Saturday, January 19, 2013
Friday, January 11, 2013
Treatment for Restless Legs Syndrome
Treatment for Restless Legs Syndrome [Internet].
2012-2013
**A number of lymphedema patients also report having restless leg syndrome.**
Editors
Source
Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov. Report No.: 12(13)-EHC147-EF.
AHRQ Comparative Effectiveness Reviews.
AHRQ Comparative Effectiveness Reviews.
Excerpt
CONTEXT:
Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a distressing, irresistible urge to move them. RLS severity and burden vary widely, and the condition may require long-term treatment.
OBJECTIVE:
To review the comparative effectiveness, efficacy, and safety of pharmacologic and nonpharmacologic treatments for RLS.
DATA SOURCES:
We searched bibliographic databases MEDLINE (via OVID), Embase, and Natural Standards through June 2012.
REVIEW METHODS:
Eligible efficacy studies included randomized controlled trials (RCTs) of individuals with RLS published in English that lasted at least 4 weeks and compared pharmacologic and/or nonpharmacologic treatments with placebo or active treatment. We assessed RLS symptom impact, sleep scale scores, disease-specific quality of life, withdrawals, and adverse effects. We included observational studies that assessed long-term (>6 months) treatment adverse effects and withdrawals.
RESULTS:
Of the 53 studies included, one active comparator and 33 placebo-controlled RCTs provided efficacy and harms data, and 18 observational studies assessed long-term harms and adherence. RCTs were typically small and of short duration, and enrolled adult subjects with severe primary RLS of long duration. Placebo-controlled RCTs (18 trials) demonstrated that dopamine agonists (pramipexole, rotigotine, ropinirole, and cabergoline) increased the percentage of subjects who had a clinically important response defined as ≥50 percent reduction from baseline in mean International RLS symptom scale scores (IRLS responders) (risk ratio [RR]=1.60; [95% confidence interval [CI]: 1.38 to 1.86], k=7), improved RLS symptom scores, patient-reported sleep scale scores (effect size=0.38; [95% CI: 0.29 to 0.46], k=8), and disease-specific quality of life (effect size=−0.37; [95% CI: −0.48 to −0.27], k=9). Dopamine agonists resulted in more patients who experienced at least one adverse event (high-strength evidence for all outcomes). Long-term augmentation (drug-induced worsening of symptoms) and treatment withdrawal were common. Alpha-2-delta ligands (gabapentin enacarbil, gabapentin, and pregabalin) increased the number of IRLS responders (RR=1.66; [95% CI: 1.33 to 2.09], k=3, high strength of evidence) and mean change in IRLS symptom scores (k=3, high strength of evidence). Intravenous ferric carboxymaltose reduced IRLS symptom scale scores versus placebo (k=1, moderate strength of evidence). Four studies assessed nonpharmacologic interventions. Compression stockings but not the botanical extract valerian improved IRLS symptom scale scores more than sham or placebo treatments. Strength of evidence was moderate for compression stockings and low for valerian. Exercise improved symptoms more than control (low-strength evidence). Near-infrared light treatment improved IRLS symptom scores more than sham (low-strength evidence). Two trials compared active treatments. In one small crossover trial, pramipexole and levodopa/benserazide resulted in similar improvements in IRLS scores (low-strength evidence). Cabergoline improved IRLS scores and resulted in less augmentation than levodopa (moderate-strength evidence). Iron improved symptoms in adults with iron deficiency (k=2) (low-strength evidence). No studies enrolled pregnant women, children, or those with end-stage renal disease. Withdrawal from mostly dopamine agonist and levodopa treatment at 1 year or more ranged from 13 to 57 percent. Treatment withdrawals were due to lack of efficacy (6% to 37%) as well as augmentation and other adverse events.
CONCLUSION:
Compared to placebo, dopamine agonists and alpha-2-delta ligands reduce RLS symptoms and improve patient-reported sleep outcomes and disease-specific quality of life. Adverse effects of pharmacologic therapies and long-term treatment withdrawals due to adverse effects or lack of efficacy are common. Long-term effectiveness as well as applicability for adults with milder or less frequent RLS symptoms, individuals with secondary RLS, and children is unknown.
see also:
Friday, January 4, 2013
Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study.
Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study.
Oct 2012
Source
Lymphoedema Clinic, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, 3rd floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK, eunice.jeffs@gstt.nhs.uk.
Abstract
Exercise is considered to be a key aspect of lymphoedema treatment, although there is little evidence for the therapeutic effect of exercise in managing breast cancer-related lymphoedema (BCRL). This small randomised controlled trial (RCT) was designed to determine the feasibility, prior to undertaking a larger RCT, of researching a daily home-based exerciseprogramme to treat stable BCRL. An experimental design compared the exercise intervention combined with standard lymphoedema self-care to self-care alone over a 6-month period. Twenty-three women with stable unilateral BCRL of ≥10 % excess limb volume (ELV) were randomly allocated to a daily home-based exercise programme and self-care (n = 11) or self-care measures alone (n = 12). The primary objective was to determine difference in limb volume reduction for the two groups. Secondary objectives were to monitor change in other areas that impact BCRL: quality of life, arm function and range of shoulder movement. All 23 women completed the trial, providing full data for each time point. The intervention group showed a clinically and statistically significant improvement in relative ELV at week 26 (95 % confidence interval (CI) -26.57 to -5.12), whereas the control group improvement crossed the line of no effect (95 %CI -17.71 to 1.1). This study demonstrated the feasibility of conducting a RCT of exercise as a therapeutic intervention in the management of BCRL. Although the sample was small, the results support the findings of other exercise studies which have shown trends towards improvement.
Thursday, December 27, 2012
BREATHING EXERCISES
- A 20% reduction in oxygen blood levels may be caused by the aging process and normal breathing habits. Poor breathing robs energy and negatively affects mental alertness. Unless breathing is exercised, aging affects the respiratory system as follows: Stiffness: The rib cage and surrounding muscles get stiff causing inhalation to become more difficult. Less elasticity and weak muscles leave stale air in the tissues of the lungs and prevents fresh oxygen from reaching the blood stream.
Rapid, Shallow Breathing: This type of breathing, often caused by poor posture and weak or stiff muscles, leads to poor oxygen supply, respiratory disease, sluggishness, or heart disease.
- The following exercises are simple ways to deepen breathing and to cleanse the lungs. These exercises will also increase energy and decrease tension.
- Lie flat on your back to get a proper sense of deep breathing. (Have some small pillows available to reduce strain by tucking them under the neck and knees. The natural course of breathing in that position will create a slight rise in the stomach upon inhaling and a slight fall upon exhaling.)
Place your hands palm down on your stomach at the base of the rib cage. (The lungs go that far down. What fills them deeper is the pushing down of the diaphragm. The diaphragm creates a suction which draws air into the lungs. the air is then expelled when the diaphragm pushes up. In this process, the life-giving oxygen fills the lungs and gets into the blood stream for distribution to the cells. Carbon dioxide is expelled from the blood into the about-to-be exhaled breath, thus cleansing the body and blood of waste products.) Lay the palms of your hands on your stomach just below the rib cage, middle fingers barely touching each other, and take a slow deep breath. (As the diaphragm pushes down, the stomach will slightly expand causing the fingertips to separate somewhat.This movement indicates full use of the lungs, resulting in a truly deep breath rather than the "puffed chest" breath experienced by many as the greatest lung capacity. Chest breathing fills the middle and upper parts of the lungs. Belly breathing is the most efficient method. Infants and small children use only this method until the chest matures. The yoga breath or roll breathing combines belly and chest breathing.
- 1. Sit up straight. Exhale.2. Inhale and, at the same time, relax the belly muscles. Feel as though the belly is filling with air.
3. After filling the belly, keep inhaling. Fill up the middle of your chest. Feel your chest and rib cage expand.
4. Hold the breath in for a moment, then begin to exhale as slowly as possible.
5. As the air is slowly let out, relax your chest and rib cage. Begin to pull your belly in to force out the remaining breath.
6. Close your eyes, and concentrate on your breathing.
7. Relax your face and mind.
8. Let everything go.
9. Practice about 5 minutes.
- Follow the instructions for inhaling the COMPLETE BREATH (Steps 1-3 above). Now, as you begin to slowly exhale, make a HUM sound. Keep making that humming sound as long as possible. Pull your stomach muscles in, squeezing out a few more seconds of humming. Then relax. Practice for 2 to 3 minutes.
- A very fine, short (though not shallow) breath exercise comes from the Chinese Tai Chi Chuan. Three short inhales are done through the nose without exhaling. On the first inhale, the arms are lifted from the sides straight out in front at shoulder height. On the second, the arms are opened out straight to the sides while still at shoulder height. And on the third, the arms are lifted straight over the head. Then, on the exhale through the mouth, the arms are moved in an arc back down to the sides. Usually, ten or twelve breaths are sufficient and will not cause light headedness. If light headedness should occur, simply stop the exercise. This exercise also has the effect of really opening up people physically. In subtle ways, this exercise uses the body in leading the mind and spirit to greater openness with each other and the environment.
- CAUTION !! Especially for older people: Never do panting or shallow breathing except while seated. Hyperventilation may occur. As long as one is seated, hyperventilation will not be a problem because, even if a brief blackout should occur, the body's automatic breathing apparatus will immediately take over.
The influences of exercise fulfillment on mental and physical functions of targeted older adults and the effect of a physical exercise intervention.
The influences of exercise fulfillment on mental and physical functions of targeted older adults and the effect of a physical exercise intervention.
Oct 2012
[Article in Japanese]
Sakurai R, Fujiwara Y, Fukaya T, Saito K, Yasunaga M, Suzuki H, Nonaka K, Kim H, Kim MJ, Tanaka C, Nishikawa T,Uchida H, Shinkai S, Watanabe S.
Source
Tokyo Metropolitan Institute of Gerontology.
Abstract
OBJECTIVES:
To investigate the influence of the differences in exercise fulfillment on mental and physical functions and the effects of exercise intervention on community-dwelling older adults.
METHODS:
Participants in this study included 260 community-dwelling older adults (mean age +/- SD, 70.4 +/- 6.0 years) who participated in the exercise intervention study (intervention and control groups). Exercise fulfillment levels (low or high), physical activity levels (low or high), mental health (WHO-5 scores), health-related QOL (SF-8 score), and physical abilities of these adults were measured during a baseline health checkup. Based on the status of the 3 exercise fulfillment groups, multivariate analysis of variance (MANOVA), which was adjusted for age, sex, and physical activity levels, was performed to compare the results of the outcome measures among the 3 groups. The intervention group (n = 88, aged 70.3 +/- 6.2 years) was divided into 2 subgroups: the deterioration subgroup (participants with low-exercise fulfillment after the intervention) and the improvement subgroup (participants with high-exercise fulfillment after the intervention). Subsequently, the intervention effects were assessed by repeated measurements of the analysis of variance (ANOVA) between the 2 subgroups.
RESULTS:
MANOVA analysis revealed that body mass index, grip strength, maximum walking speed, the WHO-5 score, and the SF-8 subscale (8 items) score differed significantly amongst the groups. The high-exercise fulfillment group demonstrated better results for these variables than the low-exercise fulfillment group. Similar results were obtained for each group with respect to the physical activity levels. The repeated-measures ANOVA revealed that time had an important effect on lower physical functions and the SF-8 subscale (1 item) score; it also revealed the important effects of body mass index, the WHO-5 score, the SF-8 subscale (6 items) score, and psychological independence on the group.
CONCLUSION:
Older adults with higher exercise fulfillment demonstrated better mental and psychological health, regardless of their physical activity levels. Older adults with low-exercise fulfillment could potentially improve their physical abilities; however, their mental and psychological health significantly differed from that of older adults with medium- or high-exercisefulfillment after exercise intervention. These findings provide preliminary evidence, which indicates that exercise can provide sufficient fulfillment and contribute to the promotion and improvement of health in older adults. Moreover, performing adequate tests on exercise fulfillment may aid in assessing the effects of intervention programs in regional healthcare systems.
Leisure activities alleviate depressive symptoms in nursing home residents with very mild or mild dementia.
Leisure activities alleviate depressive symptoms in nursing home residents with very mild or mild dementia.
Oct 2012
**Editor's note: Exercise/leisure activities can help us with depression too, even depression associated with lymphedema. It is nto only a vital part of our physical well being, but mental/emotional as well.The point being whatever your interest might be, take part in it as often as you can**
Source
Department of Psychological Studies, Hong Kong Institute of Education, Kwai Chung Hospital, Hong Kong. takcheng@ied.edu.hk
Abstract
OBJECTIVES:
To examine whether leisure activities can alleviate depressive symptoms among nursing home residents with very mild to mild dementia.
METHODS:
A cluster-randomized open-label controlled design. Thirty-six residents with at least moderate depressive symptoms were randomized by home into three conditions-mahjong (a.k.a. mah-jongg), tai chi, and handicrafts (placebo). Activities were conducted three times weekly for 12 weeks. Outcome measure was Geriatric Depression Scale (GDS) administered at baseline, posttreatment, and at 6 months.
RESULTS:
Repeated-measures analysis of variance showed a group by time interaction on the GDS. Unlike control and tai chi participants whose scores remained relatively unchanged, the mahjong group reported a drop of 3.25 points (95% confidence interval: 1.00-5.50) on the GDS at posttreatment but gained back 2.83 points (95% confidence interval: 1.95-5.47) at 6 months. Activity discontinuation might be the reason for depression to return to baseline.
CONCLUSIONS:
Mahjong can lower depressive symptoms in those with mild dementia, but activity maintenance may be essential for long-term effects.
Saturday, December 22, 2012
A Warm Water Pool-Based Exercise Program Decreases Immediate Pain in Female Fibromyalgia Patients: Uncontrolled Clinical Trial.
A Warm Water Pool-Based Exercise Program Decreases Immediate Pain in Female Fibromyalgia Patients: Uncontrolled Clinical Trial.
**Editor's note: I am including this as a number of lymphedema patients also report having fibro myalgia - Pat**
Dec 2012
Source
Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Granada, Spain.
Abstract
Fibromyalgia is characterized by chronic and extended musculoskeletal pain. The combination of exercise therapy with the warm water may be an appropriate treatment. However, studies focusing on the analysis of immediate pain during and after an exercise session are rare. This study aimed to determine the immediate changes of a warm water pool-basedexercise program (12 weeks) on pain (before vs. after session) in female fibromyalgia patients. 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks (2 sessions/week) low-moderate intensity warm water pool-based program. We assessed pain by means of a Visual Analogue Scale before and after each single session (i. e., 24 sessions). We observed immediate benefits on pain with a mean decrease ~15% in all sessions, except in the fourth one. There was an association of pain difference (pre-post) session with pain pre session (p=0.005; β=0.097±0.034) and with age (p<0.001; β=0.032±0.008). There were no significant accumulative differences on pain, pre session, post session, and pre-post changes (all p>0.05). Therefore this study showed that a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in level of pain in female patients with fibromyalgia. Improvements were higher in older women and in those with more intense pain.
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