A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report Autonomic function in panic disorder: cardiorespiratory and plasma catecholamine responsivity to multiple challenges of the autonomic nervous system Improvement in the face/name association performance after three months of physical training in elderly women. Variance in manual treatment of nonspecific low back pain between orthomanual physicians, manual therapists, and chiropractors. Conducting and Reporting Case Series and Audits - Author Guidelines for Acupuncture in Medicine Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of FINALE Comparative Safety Profile of Levofloxacin in 2523 Children With a Focus on Four Specific Musculoskeletal Disorders Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized control Assessment of the influence of exercise on heart rate variability in anxiety patients. Effects of T’ai Chi Exercise on Fibromyalgia Symptoms and Health-Related Quality of Life Effectiveness of manual therapies: the UK evidence report Autonomic and cardiovascular function in postmenopausal women: the effects of estrogen versus combination therapy. A Randomized Controlled Trial Investigating the Efficiency of Musculoskeletal Physiotherapy on Chronic Low Back Disorder Effect of Exercise Performed during Hemodialysis: Strength versus Aerobic The association between burnout and physical illness in the general population--results from the Finnish Health 2000 Study. A randomized controlled trial of geriatric screening and surveillance in general practice. A preliminary investigation into the magnitude of effect of lumbar extension exercises and a segmental rotatory manipulation on sympathetic nervous system activity. Burnout as a Predictor of Medically Certified Sick-Leave Absences and Their Diagnosed Causes Effectiveness of Workplace-Based Muscle Resistance Training Exercise Program in Preventing Musculoskeletal Dysfunction of the Upper Limbs in Manufacturing Workers Breathlessness during exercise with and without resistive loading. From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial
Background And rogen deprivation therapy ( ADT ) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture , reduced lean mass and muscle strength , mood disturbance and increased fat mass compromising physical functioning , independence , and quality of life . The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects , and cardiovascular and diabetes risk factors in men receiving and rogen deprivation for their prostate cancer . Specifically , we aim to investigate the effects of a 12-month exercise program design ed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints : 1 ) bone mineral density ; 2 ) cardiorespiratory function and maximal oxygen capacity ; 3 ) body composition ( lean mass and fat mass ) ; 4 ) blood pressure and cardiovascular function ; 5 ) lipids and glycemic control ; and 6 ) quality of life and psychological distress . Methods / Design Multi-site r and omized controlled trial of 195 men ( 65 subjects per arm ) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia . Participants will be r and omized to ( 1 ) resistance/impact loading exercise , ( 2 ) resistance/cardiovascular exercise groups and ( 3 ) usual care/delayed exercise . Participants will then undergo progressive training for 12 months . Measurements for primary and secondary endpoints will take place at baseline , 6 and 12 months ( end of the intervention ) . Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal , cardiovascular and insulin metabolism side effects of and rogen deprivation in prostate cancer patients . As this project is much longer term than previous investigations in the area of exercise and cancer , we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density , cardiovascular function , lean and fat mass , physical function and falls risk as primary study endpoints . In terms of advancement of prostate cancer care , we expect dissemination of the knowledge gained from this project to reduce fracture risk , improve physical and functional ability , quality of life and ultimately survival rate in this population . Clinical Trial RegistryA Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer ; Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted Panic disorder has been widely hypothesized to be associated with dysfunction of the autonomic nervous system . In this study , 24 patients with panic disorder and 26 healthy control subjects took part in a broad battery of autonomic function tests , each design ed to stress the autonomic nervous system in a particular fashion . Testing consisted of postural challenge , isometric exercise , cold pressor , and Valsalva maneuver . Dependent measures included heart rate , vagal tone , blood pressure , respiratory frequency , end-tidal CO2 levels , and plasma norepinephrine and epinephrine levels . The testing procedures reliably produced changes in autonomic output in the expected directions , but patients with panic disorder were not found to differ from healthy controls in their cardiorespiratory or plasma catecholaminergic responses . This pattern of normal autonomic responsivity in the patients with panic disorder was evident across multiple test conditions with varying autonomic dem and characteristics , thereby supporting the integrity of autonomic regulatory systems in this illness . These data run counter to a simple notion of autonomic dysfunction in panic disorder Several lines of evidence suggest that physical exercise not only influences the development of muscles , cardiovascular and respiratory systems , but also exerts a significant influence on the central nervous system . We examined the influence of strength and endurance training on cognitive performance in 33 healthy elderly volunteers ( women , mean age 63.5 + /-4.5 yr ) over a 3-month period of supervised training program . A control group consisted of 8 age-matched ( mean age 66.3 + /-4.6 ) healthy volunteers who did not participate in any exercise training program .  To evaluate the cognitive performance in our subjects we used two tests : face/name association test and Stroop test . The tests were applied shortly before and immediately after the training program . In the experimental group , a significant improvement in the association test performance , on average , from 71.6 + /-7.3 % to 79.7 + /-7.2 % ( P<0.0001 ) was observed over the 3-month training period . There were no changes in the Stroop test results over the same time . Likewise , there were no changes in the control groups . Our data demonstrate that the training regime that is strictly followed over a relatively short period of time may improve the performance in associative memory tasks in elderly subjects . The study supports the notion that physical exercise influences cognitive performance and extend this notion to be valid for healthy elderly subjects OBJECTIVE The aim of the study was to identify differences in the diagnosis and treatment of nonspecific low back pain  among 3 professional groups in the Netherl and s : orthomanual physicians , manual therapists , and chiropractors .  METHODS Information was obtained from training material s from professional groups , literature search es , and observation of selected practitioners at work . RESULTS In The Netherl and s , there are differences in education between the 3 professional groups . The focus of orthomanual medicine is on abnormal positions of components of the skeleton and symmetry in the spine . Manual therapy focuses on functional disorders of the musculoskeletal system . Chiropractic focuses on the musculoskeletal and nervous systems in relation to patients ' health in general . Orthomanual medicine considers inspection and palpation the most important diagnostic tools . Manual therapists and chiropractors additionally perform tests to determine functional disorders and manual therapists evaluate psychosocial influences . Chiropractors take radiographs if necessary . Orthomanual physicians apply mobilization techniques using fixed protocol s. Manual therapists and chiropractors use various manipulation and mobilization techniques and their manipulation techniques differ in amplitude and velocity . CONCLUSIONS Diagnostic techniques and treatment methods of the 3 professional groups differ considerably . For more accurate reporting of the efficacy of manipulative and mobilizing therapies , the characteristics of treatments should be described in more detail when reported in studies such as r and omized clinical trials This article aims to give guidance on the conduct and reporting of case series and audits of acupuncture , based on common problems that have arisen in the past . This type of project , and particularly the prospect i ve case series or pre- post-intervention study , may give valuable evidence of the overall effectiveness of acupuncture for example in different situations and in different conditions and provides one step in the research pathway before generating an hypothesis . The project should be design ed with the aim of reducing bias as much as possible . Careful and detailed planning is essential for the project to produce worthwhile results that readers can evaluate and replicate . Ethical issues should be considered and formal approval may be necessary . The patient group should be recruited systematic ally and baseline data obtained . The treatment given should be systematic and decisions to change or end treatment made explicit . The outcome should be measured in ways that are known to be reliable and valid . Musculoskeletal problems can be evaluated with scales for pain and confirmed by measuring one other symptom such as stiffness or one other aspect such as bothersomeness . Global change scores also provide supporting information , and the MYMOP ( Measure Yourself Medical Outcome Profile ) measure is popular when patients with different conditions are included . The design of question naires for beliefs and attitudes is a specialised area that should not be attempted without expert help . Adverse events should also be recorded . Analysis of the data and the best way of summarising and presenting the results are also discussed Background A mismatch between individual physical capacities and physical work dem and s enhance the risk for musculoskeletal disorders , poor work ability and sickness absence , termed physical deterioration . However , effective intervention strategies for preventing physical deterioration in job groups with high physical dem and s remains to be established . This paper describes the background , design and conceptual model of the FINALE programme , a framework for health promoting interventions at 4 Danish job groups ( i.e. cleaners , health-care workers , construction workers and industrial workers ) characterized by high physical work dem and s , musculoskeletal disorders , poor work ability and sickness absence . Methods / Design A novel approach of the FINALE programme is that the interventions , i.e. 3 r and omized controlled trials ( RCT ) and 1 exploratory case-control study are tailored to the physical work dem and s , physical capacities and health profile of workers in each job-group . The RCT among cleaners , characterized by repetitive work tasks and musculoskeletal disorders , aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training ( CBTr ) . Because health-care workers are reported to have high prevalence of overweight and heavy lifts , the aim of the RCT is long-term weight-loss by combined physical exercise training , CBTr and diet . Construction work , characterized by heavy lifting , pushing and pulling , the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health . At the industrial work-place characterized by repetitive work tasks , the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training , CBTr and participatory ergonomics . The overall aim of the FINALE programme is to improve the safety margin between individual re sources ( i.e. physical capacities , and cognitive and behavioral skills ) and physical work dem and s , and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group . Discussion The FINALE programme has the potential to provide evidence -based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration . Trial registration sIS RCT N96241850 , NCT01015716 and Background : Fluoroquinolones , including levofloxacin , have not been recommended for use in children largely because studies in juvenile laboratory animals suggest there may be an increased risk of fluoroquinolone-associated cartilage lesions . A large prospect i ve trial is needed to assess the risks associated with using levofloxacin in children . Objective : Assess the safety and tolerability of levofloxacin therapy in children based on observations for 1 year after therapy . Methods : Safety data were collected in children who participated in 1 of 3 efficacy trials ( N = 2523 ) and a subset of these children who also subsequently participated in a long-term 1-year surveillance trial ( N = 2233 ) . Incidence of adverse events in children r and omized to receive levofloxacin versus nonfluoroquinolone antibiotics  was compared . Based on assessment s by treating physicians and an independent data safety monitoring committee , events related to the musculoskeletal system were further categorized as 1 of 4 predefined musculoskeletal disorders ( arthralgia , arthritis , tendinopathy , gait abnormality ) considered most likely clinical correlates of fluoroquinolone-associated cartilage lesions observed in laboratory animals . Results : Levofloxacin was well tolerated during and for 1 month after therapy as evidence d by similar incidence and character of adverse events compared with nonfluoroquinolone antibiotics . However , incidence of at least 1 of the 4 predefined musculoskeletal disorders ( largely due to reports of arthralgia ) was greater in levofloxacin-treated compared with nonfluoroquinolone-treated children at 2 months ( 2.1 % vs. 0.9 % ; P = 0.04 ) and 12 months ( 3.4 % vs. 1.8 % ; P = 0.03 ) after starting therapy . Conclusions : The incidence of 1 or more of the 4 predefined musculoskeletal disorders identified in nonblinded , prospect i ve evaluations , was statistically greater in levofloxacin-treated compared with comparator-treated children Background Chronic kidney disease ( CKD ) is one of the most serious public health problems . The increasing prevalence of CKD in developed and developing countries has led to a global epidemic . The hypothesis proposed is that patients undergoing dialysis  would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity , compromising quality of life . Methods / Design A prospect i ve , consecutive , double blind , r and omized controlled clinical trial is proposed to address the effect of dialysis on sleep , pulmonary function , respiratory mechanics , upper airway collapsibility , autonomic nervous activity , depression , anxiety , stress and quality of life in patients with CKD . The measurement protocol will include body weight ( kg ) ; height ( cm ) ; body mass index calculated as weight/height2 ; circumferences ( cm ) of the neck , waist , and hip ; heart and respiratory rates ; blood pressures ; Mallampati index ; tonsil index ; heart rate variability ; maximum ventilatory pressures ; negative expiratory pressure test  , and polysomnography  ( sleep study ) , as well as the administration of specific question naires addressing sleep apnea , excessive daytime sleepiness , depression , anxiety , stress , and quality of life . Discussion CKD is a major public health problem worldwide , and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension . Sleep disorders are common in patients with renal insufficiency . Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep , and to investigate the negative influences of haemodialysis in the physiological variables of sleep , and autonomic nervous system , and respiratory mechanics and thereby compromise the quality of life of patients .Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials ( ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN : U1111 - 1127 - 9390 [ http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/ ] ) OBJECTIVES The aim of the study was to determine the status of the autonomic nervous system ( ANS ) in anxiety disorder patients and to evaluate possible exercise intervention in order to improve the ANS and overall psychiatric status of patients . PATIENTS AND METHODS The ANS function was monitored via means of heart rate variability ( HRV ) changes during a 6-week hospitalization at the Psychiatric Clinic of University Hospital in Olomouc . The status of ANS was monitored by the new evaluation method of spectral analysis ( SA ) of HRV . The research involved 43 anxiety patients ( 29 women and 14 men ) who underwent six weeks of intensive psychotherapy ;  part of the test group also participated in regular aerobic exercise . RESULTS In the sense of autonomic dysfunction we can not give clear-cut answers to the question whether the autonomic dysfunction could be one of the predictors of anxiety disorder , although our results suggest lower vagal representation in the spectra . Unlike in the healthy population the exercise had a positive impact only on a limited number of patients . Regular endurance exercise on a stationary bicycle had a positive impact on the ANS efficiency only in patients with primary ANS activity reduction . In patients with normal ANS efficiency the exercise intervention had no effect ; in some cases we even found activity reduction during the hospitalization period . However , the exercise had a positive effect on the course and outcome of the applied therapy in all patients . CONCLUSIONS ANS disturbances have not been exhibited in some patients suffering from anxiety disorder . Due to the positive impact of regular physical activity on cardiovascular , metabolic , neural , and psychological changes in organism , monitored exercise should be implemented into therapeutic programs for patients with anxiety disorders Background Fibromyalgia ( FM ) , one of the most common musculoskeletal disorders , is associated with high levels of impaired health and inadequate or limited symptom relief . The cause of this complex syndrome is unknown , and there is no known cure . Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management .  T’ai Chi , an ancient Chinese exercise , combines physical exercise with mind-body therapy . Purpose To investigate the effects of T’ai Chi exercise on FM symptoms and health-related quality of life . Design Pilot study , one group pre-to-post posttest design . Methods Participants with FM ( n = 39 ) formed a single group for 6 weeks of 1-hour , twice weekly T’ai Chi exercise classes .  FM symptoms and health-related quality of life were measured before and after exercise . Findings Twenty-one participants completed at least 10 of the 12 exercise sessions . Although the dropout rate was higher than expected , measurements on both the Fibromyalgia Impact Question naire ( FIQ ) ( Buckhardt , Clark , & Bennett , 1991 ) and the Short Form-36 ( SF-36 ) ( Ware & Sherbourne , 1992 ) revealed statistically significant improvement in symptom management and health-related quality of life . Implication s for Nursing Research Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority . T’ai Chi is potentially beneficial to patients with FM . Further research is needed to support evidence -based practice Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions . Methods The conclusions are based on the results of systematic review s of r and omized clinical trials ( RCTs ) , widely accepted and primarily UK and United States evidence -based clinical guidelines , plus the results of all RCTs not yet included in the first three categories . The strength/ quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs . Results By September 2009 , 26 categories of conditions were located containing RCT evidence for the use of manual therapy :  13 musculoskeletal conditions , four types of chronic headache and nine non-musculoskeletal conditions . We identified 49 recent relevant systematic review s and 16 evidence -based clinical guidelines plus an additional 46 RCTs not yet included in systematic review s and guidelines .Additionally , brief references are made to other effective non-pharmacological , non-invasive physical treatments . Conclusions Spinal manipulation/mobilization is effective in adults for : acute , subacute , and chronic low back pain ; migraine and cervicogenic headache ; cervicogenic dizziness ;  manipulation/mobilization is effective for several extremity joint conditions ; and thoracic manipulation/mobilization is effective for acute/subacute neck pain . The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration , and for manipulation/mobilization for mid back pain , sciatica , tension-type headache , coccydynia , temporom and ibular joint disorders , fibromyalgia , premenstrual syndrome , and pneumonia in older adults . Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation , or for Stage 1 hypertension when added to an antihypertensive diet . In children , the evidence is inconclusive regarding the effectiveness for otitis media and enuresis , and it is not effective for infantile colic and asthma when compared to sham manipulation . Massage is effective in adults for  chronic low back pain and chronic neck pain . The evidence is inconclusive for knee osteoarthritis , fibromyalgia , myofascial pain syndrome , migraine headache , and premenstrual syndrome . In children , the evidence is inconclusive for asthma and infantile colic OBJECTIVE This study examined the effects of oral estrogen ( ERT ) alone versus oral estrogen/medroxyprogesterone acetate ( HRT ) therapy on cardiovascular function , as controlled by the autonomic nervous system . STUDY DESIGN Forty-three postmenopausal women received ERT , HRT , or a placebo for 3 months in a double-blind , r and omized , placebo-controlled study . Cardiovascular hemodynamics and heart rate variability were assessed at rest and during stress . RESULTS After 3 months of therapy , oral HRT significantly increased high-frequency power ( P = .0002 ) and decreased total peripheral resistance ( P = .04 ) . The changes were evident at rest and during stress . CONCLUSION Our findings suggest that combination therapy produces a more favorable alteration of autonomic cardiovascular function than estrogen alone ( ie , combination therapy increases vagal activity ) Study Design . R and omized , single blind , controlled trial . Objective . To determine the efficacy of 2 components of musculoskeletal physiotherapy on chronic low back disorder . Summary of Background Data . Musculoskeletal physiotherapy encompasses many treatment methods , however , manual therapy and exercises to rehabilitate spinal stabilization are the most frequently used . Despite their popularity , scant evidence supports their use on subjects with chronic low back disorder . Methods . A total of 346 subjects were r and omized to manual therapy , a 10-week spinal stabilization rehabilitation program , or a minimal intervention control group . Data were collected at baseline , and 3 , 6 , 12 , and 24 months after intervention . Outcome measures recorded intensity of low back pain , disability , h and icap , medication , and quality of life . There were 4 main variables combined in a primary component analysis to form a single outcome measure ( i.e. , a measure of dysfunction ) . Results . The results indicated statistically significant improvements in favor of the spinal stabilization group at the 6-month stage in pain ( 65.9 % reduction in symptoms ) and dysfunction ( combined mean reduction of 134 , st and ard error 23.84 ) , and at the 1-year stage in medication ( 34.3 % reduction in medication ) , dysfunction ( combined mean reduction of 134 , st and ard error 18.2 ) , and disability ( mean difference in change 15.71 Oswestry Disability Index , 95 % confidence interval 19.3–10.01 ) . Conclusions . As a component of musculoskeletal physiotherapy , the spinal stabilization program is more effective than manually applied therapy or an education booklet in treating chronic low back disorder over time . Both manual therapy and the spinal stabilization program are significantly effective in pain reduction in comparison to an active control . To our knowledge and up until now , this result has not been shown in patients with chronic low back disorder Rational : Patients under regular dialysis can also present alterations in the cardiovascular , musculoskeletal , and metabolic systems . Objectives : The aim of this study is to compare the effects of strength and aerobic exercises performed during  hemodialysis ( HD ) in individuals with chronic renal disease . Material s and Methods : R and omized clinical trial . It was developed as a program of exercises three times a week , in the first 2 h of HD for 8 weeks . The patients were divided into three groups : control ( Group 1 , n : 11 ) , strength ( Group 2 , n : 11 ) , and aerobic ( Group 3 , n : 10 ) . G1 has not developed any type of physical training ; G2 utilized a training load of 40 % of one repetition maximum ( 1RM ) with anklets , and developed three series of 15 repetitions . G3 pedaled seated in the dialysis seat , during 20 min , in an ergometric bicycle , with intensity regulated by the perceived effort scale . Before and after 8 weeks , the following variables were evaluated : respiratory muscular strength , pulmonary function , functional capacity , blood biochemistry , and quality of life . Main Findings : In the pre- and post-training comparison , there was statistically significant improvement ( p < 0.05 ) in the maximal inspiratory pressure ( MIP ) , number of steps achieved ( NSA ) , and quality of life ( QoL ) in the trained groups , as compared to the non-exercised group ( G1 ) . Conclusions : The strength and aerobic exercises developed during HD can improve the respiratory muscular strength , functional performance , and quality of life , when compared to individuals presenting the disease who have not developed any type of physical training OBJECTIVE The association between burnout and physical diseases has been studied very little . The purpose of this study was to examine the relationship between burnout and physical illness in a representative nationwide population health study . METHODS As a part of the " Health 2000 Study " in Finl and , 3368 employees aged 30 - 64 years were studied .  Burnout was assessed with the  Maslach Burnout Inventory-General Survey . Physical diseases were diagnosed in a comprehensive health examination by research physicians . RESULTS Physical illness was more common among subjects with burnout than others ( 64 % vs. 54 % , P<.0001 ) , and the prevalence of diseases increased with the severity of burnout ( P<.0001 ) . Burnout was an important correlate of cardiovascular diseases among men ( OR=1.35 ; 95 % CI , 1.13 - 1.61 ) and musculoskeletal disorders among women ( OR=1.22 , 95 % CI , 1.07 - 1.38 ) when adjusted for age , marital status , education , socioeconomic status , physical strenuousness of work , smoking , physical activity , alcohol consumption , body mass index , and depressive symptoms . The prevalence of musculoskeletal disorders and cardiovascular diseases increased with the severity of all three dimensions of burnout , that is , exhaustion ( P<.0001 and P<.001 , respectively ) , cynicism ( P=.0001 and P<.001 , respectively ) , and lack of professional efficacy ( P<.01 and P<.0001 , respectively ) . CONCLUSIONS Burnout is associated with musculoskeletal diseases among women and with cardiovascular diseases among men . These associations are not explained by sociodemographic factors , health behavior , or depression . Physical illnesses are associated with all three dimensions of burnout and not only with the exhaustion dimension . In the future , the causal relationships between burnout and physical diseases need to be investigated in prospect i ve studies A r and omized controlled trial of geriatric screening and surveillance was undertaken on a practice population of 295 patients aged 70 years or more over a two-year period . In the screened group ( 145 patients ) many social problems were found and a total of 380 medical conditions were reported during the study period , 144 ( 38 per cent ) of which were previously undetected . Conditions found most frequently involved the circulatory , musculoskeletal and nervous systems ; 67 per cent of the conditions found were manageable , half being improved and the remainder resolved completely . The screening programme was found to increase the use of social and health services but it did also decrease the expected duration of stay in hospital . Independent assessment of patients in the study and control groups at the end of the two-year period showed that the screening programme had made no significant impact on the prevalence of socio-economic , functional , and medical disorders affecting health . We formed the firm impression that the study patients were made more comfortable ( by control of pain ) and less disabled , although there was no unequivocal objective evidence of this . They were , however , kept independent for longer . The findings are discussed and a model of geriatric care is suggested combining conventional management on dem and with comprehensive screening to identify the high-risk patients on whom care might need to be focussed Two commonly utilised manual therapy techniques ; McKenzie 's lumbar extension exercises ( EE ) ; and segmental rotational grade V manipulation were investigated to determine their magnitude of neurophysiological effect . Proxy measures of sympathetic nervous system ( SNS ) activity ( skin conductance ) were utilised to ascertaining neurophysiological response . This study determined the neurological effects of these two treatment techniques in addition to establishing the Biopac System as a reliable measure of neurophysiological changes . A quasi-experimental , independent group 's design was utilised , with r and om allocation of 50 normal , healthy participants into a manipulation or an EE group .  Neurophysiological measurements of skin conductance were taken in the lower limbs before , during and after the administration of the techniques . Results were converted into percentage change calculations for the intervention and the post-intervention periods . Both treatments increased SNS activity during the intervention period , 63 % for the manipulation group ( p = 0.0005 ) and 42 % for EE group ( p = 0.0005 ) with the manipulative technique having significantly greater effect ( p = 0.012 ) . Further analysis of the manipulation group found no difference between the ' opening ' and the ' closing ' side of the technique ( p = 0.76 ) . Biopac System is a reliable method for measuring SNS activity with minimum measurement variability . Preliminary evidence now exists supporting the neurophysiological effects of two lumbar techniques Stress-related illnesses , such as mental , behavioral , and cardiovascular diseases , are common causes for sick-leave absences . It is generally assumed that burnout , the chronic stress syndrome , also leads to absenteeism and poor health , but this assumption has rarely been tested . The authors investigated the prospect i ve effect of burnout on registered sick leaves and their causes in industrial employees . We collected the number of medically certified ( > 3 days ) absence episodes and their causes ( according to the International Statistical Classification of Diseases-10 diagnostic categories ) of 3,895 industrial employees from a company register during 1995 to 1998 .  Burnout was measured in 1996 with the Maslach  Burnout Inventory-General Survey , which defines burnout as a 3-dimensional syndrome consisting of components of exhaustion , cynicism , and lack of professional efficacy . In Poisson regression models , the total burnout score increased the risk for future all-cause absences after adjustment for age , sex , occupation , and baseline absence . Burnout increased the risk of future absences because of mental and behavioral disorders , diseases of the circulatory system , diseases of the respiratory system , and diseases of the musculoskeletal system . Of the separate components of burnout , exhaustion was strongly related to future diseases of the circulatory system , whereas cynicism was strongly related to future diseases of the digestive system . Other differentiated effects were also found . The results of this study show that burnout is related to increased risk of future illness . This implies that burnout prevention can reduce future absenteeism and has a major economic impact on work life and health care Aims Given the high levels of absenteeism due to musculoskeletal disorders of the upper limbs , there is a need for preventive strategies to protect workers exposed to high risk levels . The purpose of this study was to determine the effect of a workplace-based muscle resistance training exercise program in the presence of pain and musculoskeletal dysfunction of the upper extremities in manufacturing workers exposed to repetitive movements and excessive effort in the workplace . Method R and omized controlled trial in manufacturing workers . A sample of 120 healthy workers was allocated at r and om to an experimental group , which received a resistance-based exercise program , and a control group , which performed stretching exercises . Results The muscle resistance training exercise had a protective effect on the intensity of pain perceived by workers in their upper limbs ( RR : 0.62 95 % CI 0.44–0.87 ) compared with the group of workers who performed stretching exercises . Conclusion A workplace-based muscle resistance training exercise program is an effective preventive strategy in factory workers exposed to risk ; however , it is necessary for companies initially to adopt mechanisms to minimize exposure as a prevention strategy The purpose of this study was to quantify the intensity of breathlessness associated with exercise and respiratory resistive loading , with the specific purpose of isolating the quantitative contributions of inspiratory pressure , length , velocity , and frequency of inspiratory muscle shortening and duty cycle to breathlessness . The intensity of inspiratory pressure was quantified by measurement of estimated esophageal pressure ( Pes = pressure at the mouth plus lung pressure ) , the extent of shortening by tidal volume ( VT ) , and the velocity of shortening by inspiratory flow rate ( VI ) . Six normal subjects underwent five incremental ( 100 kpm X min-1 X min-1 ) exercise tests on a cycle ergometer to maximum capacity . The first and last test were unloaded and the intervening tests were performed with external added resistances of 33 , 57 , and 73 cm H2O X l-1 X s in r and om order . The resistances were selected to provide a range of pressures , tidal volumes , flow rates , and patterns of breathing . At rest and at the end of each minute during exercise the subjects estimated the intensity of breathlessness ( psi ) by selecting a number ranging from 0 to 10 ( Borg rating scale , 0 indicating no appreciable breathlessness and 10 the maximum tolerable sensation ) . Breathlessness was significantly and independently related to Pes ( P less than 0.0001 ) , VI ( P less than 0.0001 ) , frequency of breathing ( fb ) ( P less than 0.01 ) , and duty cycle [ ratio of inspiratory duration to total breath duration ( TI/TT ) ] ( P less than 0.01 ) : psi = 0.11 Pes + 0.61 VI + 1.99 TI/TT + 0.04 fb - 2.60 ( r = 0.83 ) . The results suggest that peak pressure ( tension ) , VI ( velocity of inspiratory muscle shortening ) , TI/TT , and fb contribute independently and collectively to breathlessness . The perception of respiratory muscle effort is ideally suited to subserve this sensation . The neurophysiological mechanism purported is a conscious awareness of the intensity of the outgoing motor comm and by means of corollary discharge within the central nervous system Background Fracture of the distal radius is a common clinical problem , particularly in older white women with osteoporosis . We report our work towards evidence -based and patient-centred care for adults with these injuries . Methods We developed a systematic programme of research that built on our systematic review of the evidence of effectiveness of treatment interventions for these fractures . We devised schemata showing ' typical ' care pathways and identified over 100 patient management questions . These depicted the more important decisions taken when progressing along each care pathway . We compiled a comprehensive document summarising the evidence available for each decision point from our review s of r and omised trials of treatment interventions . Using these documents , we undertook a formal and structured consultation process involving key players , including a patient representative , to obtain their views on the available evidence and to establish a research agenda . The result ing feedback was then processed and interpreted , using systematic methods . Results Some evidence from 114 r and omised trials was available for 31 of the 117 patient management questions . However , there was sufficient evidence to base some conclusions of effectiveness for particular interventions in only five of these . Though only 60 % of those approached responded , the responses received from the consultation group were often comprehensive and provided important insights into treatment practice and policy . There was a clear acceptance of the aims of the project and , aside from some suggestions for the more explicit inclusion of secondary prevention and management of complications , of the care pathways scheme . Though some respondents stressed that r and omised trials were not always appropriate , there was no direct overall criticism of the evidence document and underlying processes . We were able to identify important core themes that underpin management decisions and research from the feedback of the consultation exercise . Conclusions Overall , this project is an important advance towards evidence -based and patient-centred management of adults with distal radial fractures . It exposes the serious deficiency in the available evidence but also provides a template for further action . As well as being a valuable basis for viewing and informing current practice , the insights gained from this project should inform a future research agenda Background Despite the fact that the population of self-employed persons is still growing and at risk for long term disability due to a number of risk factors , there is still a lack of information on the effectiveness of interventions for this specific group . Methods To determine the effectiveness of physical training without a cognitive behavioral component and workplace specific exercises ( PT ) and physical training with a cognitive behavioral component and workplace specific exercises ( PTCBWE ) , we conducted a pragmatic R and omized Controlled Trial , stratified into two groups . Self-employed persons with a new work disability cl aim because of musculoskeletal disorders were r and omized to PT ( n = 53 ) or PTCBWE ( n = 76 ) , or to a corresponding usual care group ( n = 50 and n = 75 respectively ) . Both types of training consisted of cardiovascular training , strengthening , relaxation and posture exercises and took place two or three times a week , for 1–1.5 hours , during three months , also if someone had already returned to work full-time . The primary outcome measure was cl aim duration ( in days ) during 12 months follow-up . Pain severity and functional status were secondary outcome measures . All data were assessed at baseline and at 6 and 12 months follow-up . The data with regard to cl aim duration were analyzed by survival analysis and Cox regression analysis . Secondary outcome measures were analyzed by means of linear regression analysis . Results After 12 months of follow-up there was no difference in cl aim duration between PT and usual care ( Hazard Ratio 0.7 ; 95%CI , 0.4–1.1 ; p = 0.12 ) or PTCBWE and usual care ( Hazard Ratio 0.9 ; 95%CI , 0.6–1.4 ; p = 0.72 ) . Both types of physical training and usual care  improved in pain and functional status over time , but there was only a statistically significant difference in favor of PT on pain improvement at 6 months . Conclusion In this study , physical training with and without a cognitive behavioral component and workplace specific exercises for self-employed persons with musculoskeletal disorders was not shown to be effective on cl aim duration , pain severity and functional status at 12 months follow-up . Trial registration Current Controlled Trials IS RCT N67766245
Exercise therapy is effective for patients with knee osteoarthritis , sub-acute ( 6 to 12 weeks ) and chronic ( > or = 12 weeks ) low back pain , cystic fibrosis , chronic obstructive pulmonary disease , and intermittent claudication .
Furthermore , there are indications that exercise therapy  is effective for patients with ankylosing spondylitis , hip osteoarthritis , Parkinson 's disease , and for patients who have suffered a stroke .
There is insufficient evidence to support or refute the effectiveness of exercise therapy  for patients with neck pain , shoulder pain , repetitive strain injury , rheumatoid arthritis , asthma , and bronchiectasis .
Exercise therapy is not effective for  patients with acute low back pain .
It is concluded that exercise therapy is effective for a wide range of chronic disorders
The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy  for patients with disorders of the musculoskeletal , nervous , respiratory , and cardiovascular systems .