Model and Effectiveness of Endurance Exercise to Increase Physical Fitness in Intellectual Disability Subjects with Obesity: A Randomized Controlled Trial

Aim: to design a model and assess the effectiveness of endurance exercise to increase physical fitness in intelectual disability (ID) patients with obesity. Methods: a randomized-controlled clinical trial was performed in ID patients with obesity aged 10-30 years old from all Special School in DKI Jakarta, which were randomly allocated into 3 groups and then given 3 different type of exercises: lower extremity muscles endurance exercise for 20 RM followed by cardiorespiratory endurance exercise for 24-25 minutes (type I), lower extremity muscles endurance exercises for 10 RM followed by cardiorespiratory endurance exercises for 26-27 minutes (type II), and threw a tennis ball with 10 m distance for 10 minutes as control (type III). These program was performed 3 times a week for 4 months. Assesment of the exercise effectiveness was done by measuring maximum load that can be lifted and six-minutes walking test on rectangular track which was converted with the VO2 max prediction formula. Analysis was perfomed with Kruskal Wallis test. Results: two hundred and twelve (212) subjects were included in the study, randomly allocated into three types (I, II, and III) of exercises groups. The type II of endurance exercise model was proved to be more effective in increasing lower extremity muscles endurance level compared to type I and III for ID patients with obesity (p<0.05). Meanwhile, type I of endurance exercise model was proved to be more effective in increasing cardiorespiratory endurance level compared to type II and III for ID patients with obesity (p<0.05). Conclusion: lower extremity muscles endurance exercise followed by a cardiorespiratory endurance exercise can be used to increase physical fitness in ID patients with obesity. Key words: intelectual disability patient, obesity, lower extremity muscles and cardiorespiratory endurance exercise, lower extremity muscles endurance level, cardiorespiratory endurance level

Exercise Intervention for Chronic Pain Management, Muscle Strengthening, and Functional Score in Obese Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis

Background: obesity and osteoarthritis have strong inter-relationship with multi-factorial mechanism that caused pain and leads to decreased quality of life. Exercise has been identified as prevention and management against obesity and joint pain. This systematic review aims to assess the effect between exercises compared to diet group for chronic pain management, physical and mental function in obese patients with chronic musculoskeletal problem. Methods: we performed a systematic search of Randomized Control Trial studies from Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EBSCO; SCIENCEDIRECT (Elsevier); SCOPUS, grey literature, trial registry, ongoing study for published studies, and from the ClinicalTrial.gov, thesis of rehabilitation medicine in RSCM, and proceeding books for unpublished studies that was last updated on November 2016. Risk of bias was assessed using Cochrane risk-of-bias tool and data were analyzed using Review Manager 2014. Results: one study showed no difference in pain reduction (assessed using VAS) between two groups. Two studies showed improvement in physical function measured using 6MWT in exercise group at 6 and 18 months with mean difference 28.12 [11.20, 45.04] and 26.21 [9.01, 43.41]. There was no significant effects observed for Mental and Physical Function based on SF-36 after 6 months (1 study) and 18 months (2 studies) observation, with mean difference 1.10 [-0.79, 2.99] and 0.08 [-1.53, 1.70] respectively for Mental Function score and -0.30 [-2.54, 1.94]  and -0.36 [-2.30, 1.57] respectively for Physical Function score. Conclusion: exercise can improve physical function objectively, but could not reduce pain in obese patients with chronic musculoskeletal problem subjectively

Effect of Metformin on Handgrip Strength, Gait Speed, Myostatin Serum Level, and Health-related Quality of Life: A Double Blind Randomized Controlled Trial among Non-diabetic Pre-frail Elderly Patients

Background: sarcopenia contributes to the development of frailty syndrome. Frailty syndrome is potentially improved by modifying insulin resistance, inflammation, and myostatin level. This study is aimed to investigate the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health-related quality of life (HR-QoL) among non-diabetic pre-frail elderly patients. Methods: a double blind randomized controlled trial study was conducted on non-diabetic elderly outpatients aged ≥ 60 years with pre-frail status based on phenotype and/ or index criteria (Cardiovascular Health Study and/ or Frailty Index 40 items) consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. One-hundred-twenty subjects who met the research criteria were randomized and equally assigned into 3 x 500 mg metformin or placebo group. The study outcomes were measured at baseline and after 16 weeks of intervention. Results: out of 120 subjects, 43 subjects in metformin group and 48 subjects in placebo group who completed the intervention. There was a significant improvement on the mean gait speed of metformin group by 0.39 (0.77) second or 0.13 (0.24) meter/second that remained significant after adjusting for important prognostic factors (p = 0.024). There was no significant difference on handgrip strength, myostatin serum level, and HR-QoL between both groups. Conclusion: 3 x 500 mg metformin for 16 weeks was statistically significant and clinically important in improving usual gait speed as one of the HR-QoL dimensions, but did not significantly improve the EQ-5D index score, handgrip strength, nor myostatin serum level

The Influence and Feasibility of Therapeutic Exercise Videos at Home on the Functional Status of Post-COVID-19 Hospitalization

The COVID-19 pandemic pushed physicians to modify conventional practices to reduce the exposure and risk of infection among patients and health workers. Telemedicine is one of the safest methods, and telerehabilitation could prevent the sequelae of COVID-19. A quasi-experimental study with randomized sampling without masking/blinding was conducted. The study was conducted from August 2021 to March 2022 at Hospital A in Pekanbaru, Hospital B in Jayapura, and Hospital C in Jakarta, Indonesia. A total of 27 patients were recruited and divided into control and intervention groups. The control group was given conventional education on therapeutic exercise at home, while the intervention group was shown educational videos about therapeutic exercise at home. The comparison of all functional outcomes between the two groups after the intervention showed a significant difference. The intervention group improved more than the control group, except for the fatigue severity scale. Most of the responses showed that this video was feasible and useful and did not need to be supervised by health workers. Therapeutic exercise educational videos can be an option to deliver rehabilitation programs for post-COVID-19 hospitalized patients

Aquatic versus land-based exercise for cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis: a randomized controlled trial

Background: Obesity with knee osteoarthritis (OA) is related to chronic pain causing physical inactivity that leads to decreased cardiorespiratory endurance and quality of life. Aquatic and land-based exercises are effective in improving physical activity. The aim of this study is to compare between aquatic and land-based exercise to improve cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis. Methods: A single-blind, randomized, controlled trial was conducted on thirty three obese patients with knee OA who visited Obesity Clinic of Medical Rehabilitation Cipto Mangunkusumo Hospital, from October 2016 to January 2017, subjects were divided into aquatic or land-based exercise group. Aerobic and knee-strengthening exercises were given. Cardiorespiratory endurance was assessed using the Borg Scale, whereas both the BORG CR-10 and SF-36 questionnaires were used to assess quality of life. Results: After intervention, there were significant improvements in the land-based exercise group in the rating of perceived exertion (p=0.02), role limitations due to physical health (p=0.024), role limitations due to emotional problems (p=0.041), energy/fatigue (p=0.016), and the decline in pain (p=0.049) parameters. While in the aquatic exercise, there were significant improvements in leg fatigue (p=0.016), energy/fatigue (p=0.025), emotional well-being (p<0.001), and general health (p=0.045) parameters. Despite this, there were no significant differences between two groups regarding cardiorespiratory endurance and quality of life. Conclusion: This study found that patients could start aquatic exercise to reduce leg fatigue and enhanced general health and energy. After that, exercise could be continued in land-based settings to improve cardiorespiratory endurance and quality of life

Effect of Body Mass Index on Postural Balance and Muscle Strength in Children Aged 8-10 years

Background:Childhood overweight and obesity, which are considered as global epidemic, can be assessed using Body Mass Index (BMI). BMI difference can lead to anatomic changes due to an increased body load. This increase might also affect motor performance, including changes in postural balance and muscle strength. Aims and Objectives: to explain the influence of BMI on postural balance and lower limb muscle strength and to assess the correlation between those two variables in children aged 8-10 years. Material and methods:The sample consisted of 63 children aged 8-10 years, which were divided in 3 groups: BMI-normal, BMI-overweight, and BMI-obese. The postural balance was assessed using single leg balance test on MatScan and the Center Of Pressure (COP) area was recorded. Isometric muscle strength of hip extensor and knee extensor were measured using a hand-held dynamometer. Results: Obese children had significantly largerCOP area than overweight (p = 0.004) and normal weight children (p = 0.000).There were no significant differences in hip extensor muscle strength between obese children with overweight and normal weight children (p=0.527). The absolute knee extensor muscle strength in obese group was significantly higher than the overweight and normal group (p = 0.003). However the relative muscle strength of lower limb for obese children was significantly lower than for normal weight. There was no significant correlation between absolute hip extensor and knee extensor muscles strength with COP area. Conclusion: Obese children have decreased postural balance and increased absolute knee extensormuscle strength significantly when compared to overweight and normal children. There is no significant correlation between postural balance and muscle strength

Exercise Intervention for Chronic Pain Management, Muscle Strengthening, and Functional Score in Obese Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis

Background: obesity and osteoarthritis have strong inter-relationship with multi-factorial mechanism that caused pain and leads to decreased quality of life. Exercise has been identified as prevention and management against obesity and joint pain. This systematic review aims to assess the effect between exercises compared to diet group for chronic pain management, physical and mental function in obese patients with chronic musculoskeletal problem. Methods: we performed a systematic search of Randomized Control Trial studies from Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EBSCO; SCIENCEDIRECT (Elsevier); SCOPUS, grey literature, trial registry, ongoing study for published studies, and from the ClinicalTrial.gov, thesis of rehabilitation medicine in RSCM, and proceeding books for unpublished studies that was last updated on November 2016. Risk of bias was assessed using Cochrane risk-of-bias tool and data were analyzed using Review Manager 2014. Results: one study showed no difference in pain reduction (assessed using VAS) between two groups. Two studies showed improvement in physical function measured using 6MWT in exercise group at 6 and 18 months with mean difference 28.12 [11.20, 45.04] and 26.21 [9.01, 43.41]. There was no significant effects observed for Mental and Physical Function based on SF-36 after 6 months (1 study) and 18 months (2 studies) observation, with mean difference 1.10 [-0.79, 2.99] and 0.08 [-1.53, 1.70] respectively for Mental Function score and -0.30 [-2.54, 1.94]  and -0.36 [-2.30, 1.57] respectively for Physical Function score. Conclusion: exercise can improve physical function objectively, but could not reduce pain in obese patients with chronic musculoskeletal problem subjectively

Diagnostic Test of a Scoring System for Frailty Syndrome in the Elderly According to Cardiovascular Health Study, Study of Osteoporotic Fracture and Comprehensive Geriatric Assessment Based Frailty Index Compared with Frailty Index 40 Items

Aim: to get a recommendation on the best frailty syndrome diagnostic tools, that will be able to be practiced on a daily setting in Indonesia. Methods: this is a cross-sectional study with diagnostic test approach, conducted to patients in the Geriatric Outpatient Clinic of Cipto Mangunkusumo National Referral Hospital on May-June 2013. Each subject underwent a frailty evaluation using CHS, SOF, FI-CGA and FI-40 scoring systems. Then, we calculate the sensitivity, specificity, PPV, NPV, LR+ and LR- of each scoring system compared to FI-40. Results: the proportion of frail, pre-frail and fit according to FI-40 are 25.3%,71% and 3.7% respectively. In terms of differentiation frail to non-frail, CHS had 41.2% sensitivity, 95% specificity, PPV 73.7%, NPV 82.7%, LR+ 8.41 and LR- 0.62. SOF scoring system had 17.6% sensitivity, 99.5% specificity, PPV 92.3%, NPV 78.1%, LR+ 35.2 and LR- 0.83. Furthermore FI-CGA had 8.8% sensitivity, 100% specificity, PPV 100%, NPV 76.4%, LR+ ∞ and LR- 0.91. Conclusion: There is no better scoring system that could be implemented to screen for frailty syndrome other than FI-40 items. However, other scoring systems could be used as a good diagnostic tool for the syndrome. Key words: elderly patient, frailty syndrome, CHS index, SOF index, FI-CGA, FI-40