| 1. |
- Aad, G, et al.
(författare)
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- 2015
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swepub:Mat__t
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| 2. |
- Andersson, Sofia E M, 1979, et al.
(författare)
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Moderate- to high intensity aerobic and resistance exercise reduces peripheral blood regulatory cell populations in older adults with rheumatoid arthritis
- 2020
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Ingår i: Immunity & Ageing. - : Springer Science and Business Media LLC. - 1742-4933. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective Exercise can improve immune health and is beneficial for physical function in patients with rheumatoid arthritis (RA), but the immunological mechanisms are largely unknown. We evaluated the effect of moderate- to high intensity exercise with person-centred guidance on cells of the immune system, with focus on regulatory cell populations, in older adults with RA. Methods Older adults (>= 65 years) with RA were randomized to either 20-weeks of moderate - to high intensity aerobic and resistance exercise (n = 24) or to an active control group performing home-based exercise of light intensity (n = 25). Aerobic capacity, muscle strength, DAS28 and CRP were evaluated. Blood samples were collected at baseline and after 20 weeks. The frequency of immune cells defined as adaptive regulatory populations, CD4 + Foxp3 + CD25 + CD127- T regulatory cells (Tregs) and CD19 + CD24hiCD38hi B regulatory cells (Bregs) as well as HLA-DR-/lowCD33 + CD11b + myeloid derived suppressor cells (MDSCs), were assessed using flow cytometry. Results After 20 weeks of moderate- to high intensity exercise, aerobic capacity and muscle strength were significantly improved but there were no significant changes in Disease Activity Score 28 (DAS28) or CRP. The frequency of Tregs and Bregs decreased significantly in the intervention group, but not in the active control group. The exercise intervention had no effect on MDSCs. The reduction in regulatory T cells in the intervention group was most pronounced in the female patients. Conclusion Moderate- to high intensity exercise in older adults with RA led to a decreased proportion of Tregs and Bregs, but that was not associated with increased disease activity or increased inflammation.
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| 3. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
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Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review.
- 2023
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Ingår i: PloS One. - : Public Library of Science (PLoS). - 1932-6203. ; 18:3
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Forskningsöversikt (refereegranskat)abstract
- This systematic review aimed to assess the certainty of evidence for digital versus conventional, face-to-face physiotherapy assessment of musculoskeletal disorders, concerning validity, reliability, feasibility, patient satisfaction, physiotherapist satisfaction, adverse events, clinical management, and cost-effectiveness.Eligibility criteria: Original studies comparing digital physiotherapy assessment with face-to-face physiotherapy assessment of musculoskeletal disorders. Systematic database searches were performed in May 2021, and updated in May 2022, in Medline, Cochrane Library, Cinahl, AMED, and PEDro. Risk of bias and applicability of the included studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Quality Appraisal of Reliability Studies tool. Included studies were synthesised narratively. Certainty of evidence was evaluated for each assessment component using GRADE.Ten repeated-measures studies were included, involving 193 participants aged 23-62 years. Reported validity of digital physiotherapy assessment ranged from moderate/acceptable to almost perfect/excellent for clinical tests, range of motion, patient-reported outcome measures (PROMs), pain, neck posture, and management decisions. Reported validity for assessing spinal posture varied and was for clinical observations unacceptably low. Reported validity and reliability for digital diagnosis ranged from moderate to almost perfect for exact+similar agreement, but was considerably lower when constrained to exact agreement. Reported reliability was excellent for digital assessment of clinical tests, range of motion, pain, neck posture, and PROMs. Certainty of evidence varied from very low to high, with PROMs and pain assessment obtaining the highest certainty. Patients were satisfied with their digital assessment, but did not perceive it as good as face-to-face assessment.Evidence ranging from very low to high certainty suggests that validity and reliability of digital physiotherapy assessments are acceptable to excellent for several assessment components. Digital physiotherapy assessment may be a viable alternative to face-to-face assessment for patients who are likely to benefit from the accessibility and convenience of remote access.The review was registered in the PROSPERO database, CRD42021277624.
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| 4. |
- Höder, Amanda, et al.
(författare)
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Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review
- 2023
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Ingår i: BMC Women's Health. - 1472-6874. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Childbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training). Aim: The objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback. Methods: The literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance. Results: Eight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient. Conclusion: The scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.
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| 5. |
- Kucharski, Daniel, et al.
(författare)
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Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis
- 2019
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Ingår i: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 39:9, s. 1585-1594
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Tidskriftsartikel (refereegranskat)abstract
- Fatigue is described as a dominant and disturbing symptom of rheumatoid arthritis (RA) regardless of the advances in pharmacological treatment. Fatigue is also found to correlate with depression. The objective was to evaluate the impact of moderate-to-high intensity, aerobic and resistance exercise with person-centered guidance on fatigue, anxiety and depression, in older adults with RA. Comparisons were made between older adults (> 65 years) with RA taking part in a 20-week moderate-to-high intensity exercise at a gym (n = 36) or in home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 52 weeks. Outcomes were differences in Multidimensional Fatigue Inventory (MFI-20), Visual Analog Scale Fatigue (VAS fatigue), and Hospital Anxiety and Depression Scale (HADS). Analysis of metabolomics was also performed. The subscales "physical fatigue" and "mental fatigue" in MFI-20 and symptoms of depression using HADS depression scale improved significantly at week 20 in the exercise group compared with the control group. Exercise did not influence global fatigue rated by VAS or subscales "reduced motivation", "reduced activity" and "general fatigue" in MFI-20. No significant change was found on the anxiety index of HADS. The improvements in physical fatigue were associated with changes in the metabolism of lipids, bile acids, the urea cycle and several sugars. Moderate-to-high intensity exercise with person-centered guidance decreased fatigue and improved symptoms of depression and were accompanied by metabolic changes in older adults with RA.
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| 6. |
- Lange, Elvira, et al.
(författare)
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Aspects of exercise with person-centred guidance influencing the transition to independent exercise: a qualitative interview study among older adults with rheumatoid arthritis
- 2019
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Ingår i: European Review of Aging and Physical Activity. - : Springer Science and Business Media LLC. - 1813-7253 .- 1861-6909. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Besides being health enhancing and disease preventing, exercise is also an important part of the management of chronic conditions, including the inflammatory joint disease rheumatoid arthritis (RA). However, older adults with RA present a lower level of physical activity than healthy older adults. The aim of this qualitative study was to explore aspects of participation in moderate- to high-intensity exercise with person-centred guidance influencing the transition to independent exercise for older adults with RA. Methods: A qualitative interview study was conducted. In-depth interviews with 16 adults with RA aged between 68 and 75years, who had taken part in the interventionarm of a randomized controlled trial performing moderate-to-high-intensity exercise with person-centred guidance, were analysed using qualitative content analysis. Results: The analysis resulted in six main categories: A feasible opportunity to adopt exercise, Experiencing positive effects of exercise, Contextual factors affect the experience of exercise, Developing knowledge and thinking, Finding one's way, and Managing barriers for exercise. The exercise with person-centred guidance was described as a feasible opportunity to start exercising as a basis for the transition to independent exercise. They described developing knowledge and thinking about exercise during the intervention enabling them to manage the transition to independent exercise. Finding one's own way for exercise became important for sustaining independent exercise. Lastly, barriers for exercise and strategies for overcoming these were described. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise. Conclusion: The participants described several aspects of participating in exercise that influenced and facilitated their transition to independent exercise. The exercise was experienced as manageable and positive, by a careful introduction and development of an individual exercise routine in partnership with a physiotherapist. This seems to have favored the development of self-efficacy, with importance for future independent exercise. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise. The personal process of trying to make the exercise one's own, and developing knowledge about exercise and new thoughts about oneself, seemed to prepare the participants for managing independent exercise and overcoming barriers.
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| 7. |
- Lange, Elvira, et al.
(författare)
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Effects of aerobic and resistance exercise in older adults with rheumatoid arthritis: A randomized controlled trial.
- 2019
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Ingår i: Arthritis care & research. - : Wiley. - 2151-4658 .- 2151-464X. ; 71:1, s. 61-70
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the effect of a person-centered, moderate-to-high intensity, aerobic and resistance exercise protocol on older adults with rheumatoid arthritis (RA), through a randomized controlled multi-center trial.Older adults (65-75 years) with RA (n=74) were randomized to either a 20-week person-centered exercise intervention at a gym (n=36) or to home-based exercise of light intensity (n=38). Assessments were performed at baseline, at 20 weeks, and at 12 months. Primary outcome was the difference in the Health Assessment Questionnaire - Disability Index (HAQ-DI), and the secondary outcomes were the differences in physical fitness assessed by a cardiopulmonary exercise test, an endurance test, Timed Up and Go, Sit To Stand test and isometric elbow flexion force.No significant differences between the groups were found for the primary outcome HAQ-DI. Within the intervention group there was a significant improvement of HAQ-DI when compared to baseline (p=0.022). Aerobic capacity (p<0.001) and three out of four additional performance-based tests of endurance and strength significantly improved (p<0.05) in the intervention group when compared to the control group. In the intervention group 71% rated their health as much or very much improved compared to 24% of the control group (p<0.001). At the 12-month follow-up, there were no significant difference of change between the two groups on HAQ-DI. A significant between-group difference was found for change in an endurance test (p=0.022).Person-centered aerobic and resistance exercise improved physical fitness in terms of aerobic capacity, endurance and strength in older adults with RA. This article is protected by copyright. All rights reserved.
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| 8. |
- Lange, Elvira
(författare)
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Exercise in older adults with rheumatoid arthritis - a person-centred approach
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Physical activity and exercise are well known to enhance health and are recommended as part of the management of rheumatoid arthritis (RA). However, the level of physical activity among older adults with RA is found to be low and little research focuses on physical activity and exercise in older adults with RA. The overall aim of this thesis was to study different aspects of exercise with person-centred guidance in older adults with RA. Methods: A randomised controlled trial was performed to study the effects of exercise on disability, and health and fitness-related outcomes. Seventy-four older adults (>65 years) with RA were randomised to moderate- to high intensity exercise with person-centred guidance or light home-exercise for 20 weeks. After the randomised study a qualitative interview study was performed to explore how older adults with RA experience exercise, and aspects that affect the transition to independent exercise. Finally, a long-time follow-up study was performed to evaluate physical activity and physical fitness after four years. Results: The result of the thesis show that exercise with person-centred guidance did not affect disability as assessed with the Health Assessment Questionnaire - Disability Index, but positive effects were found on physical fitness, fatigue, and symptoms of depression when compared to controls. The exercise was experienced as manageable and several aspects affecting the transition to independent exercise were described, including development of a personal way to exercise. After four years, there was no significant difference between groups, when change in physical activity level was compared. In conclusion moderate- to high intensity exercise is beneficial for older adults with RA and is experienced as manageable and prepares the transition to independent exercise. This thesis supports the recommendation of physical activity as part of routine management of RA in adults above 65 years of age. However, maintaining exercise over several years is challenging.
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| 9. |
- Lange, Elvira, et al.
(författare)
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Long-time follow up of physical activity level among older adults with rheumatoid arthritis
- 2020
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Ingår i: European Review of Aging and Physical Activity. - : Springer Science and Business Media LLC. - 1813-7253 .- 1861-6909. ; 17:10
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Tidskriftsartikel (refereegranskat)abstract
- Background Physical activity and exercise are acknowledged as important parts in the management of rheumatoid arthritis (RA). However, long-term maintenance of exercise is known to be difficult. The aim of this study was to evaluate change in physical activity and physical fitness after four years in older adults with RA who had previously participated in exercise with person-centred guidance compared to controls. Method A follow-up study was performed where older adults (> 65 years) who had participated in a randomized controlled trial where they were allocated to either exercise with person-centred guidance or home-based, light-intensity exercise (controls) were invited to one visit and assessed with performance-based test, blood-sampling and self-reported questionnaires. Forty-seven out of 70 older adults accepted participation, 24 from the exercise group and 23 from the control group. Comparisons of the result with baseline values were performed and explanatory factors for increase of physical activity were examined with logistic regression. Results The result show that there was no significant difference in weekly hours of physical activity when groups where compared. However, participants in the exercise group rated significantly increased weekly hours of physical activity after four years (p = 0.004) when compared to baseline. Higher levels of fatigue, BMI and physical activity, at baseline were negatively associated with increased physical activity after four years. There was no significant difference in change of physical fitness between the groups. Within group analysis showed that the control group reported increased pain (p = 0.035), fatigue (p = 0.023) increased number of tender joints (p = 0.028) higher disease activity (p = 0.007) and worsening of global health (p = 0.004) when compared to baseline while the exercise group remained at the same level as at baseline. Conclusion These results indicate that introducing moderate- to high intensity exercise with person-centred guidance might favor increased physical activity after four years in older adults with RA. Previous partaking in moderate- to high intensity exercise might also be protective against increased disease activity, pain and fatigue over time.
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| 10. |
- Lange, Elvira, et al.
(författare)
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Physiological Adaptation in Women Presenting Fibromyalgia: Comparison with Healthy Controls
- 2017
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Ingår i: Clinical and Experimental Psychology. - : OMICS Publishing Group. - 2471-2701. ; 1:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the heart rate variability (HRV) before and after a sub-maximal exercise test in women with fibromyalgia (FM) and to compare the result to matched controls. Additionally, to compare heart rate (HR) before, during and after the sub-maximal exercise test. Methods: Twenty-four women with FM and 26 controls performed a sub-maximal exercise test. HRV was registered for 5 minutes at rest before and after the exercise test. HR was registered at baseline, during the exercise test and at recovery. Results: The HRV of the healthy group was statistically different from the exercise test but the women with FM showed no such difference. HR was significantly higher among the women with FM than in the healthy group at baseline and up to 75W but lower at peak (138/152 bpm, p<0.008). In women with FM HR during exercise (HR2) was predicted by heart rate recovery (HRR20) and physical exertion (RPE2). HRR20 and RPE2 accounted for 0.465 of the variance (p=0.006) in HR2. In healthy women HR2 correlated with HRR20 and negatively with physical activity (PhA). In the reference group HRR20 and PhA accounted for 0.448 (p=0.002) of the variance HR. Conclusion:The HRV in women with FM show less adjustment of the ANS while not being significantly affected by submaximal exercise as healthy women. In healthy women heart rate during the test was negatively related to PhA. In women with FM exertion seems to replace an effect from exercise on physiological adaptation. FM may entail imperceptible extraction of power from PhA while under load. Links to FM pain will be discussed. Women with FM seem to rate exertion “Very hard” on lower workload and HR than healthy women. The physiotherapeutic methodology for measuring HRV with basic HR monitors should be improved before it can be recommended for clinical use.
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