Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial A predominantly home-based progressive resistance exercise program increases knee extensor strength in the short-term in people with chronic obstructive pulmonary disease: a randomised controlled trial. Resistance Training with Instability for Patients with Parkinson's Disease. Feasibility and Impact of a Function Focused Care Intervention for Parkinson's Disease in the Community Exercise for falls prevention in Parkinson disease Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial. A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. Qualitative outcomes of progressive resistance exercise for people with COPD A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. Leg muscle power is enhanced by training in people with Parkinson’s disease: a randomized controlled trial Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail older people. The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial. Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Weekly exercise does not improve fatigue levels in Parkinson's disease. Intensive physical training in geriatric patients after severe falls and hip surgery. Exercise augmentation compared to usual care for Post Traumatic Stress Disorder: A Randomised Controlled Trial (The REAP study: Randomised Exercise Augmentation for PTSD) Land-based versus aquatic resistance therapeutic exercises for older women with sarcopenic obesity: study protocol for a randomised controlled trial
OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed , strength , and fitness for patients with Parkinson disease . DESIGN A comparative , prospect i ve , r and omized , single-blinded clinical trial of 3 types of physical exercise . SETTING The Parkinson 's Disease and Movement Disorders Center at the University of Maryl and and the Baltimore Veterans Affairs Medical Center , Geriatric Research Education and Clinical Center . PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were r and omly assigned to 1 of 3 arms of the trial . INTERVENTIONS ; ( 1 ) A higher-intensity treadmill exercise ( 30 minutes at 70%-80 % of heart rate reserve ) , ( 2 ) a lower-intensity treadmill exercise ( 50 minutes at 40%-50 % of heart rate reserve ) , and ( 3 ) stretching and resistance exercises ( 2 sets of 10 repetitions on each leg on 3 resistance machines [ leg press , leg extension , and curl ] ) . These exercises were performed 3 times a week for 3 months . MAIN OUTCOME MEASURES The primary outcome measures were gait speed ( 6-minute walk ) , cardiovascular fitness ( peak oxygen consumption per unit time [ $ $ VO2 ] , and muscle strength ( 1-repetition maximum strength ) . RESULTS All 3 types of physical exercise improved distance on the 6-minute walk : lower-intensity treadmill exercise  ( 12 % increase ; P=.001 ) ,  stretching and resistance exercises  ( 9 % increase ; P<.02 ) , and higher-intensity treadmill exercise  ( 6 % increase ; P=.07 ) , with no between-group differences . Both treadmill exercises improved peak $ $ VO2 ( 7%-8 % increase ; P<.05 ) more than did the stretching and resistance exercises . Only stretching and resistance improved muscle strength ( 16 % increase ; P<.001 ) . CONCLUSIONS The effects of exercise were seen across all 3 exercise groups . The lower-intensity treadmill exercise result ed in the greatest improvement in gait speed . Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness . Only the stretching and resistance exercises improved muscle strength . Therefore , exercise can improve gait speed , muscle strength , and fitness for patients with Parkinson disease . The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation ABSTRACT Background Sarcopenic obesity is associated with disability in older people , especially in women .  Resistance exercises are recommended for this population , but their efficacy is not clear . Objective To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity . Method Twenty-eight women 65 to 80 years old , with a body mass index ≥30kg/m2 and h and grip strength ≤21 kg were r and omly allocated to two groups . The experimental group underwent a 10-week resistance exercise program design ed to improve strength , power , and endurance of lower-limb muscles , with open chain and closed chain exercises . The control group had their health status monitored through telephone calls . The primary outcomes were lower limb muscle performance measured by knee extensor strength , power and fatigue by isokinetic dynamometry , and mobility measured by the Short Physical Performance Battery and by gait velocity . The secondary outcome was health-related quality of life assessed by the SF-36 Question naire . Results The average rate of adherence was 85 % , with few mild adverse effects . There were no significant between-group differences for any of the outcomes . Conclusion In this study , a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity QUESTIONS Does a 12-week , predominantly home-based program of progressive resistance exercises reduce impairments , activity limitations , and participation restrictions in people with chronic obstructive pulmonary disease ? Are any gains maintained 12 weeks after the cessation of the program ? DESIGN R and omised controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation . INTERVENTION The experimental group performed six progressive resistance exercises three times per week ( once a week hospital-based , twice a week home-based ) for 12 weeks . Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised b and s of increasing resistance . The control group received no intervention . OUTCOME MEASURES Primary outcomes were strength ( knee extensor , hip abductor , shoulder horizontal flexor , shoulder flexor ) measured using h and -held dynamometry , and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention . RESULTS The experimental group increased their knee extensor strength by 4.9 kg ( 95 % CI 1.1 to 8.7 ) more than the control group by Week 12 . However , this gain was not maintained at Week 24 . No difference between the groups was found for any of the other primary outcomes . CONCLUSIONS A predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease . However , 44 % of the experimental group were unable to complete the exercise program , highlighting the need to underst and factors influencing adherence to exercise in this population PURPOSE This r and omized controlled trial compared the effects of resistance training ( RT ) and RT with instability ( RTI ) on the timed up and go test ( TUG ) , on-medication Unified Parkinson 's Disease Rating Scale part III motor subscale score ( UPDRS-III ) , Montreal Cognitive Assessment ( MoCA ) score , Parkinson 's Disease Question naire ( PDQ-39 ) score , and muscle strength in the leg press exercise ( one-repetition maximum ) of patients with Parkinson 's disease ( PD ) . METHODS Thirty-nine patients with moderate to severe PD were r and omly assigned to a nonexercising control group ( C ) , RT group , and RTI group . The RT and RTI groups performed progressive RT twice a week for 12 wk . However , only the RTI group used high motor complexity exercises ( i.e. , progressive RT with unstable devices ) , for example , half squat exercise on the BOSU ® device . The primary outcome was mobility ( TUG ) . The secondary outcomes were on-medication motor signs ( UPDRS-III ) , cognitive impairment ( MoCA ) , quality of life ( PDQ-39 ) , and muscle strength ( one-repetition maximum ) . RESULTS There were no differences between RTI and RT groups for any of the outcomes at posttraining ( P > 0.05 ) . However , there were differences between RTI and C groups in the TUG , MoCA , and muscle strength values at posttraining ( P < 0.05 ) . Only the RTI group improved the TUG ( -1.9 s ) , UPDRS-III score ( -4.5 score ) , MoCA score ( 6.0 score ) , and PDQ-39 score ( -5.2 score ) from pre- to posttraining ( P < 0.001 ) . Muscle strength improved for both training groups ( P < 0.001 ) . No adverse events were reported during the trial . CONCLUSIONS Both training protocol s improved muscle strength , but only RTI improved the mobility , motor signs , cognitive impairment , and quality of life , likely because of the usage of high motor complexity exercises . Thus , RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD Background : Parkinson 's disease ( PD ) results in a progressive loss of function such that family caregivers provide a large percentage of the personal care to PD patients living in the home setting . Objectives : The aim of this study was to test the feasibility and impact of function-focused care for PD ( FFC-PD ) developed to optimize function and physical activity among people with PD who live in the community . Methods : This pilot study was a single-group , 2 pretest , 3 posttest repeated- measures design to investigate the impact of the FFC-PD intervention over a 12-month period . Measurements included the Self-Efficacy and Outcome Expectations for Exercise and Functional Activities , Yale Physical Activity Scale , Unified Parkinson 's Disease Rating Scale , Barthel Index , Schwab & Engl and , Timed Chair Rise , Parkinson 's Disease Question naire-39 , and Geriatric Depression Scale . Results : The impact of FFC-PD on a person with PD showed a statistically significant increase in outcome expectations for exercise , F(3 , 60 ) = 3.09 , p = .034 ; hours a week exercising , F(1 , 24 ) = 4.95 , p = .004 ; mean weekly energy expenditure , F(2,43 ) = 4.32 , p = .017 ; hours spent in overall activities , F(3 , 60 ) = 6.06 , p = .001 ; decreased disability based on the Unified Parkinson 's Disease Rating Scale , F(2 , 40 ) = 9.48 , p < .001 ; improved Parkinson 's Disease Question naire-39 score , F(3 , 60 ) = 3.81 , p = .014 ; and a trend toward significance on Barthel Index , F(1.6 , 31 ) = 3.47 , p = .055 . Discussion : Function-focused care for PD has a significant effect on increasing and on strengthening outcome expectations related to exercise , time spent in exercise , and physical activity and in improving functional performance in people with PD . Further research is needed to explore the use of objective measurements of functional performance and activity and to test FFC-PD in a r and omized controlled trial Objective : To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors , i.e. , poor balance , reduced leg muscle strength , and freezing of gait , in people with Parkinson disease . Methods : Two hundred thirty-one people with Parkinson disease were r and omized into exercise or usual-care control groups . Exercises were practice d for 40 to 60 minutes , 3 times weekly for 6 months . Primary outcomes were fall rates and proportion of fallers during the intervention period . Secondary outcomes were physical ( balance , mobility , freezing of gait , habitual physical activity ) , psychological ( fear of falling , affect ) , and quality -of-life measures . Results : There was no significant difference between groups in the rate of falls ( incidence rate ratio [ IRR ] = 0.73 , 95 % confidence interval [ CI ] 0.45–1.17 , p = 0.18 ) or proportion of fallers ( p = 0.45 ) . Preplanned subgroup analysis revealed a significant interaction for disease severity ( p < 0.001 ) . In the lower disease severity subgroup , there were fewer falls in the exercise group compared with controls ( IRR = 0.31 , 95 % CI 0.15–0.62 , p < 0.001 ) , while in the higher disease severity subgroup , there was a trend toward more falls in the exercise group ( IRR = 1.61 , 95 % CI 0.86–3.03 , p = 0.13 ) . Postintervention , the exercise group scored significantly ( p < 0.05 ) better than controls on the Short Physical Performance Battery , sit-to-st and , fear of falling , affect , and quality of life , after adjusting for baseline performance . Conclusions : An exercise program targeting balance , leg strength , and freezing of gait did not reduce falls but improved physical and psychological health . Falls were reduced in people with milder disease but not in those with more severe Parkinson disease . Classification of evidence : This study provides Class III evidence that for patients with Parkinson disease , a minimally supervised exercise program does not reduce fall risk . This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise . Trial registration : Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) Background Although physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson 's disease , this has not yet been confirmed with a large scale r and omised controlled clinical trial . The study will investigate the effects on falls , mobility and quality of life of ( i ) movement strategy training combined with falls prevention education , ( ii ) progressive resistance strength training combined with falls prevention education , ( iii ) a generic life-skills social program ( control group ) . Methods / Design People with idiopathic Parkinson 's disease who live at home will be recruited and r and omly allocated to one of three groups . Each person shall receive therapy in an out-patient setting in groups of 3 - 4 . Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks . All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase . Assessment s will occur before therapy , after the 8 week therapy program , and at 3 and 12 months after the intervention . A falls calendar will be kept by each participant for 12 months after outpatient therapy . Consistent with the recommendations of the Prevention of Falls Network Europe group , three falls variables will be used as the primary outcome measures : the number of fallers , the number of multiple fallers and the falls rate . In addition to quantifying falls , we shall measure mobility , activity limitations and quality of life as secondary outcomes . Discussion This study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson 's disease who live at home . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Background People with Parkinson 's disease are twice as likely to be recurrent fallers compared to other older people . As these falls have devastating consequences , there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson 's disease . The main objective of this r and omised controlled trial is to determine whether fall rates can be reduced in people with Parkinson 's disease using exercise targeting three potentially remediable risk factors for falls ( reduced balance , reduced leg muscle strength and freezing of gait ) . In addition we will establish the cost effectiveness of the exercise program from the health provider 's perspective . Methods / Design 230 community-dwelling participants with idiopathic Parkinson 's disease will be recruited . Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment . Participants will be r and omly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait . The intervention group will choose between the home-based or support group-based mode of the program . Participants in both groups will receive st and ardized falls prevention advice . The primary outcome measure will be fall rates . Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period . Secondary measures include the Parkinson 's Disease Falls Risk Score , maximal leg muscle strength , st and ing balance , the Short Physical Performance Battery , freezing of gait , health and well being , habitual physical activity and positive and negative affect schedule . Discussion No adequately powered studies have investigated exercise interventions aim ed at reducing falls in people with Parkinson 's disease . This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness . This pragmatic program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) QUESTIONS Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia ? Is it effective for improving muscle endurance and participants ' perceptions about use of their h and s for activities of daily living ? DESIGN R and omised controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles . INTERVENTION The wrist muscles of one r and omly-chosen h and were trained 3 times a week for 8 weeks . The control group received no intervention . OUTCOME MEASURES The primary outcome was strength measured as maximal voluntary isometric torque in Nm . The secondary outcomes were muscle endurance measured as fatigue resistance and participants ' perceptions about use of their h and s using the Canadian Occupational Performance Measure . RESULTS The mean effect on maximal voluntary isometric torque was 0.2 Nm ( 95 % CI -0.5 to 0.8 ) . This represents an 8 % increase of mean initial strength ; less than the 20 % deemed clinical ly worthwhile at the commencement of the study . The mean effect on fatigue resistance was 0.1 ( 95 % CI 0.0 to 0.2 ) . The mean effect on participants ' perceptions of performance was -0.3 ( 95 % CI -1.9 to 1.2 ) and satisfaction was -0.3 ( 95 % CI -1.6 to 1.0 ) . CONCLUSION The results indicate that progressive resistance exercise has no effect on participants ' perceptions about h and function . However , it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia Background . Falls are common and disabling in people with Parkinson ’s disease ( PD ) . There is a need to quantify the effects of movement rehabilitation on falls in PD . Objective . To evaluate 2 physical therapy interventions in reducing falls in PD . Methods . We r and omized 210 people with PD to 3 groups :  progressive resistance strength training coupled with falls prevention education , movement strategy training combined with falls prevention education , and life-skills information ( control ) . All received 8 weeks of out-patient therapy once per week and a structured home program . The primary end point was the falls rate , recorded prospect ively over a 12 month period , starting from the completion of the intervention . Secondary outcomes were walking speed , disability , and quality of life . Results . A total of 1547 falls were reported for the trial . The falls rate was higher in the control group compared with the groups that received strength training or strategy training . There were 193 falls for the progressive resistance strength training group , 441 for the movement strategy group and 913 for the control group . The strength training group had 84.9 % fewer falls than controls ( incidence rate ratio [ IRR ] = 0.151 , 95 % CI 0.071 - 0.322 , P < .001 ) . The movement strategy training group had 61.5 % fewer falls than controls ( IRR = 0.385 , 95 % CI 0.184 - 0.808 , P = .012 ) . Disability scores improved in the intervention groups following therapy while deteriorating in the control group . Conclusions . Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible OBJECTIVES Protein supplementation has been proposed as an effective dietary strategy to augment the skeletal muscle adaptive response to prolonged resistance-type exercise training in elderly people . Our objective was to assess the impact of protein supplementation on muscle mass , strength , and physical performance during prolonged resistance-type exercise training in frail elderly men and women . DESIGN / SETTING / PARTICIPANTS A r and omized , double-blind , placebo-controlled trial with 2 arms in parallel among 62 frail elderly subjects ( 78 ± 1 year ) . These elderly subjects participated in a progressive resistance-type exercise training program ( 2 sessions per week for 24 weeks ) during which they were supplemented twice daily with either protein ( 2 * 15 g ) or a placebo .  MEASUREMENTS Lean body mass ( DXA ) , strength ( 1-RM ) , and physical performance ( SPPB ) were assessed at baseline , and after 12 and 24 weeks of intervention . RESULTS Lean body mass increased from 47.2 kg ( 95 % CI , 43.5 - 50.9 ) to 48.5 kg ( 95 % CI , 44.8 - 52.1 ) in the protein group and did not change in the placebo group ( from 45.7 kg , 95 % CI , 42.1 - 49.2 to 45.4 kg , 95 % CI , 41.8 - 48.9 ) following the intervention ( P value for treatment × time interaction = .006 ) . Strength and physical performance improved significantly in both groups ( P = .000 ) with no interaction effect of dietary protein supplementation . CONCLUSIONS Prolonged resistance-type exercise training represents an effective strategy to improve strength and physical performance in frail elderly people  . Dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people . TRIAL REGISTRATION clinical trials.gov identifier : NCT01110369 The outcomes of quantitative investigations examining the effectiveness of exercise interventions for people with COPD are limited by the small number of measurement tools that can be included . In contrast , qualitative inquiry allows broader exploration of the perceived outcomes of an intervention . The purpose of this investigation is to explore the qualitative outcomes of a progressive resistance exercise ( PRE ) program for people with COPD . People with COPD , enrolled in a r and omized controlled trial of PRE , were invited to participate in two semi-structured interviews conducted at the end ( 12 weeks ) and 12 weeks after the training intervention ( 24 weeks ) . Interviews were audiotaped , transcribed and then coded independently by two research ers . Themes relating to training outcomes were then developed and described . Twenty-two participants were interviewed at 12 weeks , and 19 participants at 24 weeks . After PRE , participants reported a range of physical gains , particularly with regard to improved strength and reduced breathlessness during daily activities . Improved control and confidence during activities of daily living were important psychological benefits perceived by people with COPD , as was the social support experienced during group training sessions . At 24 weeks , confidence persisted despite a perceived plateau or dissipation of physical gains .  People with COPD reported physical , psychological and social benefits after PRE , which had a positive effect on activity performance . Although the perceived physical benefits of training were not prominent at 24 weeks , feelings of increased confidence and control persisted . Chronic Respiratory Disease 2007 ; 4 : QUESTIONS For people with idiopathic Parkinson 's disease , does a 6-week , comprehensive , home exercise program reduce falls and disability and improve health-related quality of life ? Is the program cost-effective ? DESIGN R and omised , controlled trial with concealed allocation and assessor blinding . PARTICIPANTS One hundred and thirty-three community-dwelling adults with Parkinson 's disease . INTERVENTION The experimental group completed a 6-week home program comprising progressive resistance strength training , movement strategy training and falls education . The control group completed 6 weeks of non-specific life skills training . Participants in both groups received weekly therapist-guided sessions for 6 consecutive weeks and a weekly self-directed home program . OUTCOME MEASURES The primary outcome was the rate of falls , documented for the 12-month period immediately after therapy . Secondary outcomes were disability and health-related quality of life , assessed before and after intervention and at a 12-month follow-up . RESULTS A total of 2255 falls were reported by the 12-month follow-up . The proportion of fallers in the experimental and control groups was 61 and 72 % , respectively , which was not statistically significantly different ( RR=0.85 , 95 % CI 0.66 to 1.09 ) . There was no significant between-group difference in the rate of falls ( incidence rate ratio=1.58 , 95 % CI 0.73 to 3.43 ) . A survival analysis of participant time to first fall did not show a significant between-group difference ( log-rank test χ2=0.79 , p=0.37 ) . No significant between-group differences occurred for mobility , disability or quality of life . The mean cost of delivering the experimental intervention was AUD1596 . CONCLUSION A home program of strength and movement strategy training and falls education does not prevent falls when applied at the dose used in this study . Arguably , the dosage of therapy was insufficient . Future trials need to explore further therapy content , repetitions and duration , in order to optimise outcomes and cost-effectiveness . [ Morris ME , Taylor NF , Watts JJ , Evans A , Horne M , Kempster P , Danoudis M , McGinley J , Martin C , Menz HB ( 2017 ) A home program of strength training , movement strategy training and education did not prevent falls in people with Parkinson 's disease : a r and omised trial . Journal of Physiotherapy 63 : 94 - 100 ] Objective : To determine the effects of leg muscle power training in people with Parkinson ’s disease . Design : R and omized controlled trial . Setting : University laboratory ( outcome measures and experimental intervention ) , community ( control intervention ) . Subjects : Community-dwelling people with Parkinson ’s disease . Interventions : Leg muscle power training using pneumatic variable resistance equipment ( experimental ) was compared with low intensity sham exercise ( control ) . Both groups exercised twice weekly for 12 weeks . Main measures : Primary outcomes were peak power of four leg muscle groups . Secondary outcomes were measures of muscle strength , mobility , balance and falls . Results : Exercise adherence was high in both groups . Leg muscle power was significantly better in the experimental group than the control group in all four primary outcome measures at 12 weeks after adjusting for baseline values : leg extensors ( 57.9 watts , 95 % confidence interval ( CI ) 22.0–93.7 , p = 0.002 ) ; knee flexors ( 29.6 watts , 95 % CI 7.4–51.8 , p = 0.01 ) ; hip flexors ( 68.1 watts , 95 % CI 19.6–116.5 , p = 0.007 ) ; and hip abductors ( 37.4 watts , 95 % CI 19.9–54.9 , p < 0.001 ) . The experimental group performed significantly better on tests of leg muscle strength ( p < 0.001 to 0.07 ) and showed trends toward better performance in the Timed Up and Go ( p = 0.13 ) and choice stepping reaction time ( p = 0.11 ) . There was a non-significant reduction in the rate of falls in the experimental group compared with the control group ( incidence rate ratio 0.84 , p = 0.76 ) . Conclusions : This programme significantly improved muscle power in all trained muscle groups INTRODUCTION Although h and grip strength is considered a strong predictor of negative health outcomes , it is unclear whether h and grip strength represents a useful measure to evaluate changes in muscle strength following resistance-type exercise training in older people . We assessed whether measuring h and grip strength provides proper insight in the efficacy of resistance-type exercise training to increase muscle mass , strength , and physical performance in frail older people . METHODS Prefrail and frail older people ( ≥ 65 y ) were either conducting a 24-week resistance-type exercise training or no exercise training . Before , during , and after the intervention , h and grip strength ( JAMAR ) , lean body mass ( DXA ) , leg strength ( 1-RM ) , and physical performance ( SPPB ) were assessed . RESULTS H and grip strength correlated with appendicular lean mass ( r = 0.68 ; p < .001 ) and leg strength ( r = 0.67 ; p < .001 ) . After 24 weeks of whole body resistance-type exercise training , leg extension strength improved significantly better when compared with the control group ( 57 ± 2 - 78 ± 3 kg vs 57 ± 3 - 65 ± 3 kg : p < .001 ) . Moreover , physical performance improved significantly more in the exercise group ( 8.0 ± 0.4 - 9.3 ± 0.4 points ) when compared with the control group ( 8.3 ± 0.4 - 8.9 ± 0.4 points : p < .05 ) . These positive changes were not accompanied with any significant changes in h and grip strength ( 26.3 ± 1.2 - 27.6 ± 1.2 kg in the exercise group vs 26.6 ± 1.2 - 26.3 ± 1.3 kg in the control group : p = .71 ) . CONCLUSION Although h and grip strength strongly correlates with muscle mass and leg strength in frail older people , h and grip strength does not provide a valid means to evaluate the efficacy of exercise intervention programs to increase muscle mass or strength in an older population This r and omized controlled trial with blinded assessment aim ed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson 's disease ( PD ) . Forty-eight participants with PD who had fallen or were at risk of falling were r and omized into exercise or control groups . The exercise group attended a monthly exercise class and exercised at home three times weekly . The intervention targeted leg muscle strength , balance , and freezing . The primary outcome measure was a PD falls risk score . The exercise group had no major adverse events and showed a greater improvement than the control group in the falls risk score , which was not statistically significant ( between group mean difference = -7 % , 95 % CI -20 to 5 , P = 0.26 ) . There were statistically significant improvements in the exercise group compared with the control group for two secondary outcomes : Freezing of Gait Question naire ( P = 0.03 ) and timed sit-to-st and ( P = 0.03 ) . There were statistically nonsignificant trends toward greater improvements in the exercise group for measures of muscle strength , walking , and fear of falling , but not for the measures of st and ing balance . Further investigation of the impact of exercise on falls in people with PD is warranted OBJECTIVES : Human Immunodeficiency Virus ( HIV ) infection worsens the frailty of elderly people , compromising their quality of life . In this study we prospect ively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity , who engaged in a one-year progressive resistance exercise program  to compare its effects on muscular strength , physical fitness and body composition . METHODS : Exercises for major muscular groups were performed 2 times/week , under professional supervision . Strength increase was evaluated bimonthly , while body composition , lipid and glycaemic profiles ( only of those living with HIV ) and physical fitness were evaluated before and after the one-year training . RESULTS : The participants living with HIV were lighter , had smaller Body Mass Index and were initially much weaker than controls . However , their strength increased more ( 1.52 - 2.33 times the baseline values for those living with HIV x 1.21 - 1.48 times for controls , p<0.01 ) , nullifying the differences initially seen . These effects were seen independently of gender , age or baseline physical activity . In addition , those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program . These effects were slightly more pronounced among those not using protease inhibitors , although not significantly . CONCLUSIONS : Resistance exercise safely increased the strength of older patients living with HIV adults , allowing them to achieve performance levels observed among otherwise healthy controls . These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults AIM The aim of this study was to investigate whether individualized resistance training improves the physical mobility of young people with cerebral palsy ( CP ) . METHOD Forty-eight participants with spastic diplegic CP ( 26 males , 22 females ; mean age 18y 1mo , SD 1y 11mo ) classified as level II or III on the Gross Motor Function Classification System were allocated r and omly to progressive resistance training or usual-care control . Resistance training was completed twice weekly for 12 weeks at a community gymnasium under the supervision of a physiotherapist . Exercises were based on instrumented gait analysis and targeted muscles contributing to walking difficulties . Outcomes at 12 weeks and 24 weeks included objective measures of mobility ( 6-min walk test , instrumented gait analysis , and Gross Motor Function Measure dimensions D and E ) , participant-rated measures of mobility ( Functional Mobility Scale and Functional Assessment Question naire ) , and muscle performance . RESULTS The strength of targeted muscles increased by 27 % ( 95 % CI 8 - 46 % ) compared with control group . There were no between-group differences in any objective measure of mobility at 12 weeks ( 6-min walk test : mean difference 0.1 m ; 95 % CI -21 to 21 m ) or at 24 weeks . Participant-rated mobility improved ( Functional Mobility Scale at 5 m : mean 0.6 units ; 95 % CI 0.1 - 1.1 units ; Functional Assessment Question naire : 0.8 units ; 95 % CI 0.1 - 1.6 units ) compared with control group at 12 weeks . INTERPRETATION Individualized progressive resistance training increased strength in adolescents and young adults with spastic diplegic CP . Despite participant-rated benefits , the increased strength did not result in objective improvements in mobility An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson 's disease . While progressive resistance training ( PRT ) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson 's disease , there are a limited number of r and omized trials and no studies have evaluated gait initiation performance . Thus , the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson 's disease . Eighteen individuals with idiopathic PD were r and omly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks . Biomechanical analysis of GI was performed pre- and post-intervention . Dependent variables of interest included the displacement of the center-of-pressure ( COP ) during the anticipatory postural phase of GI as well as the initial stride length and velocity . The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity . There were no improvements in any variables for the control subjects . These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP BACKGROUND Fatigue is one of the most disabling non-motor symptoms for people with Parkinson 's disease . Exercise may modify fatigue . This study examines prescribed exercise effects on physical activity levels , well-being , and fatigue in Parkinson 's disease . METHODS In this single-blinded trial , participants were r and omly assigned to either a 12 week community exercise program or control group . Primary outcome measures were fatigue ( Fatigue Severity Scale ) and physical activity . RESULTS Thirty-nine people with Parkinson 's disease were included : 20 in exercise and 19 in control . Sixty-five percent of the study group were fatigued ( n = 24 , mean 4.02 , SD 1.48 ) . Increased fatigue was associated with lower mobility and activity ( P < .05 ) . Individuals participated in a mean of 15 ( SD 10 ) exercise sessions with no significant change in fatigue , mobility , well-being , or physical activity after exercise ( P ≥ .05 ) . CONCLUSION Participation in weekly exercise did not improve fatigue in people with Parkinson 's Disease BACKGROUND Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents . There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery . OBJECTIVE To assess the feasibility , safety and efficacy of intensive , progressive physical training in rehabilitation after hip surgery . DESIGN Prospect i ve , r and omised , placebo-controlled intervention study of a 3-months training intervention and a 3-months ' follow-up . SETTING Physical training 6 - 8 weeks after hip surgery . SUBJECTS Twenty-eight ( 15 intervention , 13 control ) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement . METHODS Progressive resistance and functional training to improve strength and functional performance . RESULTS No training-related medical problems occurred in the study group . Twenty-four patients ( 86 % ) completed all assessment s during the intervention and follow-up period . Adherence was excellent in both groups ( intervention : 93 , 0+/-13 , 5 % versus control : 96 , 7+/-6 , 2 % ) . Training significantly increased strength , functional motor performance and balance and reduced fall-related behavioural and emotional problems . Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training . Patients in the control group showed no change in strength , functional performance and emotional state during intervention and follow-up . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls . Because part of the training improvements were lost after stopping the training , a continuing training regime should be established Background The physical wellbeing of people with mental health conditions can often be overlooked in order to treat the primary mental health condition as a priority . Exercise however , can potentially improve both the primary psychiatric condition as well as physical measures that indicate risk of other conditions such as diabetes mellitus and cardiovascular disease . Evidence supports the role of exercise as an important component of treatment for depression and anxiety , yet no r and omised controlled trials ( RCT 's ) have been conducted to evaluate the use of exercise in the treatment of people with post traumatic stress disorder (PTSD).This RCT will investigate the effects of structured , progressive exercise on PTSD symptoms , functional ability , body composition , physical activity levels , sleep patterns and medication usage . Methods and design Eighty participants with a Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) diagnosis of PTSD will be recruited . Participants will have no contraindications to exercise and will be cognitively able to provide consent to participate in the study .The primary outcome measures will be PTSD symptoms , measured through the PTSD Checklist Civilian ( PCL-C ) scale . Secondary outcome measures will assess depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage . All outcomes will be assessed by a health or exercise professional masked to group allocation at baseline and 12 weeks after r and omisation . The intervention will be a 12 week individualised program , primarily involving resistance exercises with the use of exercise b and s. A walking component will also be incorporated . Participants will complete one supervised session per week , and will be asked to perform at least two other non-supervised exercise sessions per week . Both intervention and control groups will receive all usual non-exercise interventions including psychotherapy , pharmaceutical interventions and group therapy . Discussion This study will determine the effect of an individualised and progressive exercise intervention on PTSD symptoms , depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage among people with a DSM-IV diagnosis of PTSD.Trial Registration Background Sarcopenic obesity is a health condition that combines excess adipose tissue and loss of muscle mass and strength . Sarcopenic obesity predisposes to more functional disabilities than obesity or sarcopenia alone . Progressive resistance exercises are recommended for older people as a potential treatment for sarcopenia and also for obesity . However , there is a lack of evidence indicating which programmes are best applied to older people , and no studies have investigated their effects on sarcopenic obese people . The aims of this protocol study are to investigate and compare the efficacy of l and -based and aquatic resistance exercise programmes on improving muscle performance , functional capacity and quality of life of older women with sarcopenic obesity . Methods / Design This is a protocol study for a parallel r and omised controlled clinical trial . Eligible participants are older women ( ≥65 years ) with a body mass index ≥30 kg/m 2 and h and grip strength ≤21 kg force . A total sample of 36 participants will be r and omly allocated to one of the intervention groups in blocks of three : l and -based , aquatic or control . Each intervention group will undergo 2-week sessions of a 10-week therapeutic exercise programme for strength , power and endurance training of the lower-limb muscles . Participants in the control group will not participate in any strengthening activity for lower limbs and will receive telephone calls once a week . Baseline and final evaluation of outcomes will encompass muscle performance of the lower limbs assessed by an isokinetic dynamometer ; functional tests of usual walking speed , maximal walking speed ( shuttle walking test ) , stair speed and the Short Physical Performance Battery ; and health-related quality of life ( Medical Outcomes Study Short Form Question naire – SF-36 ) . Data collectors will be blinded to r and omisation and will not be in touch with participants during the interventions . Discussion This study is the first r and omised controlled trial design ed to evaluate resistance exercises in older patients with sarcopenic obesity . If our hypothesis proves correct , both intervention programmes will be effective , with the l and -based exercises conferring better results in muscle performance . Trial registration Registro Brasileiro de Ensaios Clínicos :
However , most physical performance outcomes did not show clinical ly worthwhile improvement after progressive resistance exercise .
CONCLUSION This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson 's disease , but carryover of benefit does not occur for all measures of physical performance .
The current evidence suggests that progressive resistance training should be implemented in Parkinson 's disease rehabilitation , particularly when the aim is to improve walking capacity
QUESTION Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson 's disease ?