functional ability in the exercise groups and compared to those obtained in the control group. High-speed power training led to greater improvement in patients compared with low-speed strength training. CONCLUSIONS: Multicomponent exercise involving high-speed power training was beneficial in helping patients with stroke regain cardiorespiratory fitness, physical function, and muscular strength.

Development and pilot testing of novel game-based respiratory rehabilitation exercise devices for patients with tetraplegia.

BACKGROUND: Individuals with spinal cord injuries (SCI) show restricted breathing patterns with reduced lung volumes and capacities. OBJECTIVE: To improve breathing in such individuals, we aimed to develop breathing exercise devices using a user-centered design (UCD) and then assess the effects of these devices on breathing. METHODS: Patients with SCI were involved in the device development. Preliminary online survey participants were recruited from the community, and interview and pilot test participants were recruited from a patient self-help group. The four UCD phases were repeatedly performed. Users required fun, easy, multi-player, and safe exercise devices. RESULTS: Seven breathing exercise devices were developed, and 10 different game-based exercises were performed. Two individuals participated in a pilot test involving a respiratory rehabilitation exercise program conducted twice weekly for 60 min/session over 8 weeks. Lung function was assessed using a spirometer. Forced vital capacity, forced expiratory volume in 1 s, and vital capacity showed minimal changes, whereas maximum inspiratory and expiratory pressures improved. Participants reported that the exercises were entertaining and that the competitive nature of the game-like exercises encouraged further participation. CONCLUSION: Breathing exercise programs using our developed devices can improve breathing and positively affect the psychological states and sociability of users.

Effect of elastic band-based high-speed power training on cognitive function, physical performance and muscle strength in older women with mild cognitive impairment.

AIM: The effectiveness of resistance training in improving cognitive function in older adults is well demonstrated. In particular, unconventional high-speed resistance training can improve muscle power development. In the present study, the effectiveness of 12 weeks of elastic band-based high-speed power training (HSPT) was examined. METHODS: Participants were randomly assigned into a HSPT group (n = 14, age 75.0 ± 0.9 years), a low-speed strength training (LSST) group (n = 9, age 76.0 ± 1.3 years) and a control group (CON; n = 7, age 78.0 ± 1.0 years). A 1-h exercise program was provided twice a week for 12 weeks for the HSPT and LSST groups, and balance and tone exercises were carried out by the CON group. RESULTS: Significant increases in levels of cognitive function, physical function, and muscle strength were observed in both the HSPT and LSST groups. In cognitive function, significant improvements in the Mini-Mental State Examination and Montreal Cognitive Assessment were seen in both the HSPT and LSST groups compared with the CON group. In physical functions, Short Physical Performance Battery scores were increased significantly in the HSPT and LSST groups compared with the CON group. In the 12 weeks of elastic band-based training, the HSPT group showed greater improvements in older women with mild cognitive impairment than the LSST group, although both regimens were effective in improving cognitive function, physical function and muscle strength. CONCLUSIONS: We conclude that elastic band-based HSPT, as compared with LSST, is more efficient in helping older women with mild cognitive impairment to improve cognitive function, physical performance and muscle strength. Geriatr Gerontol Int 2017; 17: 765-772.

Resistance exercise training increases the expression of irisin concomitant with improvement of muscle function in aging mice and humans.

We investigated the effect of resistance training on irisin expression with improvement in muscle strength and function in aged mice and human. In the mice study, 19 months old male C57BL/6 mice were randomly assigned into two groups; control group and resistance exercise group. Ladder climbing exercise with tail weight was performed 3 days per week for 12 weeks. In the human study, participants (aged over 65 years) were randomly assigned into exercise group or control group. Elastic band exercise program consisted of 12 weeks of 1-h session 2 days per week. In the mice study, we found an increase of irisin in serum and soleus muscle as well as improvement in muscle strength (p=0.02) and muscle quality (p=0.03) without body composition change in training animals. In the human study, isokinetic leg strength and grip strength were improved in the exercise group compared to the control group without change of body composition. In addition, the level of circulating irisin level was increased. It had a positive correlation with grip strength (R=0.526, p=0.002) and leg strength (R=0.414, p=0.003) in the exercise group. Thus, resistant training might be an efficient intervention method to increase irisin levels and prevent age-related decline in muscle function.

Characterization of human atherosclerosis by optical coherence tomography.

BACKGROUND: High-resolution visualization of atherosclerotic plaque morphology may be essential for identifying coronary plaques that cause acute coronary events. Optical coherence tomography (OCT) is an intravascular imaging modality capable of providing cross-sectional images of tissue with a resolution of 10 micro m. To date, OCT imaging has not been investigated in sufficient detail to assess its accuracy for characterizing atherosclerotic plaques. The aim of this study was to establish objective OCT image criteria for atherosclerotic plaque characterization in vitro. METHODS AND RESULTS: OCT images of 357 (diseased) atherosclerotic arterial segments obtained at autopsy were correlated with histology. OCT image criteria for 3 types of plaque were formulated by analysis of a subset (n=50) of arterial segments. OCT images of fibrous plaques were characterized by homogeneous, signal-rich regions; fibrocalcific plaques by well-delineated, signal-poor regions with sharp borders; and lipid-rich plaques by signal-poor regions with diffuse borders. Independent validation of these criteria by 2 OCT readers for the remaining segments (n=307) demonstrated a sensitivity and specificity ranging from 71% to 79% and 97% to 98% for fibrous plaques, 95% to 96% and 97% for fibrocalcific plaques, and 90% to 94% and 90% to 92% for lipid-rich plaques, respectively (overall agreement, kappa=0.83 to 0.84). The interobserver and intraobserver reliabilities of OCT assessment were high (kappa values of 0.88 and 0.91, respectively). CONCLUSIONS: Objective OCT criteria are highly sensitive and specific for characterizing different types of atherosclerotic plaques. These results represent an important step in validating this new intravascular imaging modality and will provide a basis for the interpretation of intracoronary OCT images obtained from patients.

Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound.

OBJECTIVES: The aim of this study was to evaluate the feasibility and the ability of intravascular optical coherence tomography (OCT) to visualize the components of coronary plaques in living patients. BACKGROUND: Disruption of a vulnerable coronary plaque with subsequent thrombosis is currently recognized as the primary mechanism for acute myocardial infarction. Although such plaques are considered to have a thin fibrous cap overlying a lipid pool, imaging modalities in current clinical practice do not have sufficient resolution to identify thin (< 65 microm) fibrous caps. Optical coherence tomography is a new imaging modality capable of obtaining cross-sectional images of coronary vessels at a resolution of approximately 10 microm. METHODS: The OCT images and corresponding histology of 42 coronary plaques were compared to establish OCT criteria for different types of plaques. Atherosclerotic lesions with mild to moderate stenosis were identified on angiograms in 10 patients undergoing cardiac catheterization. Optical coherence tomography and intravascular ultrasound (IVUS) images of these sites were obtained in all patients without complication. RESULTS: Comparison between OCT and histology demonstrated that lipid-rich plaques and fibrous plaques have distinct OCT characteristics. A total of 17 IVUS and OCT image pairs obtained from patients were compared. Axial resolution measured 13 +/- 3 microm with OCT and 98 +/- 19 microm with IVUS. All fibrous plaques, macrocalcifications and echolucent regions identified by IVUS were visualized in corresponding OCT images. Intimal hyperplasia and echolucent regions, which may correspond to lipid pools, were identified more frequently by OCT than by IVUS. CONCLUSIONS: Intracoronary OCT appears to be feasible and safe. Optical coherence tomography identified most architectural features detected by IVUS and may provide additional detailed structural information.