A systematic review on heart-rate recovery to monitor changes in training status in athletes

Heart-rate recovery (HRR) has been proposed as a marker of autonomic function and training status in athletes. The authors performed a systematic review of studies that examined HRR after training. Five cross-sectional studies and 8 studies investigating changes over time (longitudinal) met our criteria. Three out of 5 crosssectional studies observed a faster HRR in trained compared with untrained subjects, while 2 articles showed no change as a result of training. Most longitudinal studies observed a corresponding increase in HRR and power output (training status). Although confounding factors such as age, ambient temperature, and the intensity and duration of the exercise period preceding HRR make it difficult to compare these studies, the available studies indicated that HRR was related to training status. Therefore, the authors conclude that HRR has the potential to become a valuable tool to monitor changes in training status in athletes and less well-trained subjects, but more studies and better standardization are required to match this potential

Current status and future prospects for shared decision making before and after total knee replacement surgery—a scoping review

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery

Oefentherapie bij ouderen, keuzes te over

Eens te meer wordt hiermee het belang van de oudere cliënt voor de toekomst van de fysiotherapie benadrukt. Cijfers van het Centraal Bureau voor de Statistiek (cbs ) wijzen uit dat personen ouder dan 65 jaar regelmatig door de huisarts, verpleeghuisarts en geriater naar de fysiotherapeut worden verwezen om de fysieke activiteit te verhogen met als doel de functionele capaciteit te vergroten, herstellen en/of behouden. Ouderen zijn hiermee nu al de grootste groep consumenten van de fysiotherapeut (22,5% van de eerstelijns consulten) en naar verwachting zal dit aandeel alleen maar toenemen. Ook in politiek Den Haag is men doordrongen van het belang van een actieve levensstijl tot op hoge leeftijd

Merits of exercise therapy before and after major surgery

PURPOSE OF REVIEW: Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. RECENT FINDINGS: There is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles. SUMMARY: The perioperative exercise training protocol known under the name ‘Better in, Better out’ could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials

Ontwikkeling van een beweegnorm voor ouderen in verpleeg- en verzorgingshuizen

Naast voeding is bewegen één van de essentiële pijlers in het leven. Een tekort aan beweging maakt ziek en afhankelijk, vooral bij kwetsbare ouderen die door diverse factoren uit balans dreigen te raken of geraakt zijn. Hoewel de negatieve effecten van inactiviteit algemeen bekend zijn, is er in verpleeg- en verzorgingshuizen weinig tot geen aandacht voor lichamelijke activiteit van de bewoners. TNO heeft de eerste stappen gezet voor de ontwikkeling van een beweegnorm voor ouderen in verpleeg- en verzorgingshuizen in opdracht van de Nederlandse Vereniging voor Fysiotherapie in de Geriatrie en het Koninklijk Nederlands Genootschap voor Fysiotherapie