The document discusses a client named Glenn who underwent pre-screening that revealed high risk during exercise due to medical conditions. An exercise program was implemented based on GP recommendations to help manage his conditions and reduce disease risks. Pre-screening methods are discussed as an effective way to reduce adverse events during exercise.
This document summarizes a journal club presentation on a study assessing the knowledge and practices of intensive care nurses regarding the prevention of ventilator-associated pneumonia. The study found that the nurses had average knowledge but unsatisfactory practices in preventing VAP. It concluded that additional in-service education and training programs are needed to improve nurses' knowledge and practices and reduce infections among patients. The presentation reviewed the objectives, methods, findings and conclusions of the descriptive study conducted with 50 nurses in India. It also discussed relevant literature supporting the average knowledge levels found and the need for preventative protocols and guidelines.
The document discusses various models used in nursing, including conceptual models, clinical models, role performance models, and models related to specific theorists like Nightingale. It provides objectives and considerations for effective conceptual models. Some models mentioned specifically are the agent-host-environment model, health-illness continuum model, holistic model, Milio's public health policy model, levels of prevention model, health belief model, socio-ecological model, and AIDS reduction model.
This document discusses managing disciplinary problems in nursing education. It defines discipline as activities that help students attain goals. Good discipline develops moral character and helps students live successfully in society. The aims of discipline in teaching are to create conditions for learning objectives, develop favorable attitudes, and cultivate self-control and cooperation. Principles for managing problems include using positive approaches, consistency, and deferred action over immediate punishment. Preventive measures involve effective classroom management through preparation, engagement, clear instruction, and cooperative attitudes.
Mr. Sy, a 74-year-old man, was admitted to the hospital with an indirect inguinal hernia and underwent hernia repair surgery. The nurse addressed areas like the patient's perceptions and needs, gathered health history, and identified nursing diagnoses of acute pain, risk of infection, and risk of constipation. Goals were set to improve the patient's comfort and knowledge as well as prevent complications. The nurse's actions aligned with the mutually agreed upon goals and the patient responded positively, though family involvement in care could be further emphasized.
1. The document discusses various methods and models of health education, including individual methods like lectures, seminars, workshops, and group methods like brainstorming and buzz groups.
2. It describes different types of health education models, focusing on the Motivational Model and the Health Belief Model. The Health Belief Model proposes that health behaviors are influenced by perceived susceptibility, severity, benefits, and barriers.
3. Several other models of health behavior change are mentioned, including the Trans-Theoretical Model of Change and the Theory of Planned Behavior. The document provides an overview of key approaches to promoting health education.
This document discusses various approaches to nutritional rehabilitation for malnutrition, including hospital-based, centre-based, and community-based rehabilitation. It describes diets used in rehabilitation such as milk-based diets and ready-to-use therapeutic foods. It also discusses criteria for transferring patients to rehabilitation, staffing of rehabilitation centres, community nutrition programs, and developmental stimulation techniques.
This document discusses newer vaccines and an MR vaccination campaign. It provides background on vaccine history and types. Recent developments include vaccines for pneumococcal, influenza, meningococcal, HPV, and rotavirus. Future vaccines discussed include ones for HIV. The document also outlines the need for vaccination, recently added vaccines in India's national program, and details of vaccination schedules and target groups for campaigns like one for MR in 2017.
Florence Nightingale developed the Environmental Theory, which focused on incorporating restoration of a patient's usual health status through manipulation of their environment. She believed the environment influenced health and identified five essential environmental components: pure air, pure water, efficient drainage, cleanliness, and light. Nightingale was influenced by her education, literature works, intellectuals, and religious beliefs. Her theory emphasized proper ventilation, sanitation, light, warmth, noise control and diet. The theory remains important for disease control, architecture, waste disposal, temperature control and education. It provides general nursing guidelines but lacks empirical precision.
CONCEPT, OBJECTIVES ,SCOPE, PRINCIPLES, Philosophy OF COMMUNITY HEALTH NURSEKailash Nagar
The document discusses different philosophies and concepts of community health nursing:
1) It outlines four concepts of health - biomedical, ecological, psychosocial, and holistic. The biomedical concept views health as the absence of disease, while the ecological concept sees health as a dynamic equilibrium between humans and their environment.
2) It then describes three philosophies that guide community health nursing: the philosophy of individual health rights, the philosophy of working together under competent leadership for the common good, and the philosophy that communities have potential for development and can address their own problems with education.
3) The final philosophy discussed is socialism.
This document outlines the key concepts and purposes of health education. It defines health education as the process of helping people learn behaviors to improve their health. It discusses how health education aims to prevent diseases through upgrading knowledge, building healthy trends, and changing behaviors. It also describes the roles and characteristics of health educators in medical settings, schools, workplaces, and communities in assessing needs, planning and implementing programs, evaluation, and advocating for health issues.
Nursing care plan based on self care deficit theory by Dorothea Orem. The process is on Medical Surgical Nursing. It is helpful for students of M.Sc Nursing.
Quality assurance in nursing originated with Florence Nightingale and involves establishing standards of care and measuring patient care against those standards to evaluate and promote excellence. A quality assurance program is a systematic, ongoing process that sets standards, measures patient care, gathers data, and makes recommendations for improvement. The goal is to ensure efficient, effective, and economical care. Approaches include credentialing like licensure and certification, peer review, auditing care standards and documentation, and identifying areas for improvement. Quality assurance helps improve patient care standards and professional development.
This document defines epidemiology and discusses key related concepts. It begins by defining epidemiology as "the study of the distribution and determinants of health-related states or events in specified populations." It then discusses key epidemiological terms like distribution, determinants, frequency, pattern, and the aims of epidemiology. The history of epidemiology is also summarized, highlighting the contributions of John Snow in identifying the water source of a cholera outbreak and Hippocrates' focus on environmental influences. Uses of epidemiology are listed as studying disease trends, planning health services, and searching for disease causes.
This document contains a 30 question quiz on topics related to nursing education, including philosophers of education, educational assessments, curriculum models, and the history of nursing education organizations. The questions cover subjects like John Dewey's philosophy of pragmatism, Plato's views on education, Bloom's Taxonomy, formative vs summative assessments, Problem-Based Learning, and the founding dates of the Trained Nurses Association of India and international nursing organizations. An answer key is provided at the end.
The document discusses concepts of prevention and control in healthcare. It defines four levels of prevention - primordial, primary, secondary, and tertiary. Primordial prevention aims to prevent risk factors from emerging, while primary prevention focuses on health promotion and protection before disease onset. Secondary prevention uses early diagnosis and treatment to stop disease progression. Tertiary prevention aims to reduce impairments and disabilities from established disease through rehabilitation. Control activities focus on primary and secondary prevention to reduce disease incidence, duration, transmission and burden. Monitoring and surveillance are important for detecting changes in health status and disease trends. Evaluation assesses how well prevention and control programs are performing in meeting their objectives.
This document discusses 10 models of prevention: the health belief model, holistic health model, agent-host-environment model, level of prevention model, health illness continuum model, high level wellness model, Milio's framework model, role performance model, health promotion model, and basic human need model. These models provide theoretical frameworks for understanding concepts related to preventing disease and minimizing disability.
The health belief model is a social psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services.
Holistic healthcare is complete or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person, his or her response to illness and the effect of the illness on the ability to meet self-care needs.
A nursing concept map is a visual tool that helps nursing students strategize patient care on paper. This map allows students to organize and visualize patient care concepts in an easy-to-read diagram that highlights the relationships among various nursing concepts.
Nursing concept maps are also a self-teaching strategy that can help students pre-plan their clinical assessments and provide valuable insight for post-clinical analysis. This tool increases students' clinical reasoning and judgment while optimizing learning.
Use of partial information in learning to read chinese characters 3yuxuan liu
This study investigated whether Chinese children can use partial information from phonetic components to learn pronunciations of unfamiliar compound characters. The study presented 49 2nd graders and 56 4th graders whose home language was Mandarin, and 75 2nd graders and 93 4th graders whose home language was Cantonese, with characters of four types: regular characters containing full pronunciation information; tone-different characters containing partial tone information; onset-different characters containing partial onset information; and irregular characters containing no information. Children learned more regular and partial-information characters than irregular characters, and Mandarin speakers learned more than Cantonese speakers.
This short document promotes the creation of presentations on SlideShare using Haiku Deck. It includes a stock photo and suggests the reader may be inspired to create their own Haiku Deck presentation. In just a few words, it pitches the idea of getting started making presentations with Haiku Deck on SlideShare.
Bhujbal Brothers Construction Company is a leading real estate developer in Pune established in 1988. They have developed over 10 lakh square feet of residential properties across the city known for quality construction and reliability. Their current project, Misty Trails, includes 200 flats and units for shops and offices located next to a reserved garden providing a green environment. Bhujbal Brothers offers projects across Pune and has upcoming residential and commercial projects while planning to enter the hospitality sector.
Valay is a well planned planned project or 2 BHK Apartments in Hadapsar. Highly contemporary design, proper space managment, right lifestyle amenities and good location, everything combines to create a perfectly planned, picturesque project.
Deep thought is given to the wants of the entire family and the result is a beautful abode, stylish, soothing and superb.
This document discusses the benefits of PMP certification for individuals and organizations. PMP certification demonstrates knowledge of project management methodology and best practices, increasing confidence for clients. It also helps organizations by ensuring the workforce understands methodology and values teamwork. The document congratulates individuals who completed training to facilitate PMP certification, wishing them the best on the final exam. It also congratulates others who earned Scrum Master and digital marketing certifications.
As follow-up to the workshop session on "Real-time Retail: It's What Customers Demand” moderated by Ken Morris, principal at Boston Retail Partners, we summized topics discussed during this session.
Whether you had the opportunity to attend this session, or not, I think will find the recap document to be insightful with interesting opportunities and perspectives of real-time retail.
This workshop recap encapsulating the ideas and comments that retail industry leaders debated and discussed in this session, including:
- Real-time Retail
- Personalized Selling
- Interactive CRM
- Monitor & React
- Task Management
- Nimble Execution
This document discusses various forms of non-textual communication such as music, dance, facial expressions, and body language. It notes that while textual communication dominates online interactions, platforms like YouTube and Skype allow for non-textual communication through video. Different types of non-textual communication such as music, dance, and comics are described. The document argues that studying only textual or only non-textual communication is incomplete, and that a mixed methods approach is needed to understand how these different forms of communication interact and influence each other and culture online.
The Role of Heritage in Revitalizing Landscapes - Heritage Canada 2014Brenda Barrett
The Pennsylvania Wilds demonstrates the value of the state's conservation landscape program and on working on a regional scale as a tool for rural revitalization. Such work can build a more resilient community when faced with global energy issues such as drilling for natural gas.
Matthew Dumas has over 20 years of experience working in customer service, education, and community services roles, with a focus on assisting Aboriginal students and communities. He is currently studying for a Diploma in Community Services while maintaining strong references from past employers such as the Department of Human Services, where he worked as a Customer Service Officer for three years. Dumas is a highly motivated, detail-oriented worker who enjoys collaborating with others and tackling challenges.
This document discusses Nathan Cyr, a 12-year-old boy whose hobby is making mechanical things and has a magazine called "super car" for guys. It also briefly mentions Vin Diesel's birthdate and location, technical details about a 1963 Corvette's engine, and the car from The Dukes of Hazzard TV show from 1969.
smartData offers training programs that provide exposure to business best practices and technology, develop talent through certification courses partially paid for by the company, and aim to create a well-rounded development through work, learning, and relaxation activities.
The document is about the Norwegian comedy duo Ylvis and their song "What Does the Fox Say?". Ylvis is a comedy duo formed in 2000 consisting of brothers Bård and Vegard Ylvisaker. The song speaks of animals in a fun way. The author loves animals and includes a link to the music video for the song on YouTube.
Bhujbal Brothers Construction Company is a leading real estate developer in Pune established in 1988. They have developed over 10 lakh square feet of residential properties across the city known for quality construction and reliability. Their current project, Misty Trails, includes 200 flats and units for shops and offices located next to a reserved garden providing a green environment. Bhujbal Brothers offers projects across Pune and has upcoming residential and commercial projects while planning to enter the hospitality sector.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This document summarizes international guidelines for physical activity following pregnancy from 6 sources: Australia, Canada, Norway, United Kingdom, and two from the United States. All guidelines embedded physical activity recommendations within pregnancy guidelines. They identified benefits like improved mood and fitness. Guidelines agreed that moderate physical activity does not negatively impact breastfeeding. They provided general timing for resuming activity and mentioned aerobic exercise, pelvic floor exercises, and walking. However, guidelines lacked specificity around exercise prescriptions and did not discuss sedentary behavior.
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
1) Thirty 11-year-old girls participated in a study where 16 were assigned to a Pilates intervention group and 14 served as controls.
2) The intervention group participated in hour-long Pilates classes 5 days a week for 4 weeks. Measures of BMI, BMI percentile, waist circumference, and blood pressure were taken before and after.
3) There was a significant reduction in BMI percentile for the intervention group compared to the control group. Specifically, the BMI percentile of healthy girls in the intervention group decreased more substantially.
1) Thirty 11-year-old girls participated in a study where 16 were assigned to a Pilates intervention group and 14 served as controls.
2) The intervention group participated in hour-long Pilates classes 5 days a week for 4 weeks. Controls engaged in usual activities.
3) Results showed the intervention group significantly lowered their BMI percentile by 3.1 compared to a 0.8 increase in controls.
4) Girls enjoyed Pilates and had high average attendance of 75%, suggesting Pilates may increase physical activity levels in girls.
Effect of Eight Weeks Conditioning On Body Mass Index of College StudentsIOSR Journals
This study examined the effects of an eight-week conditioning program on the body mass index (BMI) of 50 male college students aged 17 to 23 years old. The students participated in conditioning exercises six days per week for one hour each session. BMI was measured before and after the eight weeks through pre- and post-tests. The results showed that the mean BMI decreased significantly from 25.66 to 24.30, indicating that participation in regular conditioning exercises can be effective for lowering BMI in college students.
This document discusses effective physical treatments for chronic low back pain. It finds that exercise is one of the few clearly effective treatments, with systematic reviews finding exercise reduces pain and disability. While exercise is effective, the optimal implementation is unclear. Two example programs discussed are group general exercise and individually supervised specific spinal stabilization exercise. The document also discusses laser therapy for chronic back pain, but notes no systematic review has evaluated its efficacy.
Physical Activity and Cancer, a review of innovative current research. Dr. Ni...Irish Cancer Society
Physical activity guidelines exist in many EU countries to reduce cancer risk, though only a minority meet them. Research shows physical activity lowers breast, colon, and endometrial cancer risk by 25-30%, and likely other cancers, through mechanisms like reduced body fat and inflammation. Randomized trials show exercise improves outcomes for breast cancer survivors. More research is needed on optimal dose and type of activity. Ongoing studies examine biological mechanisms and effects on recurrence, survival, and quality of life.
This study evaluated adherence to dietary and lifestyle recommendations in 77 patients who underwent laparoscopic sleeve gastrectomy (LSG) bariatric surgery. The study found that only a minority of patients adhered to the recommended protein intake of at least 60 g per day at 3, 6, and 12 months post-surgery. Half of patients met the physical activity recommendation of at least 150 minutes per week at each time point. Adherence to supplementation recommendations was higher, ranging from 57.1-100% across time points. Adherence was generally medium to high but was not significantly associated with excess weight loss of at least 60% at 12 months.
Investigation of the changes on muscular endurance in response to aerobic and...Sports Journal
The rationale of the study is to investigate the changes on muscular endurance in response to aerobic and
anaerobic training among type 2 diabetic patients. To achieve the purpose of the study 45 male type 2
diabetic patients from Ongole, in the southern state of Andhra Pradesh, India, were selected as subjects.
The subjects were selected in the age group of 45 to 50 years and they were randomly assigned into three
equal groups of 15 each. Experimental group-I performed aerobic training, experimental group-II
performed anaerobic training and group III acted as control. The muscular endurance was selected as
dependent variable. The data collected from the three groups prior to and post experimentation on
selected dependent variable was statistically analyzed to find out the significant difference if any, by
applying the analysis of covariance (ANCOVA). Whenever the obtained ‘F’ ratio value was found to be
significant for adjusted post-test means, the Scheffe’s test was applied as post hoc test. In all the cases the
level of confidence was fixed at 0.05 level for significance. The result of the study produced 20.48%
percentage of improvement due to aerobic training and 15.32% of improvement due to anaerobic training
in muscular endurance of the diabetic patients
To Assess the Effect of Body Mass Index on Cardiac Efficiency in Adolescent B...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
HAL for Gait Training in MS:
- Improve gait parameters
- Decrease fatigue
- Improve balance and mobility
- Increase walking endurance
HAL: Hybrid Assistive Limb
- Powered exoskeleton suit
- Sensors in suit detect bioelectric signals from muscles
- Suit assists voluntary limb movement
Ongoing Study: Not yet published
Diabetic Peripheral Neuropathy- 6 Months Follow up Using Resisted Exercises a...inventionjournals
Introduction: An alarming global increase in type 2 diabetes, with second maximum known diabetic subjects in India, peripheral neuropathy which remain unfocussed with complications such as falls, ulcers, amputation, decreased mobility, dependence for ADL and disability associated along with. Aims and Objectives of This Research: To analyse obesity, glycemic control and neuropathy on a diabetic subject. Materials and Methodology: This original study was on a subject for 30 years with known type 2 diabetes and for 10 years with peripheral neuropathy, where the impact of resisted exercises and Proprioceptive training were analysed for 6 months period from October 2016 to March 2017. Results: A marginal reduction in obesity and improved glycemic control by 0.5% and slight lowering of Toronto clinical scoring system for diabetic neuropathy were recorded. Conclusion: The findings of this study could implicate benefits of larger population in the society as nearly 50% of diabetic develop neuropathy. Also this was an innovative and first research study among diabetic neuropathy subjects using RET and proprioceptive exercises. Key Words: HbA1C – Glycosylated Hemoglobin, IDF - International Diabetes Federation, TCSS - Toronto clinical scoring system, BMI – Body Mass Index, WC – Waist Circumference, UKPDS – United Kingdom Prospective Diabetes Study, NCV – Nerve Conduction Velocity, ACSM – American College of Sports Medicine, TENS – Transcutaneous Electrical Nerve Stimulation, VAS – Visual Analogue Scale, ADL – Activities of Daily Life
The role of exercise and physical activity in weight loss and maintingGabriel J Santos
This document discusses the role of exercise and physical activity in weight loss and maintenance. It finds that:
1) Unless overall exercise volume is very high, clinically significant weight loss is unlikely from exercise alone and will be highly variable between individuals.
2) Exercise has an important role in preventing weight regain after initial weight loss. Aerobic exercise consistent with public health guidelines may result in modest average weight loss of around 2 kg.
3) Clinicians should educate patients on reasonable weight loss expectations based on their physical activity program and emphasize the many health benefits of exercise regardless of weight loss.
An aquatic exercise program improved muscular strength, endurance, work and power in patients with multiple sclerosis. For the lower extremities, knee extensor peak torque significantly increased from pre- to mid-trial. Fatigue and work values improved significantly from pre- to post-trial. For the upper extremities, all force measurements significantly increased from pre- to post-trial. Power and total work values also improved significantly, though no significant change in fatigue was found. The results indicate aquatic exercise can induce positive changes to muscular functioning for individuals with multiple sclerosis.
2. Each client undergoing exercise must have a
completed pre-exercise questionnaire and a report
from a GP if required.
These forms are completed on the first visit to the
clinic or if we are meeting at an alternate location,
the first meeting will involve completion of these
forms.
We use the Adult Pre-Exercise Screening Tool
supplied by ESSA for this purpose.
3. Patient: Glenn
Pre-screen and risk stratification revealed that he
was at high risk during exercise.
Exercise program implemented based on GP
recommendations for weight loss to manage
symptoms of Myasthaenia Gravis and cellulitis, as
well as reduce risk of diabetes due to impaired
GTT and hypertension.
Pre-screening has been shown to be an effective
method of reducing the incidence of exercise-related
adverse events (Resnick, Ory, Coday &
Riebe, 2008).
5. American College of Sports Medicine [ACSM].
(2010). ACSM’s guidelines for exercise testing
and prescription (8th ed.). Philadelphia:
Lippincott, Williams & Wilkins.
National Health & Medical Research Council
[NH&MRC]. (2003). Clinical practice guidelines for
the management of overweight and obesity in
adults. Canberra: Commonwealth of Australia.
Resnick, B., Ory, M., Coday, M., & Riebe, D.
(2008). Professional perspectives on physical
activity screening practices: Shifting the
paradigm. Critical Public Health, 18(1), 21-32.
6. Movement capacity is assessed in patients who
present with musculoskeletal injuries or
disorders, as well as patients who will be
performing exercises that are dependent on
mobility or flexibility.
This can include healthy/athletic population
undergoing movement screening for sport e.g
overhead squat.
In clinical populations such as those recovering
from surgery, ROM assessment is vital to
determine the ongoing improvement expected
as a result of rehabilitative exercises.
9. Functional movement screening can be viewed as an analysis
of the degrees of freedom present in each joint. When
assessing a patient’s ROM we must first look at each segment
of their body to gain an understanding of ROM (Cook, 2010).
The assessment items used for this patient included
measures of both static and dynamic tasks (Gabbe, Bennell,
Wajswelner & Finch, 2004).
The assessment of active ROM in the hip is included in the
assessment items for this patient as ROM at the hip has also
been shown to be associated with low back pain (Ellison, Rose
& Sahrmann, 1990).
The lifting tasks were performed as this patient was on
workcover. It is expected that he will return to his previous
duties as a waste disposal worker at the conclusion of his
treatment.
10. Cook, G. (2010). Movement: Functional
movement systems: Screening, assessment,
corrective strategies. On Target Publications
Gabbe, B. J., Bennell, K. L., Wajswelner, H., &
Finch, C. F. (2004). Reliability of common lower
extremity musculoskeletal screening
tests. Physical Therapy in Sport, 5(2), 90-97.
Ellison, J. B., Rose, S. J., & Sahrmann, S. A. (1990).
Patterns of hip rotation range of motion: a
comparison between healthy subjects and
patients with low back pain. Physical
Therapy, 70(9), 537-541.
11. One of the primary roles of an AEP is to
develop safe, effective exercise programs and
ensure that the patient is both capable of
performing the required task and motivated
to continue to do so.
Programs should be based on screening and
assessment results.
This program was completed as part of an
assessment task.
13. The program was developed based on current
evidence relating to interventions for low back
pain.
The frequency of RT sessions was kept to 2-3
times per week
Core exercises included everyday
Generalised aerobic conditioning is beneficial in
those with cLBP
(McGill, 2004; McGill, 2007; Smeets et al, 2006)
14. Smeets, R. J., Vlaeyen, J. W., Hidding, A.,
Kester, A. D., van der Heijden, G. J., van Geel,
A. C., & Knottnerus, J. A. (2006). Active
rehabilitation for chronic low back pain:
cognitive-behavioral, physical, or both? First
direct post-treatment results from a
randomized controlled trial. BMC
Musculoskeletal disorders, 7(1), 5.
McGill, S. (2007). Low back disorders:
evidence-based prevention and rehabilitation.
Human Kinetics.
McGill, S. (2004). Ultimate back fitness and
performance. Wabuno Publishers.
15. During my placement with ActivTherapy, I was
involved in giving numerous presentations on the
role of exercise in preventing and managing
chronic conditions.
I participated in a two week “My Wellbeing”
program run by the NRMA for it’s roadside assist
staff
During these presentations I discussed the nature
of chronic disease as well as the various risk
factors associated with them as well as the
relevant tests and assessments used in detecting
them.
16. I also gave a presentation at the wellness
centre in Liverpool hospital for cancer
patients
This outlined the benefits of exercise for their
condition.
18. The presentations were designed to educate the audience as
to how to reduce risk factors for developing lifestyle related
diseases with emphasis on increasing activity an improving
dietary choices (Williams, 2001).
Physical activity as a means of managing symptoms of cancer
treatment was discussed during the presentation at the
hospital (Courneya & Friedenreich, 1997).
During both presentations I demonstrated a simple
assessment that people could use to determine their risk of
developing CVD or Diabetes (Savva et al, 2000).
19. Williams, P. T. (2001). Physical fitness and activity as
separate heart disease risk factors: a meta-analysis.
Medicine and science in sports and
exercise,33(5), 754.
Courneya, K. S., & Friedenreich, C. M. (1997). Relationship
between exercise pattern across the cancer experience and
current quality of life in colorectal cancer survivors. The
Journal of Alternative and Complementary Medicine, 3(3),
215-226.
Savva, S. C., Tornaritis, M., Savva, M. E., Kourides, Y.,
Panagi, A., Silikiotou, N & Kafatos, A. (2000). Waist
circumference and waist-to-height ratio are better
predictors of cardiovascular disease risk factors in children
than body mass index. International journal of obesity and
related metabolic disorders: journal of the International
Association for the Study of Obesity, 24(11), 1453-1458.
20. During placement I worked with clients who had
impaired glucose tolerance and hypertension.
These clients are at risk of developing diabetes
and cardiovascular disease.
The provision of lifestyle advice and exercise
programs is important to ensure that these
people do not continue to progress into a
diseased state.
I conducted group classes for those with, or at
risk of chronic disease. This included persons
with obesity, hypertension, pre/diabetes. The
classes were part of the EPC program and
participants were able to attend up to 10 classes
as part of this coverage .
21. First session of weight loss clinic program with 3 levels for
beginners – advanced. The inclusion of core exercises every
session is due to the high number of low back pain patients
who attend.
22. The provision of nutritional advice and support was
given through these classes.
At the conclusion of each class, I assessed food
diaries of participants and critiqued their food
choices if necessary.
Every 4 weeks I conducted a “shopping tour” which
involved a visit to the nearby Woolworths store
where I educated the participants on healthy food
choices and how to understand the nutritional
information displayed on each food item.
23. Below are some examples of the information provided to participants on
the shopping tour and throughout the classes. These brochures were
developed by the Australian Government National Health and Medical
Research Council and are available at www.eatforhealth.gov.au
25. Winett, R. A., & Carpinelli, R. N. (2001). Potential
health-related benefits of resistance
training. Preventive medicine, 33(5), 503-513.
Van Tulder, M., Malmivaara, A., Esmail, R., & Koes, B.
(2000). Exercise therapy for low back pain: a
systematic review within the framework of the
cochrane collaboration back review
group. Spine, 25(21), 2784-2796.
National Health and Medical Research Council,
Australian Government Department of Health and
Ageing, New Zealand Ministry of Health. Nutrient
reference values for Australia and New Zealand
including recommended dietary intakes. Canberra:
Commonwealth of Australia; 2006.
26. Patients with complex or chronic medical
conditions often present a challenge to the
AEP who must ensure that exercises are safe
and effective. A delicate line has to be walked
between conservative approaches and
proactively pushing your client to ensure
sufficient stimulus for adaptations to occur.
27. This patient had Myaesthenia Gravis,
epilepsy, hypertension, Cellulitis, Impaired
GTT.
28. Lohi, E. L., Lindberg, C., & Andersen, O. (1993).
Physical training effects in myasthenia
gravis. Archives of physical medicine and
rehabilitation, 74(11), 1178-1180.
Paul, R. H., Nash, J. M., Cohen, R. A., Gilchrist, J.
M., & Goldstein, J. M. (2001). Quality of life and
well‐being of patients with myasthenia
gravis. Muscle & nerve, 24(4), 512-516.
Pan, X. R., Li, G. W., Hu, Y. H., Wang, J. X., Yang,
W. Y., An, Z. X., & Howard, B. V. (1997). Effects of
diet and exercise in preventing NIDDM in people
with impaired glucose tolerance: the Da Qing IGT
and Diabetes Study.Diabetes care, 20(4), 537-
544.
29. During placement I was responsible for
conducting hydrotherapy sessions with
numerous patients who had undergone
surgical procedures or had sustained acute
injuries.
Hydrotherapy has been used extensively in
rehabilitation of acute injuries.
(Giaquinto, Ciotola, Dall’Armi & Margutti, 2010; Foley, Halbert,
Hewitt & Crotty, 2003)
30. Provided hydrotherapy to a patient who had
recently undergone a ORIF procedure to
repair fractured tibia and fibula.
32. Giaquinto, S., Ciotola, E., Dall’Armi, V., &
Margutti, F. (2010). Hydrotherapy after total knee
arthroplasty. A follow-up study. Archives of
gerontology and geriatrics, 51(1), 59-63.
Foley, A., Halbert, J., Hewitt, T., & Crotty, M.
(2003). Does hydrotherapy improve strength and
physical function in patients with osteoarthritis—
a randomised controlled trial comparing a gym
based and a hydrotherapy based strengthening
programme. Annals of the rheumatic
diseases, 62(12), 1162-1167.
Geytenbeek, J. (2002). Evidence for effective
hydrotherapy. Physiotherapy,88(9), 514-529.
33. Throughout my placement I was primarily
involved in providing secondary care to
patients.
Most patients were referred from a GP under
the EPC program or through work cover
insurance providers.
In many cases patients continued their
training after their EPC sessions had run out
however this is still classed as secondary
care.
Editor's Notes
Clinical portfolio by ben gonano. All placement hours completed with activtherapy in Moorebank under the supervision of Andrew Rivet.
and decision was made to refer to GP prior to commencing training.
Here is a completed Pre exercise screening tool that was filled out by a patient. His last name has been covered for confidentiality.
Presented on the next two slides are the results of movement and ROM screenings performed on a patient who presented with low back pain. Here we assessed the lumbar spinne for and lower limb for movemet and stability with emphasis on lumbopelvic complex.
Presented here are more exerts from the report of the previous patient. I performed the functional capacity assessment based on his work demands. He is required to be able to lift up to 20kg. This sllide also outlines the areas of pain and injury the patient is currently experiencing.
Functional movement screening can be viewed as an analysis of the degrees of freedom present in each joint. When assessing a patient’s ROM we must first look at each segment of their body to gain an understanding of ROM limitations and then assess their patterns of motion which may be grossly flawed but nonetheless pain free and unrestricted (Cook, 2010). The inclusion of the squat, lunge, single leg stand allow the therapist to examine these issues.
The assessment items used for this patient included measures of both static and dynamic tasks. For example the examination of lumbar flexion and extension coupled with hamstring extensibility have been shown to be valid predictors of future back pain (Gabbe, Bennell, Wajswelner & Finch, 2004).
The assessment of active ROM in the hip is included in the assessment items for this patient as ROM at the hip has also been shown to be associated with low back pain (Ellison, Rose & Sahrmann, 1990).
The lifting tasks were performed as this patient was on workcover. It is expected that he will return to his previous duties as a waste disposal worker at the conclusion of his treatment. He is required to lift objects up to 20kg above shoulder height. Therefore we will assess his ability to do so in our movement screen.
The exercise programs given to patients are designed based on initial screening and assessment results to ensure that all exercises are both safe and effective for that person’s current condition and goals.
Throughout my studies I have created numerous individualised exercise programs for the purpose of assessment and examination. One such program was completed for a client with chronic low back pain
This is an example of an exercise prograam developed for a ficticious client with low back pain. This is a copy of the first weeks training so intensty is failry low.
as that was shown to be effective at minimising fatigue and deteriorating movement patterns (McGill, 2004).
The inclusion of “core” exercises everyday has been shown to reinforce corrective movement patterns in those with back pain (McGill, 2007), and thus reduce the incidence of aberrant motion that often produces compensatory involvement of low back muscles.
The inclusion of generalised aerobic conditioning in the form of cycling has been shown to improve pain scores in subjects as well as serving to reduce body weight which is often a cause of back pain (Smeets et al, 2006).
During my placement with ActivTherapy, I was involved in giving numerous presentations on the role of exercise in preventing and managing chronic conditions.
I participated in a two week “My Wellbeing” program run by the NRMA for it’s roadside assist staff where we detailed how to incorporate exercise into their daily routine as a means of preventing the ever increasing incidence of diabetes and heart conditions among their employees (predominantly males, over 35 years of age with minimal formal education)
During this presentation I discussed the nature of chronic disease as well as the various risk factors associated with them as well as the relevant tests and assessments used in detecting them.
I also gave a presentation at the wellness centre in Liverpool hospital for cancer patients and outlined ways that exercise could help them manage symptoms of treatment as well as reducing the likelihood of developing co-conditions. This presentation also involved providing functional assessments of the audience which was used to assist in developing an individualised exercise program that they could perform unsupervised in their homes.
These slides formed a small part of the presentations
The presentations were designed to educate the audience as to how to reduce risk factors for developing lifestyle related diseases. As such the emphasis was on increasing physical activity and limiting poor dietary choices which can affect markers of health such as cholesterol, glucose and BP. A push for greater physical fitness as opposed to simply an accumulation of physical activity was also provided due to evidence that fitness may have a greater protective effect on cardiovascular health than simply low-moderate physical activity (Williams, 2001).
Physical activity as a means of managing symptoms of cancer treatment was discussed during the presentation at the hospital. The likelihood of developing co-morbid conditions is greater among post treatment cancer patients due to an increase in sedentary behaviour often attributed to fatigue. Therefore an increase in exercise and physical activities may assist this population to maintain a greater degree of health and independence (Courneya & Friedenreich, 1997).
During both presentations I demonstrated a simple assessment that people could use to determine their risk of developing CVD or Diabetes. The waist circumference measure was used and a tape with risk indications printed on it was supplied to the audience. The waist circumference measure has been shown to be an effective tool for predicting cardiovascular disease (Savva et al, 2000).
Each Class had people of varying levels of physical ability. Therefore the class required varying levels of intensity to ensure each participant could train to a level that was both safe and effective for them. We performed core exercises due to the high number of participants complaining of back pain and this has been shown in multiple studies to be an effective means of reducing symptomatic back pain.
The exercises are gradually progressed in difficulty each week to ensure sufficient stimulus for adaptation throughout the classes.
At the beginning all participants undergo a functional assessment where we record vital data which is used to determine the outcome of the sessions at the end. Throughut the duration of the classes every participant must report on their food intake for the week and their unsupervised exercises. We also provide each person with a measuring tape with risk indicators for both men and women.
All participants are given a rage of information brochures and resources to enable them to manage a healthy lifestyle. All resources are provided free from various government run programs such as eat for health .
A copy of the food diary filled out for 2 days by a participant of the classes. It also includes exercise and medications.
This is a copy of one weeks training performed with Glenn. He has a rare condition known as myaesthenia gravis which results in weakness of respiratory muscles during exertion as well as constant fatigue. On top of this condition he is obese, has hypertension, cellulitis in his legs and ankles which is painful during exercise and he currently has impaired glucose tolerance. His program was designed with the goal of weight loss as his doctor is contemplating starting him on diabetic medication however wants to see if he can lose weight on his own and possibly manage through lifestyle modification rather than medication. Due to his current functional stautus exercise needed to be low impact and low intensity. Aerobic exercise has been shown to improve symptoms of fatigue in persons with MG and as such this is included in his program. RT is also an important feature in a physical training program to ensure that strength is maintained or improved to enable easier performance of ADL. Most importantly the exercise has to be of sufficient intensity and volume to ensure changes in his blood profile pertaining to blood glucose. This has been studied extensively and researchers have found that 3 days per week at moderatete instensity for approximately 45-60 mins is sufficient to improve insulin sensittivity and glucose tolerance.
...and in the post-operative treatment of patients. It is known to decrease pain scores and improve functional ROM in individuals who have undergone knee arthroplasty and is also effective at improving strength and physical function in arthritic populations.
Some examples of conditions I managed were medial tibial stress syndrome, mastectomy, tibia and fibula spiral fracture who is the example provided, Rotator cuff repairs and ACL repairs.
During the sessions in the pool, I focused on restoring ROM, improving muscular endurance, strength and co-ordination. We performed exercises that were extrememly low impact such as wading through the water, pendulum swings with legs, squats against the wall, bicycle with legs and progressed to walking lunges, squats using foam resistance board, resisted flexion and extension and adduction and abduction, swimming (freestyle at first and eventually incorporated breast stroke due to it’s greater utilisation of leg muscles.
Open reduction and internal fixation procedure.
A report on functional capacity done after the hydrotherapy.