Primary studies included in this broad synthesis

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Journal Physiotherapy Canada
Year 2006
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PURPOSE:The purpose of this article is to present the results of a systematic review that investigated the effects of aerobic exercise interventions in people living with HIV/AIDS and to discuss the implications for physical therapy practice, education, and research.SUMMARY OF KEY POINTS:A systematic review was conducted based on the Cochrane Collaboration protocol. Eleven randomized trials of HIVpositive adults who performed aerobic exercise three times per week for at least four weeks were identified. Thirteen meta-analyses were performed. The main results indicated that aerobic exercise was associated with significant improvements in some outcomes of cardiopulmonary status (maximum oxygen consumption) and psychological status (depression-dejection symptoms). CONCLUSIONS:Performing continuous or interval aerobic exercise or a combination of continuous aerobic exercise and progressive resistive exercise for at least 24 minutes three times per week for at least five weeks appears to be safe and may be beneficial for adults living with HIV. These findings should be interpreted cautiously owing to small sample sizes and high withdrawal rates within individual studies. The results of this review support the role of exercise and, more broadly, the role of rehabilitation practice, education, and research in the care and treatment of persons living with HIV.

Primary study

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Journal Cardiopulmonary Physical Therapy Journal
Year 2006
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Resistance training (RT) has been proposed as a potential management technique for persons with congestive heart failure (CHF) with the possibility of improving the vicious CHF cycle of pump failure, neuroendocrine abnormalities, skeletal muscle myopathies, dyspnea, fatigue, increased ventilation, and increased sympathetic nervous system activity (the Muscle Hypothesis of CHF). However, very little research has examined the effects of RT in persons with CHF or the effects of RT on the Muscle Hypothesis. The purposes of this paper are to describe the long-term effects of RT in persons with CHF and attempt to describe how these effects will impact the Muscle Hypothesis of CHF. A Medline search of English articles on RT in CHF was performed with the following keywords: resistance training, strength training, weight training, resistance exercise, heart failure, and muscle hypothesis. The references of published articles were further reviewed for additional articles pertaining to RT in CHF and the potential effects on the Muscle Hypothesis. Inclusion criteria for this review were studies of RT alone or RT with aerobic exercise (AE) in persons with CHF. Three review articles and 24 studies of RT were found of which 6 studies examined RT alone, 7 studies examined RT with short bouts of AE (< 5 minutes of continuous AE), and 11 studies examined the effects of RT combined with long bouts of AE. The results of these studies revealed significant improvements in muscle strength and endurance, peak oxygen consumption, forearm blood flow, left ventricular function, and quality of life with very few complications from RT. Differences in the methods of RT were found which likely affected the observed results. Chronic RT alone or with AE appears to favorably influence many aspects of the muscle hypothesis of chronic CHF. The improvements in skeletal muscle strength and endurance, peak oxygen consumption, forearm blood flow, left ventricular function, and quality of life in persons with CHF suggest that RT prescribed alone or with AE can be done safely and has favorable effects on the CHF Muscle Hypothesis. Further examination of isolated RT and RT with short versus long bouts of AE is needed.

Primary study

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Journal Physical Therapy Reviews
Year 2004
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OBJECTIVE:Osteoarthritis (OA) is highly prevalent among older adults and is associated with increased pain, loss of strength and joint range of motion (ROM), as well as to an overall decrease in functional status. Therapeutic strength exercises are recommended as part of the standard intervention programme for the patient with OA in an effort to control pain and improve functional and health status. The purpose of this meta-analysis is to review the strength and quality of evidence supporting the effectiveness of therapeutic strengthening exercises for improving a variety of measured outcomes relevant for OA.METHODS:A systematic review was conducted, following a protocol of methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, EMBASE, and the Cochrane Controlled Trials Register. Only randomised controlled trials using strengthening exercises as an intervention and treating clients with OA were eligible. Twenty-two trials were included with 2325 patients undergoing various forms strengthening exercises (e.g. isometric, isotonic, isokinetic, concentric, concentric/eccentric, dynamic). The exercises were implemented either in stand-alone format or in combination with other exercises, such as stretching and ROM. Interventions were either facility-based, home-based or a combination of the two.RESULTS: Evidence is provided for the inclusion of strengthening exercises in the rehabilitation programme for the patient with OA. Improvements were found for strength, pain, function and quality of life (QOL). Important components of the exercise programme that influence outcome include: (i) the combination of joint-specific strengthening with general strength, flexibility and functional exercises; (ii) progression of the exercise programme; and (iii) level of client self-reliance to sustain the programme. There is no evidence that the type of strengthening (i.e. isometric, isotonic or isokinetic) has an important impact on programme outcome. However, evidence is provided that the control of pain may be a dominant mechanism by which strengthening exercise produces beneficial effects for the patient with OA.CONCLUSION:Strengthening exercises alone have some effects on improving pain and functional outcomes in clients with OA. However, in order to maximise the effectiveness of strengthening exercise for these clients, it is necessary to combine strengthening exercises with a more complete exercise programme including ROM, stretching, functional balance and aerobic exercises.