Exercise therapy

Therapeutic horse riding is often employed for disabled children. The aim of the present paper was to determine the influence of exercise in a mechanical saddle, imitating horse's walk, on the skin temperature responses in lower limbs in children with cerebral palsy. Sixteen children, aged 14-16, were enrolled into the study. Skin surface temperature was assessed with thermography, using an infrared thermovision camera, AGEMA 550, before and directly after 20 +/-5 min of exercise. The findings demonstrate that mechanical hippotherapy provides an exercise stimulus that is capable of inducing a visible change in skin temperature of paralyzed limbs. The change, however, is one of a decrease in skin temperature, which points to acute vasoconstrictive effects of exercise and to decreased skin blood flow. The results, therefore, do not support the use of mechanical hippotherapy in children suffering from cerebral palsy, with a hope to stimulate blood circulation to spastically altered...

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n ¼ 20) to a neck pain group with poor scapular posture (n ¼ 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p ¼ 0.02) and less activity in the lower trapezius (LT) (p ¼ 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p ¼ 0.09; p ¼ 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.

bone mineral density and lean mass. Only HRC training elicited adaptations in the cardiovascular system and 43 a decrease in fat mass. 44 45 46 47 48 49 65 with advancing age are examples of functional declines with aging, 66 which can severely limit physical performance and independence 67 and are negatively correlated with all cause mortality (Blair et al., 68 1995; Gulati et al., 2005; Laukkanen et al.Exercise can elicit a broad range of physiological changes. Nonethe-71 less, adaptations are specific to the exercise mode and intensity, so 72 several concurrently implemented regimes need to be performed. For 73 example, it is well known that both endurance exercise and resistance 74 training can substantially improve physical fitness and health-related 75 factors in older individuals (Cadore et al., 2012a, 2012b; Paoli et al., 76 2010). However, while endurance training is purported to be more ef-77 fective for decreasing fat mass ( Q3

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity,cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training--frequency, intensity, time (duration), type (mode), and volume (dose: intensity x duration) of exercise--are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding fr...

For neurorehabilitation of patients with spinal cord injury (SCI), the traditional emphasis on social adaptation is being expanded to include strategies that promote plasticity and regeneration in the central nervous system. Such strategies are needed to optimize recovery of neurological function. For example, the known dependence of most cellular processes on physical activity has led to the novel concept that activity is important in neural repair. This hypothesis has given rise to activity-based restoration therapies (ABRT), which aim to optimize neural activity in the damaged spinal cord, particularly below the injury level. Here, we review the basic science and clinical evidence supporting the lifelong use of ABRT for recovery from spinal cord injury. We define and describe ABRT, and discuss its components, its clinical applications, its relationship to medical management of spinal cord injury, and the potential influences of medications on recovery. We also discuss the health ...

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.

population promotion of sport for health of the general in the protection of the athlete's health and The role of International Sport Federations http://bjsm.bmj.com/content/early/2013/09/20/bjsports-2013-092999.full.html Updated information and services can be found at: These include: References http://bjsm.bmj.com/content/early/2013/09/20/bjsports-2013-092999.full.html#ref-list-1

This prospective, randomized study investigated the effect of exercise on leptin, insulin, cortisol and lipid profiles in obese children. A total of 40 obese boys aged 10-12 years with a body mass index (BMI) ≥ 30 kg/m 2 were randomly separated into an exercise group (n = 20) that underwent a 12-week aerobic exercise programme and a non-exercise (control) group (n = 20). The BMI, low-density lipoprotein, cortisol, leptin and insulin levels were significantly lower in the exercise group after 12 weeks compared with baseline values, whereas highdensity lipoprotein levels were significantly higher. In contrast, in the control group, low-density lipoprotein, cortisol and leptin levels were significantly higher after 12 weeks compared with baseline values while high-density lipoprotein levels were significantly lower. These findings indicate the importance of regular exercise in the regulation of body weight and protection against cardiovascular risk factors in obese children.

Background: Over fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. Technology-supported training holds opportunities for increasing training intensity. However, the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients.

Regular thermal therapy, using saunas or hot baths, has the potential to improve impaired insulin sensitivity and boost endothelial expression of the ''constitutive" isoform of nitric oxide synthase-effects, analogous to those of aerobic training that should promote vascular health. Previous clinical reports suggest that hot tubs may be beneficial for diabetic control, and that sauna therapy can decrease blood pressure in essential hypertension and provide symptomatic benefit in congestive heart failure. For those who lack ready access to a sauna or communal hot tub, regular hot baths at home may suffice as practical thermal therapy. Thermal therapy might be viewed as an alternative to exercise training in patients too physically impaired for significant aerobic activity.

To compare the effects of group-based and individual-based motor skill training on motor performance in children with developmental coordination disorder. Design: Randomized controlled pilot intervention study. Subjects/patients: Twenty-three children (4 girls) with developmental coordination disorder (mean age (standard deviation (SD)) 8 years (1 year and 2 months)). Methods: Twelve children were randomly assigned to undergo a motor training programme once a week for 8 consecutive weeks in a group setting, and 11 children received the same training on an individual basis during the same period. Each child was also instructed to perform home exercises on a daily basis. The Movement Assessment Battery for Children (MABC) was used to assess motor ability. Home exercise compliance and parental satisfaction with the programmes were also evaluated. Results: A significant reduction in the MABC total impairment score was found following both group-based (mean-4.4 (SD 5.0), p = 0.003) and individual-based training (mean-5.2 (SD 5.1), p = 0.016). However, the change in total impairment score did not differ significantly between the 2 groups (p = 0.379). There was similarly no significant between-group difference in home exercise compliance (p = 0.288) and parental satisfaction (p = 0.379). Conclusion: Group-based training produced similar gains in motor performance to individual-based training. Groupbased training may be the preferred treatment option due to the associated cost savings.

C onnective tissue requires motion to maintain its structural integrity. Motion, with its demands for tissue elongation, shortening, and support, creates the necessary stresses for normal fiber biology. Biologic tissues respond to these stress signals by changing their collagen matrix to meet the functional demands of motion. The connective tissue matrix is made up of structural fibers such as collagen, elastin, and fibrin, which are held together by chemical bonds and a fluid ground substance. The weave or alignment of these structural fibers can be classified as either dense or loose packed. Dense connective tissue that functions to support or limit motion, such as bone, ligament, and tendons, has parallel, tightly aligned fibers. When tension is applied to dense connective tissue, there is initial lengthening until all slack has been taken up, followed by gradual stretch or elongation, after which fiber disruption occurs.l Conversely, loose connective tissue, such as that found in joint capsules, muscle, fascia, and skin, contributes to flexibility through its random fiber orientation. This loose weave allows great lengthening without tension buildup until all the fibers have been essentially straightened. 2 Both types of tissues, dense and loose, have a filler gel that acts to separate and lubricate the collagen fibers. This mucopolysaccharide gel combined with water forms a ground substance that varies from low concentration in dense tissue to high concentration in loose tissue. 3 The two factors of fiber orientation and ground substance ratio, although unique to each tissue, are very dynamic and

Les é tudes ayant é valué l'activité physique des patients dialysé s ré vè lent une sé dentarité importante. Cette sé dentarité est associé e à une surmortalité. À l'inverse, les bé né fices en termes de morbi-mortalité de l'activité physique dans cette population sont nombreux. Des recommandations existent pour ces patients : il s'agit de celles é noncé es pour la population gé né rale adulte âgé e. Pour autant, rares sont les centres qui mettent en place des programmes d'activité physique chez les patients dialysé s. Les raisons en sont multiples, parmi lesquelles on retrouve, du cô té des soignants, le manque de connaissance. L'objectif de cet article est de pré ciser les modalité s d'é valuation de l'activité physique chez les dialysé s et de mise en place de programme pour lutter contre la sé dentarité. L'é valuation initiale par des moyens simples est indispensable. Elle requiert idé alement l'intervention d'un spé cialiste de l'activité physique. Les principaux types d'exercice sont pré senté s, ainsi que les diffé rents types de programmes et leurs ré sultats. Il est important de souligner qu'aucun effet indé sirable grave n'a é té rapporté au cours des diffé rents programmes et que leur faisabilité a é té dé montré e. La lutte contre la sé dentarité chez les patients dialysé s doit faire partie des objectifs des é quipes soignantes, au même titre que la lutte contre les autres facteurs de risque cardiovasculaire. ß 2014 Association Socié té de né phrologie. Publié par Elsevier Masson SAS. Tous droits ré servé s.

We review data from our institution demonstrating the benefits of cardiac rehabilitation and exercise training on coronary risk factors, exercise capacity, behavioral characteristics, and quality of life in various subgroups of patients. In addition, we discuss our research in several other areas of preventive cardiology, including lipid disorders, hypertension, left ventricular hypertrophy, fish oils, and antioxidants. We believe that we are now in a very exciting era in which a multifactorial approach to the primary and secondary prevention of coronary artery disease is needed in order to further reduce morbidity and mortality rates.

Eighty-two patients aged >70 years with heart failure were randomized to a gentle, seated exercise program or to usual care. Six-minute walk distance and quality of life did not change between groups, but daily activity as measured by accelerometry increased in the exercise group relative to the control group. ᮊ2005

Strength training is recommended for children with cerebral palsy. However, it is difficult for moderately impaired children with cerebral palsy, who require crutches for ambulation, to participate in this type of training. The purpose of this study was to investigate whether whole-body vibration training is an effective method of strengthening in a moderately impaired child with cerebral palsy. [Subject and Methods] This report describes an 8-year-old Japanese boy with cerebral palsy, who was ambulatory with crutches. The subject participated in physical therapy twice a week for 5 weeks. Whole-body vibration training was selected to complement the standing practice. The patient's crutch-walking ability, gross motor function, and spasticity were evaluated. [Results] The number of steps and walking duration were reduced in a 5-m walk test with crutches and gross motor function was improved. Further, the spasticity was reduced. [Conclusion] Whole-body vibration training is an effective physical therapy intervention in moderately impaired children with cerebral palsy, who are unable to walk without crutches.

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found betwee...

Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain, spinal mobility, disability, psychological state, and aerobic capacity. Sixty patients with chronic low back pain were randomized to three groups: group 1, aerobic exercise + home exercise; group 2, physical therapy (hot pack, ultrasound, TENS) + home exercise; group 3, home exercise only. Spinal mobility, pain severity, disability, and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up. Aerobic capacities of the patients were measured before and after treatment. All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up, and there was no significant difference between the groups. In group 2, a significant decrease in Beck Depression Inventory scores was observed with treatment. At 1-month follow-up, group 1 and 2 showed significant decreases in General Health Assessment Questionnaire scores. In group 2, there was also a significant improvement in Roland Morris Disability scores. There were similar improvements in exercise test duration and the MET levels in all the three groups. All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain. On the other hand, physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance.

Introduction: Obstructive sleep apnea (OSA) is difficult to manage for those who are intolerant or noncompliant with standard facial mask treatment options. Current treatment options do not address the underlying cause of OSA. Exercise as a treatment option has been found to improve OSA indices. Study objectives: To assess the efficacy of exercise on apnea/hypopnea index (AHI) in adult patients with OSA via a systematic review and meta-analysis. Additional objectives included evaluation of other indices of OSA and well-being in patients after completing an exercise regimen. Measurements and results: Web of Science, MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials were searched based on a priori criteria of all studies evaluating the effect of an exercise program on various sleep apnea indices. Both PRISMA statement and MOOSE consensus statement were adhered to. Eight Articles (182 participants) were included: a meta-analysis using a random effects model showed, a decrease in AHI (unstandardized mean difference [USMD], À0.536, 95% confidence interval [CI], À0.865 to À0.206, I 2 , 20%), reduced Epworth sleepiness scale (ESS) (USMD, À1.246, 95% CI, À2.397 to À0.0953, I 2 , 0%), and lower body mass index (BMI) (USMD, À0.0473, 95% CI, À0.0375 to 0.280, I 2 , 0%), in patients receiving exercise as treatment. Relative risks (RR) and odds ratios (OR) showed decreases in AHI (OR: 72.33, 95% CI, 27.906 to 187.491, RR: 7.294, 95% CI, 4.072 to 13.065) in patients receiving exercise as treatment. Conclusion: Among adult patients with OSA, exercise as the sole intervention was associated with improved clinical outcomes.

The aim of this study was to compare the effect of a period of therapeutic exercise and reflexology on pain intensity and range of motion in elderly women with knee osteoarthritis. Methods 45 elderly women with osteoarthritis of the knee were purposefully selected and randomly divided into three groups of 15: therapeutic exercise, reflexology and control. The therapeutic exercise and reflexology group practiced therapy and reflexology for 4 weeks and 5 sessions per week. The control group also performed their daily activities. To assess the intensity of pain and the range of motion of the subject's knee, the visual pain scale VAS and goniometer were used in pre-test and post-test, respectively. Data analysis was performed by one-way analysis of variance and Tukey's Post Hoc test. Results The results showed that both types of therapeutic exercise protocol and reflexology have positive and significant effects on reducing pain intensity and increasing range of motion of the knee joint of the subjects (P≤0.05), and the therapeutic exercise protocol compared to the protocol. Reflexology had more significant effects on the rate of increase in range of motion (P=0.001; P=0.001, respectively). Conclusion Based on the results, the use of both protocols of therapeutic exercise and reflexology is recommended to reduce the severity of pain and increase the range of motion of elderly women with osteoarthritis of the knee. Simultaneous use of these two protocols for treatment and greater effectiveness in this group of patients is recommended

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO 2m ax ) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity signi cantly increased in the ET group, whereas no change was observed in the SP group, and a signi cant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was signi cantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey con rmed the bene cial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases that share some symptoms such as muscular weakness and inflammation of skeletal muscle. Complete recovery of muscle function with pharmacological treatment does not always occur, suggesting that physical inability is a great concern for these patients. In this context, it has been speculated that physical exercise could result in functional benefits to patients with IIM, leading to an improvement in quality of life. In fact, recent studies of polymyositis (PM) and dermatomyositis (DM) support the notion that exercise training improves or at least stabilizes muscle strength and functional ability without inducing disease flares. Importantly, these benefits were observed not only during the chronic phase, but also in the course of active disease. This positive effect was found to be long term, as demonstrated by a six-month significant improvement in exercise capacity and strength. Together, these findings indicate that a well controlled exercise program can be recommended for patients with DM and PM. The optimal exercise modality training and the underlying mechanism for this encouraging response remain to be determined in future studies.

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is the neuropsychologist.

Objective: To investigate the role of conventional gait training and partial weighte supported treadmill gait training (PWSTT) in improving the balance of patients with Parkinson disease (PD). Design: Prospective randomized controlled design. Setting: National-level university tertiary hospital for mental health and neurosciences. Patients: Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic. Methodology: The patients were randomly assigned into 3 equal groups: (1) a control group only received a stable dosage of dopaminomimetic drugs; (2) a conventional gait training (CGT) group that received a stable dosage of dopaminomimetic drugs and conventional gait training; and (3) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20% of body weight. The sessions for the CGT and PWSTT groups were provided for 30 minutes per day, 4 days per week, for 4 weeks (16 sessions). Outcome measures: The Unified Parkinson Disease Rating Scale (UPDRS) motor score, dynamic posturography, Berg Balance Scale, and Tinetti performance-oriented mobility assessment (POMA) were used as main outcome measures. Results: A significant interaction effect was observed in the UPDRS motor score, mediolateral index, Berg Balance Scale, limits of stability (LOS) total score, POMA gait score, and balance score. Post-hoc analysis showed that in comparison with the control group, the PWSTT group had a significantly better UPDRS motor score, balance indices, LOS in 8 directions, POMA gait, and balance score. The CGT group had a significantly better POMA gait score compared with control subjects. Compared with the CGT group, the PWSTT group had a significantly better UPDRS motor score, mediolateral index, POMA gait score, and LOS total score. Conclusion: PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD.

Objective Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. Design A prospective longitudinal 12-week pilot study. Setting A university hospital HD unit and patients' homes. Participants A convenience sample of nine older ([55 years) patients undergoing HD.

Pulmonary rehabilitation programmes are often costly and dependent on the infrastructure of specialised centres. We developed a modular, outpatient-based rehabilitation programme, which is inexpensive and can be implemented in a variety of settings. The aim of this study was to determine the effects and feasibility of this programme. Thirteen patients with COPD and 7 patients with asthma were enrolled by their primary care physician because of dyspnoea. Initial assessment included cardiopulmonary exercise testing, six-minute walking distance, lung function testing and multiple questionnaires addressing dyspnoea, depression and quality of life issues. The training consisted of 36 sessions of high intensity training of 2 hours duration to improve exercise tolerance, including 30 minutes of stationary cycling at the anaerobic threshold. Another complete assessment was done on completion of the study at 3 months. The six-minute walking distance improved significantly from 401 to 551 m (...

Purpose To establish physiotherapy management of cancer-related fatigue (CRF), in particular, to determine physiotherapy exercise management of CRF. Methods All physiotherapist members of the UK Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) received a questionnaire. Results The response rate was 65% (223/341). Therapists had a mean of 6.8 years (+/−5.6) experience in oncology and/or palliative care. Seventy-eight percent of therapists recommend and/or use exercise as part of the management of CRF; 74% teach other strategies, most commonly energy-conservation techniques (79%). Therapists recommend and/or use exercise in similar frequencies with a range of cancer types, before (32%), during (53%) and following treatment (59%) and during advanced stages of the disease (68%). The most common barrier encountered by therapists in recommending and/or using exercise was related to the lack-of-exercise guidelines for patients with CRF (71%).

The aim of this study was to integrate a gaze training intervention (i.e., quiet eye training; QET) that has been shown to improve the throwing and catching skill of children with Developmental Coordination Disorder (DCD), within an approach (i.e., group therapy) that might alleviate the negative psychosocial impact of these motor skill deficits. Twenty-one children with DCD were split into either QET (8 male 3 female, mean age of 8.6 years (SD = 1.04) or technical training (TT) groups (7 male 3 female, mean age of 8.6 years (SD = 1.84). The TT group were given movement-related instructions via video, relating to the throw and catch phases, while the QET group were also taught to fixate a target location on the wall prior to the throw (QE1) and to track the ball prior to the catch (QE2). Each group partook in a 4-week, group therapy intervention and measurements of QE duration and catching performance were taken before and after training, and at a 6-week delayed retention test. Pare...

Purpose:This study examined the effects of a five-week intervention combining vigorous interval training (VIT) with diet among twenty-four obese adolescents. Fourteen girls and ten boys (aged 14–15) schooled in a pediatric rehabilitation center participated. Methods:The VIT intensity was targeted and remained above 80% of maximal heart rate (HR) and over six kilocalories per minute. Pre- and postintervention measures were body composition (BMI, weight, body fat percentage), physical self-perceptions (PSP), physical fitness (6-min walking distance and work) and its associated physiological responses (HRpeak and blood lactate concentration). A series of two-way analyses of variance or covariance controlling for weight loss were used to examine the changes. Results:Significant improvements were found in body composition, physical fitness and PSP (endurance, activity level, sport competence, global physical self-concept and appearance). In addition, boys presented higher levels of perce...

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

An important goal in rehabilitation engineering is to develop technology that allows individuals with severe motor impairment to practice arm movement without continuous supervision from a rehabilitation therapist. This paper describes the development of such a system, called Therapy WREX or ("T-WREX"). The system consists of an orthosis that assists in arm movement across a large workspace, a grip sensor that detects hand grip pressure, and software that simulates functional activities. The arm orthosis is an instrumented, adult-sized version of the Wilmington Robotic Exoskeleton (WREX), which is a five degrees-of-freedom mechanism that passively counterbalances the weight of the arm using elastic bands. After providing a detailed design description of T-WREX, this paper describes two pilot studies of the system's capabilities. The first study demonstrated that individuals with chronic stroke whose arm function is compromised in a normal gravity environment can perform reaching and drawing movements while using T-WREX. The second study demonstrated that exercising the affected arm of five people with chronic stroke with T-WREX over an eight week period improved unassisted movement ability (mean change in Fugl-Meyer score was 5 points 2 SD; mean change in range of motion of reaching was 10%, 0 001). These results demonstrate the feasibility of automating upper-extremity rehabilitation therapy for people with severe stroke using passive gravity assistance, a grip sensor, and simple virtual reality software.

Background: Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. Aims: To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice. Methods: Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. Results: Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. Conclusion: In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current bestpractice and an integrated multidisciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.

This article presents an overview of physical therapy management for patients with pathological musculoskeletal conditions of the shoulder. The importance of a thorough physical examination is stressed because proper treatment is based on this information. The primary goals of management should include the alleviation of acute inflammation and pain and the avoidance of subsequent soft tissue shortening. Medical and surgical treatments for common shoulder disorders also are discussed.

Background: Syndromes characterized by chronic, medically unexplained fatigue, effort-and stress-intolerance, and widespread pain are highly prevalent in medicine. Results: In chronic fatigue syndrome (CFS) and fibromyalgia (FM), various perpetuating factors may impair patients' quality of life and functioning and impede recovery. Although cognitive-behavioral and gradedexercise therapy are evidence-based treatments, the effectiveness and acceptability of therapeutic interventions in CFS/FM may largely depend on a customized approach taking the heterogeneity of perpetuating factors into account. Conclusion: Further research should clarify the aim and outcome of different treatment strategies in CFS/FM, as well as the underlying mechanisms of change, including those facilitating neurobiological recovery.

The meaning of women's experience of living with long-term urinary incontinence is powerlessness Aim. The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). Background. Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. Method. Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Findings. The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. Relevance to clinical practice. Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities.

Background: The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also rise. Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. In order to facilitate the evidence-based management of ITBS in runners, more needs to be learned about the aetiology, diagnosis and treatment of this injury. Objective: This article provides a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners. Search strategy: The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and reference lists were searched for relevant articles. Selection criteria: Systematic reviews, clinical trials or observational studies involving adult runners (>18 years) that focused on the aetiology, diagnosis and/or treatment of ITBS were included and articles not written in English, French, German or Dutch were excluded. Data collection and analysis: Two reviewers independently screened search results, assessed methodological quality and extracted data. The sum of all positive ratings divided by the maximum score was the percentage quality score (QS). Only studies with a QS higher than 60% were included in the analysis. The following data were extracted: study design; number and characteristics of participants; diagnostic criteria for ITBS; exposure/treatment characteristics; analyses/outcome variables of the study; and setting and theoretical perspective on ITBS.