Efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass: a prospective longitudinal clinical trial.

Low muscle mass is a common condition among older adults that adversely affects strength, physical performance and quality of life. This study aimed to investigate the efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass, which was defined as appendicular skeletal mass (ASM) measured by bioimpedance analysis lower than 5.7 kg/m2 in females, and lower than 7.0 kg/m2 in males. This home-based resistance exercise program targets 10 muscles with a frequency of 3-5 days/week for 24 weeks. ASM, grip strength, gait speed and functional reach were measured at baseline, 3 and 6 months. The same four outcomes were then remeasured at 9 months to assess long-term effects. A total of 112 participants (average age: 70 years) were recruited. The mean difference between baseline and 6 months was statistically significant for all outcomes, including ASM [0.12 kg/m2: 95% confidence interval (CI), 0.05-0.18; P = 0.001], gait speed (0.19 meter/s: 95% CI, 0.14-0.25; P < 0.001), grip strength (2.06 kg: 95% CI, 1.32-2.80; P < 0.001), and functional reach distance (4.18 cm: 95% CI, 3.18-5.18; P < 0.001). Change over time for all main outcomes from baseline to 9 months also showed statistically significant improvement. The most commonly reported adverse events were muscle pain, joint pain and fatigue. The majority of participants (90-93%) had good exercise compliance, even at the end of the study. In conclusion, this 24-week simple home-based resistance exercise program significantly improved all main outcomes with low adverse events, and most participants continued the program after the end of the intervention.

Effects of Buddhist walking meditation on exercise capacity and quality of life of patients with chronic heart failure: A randomized controlled trial.

BACKGROUND: Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). PURPOSE: To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. METHODS: Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. RESULTS: The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. CONCLUSIONS: The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.

Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After Coronary Artery Bypass Graft Surgery.

BACKGROUND: Although the use of incentive spirometry with a deep breathing exercise (DBE) is widely used in clinical practice in patients who have undergone coronary artery bypass graft (CABG) surgery, the effect of this combination therapy has not been conclusively elucidated. The aim of this study was to investigate the effect of postoperative combined incentive spirometry and DBE versus DBE alone on inspiratory muscle strength following CABG. METHOD: This randomised clinical trial was conducted in patients scheduled to undergo CABG surgery at Siriraj Hospital, Bangkok Thailand. The study group received incentive spirometry and DBE, and the control group received DBE only. Maximal inspiratory pressure (MIP) before surgery and at day 4 after surgery was assessed by a respiratory pressure meter. Secondary outcomes, including postoperative pulmonary complication and duration of postoperative hospitalisation, were obtained from the medical records. RESULTS: Ninety (90) patients were included, with 47 and 43 patients assigned to the study and control groups, respectively. In both groups, there was a significant reduction in MIP from preoperative baseline to postoperative day 4; however, the MIP in the incentive spirometry group had a significantly smaller reduction in MIP compared with the control group (33.0±23.2% vs 47.2±20.1%, respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no difference between groups regarding secondary outcomes. CONCLUSIONS: Patients in the study group had significantly better recovery of inspiratory muscle strength on day 4 post-CABG than patients in the control group. There was no significant difference between groups for either postoperative pulmonary complications or length of hospital stay.

The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients.

PURPOSE: To study the efficacy of traditional Thai massage (TTM) versus conventional physical therapy (PT) programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL) in Thai stroke patients. METHODS: This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand). The study included 50 stroke (onset ≥ 3 months) outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥ 1+ on the modified Ashworth Scale who were ≥ 50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects) or the control group receiving the PT program (26 subjects). Both groups received treatment (either TTM or PT) twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6. RESULTS: At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group. CONCLUSION: This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with adequate sample size are necessary.

Epidemiology of urinary tract infection among spinal cord injured patients in rehabilitation ward at Siriraj Hospital.

BACKGROUND AND OBJECTIVE: A prophylactic antibiotic in retrograde investigations (Ix) such as an urodynamic study was suggested by the European Association of Urology in order to prevent urinary tract infection (UTI) in the neurogenic bladder However finding an appropriate antibiotic is questionable since bacterial types and their sensitivities are variable in different settings. Therefore, the present study was aimed to find out the epidemiology of UTI in spinal cord injured (SCI) patients within the rehabilitation ward at Siriraj Hospital. MATERIAL AND METHOD: A retrospective chart review of 100 SCI patients admitted to the rehabilitation ward between 2006 and 2010 was done. Symptomatic UTI events, urine cultures, and sensitivities (C/S) were reviewed Demographic data and possible UTI-associated factors were collected and examined the association with the occurrence of UTI RESULTS: There were 64 males and 36 females with a mean age of 42.9 (SD 15.8) years. Most of them (77%) were injured at cervical and thoracic spinal cords. Forty-five patients had 57 UTI episodes. Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%), and Enterococcus faecalis (7.7%). The top three most sensitive antibiotics were imipenem, amikacin, and piperacillin/tazobactam. Unfortunately, gentamicin, ceftriaxone, and ciprofloxacin, which were frequently used as a prophylactic antibiotic, had the efficacy for only 51.9%, 38.5%, and 28.8% ofpathogens respectively. The mean length ofstay ofpatients with UTI was far greater than non-UTI patients, 45.5 (SD 24.4) versus 30.4 (SD 14.8) days (p = 0.001). Vesicoureteric reflux (VUR) (OR 21.2, 95% CI2.1 to 214.2) and increased intravesical pressure at storage phase (OR 1.1, 95% CI 1.004-1.113) were significant riSk factors for post investigation UTI. CONCLUSION: UTI was commonly observed in SCI patients within the rehabilitation ward The most common uropathogen was Escherichia coli. Therefore, a prophylactic antibiotic such as amikacin should be prescribed in patients with VUR and increased intravesical pressure at storage phase.

Effect of hand size on the stimulation intensities required for median and ulnar sensory nerve conduction studies.

OBJECTIVES: To examine the effect of hand size on median and ulnar sensory nerve conduction study (NCS) stimulation intensities and pain scores. DESIGN: Prospective, single group design to compare main outcomes by using a standard distance of 14cm versus the proximal wrist crease in 3 different hand sizes. SETTING: Electrodiagnostic laboratory in a department of rehabilitation medicine. PARTICIPANTS: Healthy volunteers (N=25) aged 20 to 30 years. INTERVENTIONS: Hand size was determined, based on the distance between the proximal wrist crease and the base of the long finger, resulting in 3 groups (≤11cm, >11-12cm, >12cm) with 12 hands per group. Antidromic median and ulnar sensory NCSs were performed. The nerves were randomly stimulated at the proximal wrist crease and 14cm from the recording electrode. MAIN OUTCOME MEASURES: Supramaximal stimulation intensities and 10-cm visual analog scale (VAS) pain scores at each stimulating site were recorded and compared. RESULTS: Thirty-six hands from 25 young healthy volunteers were studied. There was no correlation between the body mass index (BMI) and stimulation intensity, and BMI and VAS (r<0.3) in both median and ulnar nerves. Overall analysis showed that the stimulation intensity and VAS at 14cm were significantly greater than at the proximal wrist crease. Subgroup analysis showed the same result in all groups for the median sensory NCS, but in only the small hand group for the ulnar sensory NCS. CONCLUSIONS: When the same distance is used for NCSs regardless of patient size, smaller individuals required greater stimulation and reported greater discomfort. This may reflect greater nerve depth and suggests that one size fits all may not be the best approach with NCSs.