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Sarah L. West, Adam Gassas, Tal Schechter, R. Maarten Egeler, Paul C. Nathan and Greg D. Wells

Hematopoietic stem-cell transplant (SCT) is increasingly used to treat children with cancer, and survival following SCT is improving. One predominant consequence of childhood cancer therapy is increased physical morbidity, which is worse in pediatric SCT recipients compared with children treated with chemotherapy or radiation alone. There are many factors that contribute to exercise intolerance and reduced physical function during the pretransplant, peritransplant, and posttransplant phases. These include side effects from chemotherapy or radiation, excessive immobility due to bed rest, infections, the negative effects of immunosuppressants, and graft vs host disease, all of which can impair cardiorespiratory fitness, muscle strength, and muscle function. Few studies have investigated the effects of exercise in childhood SCT recipients. In a small number of published studies, exercise interventions have been demonstrated to improve cardiorespiratory fitness, preserve or increase muscle mass, and improve muscle strength in children following SCT. The use of exercise as medicine may be a noninvasive and nonpharmaceutical treatment to target physical complications post-SCT. Researchers and health-care professionals should work together to develop exercise prescription guidelines for this unique and important population.

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Carl G. Mattacola and Lori L. Rice

Context:

Dissemination of information regarding the latest research findings in rehabilitative health care is often limited to professional journals.

Objective:

The purpose of the paper is to describe opportunities to better distribute scientific information to wider swaths than normally contained within a readership of a journal, to describe a process to deliver important information via the Cooperative Extension Service, and provide an example of such an informational brochure.

Design:

An interdisciplinary approach was developed to provide access to a larger cohort of individuals the latest research findings regarding heat and hydration.

Data Extraction:

CINAHL, Medline, and Sport Discus were reviewed from 1966 to 2006 using the terms Heat, Hydration, Rhabdomyolysis, Rehabilitation, Heat Exhaustion, Heat Stroke, and Dehydration.

Data Synthesis:

We found substantial information describing recommendations for preventing, recognizing, and treating illness due to variance in heat and hydration. The information was succinctly summarized, converted to a 7th grade reading level, and shared with a larger audience via a unique model available through Cooperative Extension Agencies.

Conclusion:

Providing scientific information via a Cooperative Extension Model enables sharing of information from experts to communities. This methodology increases the distribution of the latest scientific knowledge to broader audiences.

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Derek T. Smith, Stacey Judge, Ashley Malone, Rebecca C. Moynes, Jason Conviser and James S. Skinner

Reduced strength, balance, and functional independence diminish quality of life and increase health care costs. Sixty adults (82.2 ± 4.9 years) were randomized to a control or three 12-week intervention groups: bioDensity (bD); Power Plate (PP) whole-body vibration (WBV); or bD+PP. bD involved one weekly 5-s maximal contraction of four muscle groups. PP involved two 5-min WBV sessions. Primary outcomes were strength, balance, and Functional Independence Measure (FIM). No groups differed initially. Strength significantly increased 22–51% for three muscle groups in bD and bD+PP (P < .001), with no changes in control and PP. Balance significantly improved in PP and bD+PP but not in control or bD. bD, PP, and bD+PP differentially improved FIM self-care and mobility. Strength improvements from weekly 5-min sessions of bD may impart health/clinical benefits. Balance and leg strength improvements suggest WBV beneficially impacts fall risk and incidence. Improved FIM scores are encouraging and justify larger controlled trials on bD and bD+PP efficacy.

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Robert Carter III, Samuel N. Cheuvront and Michael N. Sawka

Objectives:

We report our observations on one soldier with abnormal hyperthermia during exercise in the heat compared with prior exercise and following acute local (non-febrile) infection. Also, we report on 994 heat stroke hospitalizations in the U.S. Army. It is known that prior infection is a risk factor for heat illness and some of the 37 heat stroke deaths cited infections (eg, pneumonia, influenza) in the medical records.

Results:

This case report illustrates complete recovery from abnormal hyperthermia, which occurred in a laboratory setting during mild, low intensity exercise. In a field setting, this case may have resulted in serious heat illness. As with most of the heat stroke cases, rapid medical attention (ie, cooling and rehydration) and the age group (19 to 26) that represents majority of the heatstroke cases in U.S. Army are likely factors that contribute successful treatment of heatstroke in the field environment.

Conclusions:

We conclude that acute inflammatory response can augment the hyperthermia of exercise and possibly increase heat illness susceptibility. Furthermore, it is important for health care providers of soldiers and athletes to monitor acute local infections due to the potential thermoregulatory consequences during exercise in the heat.

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Kevin Patrick, Michael Pratt and Robert E. Sallis

Background:

Healthcare professionals are influential sources of health information and guidance for people of all ages. However healthcare providers do not routinely address physical activity (PA). Engaging health professionals in a national plan for physical activity will depend upon whether proven strategies can be found to promote PA within clinical settings.

Methods:

The literature on promoting PA in healthcare settings was reviewed, as were recommendations from healthcare organizations and evidence-gathering entities about whether and how PA should be promoted in healthcare.

Key recommendations:

Evidence is mixed about whether interventions based in healthcare settings and offered by healthcare providers can improve PA behaviors in patients. Brief stand-alone counseling by physicians has not been shown to be efficacious, but office-based screening and advice to be active, followed by telephone or community support for PA has proven effective in creating lasting PA behavior improvement. Healthcare delivery models that optimize the organization of services across clinical and community resources may be very compatible with PA promotion in health care. Because of the importance of PA to health, healthcare providers are encouraged to consider adding PA as a vital sign for each medical visit for individuals aged 6 years and older.

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Stefan C. Garcia, Jeffrey J. Dueweke and Christopher L. Mendias

Context: Manual isometric muscle testing is a common clinical technique used to assess muscle strength. To provide the most accurate data for the test, the muscle being assessed should be at a length in which it produces maximum force. However, there is tremendous variability in the recommended positions and joint angles used to conduct these tests, with few apparent objective data used to position the joint such that muscle-force production is greatest. Objective: To use validated anatomically and biomechanically based musculoskeletal models to identify the optimal joint positions in which to perform manual isometric testing. Design: In silico analysis. Main outcome measure: The joint position which produces maximum muscle force for 49 major limb and trunk muscles. Results: The optimal joint position for performing a manual isometric test was determined. Conclusion: Using objective anatomical models that take into account the force-length properties of muscles, the authors identified joint positions in which net muscle-force production was predicted to be maximal. This data can help health care providers to better assess muscle function when manual isometric strength tests are performed.

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Judy Kruger, Sandra A. Ham and Serena Sanker

Background:

Physical inactivity is associated with increased morbidity and mortality. This study provides prevalence estimates of inactivity by select characteristics among older adults.

Methods:

Respondents ≥50 years of age were selected from the 2005 Behavioral Risk Factor Surveillance System (N = 185,702).

Results:

Overall, 30.0% of older adults did not engage in leisure-time physical activity. Within each racial/ethnic group, the prevalence of inactivity was highest among Hispanic men (41.9%) and women (42.4%). Among men with and without disabilities, chronic disease conditions associated with inactivity were angina or coronary artery disease. Among women with disabilities, chronic disease conditions associated with inactivity were stroke and diabetes; among women without disabilities only diabetes was significantly associated with inactivity.

Conclusion:

Regular physical activity is an important means to maintaining independence, because it substantially reduces the risk for developing many diseases; contributes to healthy bones, muscles, and joints; and can reduce the risk for falling. Health care providers are encouraged to discuss concerns regarding physical activity with their patients.

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Janet Simon and Matt Donahue

Clinical Scenario:

Ankle taping and bracing are commonly used to reduce the risk of sports-related ankle sprains. Mechanical- and neuromuscular-control facilitation has been the focus of their effectiveness. Another potential advantage to using ankle taping or bracing is an increased sense of confidence, stability, and reassurance that the individual may experience when performing a dynamic-balance activity. Since ankle sprains are one of the most common sport-related injuries treated by clinicians, treatment and prevention of these injuries is a priority for many health care providers. However, the psychological effects of taping or bracing on athletes are still unknown. Researchers have described athletes’ emotional responses and psychological reactions after athletic injuries. However, athlete reactions related to adhesive taping or bracing are limited. There is anecdotal evidence showing that football players stated they would tape a body part even if it was not injured as part of a superstitious pregame ritual. Therefore, the purpose of this article was to determine if individuals who have had their ankle taped or braced experience an increased sense of confidence, stability, or reassurance when performing a dynamic-balance activity.

Focused Clinical Question:

Does ankle taping or bracing create an increased sense of confidence, stability, and reassurance when performing dynamic-balance activity in physically active people?

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Kim D. Lu, Krikor Manoukian, Shlomit Radom-Aizik, Dan M. Cooper and Stanley P. Galant

Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptoms and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.

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James L. Farnsworth, Youngdeok Kim and Minsoo Kang

Background:

Disruptive sleeping patterns have been linked to serious medical conditions. Regular physical activity (PA) has a positive impact on health; however, few research have investigated the relationships between PA, body mass index (BMI), sedentary behaviors (SB), and sleep disorders (SD).

Methods:

Data from the 2005–2006 NHANES were analyzed for this study. Participants (N = 2989; mean age = 50.44 years) were grouped based upon responses to SD questions. Accelerometers were used to measure the average time spent in moderate or vigorous physical activity (MVPA) and SB. Multinomial logistic regression analyses were used to examine the associations between PA, SB, and SD after controlling for covariates and to explore potential moderation effects among common risk factors and the main study variables.

Results:

Among middle-aged adults, PA was significantly associated with SD [Wald χ2 (8) = 22.21; P < .001]. Furthermore, among adults in the highest tertile of SB, PA was significantly associated with SD [Wald χ2 (8) = 32.29; P < .001].

Conclusions:

These results indicate that middle-aged adults who are less active may have increased likelihoods of SD. It is important for health care professionals to continue developing methods for increasing PA to decrease the risk of SD.