Exercise Training to Improve Independence and Quality of Life in Impaired Individuals : Exercise and Sport Sciences Reviews

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Exercise Training to Improve Independence and Quality of Life in Impaired Individuals

Haddad, Jeffrey M.; Rietdyk, Shirley; Claxton, Laura J.

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Exercise and Sport Sciences Reviews: July 2012 - Volume 40 - Issue 3 - p 117
doi: 10.1097/JES.0b013e31825572f4
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In this issue of Exercise and Sport Sciences Reviews, the article by Drs. Li and Hondzinski demonstrates that exercise training may reverse sensory deterioration, improve leg strength and gait speed, and prevent the early onset of peripheral neuropathy in patients with diabetes (5). These findings are promising given that medical and nontraining therapeutic interventions provide some symptom relief but do not prevent or reverse disease progression. Their work described in this article adds to a growing body of research that has found that exercise training improves sensorimotor function and reduces fall risk in impaired populations. However, two important issues that still need to be addressed are assessing the impact of treatment on quality of life and independence, and determining the best treatment for a specific disability.

Whereas most papers focus on strength, sensory acuity, and clinical scores (e.g., the Berg Balance Scale, Up & Go test (Berg) and the Timed Up-and-Go (TUG)), Li and Hondzinski discuss the first important issue: improving quality of life and independence. A recent review suggests that although training improves basic outcome measures, it does not impact disability (4). Therefore, there is a critical need to develop outcome measures that directly translate to improved independence and quality of life. Independence requires successful completion of daily activities, which are typically multitask in nature (1). For example, talking to a spouse while leaning forward to put away groceries requires the maintenance of an unstable posture while listening, speaking, and performing a manual task. Although the ability to perform multitask behaviors emerges in childhood (2), disease and age compromise the ability to perform most daily activities and increase the risk of falling (1). Therefore, measures of treatment efficacy should include multitask performance in addition to more typical assessments (6).

The second important issue considers the most beneficial treatment for a specific disorder. For example, treadmill training improves disease severity in people with Parkinson’s disease likely because of the rhythmic external cue of the treadmill belt and improved sensorimotor integration (3). Treadmill training likely would be less effective in other disorders because it addresses key impairments of Parkinson’s disease. The most effective treatment for each disorder cannot be determined from the existing literature because of the wide variety of exercise treatments, durations, and populations. Treatment with a trained therapist likely will be the most efficacious, but the implementation is not practical at a population level. From a public health perspective, the intervention must be inexpensive and readily available to the community, such as the Tai Chi intervention discussed in the article. Another option includes using interactive training devices. For example, various devices are available that require individuals to control their balance on an unstable surface while receiving real-time visual feedback of their performance. The interactive nature of these devices is motivating, and training can be completed with minimal therapist supervision. However, the efficacy of these devices has not been established fully. Future research should focus on training paradigms that are implemented easily, low cost, and likely to promote adherence. Multiple paradigms also should be compared in specific populations. Last, efficacy should be assessed through multiple measures, such as fall risk, quality of life, sensory acuity, multitask activities, and duration of benefit. Review papers that compare and summarize training paradigms in specific populations, such as the one by Li and Hondzinski, are needed to determine optimum treatment and facilitate translation to clinical practice.

Jeffrey M. Haddad

Shirley Rietdyk

Laura J. Claxton

Department of Health and Kinesiology

Purdue University

West Lafayette, IN

This work was not supported by any funding.

The authors declare no conflicts of interest.

References

1. Faulkner KA, Redfern MS, Cauley JA, et al.. Multitasking: Association between poorer performance and a history of recurrent falls. J. Am. Geriatr. 2007; 55: 570–6.
2. Haddad JM, Claxton LJ, Keen R, et al.. Development of the coordination between posture and manual control. J. Exp. Child. Psychol. 2012; 111: 286–98.
3. Herman TN, Giladi N, Hausdorff JM. Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: A mini-review. J. Neural. Trans. 2009; 116: 307–18.
4. Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J. Gerontol. A. Biol. Sci. Med. Sci. 2004; 59: 48–61.
5. Li L, Hondzinski JM Select Exercise Modalities May Reverse Movement Dysfunction due to Peripheral Neuropathy. Exer. Sports Sci. Rev. 2012; 40: 133–7.
6. Silsupadol P, Shumway-Cook A, Lugade V, et al.. Effects of single-task versus dual-task training on balance performance in older adults: A double-blind, randomized controlled trial. Arch. Phys. Med. Rehabil. 2009; 90: 381–7.
©2012 The American College of Sports Medicine