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RANDOMIZED CONTROLLED TRIAL OF SPECIFIC SPINAL STABILIZATION EXERCISES AND CONVENTIONAL PHYSIOTHERAPY FOR RECURRENT LOW BACK PAIN
Cairns MC, Foster NE, Wright C. Spine 2006;31:E670–81
Background:
Spinal stabilisation exercises are a popular form of physiotherapy management for low back pain (LBP), and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result.
Research question/s:
Does the addition of specific spinal stabilisation exercises to conventional physiotherapy for patients with LBP improve pain and function over a 12-month period?
Methodology:
Subjects: 97 patients with recurrent LBP (age 18–60 yrs) (70%) provided 12-month follow-up data.
Experimental procedure: Using a stratified randomisation (for laterality of symptoms, duration of symptoms, and disability), subjects were assigned to either “conventional” physiotherapy (CON = 50; general active exercise and manual therapy) or “conventional” physiotherapy plus specific spinal stabilisation exercises (CON+SS = 47). Back-specific functional disability (Roland Morris Disability Questionnaire), pain, quality of life and psychological measures were collected at 6 and 12 month, and 12 months was the primary outcome.
Measure of outcome: Physical functioning (Roland Morris Disability Questionnaire) at 12 months.
Main finding/s:
There was improved physical functioning, pain intensity, and physical component of quality of life in both groups, with no significant difference between the two groups.
Conclusion/s:
In a 12-month follow-up clinical trial, the addition of spinal stabilisation exercises to conventional physiotherapy (general exercises and manual therapy) did not improve physical function and pain more than conventional physiotherapy alone, in patients suffering from recurrent LBP.
Evidence based rating:
8/10
Clinical interest rating:
8/10
Type of study:
Randomised controlled clinical trial (multi-centre)
Methodological considerations:
Well conducted study
Keywords:
lumbar spine, rehabilitation, physiotherapy, stabilisation exercises, low back pain, manual therapy
EFFECTS OF LIFETIME EXERCISE ON THE OUTCOME OF IN VITRO FERTILIZATION
Morris SN, Missmer SA, Cramer DW, . Obst Gynecol 2006;108:938–45
Background:
Regular exercise is promoted for general health, yet “excessive” exercise may have a negative impact on fertility.
Research question/s:
Does exercise before the first cycle of in vitro fertilisation (IVF) affect cycle outcomes such as successful live births?
Methodology:
Subjects: 2232 patients who were undergoing their first cycle of IVF for the treatment of infertility.
Experimental procedure: Subjects were assessed at three IVF clinics, at which time exercise activity (hrs/week, years of exercise, type of exercise) was documented (self-reported). Subjects were then followed prospectively. The primary IVF outcomes were successful live birth and four points of cycle failure (cycle cancellation, failed fertilisation, implantation failure and pregnancy loss).
Measures of outcome: The relationship between self-reported exercise and cycle outcome.
Main finding/s:
Women who reported regular exercise were no more likely to have a live birth compared with those women who did not report exercise (OR = 0.8, 95% CI 0.7 to 1.0; p = 0.07).
Women who participated in cardiovascular exercise had a 30% lower chance of successful live birth (OR 0.7, 95% CI 0.6 to 0.9) than women who reported no exercise.
Conclusion/s:
Regular exercise duration or frequency (>4 hrs/week, 1–9 years) and type (cardiovascular exercise) before commencing an IVF programme may negatively affect outcomes (decreased successful live birth, pregnancy loss, implantation failure, cycle cancellation).
Evidence based rating:
7.5/10
Clinical interest rating:
8/10
Type of study:
Prospective cohort study
Methodological considerations:
Well conducted study, possible confounding variables not all controlled for
Keywords:
exercise, fertility, in vitro fertilisation
EFFECTS OF EXERCISE ON BREAST CANCER PATIENTS AND SURVIVORS: A SYSTEMATIC REVIEW AND META-ANALYSIS
McNeely M, Campbell KL, Rowe BH, . CMAJ 2006;175:34–41
Background:
Participation in regular physical activity has potential benefits and can improve the quality of life in women with breast cancer.
Research question/s:
What are the benefits (physical function, fitness, quality of life) of regular exercise in patients recovering from breast cancer?
Methodology:
Experimental procedure: 14 randomised controlled clinical trials (n = 717) that examined exercise interventions for breast cancer patients or survivors with quality of life, cardio-respiratory fitness or physical functioning as primary outcomes were identified and scored for methodological quality on an eight-point scoring system. Initially, 136 published studies were obtained from the Cochrane Central Register of Controlled Trials, Medline, EMBASE, CINAHL, PsychINFO, CancerLit, PEDro and SportDiscus search facilities. Data on symptoms of fatigue, body composition and adverse effects were also included.
Measures of outcome: Quality of life (Functional Assessment of Cancer Therapy–General, Functional Assessment of Cancer Therapy–Breast), physical functioning, peak oxygen consumption, symptoms of fatigue.
Main finding/s:
Exercise also led to significant improvements in physical functioning and in reducing symptoms of fatigue.
Conclusion/s:
In a meta-analysis, exercise training is identified an effective intervention to improve quality of life, cardio-respiratory fitness, physical functioning and fatigue in breast cancer patients and survivors.
Evidence based rating:
8/10
Clinical interest rating:
8/10
Type of study:
Meta-analysis
Methodological considerations:
Small sample sizes, larger trials required
Keywords:
cancer, breast cancer, physical activity, exercise, meta-analysis
EFFECT OF ESOPHAGEAL ACID AND PROPHYLACTIC RABEPRAZOLE ON PERFORMANCE IN RUNNERS
Rodriguez-Stanley S, Bemben D, Zubaidi S, . Med Sci Sports Exerc 2006;38:1659–65
Background:
The effects of acid reflux on exercise performance is not well documented, neither is it known if suppression of acid reflux can improve running performance.
Research question/s:
Does oesophageal acid perfusion during exercise impair pulmonary function and exercise performance, and does acid suppression with rabeprazole (RAB) 20 mg/day increases exercise performance during oesophageal acid infusion?
Methodology:
Subjects: 24 trained runners (11 with heartburn (HB), 13 without heartburn (CON)).
Experimental procedure: Phase 1 study: Oesophageal evaluations, baseline maximum exertion test and a standard Bruce protocol maximal stress test were performed before runners were randomised to control oesophageal infusion (naso-gastric tube, no fluid) or oesophageal acid perfusion (0.1 N HCl) during exercise. Subjects were then crossed over to the alternate perfusion. Phase 2: 16 runners with HB underwent three sessions (randomly conducted on different days at baseline and 8 and 12 wk of RAB 20 mg) with both acid and sham perfusion during running.
Measures of outcome: Lung functions tests, running performance (time to exhaustion (minutes)).
Main finding/s:
Phase 1 lung function tests: No differences between groups and intervention (acid vs no acid) were observed.
Phase 2: Time to exhaustion was significantly decreased with acid perfusion at all time points (p<0.05) but there was no effect of acid suppression medication. No difference in pulmonary function was present at week 12 versus baseline.
Conclusion/s:
Running performance is decreased by oesophageal acid perfusion, but suppression of endogenous acid secretion did not improve exercise performance—changes in cardiopulmonary function do not explain the decreased exercise performance during acid perfusion.
Evidence based rating:
8/10
Clinical interest rating:
8/10
Type of study:
Randomised controlled clinical trial
Methodological considerations:
Well conducted study
Keywords:
gastro-oesophageal reflux, heartburn, runners, exercise performance, pulmonary function, time to exhaustion, energy expenditure