The effects of an unsupervised water exercise program on low back pain and sick leave among healthy pregnant women – A randomised controlled trial

<div><p>Background</p><p>Low back pain is highly prevalent among pregnant women, but evidence of an effective treatment are still lacking. Supervised exercise–either land or water based–has shown benefits for low back pain, but no trial has investigated the evidence of an unsupervised water exercise program on low back pain. We aimed to assess the effect of an unsupervised water exercise program on low back pain intensity and days spent on sick leave among healthy pregnant women.</p><p>Methods</p><p>In this randomised, controlled, parallel-group trial, 516 healthy pregnant women were randomly assigned to either unsupervised water exercise twice a week for a period of 12 weeks or standard prenatal care. Healthy pregnant women aged 18 years or older, with a single fetus and between 16–17 gestational weeks were eligible. The primary outcome was low back pain intensity measured by the Low Back Pain Rating scale at 32 weeks. The secondary outcomes were self-reported days spent on sick leave, disability due to low back pain (Roland Morris Disability Questionnaire) and self-rated general health (EQ-5D and EQ-VAS).</p><p>Results</p><p>Low back pain intensity was significantly lower in the water exercise group, with a score of 2.01 (95% CI 1.75–2.26) vs. 2.38 in the control group (95% CI 2.12–2.64) (mean difference = 0.38, 95% CI 0.02–0.74 p = 0.04). No difference was found in the number of days spent on sick leave (median 4 vs. 4, p = 0.83), disability due to low back pain nor self-rated general health. There was a trend towards more women in the water exercise group reporting no low back pain at 32 weeks (21% vs. 14%, p = 0.07).</p><p>Conclusions</p><p>Unsupervised water exercise results in a statistically significant lower intensity of low back pain in healthy pregnant women, but the result was most likely not clinically significant. It did not affect the number of days on sick leave, disability due to low back pain nor self-rated health.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02354430" target="_blank">NCT02354430</a></p></div

Mode of delivery, maternal and infant outcomes.

<p>Mode of delivery, maternal and infant outcomes.</p

Secondary outcomes.

<p>Secondary outcomes.</p

Participant flowchart.

<p>Participant flowchart.</p

Exercise, time spent on exercise and types of exercise at follow-up at 32 weeks.

<p>Exercise, time spent on exercise and types of exercise at follow-up at 32 weeks.</p

Baseline characteristics of study participants by randomisation group.

<p>Baseline characteristics of study participants by randomisation group.</p

The effect of time-of-day and chest physiotherapy on multiple breath washout measures in children with clinically stable cystic fibrosis

<div><p>Background</p><p>In this pilot study we investigated daytime variation of multiple breath nitrogen washout (N₂MBW) measures in children with clinically stable cystic fibrosis. To our knowledge the effect of time-of-day on multiple breath washout measures in patients with cystic fibrosis has not previously been reported. Furthermore, we assessed the influence of chest physiotherapy on N₂MBW measures.</p><p>Methods</p><p>Ten school children with cystic fibrosis performed N₂MBW followed by spirometry and plethysmography in the morning and afternoon at three visits that were one month apart. Chest physiotherapy was performed immediately before the afternoon measurements at visit 2 and immediately before morning and afternoon measurements at visit 3. The influence of time-of-day and chest physiotherapy on the measures was evaluated using linear mixed models.</p><p>Results</p><p>There were adequate quality data from 8 children with median age (range) 9.6 (6.0; 15.1) years. Baseline lung clearance index (LCI) (range) was 9.0 (7.1; 13.0) and baseline FEV₁% predicted was 97.5 (78.5; 117.9). No N₂MBW measures were significantly influenced by time-of-day or chest physiotherapy. LCI (95% confidence interval) decreased non-significantly 0.05 (-0.32; 0.22) during the day and increased non-significantly 0.08 (-0.26; 0.42) after chest physiotherapy. All spirometric measures were unaffected by time-of-day and chest physiotherapy. For plethysmographic measures FRC_pleth decreased significantly (p<0.01) 110 mL during the day, whereas a borderline significant (p = 0.046) decrease in ΔFRC_pleth-MBW during the day and a borderline significant (p = 0.03) increase in TLC after CPT were observed.</p><p>Conclusion</p><p>This study demonstrated that the time-of-day as well as chest physiotherapy performed immediately prior to N₂MBW had no consistent or significant influence on N₂MBW measures. However, we emphasize that further studies of the effect of both daytime variation and the effect of chest physiotherapy on multiple breath washout measures are warranted.</p></div

The overall mean values and the estimated effect of time-of-day (Day) and chest physiotherapy (CPT) on N₂MBW and spirometry.

<p>The overall mean values and the estimated effect of time-of-day (Day) and chest physiotherapy (CPT) on N₂MBW and spirometry.</p

Difference in LCI between morning and afternoon.

<p>Lines represent each individual. N = 8. Average of the morning LCI’s compared to the afternoon LCI’s (Fig 3A), average of the two morning LCI’s with no prior CPT compared to the one afternoon LCI with no prior CPT (Fig 3B), and the one morning LCI with prior CPT compared to the average of the two afternoon LCI’s with prior CPT (Fig 3C).</p

Study design.

<p>Lung function testing was performed morning (AM) and afternoon (PM) at each visit. Chest physiotherapy (CPT) was performed immediately prior to afternoon measurements at visit 2 and prior to both morning and afternoon measurements at visit 3.</p