Effects of a lower extremity exercise program on gait biomechanics and clinical outcomes in children and adolescents with obesity: A randomized controlled trial.

BACKGROUND: Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes. RESEARCH QUESTIONS: Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity? METHODS: This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated. RESULTS: Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort. SIGNIFICANCE: Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. CLINICAL TRIALS REG. NO: clinicaltrials.gov (NCT02545764).

[Transition from child and adolescent to adult mental health care]. / La transition entre soins pédopsychiatriques et soins en psychiatrie adulte.

Adolescents and young adults are at particularly at-risk population in mental health. For a large majority of patients suffering from chronic psychiatric condition, the age of onset of psychiatric symptoms is less than 24 years, while the coverage in psychiatric care is the lowest between 16 and 24. Presenting a psychiatric pathology during childhood and adolescence constitutes an independent risk factor for the occurrence of adverse life events in adulthood. Furthermore, that population is at the edge between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Transition is the deliberate and planned movement from CAMHS to AMHS. CAMHS and AMHS struggle to achieve optimal transitions between them. Many barriers exist at the interface of the two types of structure and some young people who require continuous care during this period do not have access to it. There are also too few specific psychiatric services for the population of adolescents and young adults. Some recommendations emerge to intend to guide practices, but the literature lacks data to better define this population and build guidelines about the transition between CAMHS and AMHS and about specific services for adolescents and young adults in psychiatry.

Les adolescents et jeunes adultes constituent une population particulièrement à risque en santé mentale. Pour une grande majorité des patients souffrant d'une pathologie psychiatrique chronique, l'âge d'apparition des symptômes est inférieur à 24 ans, alors que la couverture en soin psychiatrique est la plus faible entre 16 et 24 ans. La présence d'une pathologie psychiatrique durant l'enfance ou l'adolescence constitue un facteur de risque indépendant pour la survenue d'événements de vie défavorables à l'âge adulte. Cette population se situe par ailleurs à la lisière entre soins pédopsychiatriques et soins psychiatriques adultes. La transition est le passage délibéré et planifié d'un service de pédopsychiatrie vers un service de psychiatrie adulte. Ces deux systèmes de soins peinent à s'accorder pour réaliser des transitions optimales. De nombreuses barrières existent à l'interface des deux types de structures et certains jeunes qui nécessitent une prise en charge continue durant cette période de leur vie n'y ont pas accès. Il existe également trop peu de services psychiatriques pouvant accueillir cette population de manière spécifique. Certaines pistes émergent pour tenter de guider les pratiques, mais la littérature manque de données permettant de définir cette population et de créer des guidelines en ce qui concerne la transition entre pédopsychiatrie et psychiatrie adulte ainsi que la création de dispositifs psychiatriques spécifiques pour les adolescents et jeunes adultes en psychiatrie.

[Depression in childhood and adolescence]. / Dépression de l'enfant et de l'adolescent.

Child and adolescent depression is often unknown due to its varied and heterogeneous clinical presentation that makes the diagnosis complex. Indeed, it differs from adult depression by some aspects as the absence of depressive experience. It is a major risk factor for suicide, dropping out of school and social isolation. We will identify the specific clinical signs to make a diagnosis in children and adolescents and to identify therapeutic approaches. On the other hand, we will try to highlight the risk factors of depression.

La dépression de l'enfant et de l'adolescent est souvent méconnue en raison de sa présentation clinique variée et hétérogène qui rend le diagnostic complexe. En effet, elle se différencie de celle de l'adulte de par certains aspects dont le vécu dépressif qui est souvent absent. Elle est un facteur de risque majeur de suicide, de décrochage scolaire et d'isolement social. Nous allons dégager les signes cliniques spécifiques qui permettront de poser un diagnostic chez l'enfant et l'adolescent et de dégager des pistes thérapeutiques. D'autre part, nous essaierons de mettre en évidence les facteurs de risques de dépression.

Effects of resistance exercise in prostate cancer patients: a meta-analysis.

PURPOSE: The aim of the present meta-analysis was to quantify effects of resistance exercise (RE) on physical performance and function, body composition, health-related quality of life (HRQoL), and fatigue in patients with prostate cancer. METHODS: Trial data were obtained from the databases PubMed, MEDLINE, EMBASE, SCOPUS, and the Cochrane Library as of inception to 31st of December 2016. Thirty-two trials with 1199 patients were included. Results that were measured by using the same assessment method in five or more of the original studies were pooled in a meta-analysis. RESULTS: Pooled studies showed significant improvements of muscular strength in the upper and lower body (95% CI [2.52, 7.97] kg; p < 0.001 and 95% CI [10.51, 45.88] kg; p = 0.008, respectively) after RE. Furthermore, significant improvements were seen for body composition (body fat percentage 95% CI [-0.79, -0.53] %; p < 0.001; lean body mass 95% CI [0.15, 1.84] %; p = 0.028; trunk fat mass 95% CI [-0.73, -0.08] kg; p = 0.024). Additionally, the improvement of the 400-m walk time was significant (95% CI [-21.55, -14.65] s; p < 0.001). Concerning fatigue and HRQoL, there were not sufficient data for analysis. CONCLUSIONS: RE seems to be a promising approach in order to counteract loss of muscle mass, muscle strength, and physical performance in patients suffering from prostate cancer and its treatment-related side effects. RE should play part in interdisciplinary cancer rehabilitation and care of this patient group. Nevertheless, further research should investigate RE further to determine which protocols are the most pragmatic, yet yielding best patient outcomes.

Resistance exercise and secondary lymphedema in breast cancer survivors-a systematic review.

PURPOSE: The aim of the present review was to determine effects of strength exercise on secondary lymphedema in breast cancer patients. METHODS: Research was conducted by using the databases PubMed/Medline and Embase. Randomized controlled trials published from January 1966 to May 2015 investigating the effects of resistance exercise on breast cancer patients with or at risk of secondary lymphedema in accordance with the American College of Sports Medicine exercise guidelines for cancer survivors were included in the present study. RESULTS: Nine original articles with a total of 957 patients met the inclusion criteria. None of the included articles showed adverse effects of a resistance exercise intervention on lymphedema status. In all included studies, resistance exercise intensity was described as moderate to high. CONCLUSIONS: Strength exercise seems not to have negative effects on lymphedema status or might not increase risk of development of lymphedema in breast cancer patients. Further research is needed in order to investigate the effects of resistance exercise for patients suffering from lymphedema.

The effects of resistance exercise on physical performance and health-related quality of life in prostate cancer patients: a systematic review.

PURPOSE: Physical exercise has been shown to be an effective, safe, and quite inexpensive method to reduce cardiovascular and metabolic risk factors and is currently in the process of establishing its relevance for cancer specific morbidity and mortality. The aim of this systematic review was to focus on specific effects of resistance exercise (RE) in the adjuvant therapy and rehabilitation of prostate cancer patients (PCaPs) receiving or having received androgen deprivation therapy (ADT). METHODS: A systematic literature search focusing on relevant and peer-reviewed studies published between 1966 and September 2014, using PubMed, EMBASE, MEDLINE, SCOPUS, and Cochrane Library databases, was conducted. RESULTS: The majority of studies demonstrated RE as an effective and safe intervention to improve muscular strength and performance, fatigue and quality of life (QoL) in PCaPs, while there is inconclusive evidence concerning cardiovascular performance, body composition, blood lipids, bone mineral density (BMD), and immune response. CONCLUSION: Existing evidence leads to the conclusion that RE seems to be a safe intervention in PCaPs with beneficial effects on physical performance capacity and QoL. Nevertheless, further research in this field is urgently needed to increase understanding of exercise interventions in PCaPs.

A systematic review on the effectiveness of medical training therapy for subacute and chronic low back pain.

Medical training therapy (MTT) to improve muscular strength and endurance follows evidence based guidelines and is increasingly recommended to patients suffering from subacute and chronic back pain (LBP). This study investigated whether MTT was effective in reducing pain and improving function in patients with subacute or chronic LBP. Data sources were MEDLINE, EMBASE, CINAHL, Pedro, Cochrane Central Register of Controlled Trials. We included RCTs that examined exercise or MTT in adult patients with LBP compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: pain intensity; functional status, absenteeism. Two independent reviewers performed quality assessment. Visual analogue scale ratings ranging from 0-10 MTT quantified the MTT aspects of the intervention. Studies with rating scores >7.5 were included. We identified only 2 studies that examined the effectiveness of MTT. Both trials, one was of high quality, found MTT to decrease pain and improve function significantly better than therapy of uncertain effectiveness. There is moderate evidence that would support the effectiveness of MTT in the treatment chronic LBP. Future high quality RCT will have to clarify whether MTT is effective and would be superior to other forms of therapeutic exercise.

Serum levels of tumour necrosis factor-alpha and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate--preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy.

The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.

Effects of TGF-betas and a specific antagonist on apoptosis of immature rat male germ cells in vitro.

Massive apoptosis of pubertal male germ cells is important for the development of functional spermatogenesis in the adult testis. Although the trigger(s) for male germ cell loss at puberty remain undefined, we have hypothesized that transforming growth factor-betas (TGF-betas) play an active role. Here we demonstrate that the three mammalian TGF-beta isoforms, TGF-beta1, TGF-beta2 and TGF-beta3, induce distinct apoptosis of pubertal spermatogonia and spermatocytes in a dose-dependent manner. Induction of male germ cell death by activation of caspase-3 was most pronounced with TGF-beta2 compared to TGF-beta1 and TGF-beta3. Furthermore, we found colocalization of activated caspase-3 with apoptotic protease-activating factor-1 (Apaf-1) in apoptotic germ cells, thus indicating the importance of the intrinsic mitochondrial pathway in TGF-beta-induced apoptosis. The specificity of the TGF-beta effects was proven by addition of recombinant latency-associated peptide against TGF-beta1 (rLAP-TGF-beta1) which completely abolished TGF-beta1-induced and TGF-beta3-induced germ cell apoptosis. Although TGF-beta2-triggered germ cell death also was significantly reduced by rLAP-TGF-beta1, inhibition was not maximal. Our results suggest that the three TGF-beta isoforms induce apoptosis of pubertal male germ cells via the mitochondrial pathway in vitro and are thus likely candidates involved in the excessive first wave of apoptosis of male germ cells during puberty.

Implementation of the Vienna Hydrotherapy Group for Laryngectomees--a pilot study.

GOALS: Laryngectomy involves several problems for the individual, such as the need to cope with a stoma, adjustment to tracheostomal breathing, and the formation of a voice. Contact with water, resulting in aspiration, may prove fatal for laryngectomized patients in the absence of appropriate aids. The aim of this pilot study was to conduct a hydrotherapy group for laryngectomized patients and to evaluate its feasibility and outcome in relation to the goals of therapy. PATIENTS AND METHODS: Six male patients who had undergone laryngectomy were included in a pilot study. The patients underwent a structured hydrotherapy rehabilitation program (three times a week for 8 weeks), using a special underwater therapy device. The patients' posture was controlled by posturography and their endurance capacity by standard ergometry and the 6-min walk. The parameters of fatigue, expectoration, mobility, elasticity/flexibility, postural control/coordination, and general well being were registered on a visual analog scale (VAS). Quality of life was assessed by having the patients fill out the German version of the SF-36 Health Survey. MAIN RESULTS: Posturograpy findings showed an improvement of two subtests ( p<0.028). Exercise testing showed an improved endurance capacity ( p<0.028). The patients were able to walk a greater distance in the 6-min walking test ( p<0.028). The VAS also showed an improvement of endurance capacity ( p<0.028), fatigue ( p<0.028), expectoration ( p<0.043), mobility of the neck and shoulder ( p<0.027), flexibility ( p<0.027), postural control and coordination ( p<0.028), and general well being ( p<0.028). On the SF-36 Health Survey, the patients were improved in the items "Physical functioning" ( p<0.027), "Vitality" ( p<0.027) "Role-physical" ( p<0.026), and "Social functioning" ( p<0.043). CONCLUSIONS: A hydrotherapy group for laryngectomized patients proved to be safe, feasible, and effective in this pilot study.

Aerobic exercise for a patient suffering from metastatic bone disease.

A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease participated in an aerobic exercise program consisting of ergometer cycling three times a week for 1 year. Feasibility, safety and beneficial effects of the program were proven for the patient in this case study. VO(2)max (20.2% after 16 weeks, 52.7% after 12 months) and peak work capacity (15.5% after 16 weeks, 35.7% after 12 months) had increased. The patient experienced a marked improvement in physical performance and in quality of life. Aerobic exercise, initiated and executed with appropriate care, may serve as a useful additional means of palliative treatment in some cancer patients with bone metastases.

[Postoperative rehabilitation of patients with carpal tunnel syndrome]. / Postoperative Rehabilitation von Patienten mit Karpaltunnelsyndrom.

The purpose of this study was to investigate the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome. Only original articles concerning the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome were included in this investigation. Concerning these topics only seven original articles were found. There was no significant influence of splinting for several weeks found on the symptom "pain" in the literature. Even there was a delay of returning to activities of daily living and the recovery of fist und keypinch strength through splinting. A program of physiotherapy and ergotherapy lead to a significant shorter recovery of dexterity in comparison to an home exercise program. Even the rehabilitated patients showed a shorter return-to-work interval. After carpal tunnel surgery neither physiotherapy nor splinting lead to a significant release of the symptom "pain". But physiotherapy leads to a shorter recovery of dexterity and shorter return-to-work interval. Due to the lack of knowledge about this topic further controlled clinical studies investigating the rehabilitation process after carpal tunnel surgery would be necessary.

[Aerobic physical training in a breast cancer patient with inflammatory recurrence]. / Aerobes Bewegungstraining bei einer Mammakarzinompatientin mit inflammatorischem Rezidiv.

Aerobic exercise has positive effects on physical performance and illness-related quality of life of cancer patients. However reports of advanced cancer patients who exercise are rare in medical literature. A 38-year-old female patient suffering from breast cancer performed an aerobic exercise program during adjuvant chemotherapy (cycle ergometry, 3x/w). After the diagnosis of relapsed inflammatory breast cancer, oncological treatment was changed to radiation therapy to reduce tumour mass. The patient continued the exercise program until palliative mastectomy. Her compliance was excellent. Despite the underlying progressive disease, endurance performance improved substantially. These findings were supported by a subjective score (Grimby). Evaluation of quality of life (SF-36, EORTC-QLQ-C30) revealed improvements of emotional wellbeing, emotional role, vitality and physical functioning, but increasing pain. The patient reported benefit due to increased psychological, social and physical wellbeing. This case report demonstrates feasibility and benefits of aerobic exercise for a patient with advanced breast cancer undergoing palliative treatment.