Usability of a telehealth-nurse supported home-based walking training for peripheral arterial disease - The Keep Pace! pilot study.

Background: Guidelines recommend walking trainings for peripheral arterial disease (PAD) management. Supervised walking training is superior to walking advise to improve the walking distance. Telehealth service with nurse support may close this gap. Patients and methods: This study introduces a telehealth service, "Keep pace!", which has been developed for patients with symptomatic PAD (Fontaine stage IIa and IIb), enabling a structured home-based walking training while monitoring progress via an app collecting unblinded account of steps and walking distance in self-paced 6-minute-walking-tests by geolocation tracking to enhance intrinsic motivation. Supervision by nurses via telephone calls was provided for 8 weeks, followed by 4 weeks of independent walking training. Patient satisfaction, walking distance and health-related quality of life were assessed. Results: 19 patients completed the study. The analysis revealed an overall high satisfaction with the telehealth service (95.4%), including system quality (95.1%), information quality (94.4%), service quality (95.6%), intention to use (92.8%), general satisfaction with the program (98.4%) and health benefits (95.8%). 78.9% asserted that the telehealth service lacking nurse calls would be less efficacious. Pain-free walking distance (76.3±36.8m to 188.4±81.2m, +112.2%, p<0.001) as well as total distance in 6-minute-walking test (308.8±82.6m to 425.9±107.1m, +117.2%, p<0.001) improved significantly. The telehealth service significantly reduced discomfort by better pain control (+15.5%, p=0.015) and social participation (+10.5%, p=0.042). Conclusions: In conclusion, patients were highly satisfied with the telehealth service. The physical well-being of the PAD patients improved significantly post vs. prior the telehealth program.

The Impact of a Nurse-Led Exercise Activity for Cancer-Related Fatigue in Patients With Leukemia.

Many patients with leukemia experience cancer-related fatigue (CRF). However, when patients are admitted for treatment with chemotherapy, clinicians often overlook CRF and interventions that can help to manage it. The purpose of this four-week intervention was to determine whether a nurse-led exercise activity would reduce CRF and increase physical activity compared to current practice. The results suggest that nurse-led exercise programs can immediately decrease CRF and increase activity in admitted patients with leukemia receiving chemotherapy. Including patients in nurse-led exercise activities can support active participation in their own care during and after hospitalization.

Design of Exercise Nursing Program for Pelvic Floor Muscle Function Recovery at 42 Days Postpartum.

In order to explore the effect of exercise nursing intervention for pelvic floor muscle function recovery at 42 days postpartum, this paper conducts experimental research through controlled experiments, combines statistical methods to carry out digital processing, and sets a single variable of nursing intervention to provide a basis for experimental control, and statistical test results are used for effect evaluation. It has been discovered via experimental study that pelvic floor muscle function recovery exercise training for normal delivery women may enhance the mother's compliance with the pelvic floor muscle function exercise. Moreover, it can reduce the occurrence of urinary incontinence and pelvic organ prolapse, improve the postpartum pelvic floor function of postpartum women, improve the quality of life, and have a significant recovery effect. In addition, it is a simple, noninvasive, and highly safe continuation nursing measure, which can effectively improve the quality of obstetric care and has strong clinical use value.

Effectiveness of Rehabilitation Nursing versus Usual Therapist-Led Treatment in Patients with Acute Ischemic Stroke: A Randomized Non-Inferiority Trial.

PURPOSE: To determine the effectiveness of rehabilitation nursing program interventions in patients with acute ischemic stroke. PATIENTS AND METHODS: An assessment-blinded randomized controlled trial was conducted at a tertiary referral hospital in China. Eligible patients were stratified according to their weighted corticospinal tract lesion load and then randomly assigned to an experimental group (n = 121) or a control group (n = 103). The experimental group received rehabilitation nursing from well-trained, qualified nurses (30 minutes per session, two sessions per day for seven consecutive days). The control group received therapist-led rehabilitation with the same timing and frequency. Comparative analysis of the primary outcomes was performed to determine non-inferiority with a predetermined non-inferiority margin. The primary outcomes were the Motor Assessment Scale, Fugl-Meyer Assessment, and the Action Research Arm Test assessed at baseline and after seven days of treatment. The secondary outcomes were the modified Barthel Index, the National Institutes of Health Stroke Scale, and the modified Rankin Scale, evaluated before and after the intervention and at 4 and 12 weeks of follow-up. RESULTS: Two hundred participants completed the trial. In both groups, all outcomes improved significantly after seven days and at follow-ups. The rehabilitation nursing program was non-inferior to therapist-led treatment with lower 95% confidence limits beyond the margins for primary outcomes (P < 0.001). CONCLUSION: Both treatments had comparable effects; however, no definite conclusion could be drawn. Adequately powered studies are required.

Assisted Walking Program on Walking Ability in In-Hospital Geriatric Patients: A Randomized Trial.

OBJECTIVES: The main aim of this study was to evaluate if an individualized assisted walking program (IAWP) for hospitalized older patients could improve walking ability compared with usual geriatric care and rehabilitation. DESIGN: A randomized controlled trial with an active control group, open labeled with parallel assignment was conducted between October 2018 and January 2020. SETTING: Geriatric ward. PARTICIPANTS: A total of 387 hospitalized patients (≥65 years) were randomly assigned to an intervention or control (usual-care) group. INTERVENTION: The control group received usual hospital care. The intervention group received also an IAWP. MEASUREMENTS: The primary endpoint was change in walking ability from hospital admission (considering both current and pre-admission status) to discharge, as assessed with the Braden Activity subscale measures. The secondary endpoint was the occurrence of in-hospital adverse events, such as complications of mobility, pressure ulcers, falls, pain and mortality, and the length of hospital stay. Intention-to-treat and per-protocol analyses were performed. RESULTS: Baseline characteristics were similar between intervention and control groups. The intervention group, relative to the control group, had significantly improved walking ability at discharge (P < .001). There were no statistically significant differences between the groups in terms of in-hospital adverse events. No adverse effects were detected. CONCLUSION: In in-hospital patients aged 65 and older, an IAWP improves walking ability at discharge.

Exercise as a Therapeutic Intervention.

Evidence supports exercise as a first-line option for many chronic diseases. Although recommendations suggest 150 to 300 minutes a week of moderate-intensity or 75 to 150 minutes a week of vigorous-intensity aerobic activity, replacing sedentary behaviors with light-intensity activities reduces risks of all-cause mortality, and cardiovascular disease (CVD) mortality and incidence of CVD and type 2 diabetes mellitus. Exercise has positive effects on brain function, cognition, and depressive symptoms. Based on such evidence, health care providers should incorporate evaluation of physical activity into patient care. Patients should be evaluated for readiness and ability to exercise and encouraged to increase activity level.

Using the Integrative Model of Behavioral Prediction to Understand Female Breast Cancer Survivors' Barriers and Facilitators for Adherence to a Community-Based Group-Exercise Program.

OBJECTIVES: To identify facilitators and barriers associated with adherence to the EXPINKT exercise program for breast cancer survivors in a convenience sample of women. DATA SOURCES: Focus groups discussions; The Integrative Model of Behavioral Prediction. CONCLUSION: Findings suggest that program adherence could be achieved by the establishment, via staff and processes, of a positive and safe exercise environment, which instills a sense of accountability while developing exercise self-efficacy. Further, multiple referral pathways and promotion of exercise benefit during and following treatment by oncology nurses may assist in enrolment in the program. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses may play a unique role in informing and stimulating female breast cancer survivors to partake in breast cancer-specific exercise programs. Results of this study show that most women are unaware of the benefits related to exercising in relation to cancer recovery, as well as the existence of breast cancer-specific exercise programs. Therefore, oncology nurses may play an important role in creating this awareness. Furthermore, shaping a route to adherence to such exercise programs is essential for breast cancer survivors to become and stay sufficiently active.

Efectividad de los ejercicios de equilibrio entre los adultos mayores en Depok, Indonesia / Effectiveness of balance exercise among older adults in Depok City, Indonesia

OBJETIVO: Las caídas son uno de los problemas más serios entre los adultos mayores. El deterioro del equilibrio es una de las causas importantes de la caída. Este estudio tiene como objetivo investigar el efecto de un ejercicio de equilibrio de ocho semanas sobre la estabilización postural y el riesgo de caídas entre los adultos mayores en la comunidad. MÉTODO: Este estudio cuasi experimental empleó un diseño previo y posterior a la prueba utilizando un grupo de control. El estudio incluyó un grupo de intervención de 30 encuestados y un grupo de control de otros 30 encuestados. La muestra se seleccionó usando muestreo aleatorio de múltiples etapas. Los datos se analizaron mediante una prueba t. RESULTADOS: El ejercicio de equilibrio afectó significativamente el equilibrio postural y el riesgo de caída. Hubo diferencias significativas entre los dos grupos (grupo de intervención y grupo de control) en el equilibrio postural (p < 0,001) y el riesgo de caída (p = 0,023). CONCLUSIÓN: El ejercicio de equilibrio se puede utilizar como uno de los esfuerzos preventivos para mantener el equilibrio postural y reducir el riesgo de caídas entre los adultos mayores en la comunidad. En el futuro, el estudio puede considerar la variación de edad para conocer la efectividad del ejercicio de equilibrio

OBJECTIVE: Falls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia. METHOD: This quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test. RESULTS: The balance exercise significantly affected the respondents' postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023). CONCLUSIÓN: Balance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise

Intervenciones educativas sobre nutrición y actividad física en niños de Educación Primaria: una revisión sistemática / Educational interventions on nutrition and physical activity in Primary Education children: a systematic review

INTRODUCCIÓN: Las intervenciones educativas en el entorno escolar, parecen la forma más efectiva de actuar contra la obesidad infantil. Los objetivos de esta revisión sistemática fueron, describir las intervenciones educativas sobre alimentación y/o actividad física llevadas a cabo en alumnos de Educación Primaria con el fin de disminuir o prevenir la obesidad infantil y analizar la eficacia de dichas intervenciones. METODOLOGÍA: Se realizó una búsqueda bibliográfica en las bases de datos WOS y SCOPUS. Los criterios de elegibilidad fueron esTablecidos en base al acrónimo PICOS: (P) niños de educación primaria (6-12 años), (I) estudios que llevaran a cabo intervenciones de nutrición y/o actividad física en el ámbito escolar, (C) no recibir ninguna intervención, (O) evaluar el efecto de los programas educacionales sobre la obesidad infantil, (S) estudios experimentales, publicados entre 2013 y 2017. RESULTADOS Y DISCUSIÓN: Se identificaron 571 artículos, y finalmente se incluyeron 22 estudios. Se encontró que las intervenciones más prometedoras fueron las combinadas. La duración, la participación de los padres, el sexo y nivel socioeconómico pueden influir en la efectividad de las intervenciones. Se observó una escasez de intervenciones teóricamente fundamentadas. CONCLUSIONES: Las intervenciones con mejores resultados son las combinadas, con actividades incluidas en el currículo y la participación de los padres. Las intervenciones a largo plazo parecen tener mejores resultados. Estos programas ayudan a la adquisición de hábitos saludables y existe cierta evidencia de que son útiles en la disminución del Índice de Masa Corporal (IMC) o en la prevención de la obesidad infantil

INTRODUCTION: Educational interventions in the school environment seem the most effective way to act against childhood obesity. The objectives of this systematic review were to describe the educational interventions on nutrition and / or physical activity carried out in primary school students in order to reduce or prevent childhood obesity and analyze the effectiveness of these interventions. METHODOLOGY: A bibliographic search was carried out in the WOS and SCOPUS databases. Eligibility criteria were established based on the acronym PICOS: (P) primary school children (6-12 years), (I) studies that will carry out nutrition and / or physical activity interventions in the school setting, (C) not receive any intervention, (O) evaluate the effect of educational programs on childhood obesity, (S) experimental studies, published between 2013 and 2017. RESULTS AND DISCUSSION: 571 articles were identified, and finally 22 studies were included. It was found that the most promising interventions were the combined ones. Duration, parental involvement, gender and socioeconomic status can influence the effectiveness of interventions. A shortage of theoretically based interventions was observed. CONCLUSIONS: The interventions with the best results are the combined ones, with activities included in the curriculum and the participation of the parents. Long-term interventions seem to have better results. These programs help the acquisition of healthy habits and there is some evidence that they are useful in decreasing the Body Mass Index (BMI) or in the prevention of childhood obesity

Impacte de um programa de exercício físico na capacidade funcional de idosos institucionalizados / Impact of a physical exercise program on the functional capacity of the institutionalized elderly

Introduction: Preventive, promotion and rehabilitation actions such as physical exercise have been able to improve the functional capacity of the institutionalized elderly. Aims: To evaluate the impact of a physical exercise program on the functional capacity of institutionalized elderly. Method: Quantitative study with a quasi-experimental design, without control group, with pre and post intervention evaluation, in a convenience sample of 23 elderly. The instrument for data collection was the form with outcome and independent variables. The study was approved by the Ethics Committee of the Escola Superior de Enfermagem do Porto. Results: The majority are female (60.9%), with a mean age of 82.4 years and a high prevalence of cerebrovascular disease (91.3%). ¾ of the sample (74%) is polymedicated. The occurrence of falls in the last 12 months was low (13%). There was a significant improvement in joint amplitude and muscular strength in all movements and joints of the upper and lower limbs. Palmar grip strength improved in both hands. A better performance was observed in the implementation of POMA I, and the number of risk-free elderly people with a high risk of falls increased. The repercussion of improvements in self-care capacity was not effective in some domains, although the mean scores obtained showed a slight improvement trend. Of the psychosocial effects, most participants (60.9%) agreed that they improved health and mood. Conclusions: The physical exercise program implemented to institutionalized elderly, without cognitive deficit, improved the functional and psychosocial capacity

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Development of a Web Exercise Video for Nursing Intervention in Outpatients With Low Back Pain.

The purpose of this study was to develop a Web exercise video for nursing intervention among outpatients with low back pain by applying the analysis-design-development-implementation-evaluation model to promote continuous exercise. During the analysis phase, we assessed the needs for the lower back exercise video as well as details of the current situations of the participants. Additionally, we investigated the intervention methods that the medical practitioners thought would be helpful in promoting lower back exercise. After the design and development phase, a lower back exercise video of 5 minutes 46 seconds was developed. The main contents in the video were the stretching and flexing exercises of the spine and muscles, including "One knee to chest," "Both knees to chest," "Hip bridge," "Prone position to erect spine," "Kneeling back extension," "Kneeling, opposite arm and leg raised," and "Sitting rotation stretch." For the implementation and analysis phase, a pilot test was done. The lower back exercise video was posted on the Web site, and participants watched the video and exercised individually. Participants reported that they were able to use the Web video whenever required, and after following the video a few times, they grew accustomed to the practice and were able to perform it repeatedly to help strengthen the lower back. In the future, experimental research is needed to confirm the effectiveness of exercise using Web video.

The effect of a nurse-led self-management program on outcomes of patients with chronic obstructive pulmonary disease.

PURPOSE: To examine the effectiveness of a nurse-led self-management program on outcomes of patients with chronic obstructive pulmonary disease (COPD). DESIGN: A randomized controlled, single-blind trial, carried out from October 2017 to December 2018, included 154 participants admitted with COPD to the Affiliated Hospital of Zunyi Medical University in Guizhou, (randomized into intervention (n = 77) and control groups (n = 77)). MATERIALS AND METHODS: Participants in the intervention group underwent a nurse-led self-management program in addition to routine care, and participants of the control group received only routine care. The main outcome measures were COPD-related readmission and emergency department visits, the 6-minute walk distance (6MWD) test for measurement of exercise capacity, the St George Respiratory Questionnaire (SGRQ) for measurement of health-related quality of life, and the COPD Transitional Care Patient Satisfaction Questionnaire (CTCPSQ) for measurement of satisfaction. Data collection was conducted at baseline (T1) and after 3 (T2), 6 (T3) and 12 mo (T4). Findings Compared to the control group, participants in the intervention group showed significantly fewer COPD-related hospital admissions (P = 0.03) and emergency department visits (P = 0.001) and higher total CTCPSQ scores (P = 0.001) at 12 mo. Meanwhile, analysis of variance showed a significantly greater improvement in exercise capacity and health status over time in the nurse-led program group than in the control group, P < 0.001. CONCLUSIONS: This study demonstrated that the nurse-led self-management program was effective in decreasing hospital readmissions and emergency department visits and improving exercise capacity, health-related quality of life and satisfaction for patients with COPD.

The Impact of a Phone Assistance Nursing Program on Adherence to Home Exercises and Final Outcomes in Patients Who Underwent Shoulder Instability Surgery: A Randomized Controlled Study.

PURPOSE: The purpose of this study was to assess the impact of a phone assistance nursing program as an adjunct to conventional physiotherapy to increase adherence to a home exercise program on functional outcomes of patients who underwent shoulder instability surgery. METHODS: A randomized controlled study of 70 patients allocated to a phone assistance program (study group, n = 36 patients) or conventional postoperative management (control group, n = 34 patients) was conducted. All patients in both groups received conventional rehabilitation at the outpatient clinic after surgery. In addition, patients in the study group received phone calls from a nurse (who had access to a physiotherapist) 3 days per week. During the calls these patients received a coaching session about self-care and support with the home exercise program. Evaluations were performed during a follow-up of 12 months for range of motion (ROM), pain (visual analog scale [VAS] score), Disability of the Arm, Shoulder, and Hand (DASH) score, Oxford Shoulder Instability Score (OSIS), and Rowe score. RESULTS: All scores significantly improved from preoperative to the final follow-up in both groups (p = .001). At the final follow-up, there were no significant differences between groups in VAS, DASH, or Rowe scores. However, those in the study group had significantly better OSIS (p = .013) and ROM (p = .001), particularly for anterior forward motion (p = .001). Likewise, the study group achieved full motion and function significantly faster than the control group (p = .002). The amount of rehabilitation sessions at the outpatient clinic was 1.7 times higher in the control group (p = .004) than in the study group. CONCLUSION: The phone assistance nursing program was an effective procedure to significantly improve the outcomes of conventional physiotherapy in patients who have undergone an operation for shoulder instability.

Identificación del riesgo para el desarrollo de la Diabetes Mellitus en usuarios de Atención Básica de Salud / Rastreamento do risco para desenvolvimento do Diabetes Mellitus em usuários da Atenção Básica de Saúde / Risk screening for Diabetes Mellitus development in users of Basic Health Care

Objetivo: Identificar el riesgo para el desarrollo de la diabetes mellitus tipo 2 en los usuarios de la red de atención primaria de salud. Método: Estudio transversal, descriptivo, con abordaje cuantitativo, constituido por 266 usuarios registrados en unidades de salud de la familia. Se utilizaron dos instrumentos. El primero, cuestionario compuesto por variables sociodemográficas: sexo, edad, estado civil, escolaridad. El segundo, la escala Finnish Diabetes Risk Score. Para el análisis, se utilizó la estadística inferencial, con el cálculo de las razones de prevalencias brutas con intervalo de confianza del 95%. Resultados: El riesgo bajo se encontró en 43 (16,2%) de los entrevistados y el riesgo muy alto encontrado en 4 (1,5%). La mayoría de los participantes presentaron un riesgo discretamente elevado 83 (31,2%). Se ha observado asociación estadísticamente significativa en las prevalencias de los factores de riesgo: edad aumentada, sobrepeso, obesidad, circunferencia abdominal aumentada, inactividad física, ingesta no habitual de legumbres y frutas, uso de medicación para hipertensión, antecedentes personales de hiperglucemia e historial familiar de diabetes mellitus tipo 2. Conclusión: El estudio mostró que todos los investigadores presentaron algún riesgo para el desarrollo de la diabetes mellitus tipo 2 y que varios factores de riesgo estuvieron presentes en los mismos, así pues, justificar la importancia del rastreo como una acción preventiva

Objetivo: Identificar o risco para o desenvolvimento do diabetes mellitus tipo 2 em usuários da rede de atenção básica de saúde. Método: Estudo transversal, descritivo, com abordagem quantitativa, constituído por 266 usuários cadastrados em unidades de saúde da família, foram utilizados dois instrumentos. O primeiro, questionário composto por variáveis sociodemográficas: sexo, idade, estado civil, escolaridade. O segundo, a escala Finnish Diabetes Risk Score. Para análise, foi utilizada a estatística inferencial, com o cálculo das razões de prevalências brutas com intervalo de confiança de 95%. Resultados: O risco baixo foi encontrado em 43 (16,2%) dos entrevistados e o risco muito alto encontrado em 4 (1,5%). A maioria dos participantes apresentaram risco discretamente elevado 83 (31,2%).Houve associação estatisticamente significativa nas prevalências dos fatores de risco: idade aumentada, sobrepeso, obesidade, circunferência abdominal aumentada, inatividade física, ingestão não habitual de legumes e frutas, uso de medicação para hipertensão, antecedentes pessoais de hiperglicemia e histórico familiar de diabetes mellitus tipo 2. Conclusão: O estudo mostrou que todos os investigados apresentaram algum risco para desenvolvimento do diabetes mellitus tipo 2 e que vários fatores de risco estiveram presentes nos mesmos, assim, justificar-se a importância do rastreamento como uma ação preventiva

Objective: To identify the risk for the development of type 2 diabetes mellitus in users of the basic health care network. Method: Across-sectional, descriptive study with a quantitative approach, consisting of 266 users enrolled in family health units, two instruments were used. The first, a questionnaire composed of sociodemographic variables: sex, age, marital status, schooling. The second, the Finnish Diabetes Risk Score scale. For analysis, inferential statistics were used, with the calculation of crude prevalence ratios with 95% confidence interval. Results: Low risk was found in 43 (16.2%) of the interviewees and the very high risk found in 4 (1.5%). The majority of the participants presented a slightly elevated risk 83 (31.2%). There was a statistically significant association in the prevalence of risk factors: increased age, overweight, obesity, increased abdominal circumference, physical inactivity, unusual intake of vegetables and fruits, use of hypertension medication, personal history of hyperglycemia and family history of type diabetes mellitus 2. Conclusion: The study showed that all the investigators presented some risk for the development of type 2 diabetes mellitus and that several risk factors were present in them, thus justifying the importance of screening as a preventive action

Steps to Enhance Early Recovery After Hematopoietic Stem Cell Transplantation: Lessons Learned From a Physical Activity Feasibility Study.

AIMS: This pilot study tested and refined a free-living physical activity intervention. The investigators evaluated the acceptability and feasibility of the intervention after hematopoietic stem cell transplantation and determined preliminary effects on physical activity, fatigue, muscle strength, functional ability, and quality of life. DESIGN: This pilot study used a 1-group, pretest-posttest design. METHODS: The free-living physical activity intervention consisted of an education component and 6 weeks of gradually increasing physical activity after discharge from the hospital. The intervention was designed to increase steps by 10% weekly. Subjects were assessed before transplantation and during the seventh week after discharge from the hospital after completing the intervention. Pretest-posttest scores were analyzed with paired t tests. RESULTS: Subject wore the physical activity tracker for an average of 38 of 42 days and met their physical activity goals 57% of the time. Subjects reported significantly less physical fatigue after the free-living physical activity intervention compared with baseline (P = .05). Improvements in quality of life approached significance (P = .06). CONCLUSION: The findings demonstrate that the free-living physical activity intervention implemented during the very early recovery period after transplantation is feasible and acceptable. The intervention potentially reduces fatigue and improves quality of life. The positive results must be interpreted cautiously given the pilot nature of the study. The evidence supports continued investigation.

[Physical activities adapted to homeless people]. / Les activités physiques adaptées aux personnes sans domicile fixe.

Around ten homeless people were invited to take part in a programme of physical activities to improve their health status. Only motricity and walking pathways were followed assiduously for eight weeks. The assessment of the physical condition and quality of life showed an improvement in these areas, in particular for one of the participants. However, the lack of motivation and assiduity remains an obstacle to regular activity.

Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions: Long-term follow-up of participants from two randomised controlled trials in UK primary care.

BACKGROUND: Physical inactivity is an important cause of noncommunicable diseases. Interventions can increase short-term physical activity (PA), but health benefits require maintenance. Few interventions have evaluated PA objectively beyond 12 months. We followed up two pedometer interventions with positive 12-month effects to examine objective PA levels at 3-4 years. METHODS AND FINDINGS: Long-term follow-up of two completed trials: Pedometer And Consultation Evaluation-UP (PACE-UP) 3-arm (postal, nurse support, control) at 3 years and Pedometer Accelerometer Consultation Evaluation-Lift (PACE-Lift) 2-arm (nurse support, control) at 4 years post-baseline. Randomly selected patients from 10 United Kingdom primary care practices were recruited (PACE-UP: 45-75 years, PACE-Lift: 60-75 years). Intervention arms received 12-week walking programmes (pedometer, handbooks, PA diaries) postally (PACE-UP) or with nurse support (PACE-UP, PACE-Lift). Main outcomes were changes in 7-day accelerometer average daily step counts and weekly time in moderate-to-vigorous PA (MVPA) in ≥10-minute bouts in intervention versus control groups, between baseline and 3 years (PACE-UP) and 4 years (PACE-Lift). PACE-UP 3-year follow-up was 67% (681/1,023) (mean age: 59, 64% female), and PACE-Lift 4-year follow-up was 76% (225/298) (mean age: 67, 53% female). PACE-UP 3-year intervention versus control comparisons were as follows: additional steps/day postal +627 (95% CI: 198-1,056), p = 0.004, nurse +670 (95% CI: 237-1,102), p = 0.002; total weekly MVPA in bouts (minutes/week) postal +28 (95% CI: 7-49), p = 0.009, nurse +24 (95% CI: 3-45), p = 0.03. PACE-Lift 4-year intervention versus control comparisons were: +407 (95% CI: -177-992), p = 0.17 steps/day, and +32 (95% CI: 5-60), p = 0.02 minutes/week MVPA in bouts. Neither trial showed sedentary or wear-time differences. Main study limitation was incomplete follow-up; however, results were robust to missing data sensitivity analyses. CONCLUSIONS: Intervention participants followed up from both trials demonstrated higher levels of objectively measured PA at 3-4 years than controls, similar to previously reported 12-month trial effects. Pedometer interventions, delivered by post or with nurse support, can help address the public health physical inactivity challenge. TRIAL REGISTRATIONS: PACE-UP isrctn.com ISRCTN98538934; PACE-Lift isrctn.com ISRCTN42122561.

Management of behavioural and psychological symptoms of dementia by an aroma-massage with acupressure treatment protocol: A randomised clinical trial.

AIMS AND OBJECTIVES: This study evaluates the clinical effectiveness of a multicomponent aroma-massage with an acupressure treatment protocol and compared it to cognitive training for the management of behavioural and psychological symptoms of dementia. BACKGROUND: Pharmacological interventions have been unsatisfactory in managing behavioural and psychological symptoms of dementia; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost-effective intervention. DESIGN: This randomised clinical trial utilised a three-arm parallel group design. Cognitive training was used as a conventional intervention to manage behavioural and psychological symptoms of dementia, whereas exercise was considered "treatment as usual" in this study; both were used as comparisons with the experimental protocol. There were three treatment groups: Group 1: aroma-massage with acupressure + exercise, Group 2: cognitive training + exercise and Group 3: aroma-massage with acupressure + cognitive training. METHOD: Sixty older adults were recruited and randomly assigned to the three groups (20 each). Using the 29-item Chinese Version of the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Mini-mental State Examination and Barthel Index-20, the outcome measures were assessed at preintervention, postintervention and the 3-month follow-up to assess behaviour, Activities of Daily Living, cognition, and behavioural and psychological symptoms of dementia severity and distress. Multiple comparisons performed through repeated measures were analysed to detect between-group differences and within-subject differences, as well as the interaction effects between groups and times. RESULTS: The Group 1 and 3 participants showed a significant reduction in the severity and distress caused by behavioural and psychological symptoms of dementia, whereas Group 2 did not demonstrate similar effects. CONCLUSIONS: This clinical study suggests that aroma-massage with acupressure is as effective as cognitive training and can enhance cognitive training in reducing the severity and distress of behavioural and psychological symptoms of dementia. RELEVANCE TO CLINICAL PRACTICE: Aroma-massage with acupressure may serve as an adjunct therapy to reduce behavioural and psychological symptoms of dementia. This therapy is safe, cost-effective and can be implemented by caregivers and family members who are not professionally trained.

The effects of a nurse-supervised home exercise programme on improving patients' perceptions of the benefits and barriers to exercise: A randomised controlled trial.

AIMS AND OBJECTIVES: To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. BACKGROUND: Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. DESIGN: This was a post hoc analysis of a randomised, two-group parallel study. METHODS: A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. RESULTS: There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. CONCLUSION: Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. RELEVANCE TO CLINICAL PRACTICE: Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team.