scholarly journals Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial

Physiotherapy ◽  
2019 ◽  
Vol 105 ◽  
pp. e13-e14
Author(s):  
C. Battle ◽  
K. James ◽  
P. Temblett ◽  
H. Hutchings
Keyword(s):  
Critical Illness ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Exercise Rehabilitation ◽  
Supervised Exercise ◽  
Randomised Controlled

scholarly journals Development of a Complex Exercise Rehabilitation Intervention for People with Pulmonary Hypertension: The Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) Trial

2020 ◽  
Author(s):  
Stuart Ennis ◽  
Harbinder Sandhu ◽  
Julie Bruce ◽  
Kate Seers ◽  
Tamar Pincus ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Randomised Controlled Trial ◽  
Systematic Reviews ◽  
Controlled Trial ◽  
Exercise Physiology ◽  
Home Exercise ◽  
Exercise Interventions ◽  
Exercise Rehabilitation ◽  
Supervised Exercise ◽  
Randomised Controlled

Abstract Background: People with pulmonary hypertension (PH) are not routinely referred for exercise rehabilitation despite the potential for reducing breathlessness and improving quality of life. We describe the development of a supervised exercise-based rehabilitation programme for this group. The intervention will be tested in a randomised controlled trial (Supervised Pulmonary Hypertension Exercise Rehabilitation trial: SPHERe).Methods: Work was completed in three phases; 1) systematic review, 2) stakeholder engagement with consensus from expert opinion, and 3) intervention piloting and acceptability testing. Our systematic reviews identified exercise interventions for pulmonary hypertension. The draft intervention was ratified through discussions with representatives from medicine, exercise physiology, psychology, and patients. We subsequently assessed the SPHERe intervention in a pre-pilot. Results: Systematic reviews report that exercise might be safe and effective in this population. We found that other exercise interventions were within existing international cardiopulmonary rehabilitation guidelines. Stakeholder opinion and consensus shaped components of the SPHERe intervention, including addition of individual behavioural education sessions to promote adherence to exercise. Our pre-pilot investigation identified a number of condition-specific issues relating to safety and fear avoidance. We addressed these by adding two familiarisation sessions. The development of comprehensive intervention training manuals for participants and practitioners will ensure standardised delivery.Discussion: The SPHERe intervention incorporates three main components: supervised gym exercise, behavioural strategies to encourage adherence, and a home exercise plan for people with pulmonary hypertension. We will evaluate the clinical and cost-effectiveness of the SPHERe intervention in a multicentre randomised controlled trial for people with pulmonary hypertension (ISCRTN no.:10608766)

scholarly journals Evaluating differences in the clinical impact of a free online weight loss programme, a resource-intensive commercial weight loss programme and an active control condition: a parallel randomised controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Aidan Q. Innes ◽  
Greig Thomson ◽  
Mary Cotter ◽  
James A. King ◽  
Niels B. J. Vollaard ◽  
...  
Keyword(s):  
Weight Loss ◽  
Randomised Controlled Trial ◽  
Active Control ◽  
Body Mass ◽  
Controlled Trial ◽  
Free Access ◽  
Healthy Weight ◽  
Supervised Exercise ◽  
Weight Loss Programme ◽  
Randomised Controlled

Abstract Background Finding effective intervention strategies to combat rising obesity levels could significantly reduce the burden that obesity and associated non-communicable diseases places on both individuals and the National Health Service. Methods In this parallel randomised-controlled trial, 76 participants who are overweight or obese (50 female) were given free access to a fitness centre for the duration of the 12-week intervention and randomised to one of three interventions. The commercial intervention, the Healthy Weight Programme, (HWP, n = 25, 10/15 men/women) consisted of twelve 1-h nutrition coaching sessions with a nutritionist delivered as a mixture of group and 1 to 1 sessions. In addition, twice-weekly exercise sessions (24 in total) were delivered by personal trainers for 12 weeks. The NHS intervention (n = 25, 8/17 men/women) consisted of following an entirely self-managed 12-week online NHS resource. The GYM intervention (n = 26, 8/18 men/women) received no guidance or formal intervention. All participants were provided with a gym induction for safety and both the NHS and GYM participants were familiarised with ACSM physical activity guidelines by way of a hand-out. Results The overall follow-up rate was 83%. Body mass was significantly reduced at post-intervention in all groups (HWP: N = 18, − 5.17 ± 4.22 kg, NHS: N = 21–4.19 ± 5.49 kg; GYM: N = 24–1.17 ± 3.00 kg; p < 0.001) with greater reductions observed in HWP and NHS groups compared to GYM (p < 0.05). Out with body mass and BMI, there were no additional statistically significant time x intervention interaction effects. Conclusions This is the first study to evaluate the efficacy of both a free online NHS self-help weight-loss tool and a commercial weight loss programme that provides face-to-face nutritional support and supervised exercise. The findings suggest that both interventions are superior to an active control condition with regard to eliciting short-term weight-loss. Trial registration ISRCTN Registry - ISRCTN31489026. Prospectively registered: 27/07/16.

scholarly journals Nutrition and Exercise in Critical Illness Trial (NEXIS Trial): a protocol of a multicentred, randomised controlled trial of combined cycle ergometry and amino acid supplementation commenced early during critical illness

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027893 ◽  
Author(s):  
Daren K Heyland ◽  
Andrew Day ◽  
G John Clarke ◽  
Catherine (Terri) Hough ◽  
D Clark Files ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Amino Acid ◽  
Critical Illness ◽  
Randomised Controlled Trial ◽  
Protein Intake ◽  
Controlled Trial ◽  
Cycle Ergometry ◽  
Amino Acid Supplementation ◽  
Acid Supplementation ◽  
Randomised Controlled

IntroductionSurvivors of critical illness often experience significant morbidities, including muscle weakness and impairments in physical functioning. This muscle weakness is associated with longer duration mechanical ventilation, greater hospital costs and increased postdischarge impairments in physical function, quality of life and survival. Compared with standard of care, the benefits of greater protein intake combined with structured exercise started early after the onset of critical illness remain uncertain. However, the combination of protein supplementation and exercise in other populations has demonstrated positive effects on strength and function. In the present study, we will evaluate the effects of a combination of early implementation of intravenous amino acid supplementation and in-bed cycle ergometry exercise versus a ‘usual care’ control group in patients with acute respiratory failure requiring mechanical ventilation in an intensive care unit (ICU).Methods and analysisIn this multicentre, assessor-blinded, randomised controlled trial, we will randomise 142 patients in a 1:1 ratio to usual care (which commonly consists of minimal exercise and under-achievement of guideline-recommended caloric and protein intake goals) versus a combined intravenous amino acid supplementation and in-bed cycle ergometery exercise intervention. We hypothesise that this novel combined intervention will (1) improve physical functioning at hospital discharge; (2) reduce muscle wasting with improved amino acid metabolism and protein synthesis in-hospital and (3) improve patient-reported outcomes and healthcare resource utilisation at 6 months after enrolment. Key cointerventions will be standardised. In-hospital outcome assessments will be conducted at baseline, ICU discharge and hospital discharge. An intent-to-treat analysis will be used to analyse all data with additional per-protocol analyses.Ethics and disseminationThe trial received ethics approval at each institution and enrolment has begun. These results will inform both clinical practice and future research in the area. We plan to disseminate trial results in peer-reviewed journals, at national and international conferences, and via nutritional and rehabilitation-focused electronic education and knowledge translation platforms.Trial registration numberNCT03021902; Pre-results.

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