Vol 4 Issue 1
ISSN: 2226-9541
JOPSM Journal of Physiotherapy and Sports Medicine
Journal of Physiotherapy & Sports Medicine (JOPSM) Volume 4, Issue 1, 2015
Editor-in-Chief
Associate Editor
Umer Sheikh, MSc. Advancing Physiotherapy (UK), MSc. APA (Ireland/Belgium), MCSP (UK), SRP (UK), MAACP (UK), BSPT (PU), MPPS (PK) - Woking, UK
Adnan Khan, MSc (UK), MCSP (UK), MICSP (Ireland), MAACP (UK), BSPT (PU) Staffordshire, UK
International Advisory Board
Editorial Board Muhammad Atif Chishti, MSc. Musculoskeletal Physiotherapy (UK), MCSP (UK), SRP (UK), MAACP (UK), BSPT (PU), MPPS (PK) Middlesborough, UK Sameer Gohir, MSc Sports Physiotherapy (UK), MSc APA (Ireland/Belgium), MCSP (UK), SRP (UK), MISCP (Ireland), MSHC (KSA) - London, UK Rashid Hafeez M.Phil (Physiotherapy), MSc. APA (Belgium/Ireland), BSPT (PK) Dr. Fariha Shah, DPT (USA) - Lahore, PK Mohammad Bin Afsar Jan, MSPT (AUS), BSPT (PK) - Peshawar, PK
Shumaila Umer Sheikh, MSc Paediatric Physiotherapy (UK), MSc APA (Belgium/Ireland), MISCP (Ireland), BSPT (PU) - West Byfleet, UK Muhammad Atif Khan, BSc, MSc, Pgd (Ortho med), ESP, Spinal Practitioner, Berkshire, UK Muhammad Asim Ishaque, MSc Musculoskeletal Physiotherapy (UK), MCSP (UK), SRP (UK), BSPT (PK) London, UK Dr Junaid Amin DPT (PK), BSPT (PK) KSA Shahbaz Iqbal MSc Physiotherapy (USA), tDPT (USA), McKenzie Cert.
Managing Editor Beenish Zaman, tDPT (PK), BSPT (PK) Lahore, PK
This journal subscribes to the principles of the Committee on Publication Ethics http://publicationethics.org/
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Journal of Physiotherapy & Sports Medicine (JOPSM) Volume 4, Issue 1, 2015 Table of Content
Editorial........................................................................................................................................01 Intra rater and Inter rater reliability of Skin Fold Calliper in Children with Cerebral Palsy…………………………………………………………………………………………………………………………………………...03 Comparing Learned Skills in Physiotherapy with Actual Practice of Physiotherapist.........……………12 Comparison of distance covered during 2 minute walk test and 6 minute walk test and its correlation with physiological cost index in elderly population …………………………………………………..21 Relation of Post-Operative Complications of Mastectomy in Patients of Breast Cancer with Obesity …………………………………………………………………………………………...........................................................29 Effects of Aerobic Dance Exercises versus Strength Training Exercises on Body Composition Parameters in Adolescent, Adult and Middle Aged Overweight/Obese Females………………………………………………………………………..…………………..………………………………………..34 Guidelines for Authors..................................................................................................................47
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Postgraduate Institute of Physiotherapy
JOPSM Editorial Office | 4 Brantwood Drive, West Byfleet, Surrey, United Kingdom E-mail: info@pgip.co.uk
[Editorial]
Bridging the GAPintegrating research and clinical reasoning 1
Adnan Iftikhar, MSc, MCSP
Evidence based practice is application of best available research knowledge when making clinical decision. Clinicians and patients are always remain central to decision making and always been informed to make their decision on the basis of RCTs, systematic reviews and meta-analysis. However , evidence base practice has not yielded exceptional results due to the fact that clinician do not have enough time and experience to keep up with and evaluate the increasing frequency of research which is often having conflicting results. Secondly results of the researches are so complicated and described in a way that it rather complicates the problem than informing clinician to take best possible decision. There are certain limitation of the research in its generalisation, and transferability. By generalisation it is considered that whether the results of the studied population is applicable to those groups which have the similar clinical diagnosis but the trials which should produce more robust and reliable results would include multiple sites and wide variety of different countries. These trials may be large in number but not always be the representative of the overall the population due to its with same clinical problem due to inclusion and exclusion criteria. We may be able to exclude co-morbidies in research but unable to take them out from clinical practice. Experimental research conclude the net
results in group of individuals but not transferable to all individuals within the groups which is the fundamental limitation of the research. On the top of this there is lot of heterogeneity within the individual response to treatment, with some responding well and others are worst. To overcome this problem, guidelines and recommendation are formulated to bring best possible evidence in one place and allow clinician to inform their decision in day to day practice but these are more of prescriptive in nature and all guidelines usually accompanied by a statement that these can be modified for individual patient , which leaves clinician to use their own clinical experience and clinical reasoning abilities .it is also important to note that latest guidelines are most of the time are different from the previous one. Most of the RCTS, meta-analysis and systematic reviews come with conflicting results and there are some areas where there are no guidelines or extensive research is available but clinician has to make the clinical decision. If there is inconclusive, conflicting and limited research available, this gap needs to be filled with clinical reasoning for best care of the patient which is often ignored in the presence of guidelines and experimental research as white and black. Clinical reasoning is the disciplined, analytical, scientific approach that integrates all the
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Editorial] relevant information in the search for the best approach to diagnosis and therapy for individual patients. It does not supply generic answers for groups and is, therefore, not the same as expert opinion, which proposes general approaches in clinical guidelines. Clinical reasoning remains integral in clinical decision making in presence of conflicting evidence, and limitation in transferability and generalization of the results. However the evaluation of the evidence is only the one part, guidelines are the other but bridging the gap where there is lack of evidence, conflicting research and clinical comorbid
conditions, clinical reasoning is the only tool which can assist to make clinical decision. Taking judicious decisions on the basis of real life clinical scenarios, with appropriate clinical reasoning based on experience and research, patient preferences, reasonable recommendation would remain essential and leave room for clinician for exercising their reasoning process. Therefore we need to integrate clinical reasoning with contemporary evidence to bridge the gap between the two and emphasize the clinical reasoning teaching in medical studies.
Corresponding Author Adnan Iftikhar, MSc, MCSP Extended Scope Practitioner/Clinical Lead 1
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report]
Intra rater and Inter rater reliability of Skin Fold Calliper in Children with Cerebral Palsy Suchi Umeshchandra Dubey 1 Sharaddha Jasmin Diwan2 Binal A Gajjar3 123
Institutional Affiliations: - SBB College of Physiotherapy, Ahmedabad, Affiliated To Gujarat University
Abstract Skin fold measurements are common method for determining body fat composition. Accurate measurement of nutritional status in children with cerebral palsy (CP) is a challenge because of contractures, splints and wheelchairs. Earlier instruments were costly and not easily available but skin fold calliper is less costly and less time consuming. The reliability of skin fold measurements varies from tester to tester depending on their skill and experience. Objective The study aims to find the intra rater and inter rater reliability of skin fold calliper
in children with CP. Methods After getting approval from institutional ethic’s committee (IEC), Intra rater & inter
rater reliability of skin fold calliper was tested on 20 CP children of all clinical types & gross motor function classification system (GMFCS) levels above 5 years at paediatric rehabilitation department, Ahmedabad. Children with any other neurological conditions and not willing to participate were excluded. Prior to skin fold measurement girth measurement of mid forearm and calf, height, weight, waist hip ratio were taken of right side. Skin fold thickness (SFT) for right triceps, calf and abdomen were taken by 3 independent therapists after 1 minute rest, intra and inter rater reliability of skin fold calliper was checked by intra class correlation coefficient (ICC). Results Intra rater reliability (ICC = 0.992, p<0.000) and inter rater reliability (ICC=0.991,
p<0.000).
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[Research Report] Conclusion Skin fold calliper has excellent intra-rater and inter-rater reliability for
measuring SFT in CP children above 5 years of age of different locomotor abilities. Keywords: Skin fold calliper, Obesity, Cerebral palsy, Reliability
Introduction
Weight-for-height centiles (WHC) was represented as USAâ&#x20AC;&#x2122;s National Centre for
Cerebral palsy (CP) is the most common
Health Statistics (NCHS) growth charts5.
cause of physical disability in childhood
Charney et al found WHC not a valid
occurring in 1 of 500 children group
of
permanent
1-3
. It is a of
children [5]. Due to alteration in body
movement and posture, causing activity
composition and proportion in CP child, it
limitation,
non-
alters the ability of WHC to reflect fat
progressive disturbances that occurred in
stores in the body. Hence, it has poor
i.e.,
disorders
indicator of nutritional status for CP
attributed
to 2
the developing foetal or infant brain . In
performance
addition to disordered movement
or
Accurate measurement of nutritional status
posture, children may have a range of
in CP children is a challenge due to
associated
presence of contractures, splints and
disabilities,
including
intellectual disability, hearing and visual
as
nutritional
indicator6.
wheelchairs7.
deficits, nutrition, feeding and swallowing problems,
respiratory
infections
and
Stallings et al 1995 studied a small group of children with CP and concluded that
epilepsy. 1-3
nutritional
status
can
be
accurately
Malnutrition is common in children with
assessed by measuring SFT, because it
CP4. Severely affected children are at
accurately
nutritional risks and less severely affected
composition.
determines
body
fat
children have nutritional deficiency. Due to
high
prevalence
and
negative
consequences of cerebral palsy leads to difficulty in identification and correction of malnutrition in these children. Hence, assessment of nutritional status of cerebral palsy children is a challenge for all clinicians5.
Earlier available instruments were very costly and also not easily available. Whereas, skin fold calliper is cheaper, easily available and also it is less time consuming.8 Reliability is one of the essential elements of a valid instrument. It refers, to consistency of measurements when testing procedures are repeated on a
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] population of individuals or groups. Inter
hemiplegic CP and for rest 19 subjects
rater
of
right side SFT was taken. Study was
differences produced by different raters
approved by Institutional ethics committee
and intra rater reliability is the extent of
(IEC) (PTC/IEC/93/2012-13). Nature and
differences produced when used by the
purpose of the study was explained.
same rater over time. The reliability of
Written informed consent was taken from
skin fold measurements varies from tester
the parent or guardian of the child and oral
to tester according to their skill and
consent of a child was taken prior to the
experience of measuring SFT with skin
study.
fold calliper. Hence, the need to study the
Procedure
intra rater and inter rater reliability of skin
The present study was approved by a local
fold calliper in children with CP arises.
committee consisting of senior researchers
reliability
is
the
extent
at
Aims and Objectives
the
division
Karolinska
of
physiotherapy,
Institute.
Ethical
To find intra rater and inter rater reliability
considerations of the study have followed
of skin fold caliper in children with
the recommendations of the Helsinki
cerebral palsy
declaration
and
the
Medical
Ethics
Committee.
Methodology
Subjects
Prior to skin fold measurements girth
Participants
20 subjects with CP were recruited for this study
and
paediatric
study
was
rehabilitation
conducted
at
department,
Ahmedabad. CP children of all clinical types, all GMFCS level and above 5 years of age were included whereas children with any other neurological conditions like spina bifida, autism, Downâ&#x20AC;&#x2122;s syndrome and not willing to participate in the study were excluded. Skin fold thickness of 1 subject was taken for left triceps, left calf and abdomen as the subject was left
measurement of mid forearm and mid calf of right side, height, weight and waist hip ratio was taken. Skin fold thickness (SFT) of right triceps, right calf and abdomen was taken by 3 independent therapists with variable clinical experience of (14 years, 9 years, PG student). SFT for right triceps and right calf was measured in high sitting position and for abdomen in supine lying position. But for 1 subject SFT of right calf was measured in prone position. For intra rater reliability, therapist 1 checked
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] SFT for all 3 muscles for 3 trials and mean
participants were GMFCS level I to III had
of them was calculated as the final reading.
7 children with 3 hemiplegic, 2 spastic
Then after 1 minute rest interval same
diplegic and 2 spastic triplegic CP and
therapist checked the SFT for all the 3
GMFCS level IV to V had 13 children
muscles for 3 trials and mean of them was
with 2 athetoid, 2 quadriplegic, 5 spastic
calculated as final reading. For inter rater
diplegic, 4 spastic triplegic CP. Table – 1
reliability, therapist 1 measured SFT for
shows demographic details of study
all 3 muscles for 3 trials and mean of them
participants with mean score for height
was calculated as final reading and rest
(110 ± 4.78 cms), weight (15 ± 3 kgs) and
interval of 1 minute was given. Then after
waist hip ratio (0.78 ± 0.23). Statistical
1 minute therapist 2 measured SFT for all
analysis showed excellent intra rater
the 3 muscles for 3 trials and mean of them
reliability (ICC = 0.992, p < 0.000) and
was calculated as final reading and then
inter rater reliability (ICC = 0.991, p <
again 1 minute rest was given. Finally
0.000) of skin fold calliper.
therapist 3 measured SFT for all the 3
Table 1:- Mean and standard deviation of
muscles for 3 trials and mean of them was
the variables
calculated as final reading and 1 minute Table 2:- ICC for Intra rater and Inter rater
rest interval was given.
reliability Statistical Analysis
Discussion
Data analysis was done using SPSS for windows version 16. Intra rater and inter
The present study was carried out with the
rater reliability of skin fold calliper for all
aim to assess the intra rater and inter rater
subjects
reliability of skin fold calliper in children
was
Correlation
checked
Coefficient
by
Intraclass
(ICC).
The
significance level was set to p < 0.05.
with CP above 5 years of age. The result of present study indicates that skin fold calliper has excellent intra rater (ICC =
Results 20 children with CP of either gender with age range from 5 to 15 years with mean age ( 8.5 ± 2.5 years) were tested to measure reliability of skin fold calliper using ICC. Demographic details of study
0.992, p<0.000) and inter rater reliability (ICC = 0.991, p<0.000) for measuring SFT in CP children above 5 years of age of different locomotor abilities which is clinically applicable for right triceps, right calf and abdomen.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] Previous studies by Isaac et al in 1997
retrospectively. Height or a proxy for
showed that, if only body weight and
height, mid-upper arm circumference,
height is considered on NCHS charts there
weight, and skin fold thicknesses were
are chances that child is incorrectly
recorded. Mid-upper arm fat area was
assessed as overweight, when higher
calculated for each participant.
percentile for triceps skin fold and arm
standards lack adequate sensitivity for
girth
are
identification of severely depleted fat
muscular9-10. Hamill et al in 1979, studied
stores in children with CP. Use of triceps
children with low muscle tone. Arm
SFT, using cut-off value of <10th centile
circumference or skin fold adjusted girth at
for age and sex, is recommended to screen
low percentile fold was considered to be
for suboptimal fat stores in children with
under weight until realized skin fold
CP.15
measurement
when
they
measurements shows adequate adipose tissue stores11. Result of present study is in accordance with those of Stallings and Janet et al in 1999 who studied that anthropometric easier
and
measurement
reliable
permits
measurement
in
children with disability for both lying in
WHC
Results of present study cannot be compared in totality with the above studies due
to
differences
in
sample
size,
demographic characteristics, age of CP children and selection criteria.
Conclusion
bed or out patients sitting in wheelchairs12. Studies by Stevenson et al in 1994 showed excellent intra rater and inter rater reliability for anthropometric database and each measure was completed twice and
Lisa J Samson et al in 1999 evaluated centiles
(WHC)
in
screening children with cerebral palsy (CP) for depleted body fat and to identify an alternate screening method. Growth data of
276 children aged from 3 to 12
years
with
CP
were
reliability was observed in present study for measuring SFT in CP children above 5 years of age which is clinically applicable for right triceps, right calf and abdomen.
average was used for analysis13-14.
weight-for-height
Excellent intra rater and inter rater
Future Recommendations Future studies can be done with more number of subjects, finding reliability in different age groups of CP, reliability for other muscles, reliability in males and females.
analyzed
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 7
[Research Report] Acknowledgements 7.
Author(s) would like to thank all the children and their parents for providing valuable support and information. We would also thank our institution to provide
8.
9.
with all necessary resources throughout course of the study.
10.
References 1.
2.
3.
4.
5.
6.
Schlenker J, et al. The child with a developmental disability. In: BCDNA manual of nutritional care. Vancouver, BC dietitian nutritionist assoc. 1992 ; 54-8 Schlenker J, et al. Nutrition Committee, Canadian pediatric society. Undernutrition in children with neurodevelopmental disability. Can Med Assoc. 1994; 151 : 753-9 Schlenker J, et al. Position of the American Dietetic Association: Nutrition in comprehensive program planning for persons with developmental disabilities. J An Diet Assoc. 1997; 97 (2): 189-93 Stallings VA,et al. Nutritional status and growth of children with diplegic or hemiplegic cerebral palsy. Developmental Medicine & Child Neurology. 1993a ; 35:997–1006. Charney EB, Davies JC, Cronk CE, et al. Nutrition-related growth failure of children with quadriplegic cerebral palsy. Developmental Medicine & Child Neurology. 1993b; 35:126–38. Spender Q, Cronk CE, Charney EB, et al. Assessment of linear growth of children with CP: use of alternative measures to
11.
12.
13.
14.
15.
height or weight. Dev Med Child Neuro. 1989; 31 : 206-14 Cronk CE, Zemel BS, Charney EB, et al. Body composition in children with spastic quadriplegic cerebral palsy. Journal of Pediatrics. 1995; 126:833–9. Janet, et al. Development and application of a pediatric anthropometric evaluation system. 1999 Isaacs JS cialone, et al. growth in children with special health care needs a community nutrition pocket guide. 1997 Issacs JS cialone, et al. Dietetics in development and psychiatric disorders and pediatrics nutrition practice group of the American dietetic association and ross products division abbot laboratories. 1997 Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM, et al. Physical growth: National Center for Health Statistics percentiles. American Journal of Clinical Nutrition. 1979; 32:607–29. Stallings VA, Charney EB, Dvies JC, et al. Nutrition related growth failure of children with Quadriplegic CP. Dev Med Child Neurol. 1993; 35: 126-38 Stevenson RD, et al. Use of segmental measures to estimate stature in children with cerebral palsy. Archives of Pediatric and Adolescent Medicine. 1995; 149:658– 62. Hayes RP, Carter LV, Blackman JA, et al. Clinical correlates of linear growth in children with cerebral palsy. Developmental Medicine & Child Neurology. 1994; 36:135–42. Lisa J Samson-Fang MD, et al. Identification of malnutrition in children with cerebral palsy: poor performance of weight-for-height centiles. 2000; – volume - issue 03.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] Tables
Parameters
Mean (X ) SD
Age
8.5 ±2.5 (years)
Height
110 ±4.78 (cms)
Weight
15 ±3 (kgs)
Waist hip ratio
0.78 ±0.23
Table 1. Mean and standard deviation of the variables
ICC Intra rater 0.992 reliability Inter rater 0.991 reliability
Upper bound 0.985
Lower bound 0.996
P value
0.985
0.995
0.000
0.000
Table 2. ICC for Intra rater and Inter rater reliability
Figures
Figure 1. Skin Fold Calliper
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report]
Figure 2. Position for Measuring SFT of Triceps
Figure 3. Position for Measuring SFT of Calf
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report]
Figure 4. Position for Measuring SFT of Abdomen Corresponding Author 1
Suchi Umeshchandra Dubey (MPT student) Institutional Affiliation: - SBB College Of Physiotherapy, Ahmedabad, Affiliated To Gujarat University Address: - D-27, Birladham , Kharach , Kosamba [R.S], Bharuch [Dis.] – 394 120, Gujarat , India Telephone No. : - 91+ 9824552905 E-mail id:- dubeysuchi40@gmail.com 2 Sharaddha Jasmin Diwan (Lecturer, SBB Physiotherapy College, Ahmedabad, India) Address: - B/403, Sopan Flats, Nr. ICICI Bank, New C G Road, Chandkheda, Ahmedabad – 382 424, Gujarat, India Telephone No.:- 9824264617 E- mail id:- drshraddhadiwan@gmail.com 3 Binal A Gajjar (Lecturer, SBB Physiotherapy College, Ahmedabad, India) Telephone No.: - 9426768540 E-mail id: - gajjar_binal2228@yahoo.co.in © 2015 PGIP. All rights reserved.
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report]
Comparing Learned Skills in Physiotherapy with Actual Practice of Physiotherapist Dr. Faiza Sharif ¹, Dr. Hira Dilshad Ali ², Dr. Halima Shoukat ³
Abstract Background Physiotherapy is a relatively younger profession to have established as an
independent entity and discipline. Efforts are being pooled to identify appropriate training and curriculum to match the expected role after graduation. Current curricula being used are based on imported concepts, which may not be suitable to conditions in Pakistan. Objective To list and assess the gaps in training and expected role of a performing
physiotherapist. Study design Cross sectional study Inclusion criteria Physiotherapy graduates having BSc (Hons) degree in the previous one to three years of either gender and in practice of physiotherapy for at least 1 year working in both public and private sectors. Exclusion criteria Physiotherapists having gaps in the practice of physiotherapy after
qualifying and owners of the private clinics. Study settings Physiotherapy Department of Fatima Memorial Allied Health Faculty. Methodology The self administered questionnaire designed was answered by 100 purposively selected physiotherapists who had applied the learning of physiotherapy for at least 1 year in various institutions of Lahore. Results Anatomy, kinesiology/biomechanics, therapeutic exercises, electrotherapy &
actinotherapy and physiotherapy treatment were identified in varying levels to have been under stressed in training and more required to be practiced. The subjects which were over stressed included: physiology, medical physics, and pathology, pharmacology, medicine, surgery and research concepts. KEY WORDS: Learned skills, physical therapy, physical therapist
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] Introduction
In current situation there is a gap between the learned skills gained in physical
Physiotherapy profession has recently evolved from bachelor degree to doctoral level
profession.
attained
the
level
Physiotherapy of
has
autonomous
profession with direct access of the
therapy and actual practice of the physical therapist. Therefore, identification of this gap is essential for physical therapist practice.4 Physical therapy education in Pakistan
patients assuming full responsibility. Due
Different universities & colleges offer
to growing role of physiotherapy in health
degree in physical therapy in Pakistan to
and social systems, core competencies are
improve patient rehabilitation & quality of
needed in physical therapy practice.
health in the country. The students study
Physical
Anatomy,
therapists
consultants,
now
academicians,
work
as
supervisors,
evaluate patients in addition to traditional
Physiology,
Kinesiology,
Biochemistry,
Biomechanics,
Medical
Physics, Pathology, Therapeutic exercise,
1
treatment role . To fulfill all these roles,
Electrotherapy
&
the physical therapists require knowledge
Pharmacology,
Medicine,
and skills that should be attained during
Physiotherapy treatment, Biostatistics &
graduation. Due to diverse roles in health
Research Methods during their graduation.
care
of
Students are enrolled in this field without
therapy
gender discrimination at usually age of 18-
system
competence,
and the
importance physical
education needs some changes at the
20 years.
undergraduate and graduate levels and also
Like
any
new
Actinotherapy,
field,
Surgery,
physiotherapy
2
in continuing educational programs .
qualified
To gain the core competencies and
optimally utilized in health care system.
provision of evidence based physical
Some
therapy services, the profession has to
inadequate number of jobs in the public
meet the developments in research, science
sector, inadequate facilities provisions in
and technology. This can be achieved by
the
bringing change in academic curriculum so
opportunities in the private sector, minimal
that the physiotherapy graduates are
awareness
competent enough to provide health care
efficacy among general community for
of
personnel
these
reasons
physiotherapy
of
have
not
been
included
units,
physiotherapy
;
limited
services,
3
services .
support of other partners in the health care etc5.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 13
[Research Report] In this study the learned skills of a
actual practice. This exercise will identify
physiotherapist were determined according
some of the factors which could be
to the standards of the university from
modified at the faculty level and those at
which
the service delivery level in order to
they
graduated.
The
physiotherapistâ&#x20AC;&#x2122;s essential skills include
improve
assessment of the patients and planning
physiotherapy practice.
and carrying out individually designed treatment
for
physiotherapists
the
patients.
should
have
The
educational
status
of
Methods
good
Design: Cross sectional description study
communication skills and supportive with
based on qualitative parameters of training
patients. This was determined by two
and working skills.
methods: Setting: Physiotherapy Department of
1. Problem solving situations 2. Actual observations of patient care These were compared with the standard operational procedures designed keeping in mind the curriculum being followed at teaching institutions as prescribed by the
analyzed.
Physiotherapy
Rationale
After discussion with the various stake holders and the trainees, it was felt that there is a gap between what is pursued as curriculum and what required in the field practice is. Very little effort has been undertaken to investigate the obstacles to practice
related
to
physiotherapy in Pakistan. As a pioneer effort this study is being planned to correlate
Sample size: A sample of 100 was
Inclusion criteria:
b) Skill based
initially
to April 2014.
purposive sample
a) Academic cognitive knowledge
based
Duration: 4 months from December 2013
Sampling technique: Non probability
university and classified into two parts
evidence
Fatima Memorial Allied Health Faculty.
the
physiotherapy
academic training with ground realities of
graduates
having
BSc
(Hons) degree in the previous one to three years of either gender and in practice of physiotherapy for at least 1 year working in both public and private sectors. Exclusion criteria:
Physiotherapists
having
gaps
in
the
practice of physiotherapy after qualifying and owners of the private clinics were excluded. Data collection:
An exploration of all the performing physiotherapists
in
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Lahore
health
Page 14
[Research Report] institutions was conducted with the help of
how well were they covered or not covered
the University of Health Sciences Record
in relation to their need in practical life.
as well as of other universities of Lahore Five subjects were identified as under
granting BSc in physiotherapy.
stressed in training and used to a greater
Results
extent
in
professional
life.
These
assessments were obtained on Likert scale Out of 100 respondents 45 were males and 55 females. Their age ranged from 17 years to 40 years with a mean age of 27.9Âą3.8 years. Males were slightly of higher age than the females. Almost one third males were around 30 years of age while one third females were of 25 years of age.
and quantified in a logical order to calculate the final scale for each item (Table 1). Seven subjects were assessed as over stressed during training (Table 2). The respondents were asked to suggest reasons for inappropriate teaching strategy (Table 3). Following clinical skills were identified as under stressed in training and
Most of the respondents were in general
used to a greater extent in professional life.
practice (58%) , only 7% were involved in
These assessments were obtained on Likert
cardiopulmonary practice and almost same
scale and quantified in a logical order to
number were involved in neuromuscular ,
calculate the final scale for each item
teaching and pediatrics (12%,10%,13%
(Table 4). The respondents were asked to
respectively).
suggest reasons for mismatched skill training (Table 5).
Most of the respondents (70%) were graduates
of
Sciences
and
University the
Of
Health
remaining
(30%)
graduated from King Edward Medical University. More than one third (38.0%) were graduates of 2010 and only 8.0% were fresh graduates of 2012.
Discussion In developing the balance of course content, there is always a danger of squeezing the vital areas by the confidence building subjects. During course coverage there is also a need to elaborate the clinical
Respondents were asked to evaluate
skill training and application of different
carefully the 12 main components of
manual techniques of physiotherapy. This
training subjects and provide a scale of
is more pertinent in physiotherapy which is skill based and manual techniques
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 15
[Research Report] application. Lastly it is also a matter of
University
should
ensure
the
importance to consider the differential
availability of vital instruments and
geographical diversities in which the
equipments in various hospitals where
profession is to be practiced. Some of the
bulk of physiotherapists have to work.
procedures, knowledge and values may have to be adjusted in accordance with the
This study has identified some of the subjects as overstressed, simply because were
not
being
practiced
in
accordance with their coverage during training. Obviously, some of the subjects were considered as unnecessary because these were not going to be applied immediately after graduation. However their need for a later stage can hardly be disregarded. This invites a consideration of covering same area at a time when specially desired — a need for continued medical education.
Recommendations
Physiotherapists should develop its council
prevailing consumer values.
these
to
structure
ensure
and
proper
betterment
service of
the
physiotherapy profession Suggested modifications in training given by the participants
Less time should be given to those subjects who have little clinical use. More practical based and hands on training should be incorporated to master the students in clinical skills. Updated edition of some books
should
be
included
in
the
curriculum. Students should have practical demonstration of different modalities in clinical rotations. Physiotherapy students should
have
exposure
to
different
departments of the hospitals and given an opportunity to treat patients in final year of
University should create a committee of teachers from various institutions
their graduation. New topics in area of research should be explored.
who contribute their ideas in revising curriculum content and pattern of coverage.
Conclusion The role of the physical therapist is
Committee should meet periodically
expanding in response to the changing and
(at least after every 2 years) to update
complex needs of clinical practice as well
the recent advances in discipline of
as the expectations imposed by American
physical therapy.
physical
therapy
association’s
Vision
2020. New graduates in physical therapy
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 16
[Research Report] are expected to be prepared to fulfill
Service learning
multiple
Evidence based training
Clinical education
the role of the clinician in contemporary
Practice management skill training
physical therapist practice.
Reflective practice training
To fulfill different roles in health system,
Collaborative educational projects
professional
roles,
including
researcher, academician, administrator or in management, and to thoroughly assume
the physical therapists require knowledge
These will strengthen the role of the
and skills that should be attained during
physical
graduation. In current situation there is a
Ultimately,
gap between the learned skills gained in
transform the role of the physical therapist
physical therapy and actual practice of the
in clinical practice.
therapist this
in role
health
system.
expansion
will
physical therapist. Therefore, identification of the gaps in learned skills and actual
This investigation was worthwhile and
practice is essential for physical therapist6.
timely. Evidence, as well as the findings of
Participants in this study emphasize that
this study, identify that curricular change
the integration of new subjects like
is a process and is occurring7. Participants
musculoskeletal
therapy,
in
therapy,
recommendations for facilitating greater
neurodevelopment techniques during final
integration of advanced level skills in
year of undergraduate physical therapy
undergraduate physical therapy education.
education.
When faculty, students, and clinicians
and
manual
cardiopulmonary
this
study
provide
several
become less naïve and more informed, Participants suggested new teaching and
then role resistance will diminish, role
learning methodologies in order to make
dissonance
the student’s centered approach and to get
expansion will occur. Reframing will
effective
ultimately help to position and guide the
outcomes.
They
suggested
following methods to be included in
will
reconcile,
and
role
role expansion process.
teaching during undergraduate physical therapy education:
Simulated learning programs
Problem based learning
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 17
[Research Report] References
1.
2.
3.
4.
Johnson MP, Abrams SL. Historical perspectives of autonomy within the medical profession: considerations for 21st century physical therapy practice. J Orthop Sports Phys Ther. 2005;35(10):628-36. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet. 2010;376(9756):1923-58. Portney L, Watkins M. Foundations of clinical research: applications to practice. Prentice Hall, Upper Saddle River, NJ. 2008. Sharma K, Zodpey S. Need and opportunities for health management
5.
6.
7.
education in India. Indian journal of public health. 2010;54(2):84. Nilsen P, Bernhardsson S. Towards evidence-based physiotherapy-research challenges and needs. Journal of physiotherapy. 2013;59(3):143-4. Sharma K, Zodpey S. Need and opportunities for health management education in India. Indian journal of public health. 2010;54(2):84. Foord-May L. A facultyâ&#x20AC;&#x2122;s experience in changing instructional methods in a professional physical therapist education program. Physical Therapy. 2006;86(2):223-35.
Tables Sr no. 1
Subjects Anatomy
Coverage scale (%) 3.4
Practice scale (%) 3.8
Under stressed (%) 11.8
2
Therapeutics Exercises
2.1
3.1
44
3
Kinesiology & Biomechanics
2.5
3.1
25
4
Physiotherapy Treatment
3.1
3.8
22.5
5
Electrotherapy & Actinotherapy
2.3
3.1
34.7
2.7
3.4
27.6
Total
Table no. 1: Subjects assessed to have been covered with lesser stress than required in practice.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 18
[Research Report] Sr no.
Subjects
Coverage scale (%)
Overstressed (%)
1.5
Practice scale needed (%) 1.1
1
Medical physics
2
Surgery
1.3
1.2
7.7
3
Pathology
1.5
1.1
25.5
4
Pharmacology
1.1
0.9
18.1
5
Physiology/ Biochemistry
1.1
0.7
31.8
6
Medicine
1.5
1.2
19
7
Biostatistics & Research
1.2
0.8
33.3
1.3
1.0
23.1
26.6
Methodology Total
Table no 2: Subjects assessed to be well covered and underutilized in practice.
Serial no.
Major reasons
N%
1
Poor interest in the subjects
23.0
2
Too much time allocated
38.0
3
Too little time allocated
15.0
4
Not well covered
10.0
5
Not properly understood
8.0
6
Not well managed
6.0
Table no 3: Ascribed reasons for unsatisfied theory teaching
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 19
[Research Report] Sr no.
Types of skills
Coverage scale (%)
1
Musculoskeletal techniques
2.5
Practice scale used (%) 3.9
2
Therapeutic exercises
2.7
3.1
14.8
3
Electrotherapeutic techniques
3.2
3.8
18.7
4
Neurodevelopment techniques
1.4
2.1
50.0
5
Cardiopulmonary techniques
1.5
2.3
53.9
2.2
3.0
30.4
Total
Under stressed (%) 14.8
Table no 4: Skills assessed to have been covered with lesser stress than required in practice Serial Major reasons no. Poor interest in the skill training 1
% 18
2
Less time allocated
37
3
Not well covered
22
4
Teachers not well trained
12
5
Skill learning unsupervised
11
Table no 5: Ascribed reasons for unsatisfactory skill training Corresponding Author Dr. Faiza Sharif, Physical Therapist, DPT, BSPT Senior Lecturer at University of Lahore, Pakistan Lahore road behind national flour mills street # 3, house # 1, Sheikhupura E-mail address: faizasharifz@hotmail.com Mobile no.: 0321-4600797 2 Dr. Hira Dilshad Ali, Physical therapist E-mail address: hiraali_d@hotmail.com 3 Dr. Halima Shoukat, Physical Therapist, DPT, BSPT Lecturer at University of Lahore, Pakistan E-mail address: halima.shoukat@yahoo.com 1
Š 2015 PGIP. All rights reserved.
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy [Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 20
[Research Report]
Comparison of distance covered during 2 minute walk test and 6 minute walk test and its correlation with physiological cost index in elderly population Dr. Sweety Shah 1, Patel Roshni Hasmukhbhai2
Abstract Introduction Functional endurance is necessary for people to live independently. 6 minute
walk test (MWT) is used to assess walking distance in elderly, but can be both time consuming for the investigator and exhausting for elderly people. So shorter duration 2 MWT is used. Physiological cost index (PCI) is a simple tool used to measure energy expenditure during walking. This study investigated distance walked, test-retest reliability, and relationship between 2 MWD (minute walk distance) and 6MWD and PCI in elderly population. Objective The aim of this study was to correlate the 2 MWD and 6 MWD and find correlation with PCI in elderly population. Method A comparative study included 29
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 21
[Research Report] elderly people, conducted at college of physiotherapy, Ahmadabad. Informed written consent was taken. Participants were taken based on inclusion and exclusion criteria. Baseline Heart rate and Blood pressure were recorded for both 2 MWT and 6 MWT. Participants walked on 25 meter straight course of 2 minute period for 2 MWT. Rest for 30 minute was given and again same participants walked on 30 meter straight course of 6 minute for 6MWT. Distance covered in 2 MWT and 6 MWT was measured by measure tape. PCI was calculated by using fingertip oxymeter in both tests. Reliability of 2 MWD and 6 MWD were determined by retesting the same person on second and third day later. Post exercise HR and BP were taken. PCI was calculated by below equation. Level of significance was kept at 5%. Result The statistical analysis showed that test retest reliability of 6 MWD (ICC = 0.87, p<0.001), 2 MWD (ICC=0.998, p<0.001), spearman correlation test between 2 MWD and 6 MWD (r=0.501, p=0.021), between 6 MWD and 6 PCI (r=0.111, p=0.632), between 2 MWD and 2 PCI (r= 0.075, p=0.745). Conclusion Based on distance walked, reliability & correlation between 2 MWD & 6 MWD, 2 MWT is a moderate alternative to 6 MWT for indicating functional endurance in elderly population. Keywords: 2 MWT, 6 MWT, PCI, elderly population
Introduction
Society has recommended the 6 MWT and published
Functional endurance is necessary for people to live independently. Walk test, have been used since at least the 1970s to quantify functional endurance2. Walk test most widely used among the patients with pulmonary,2,3 cardiac diagnoses,4,5 patients with
neurological
amputation, renal,
11
9
problems,
6,7
circulatory insufficiency,
for
its
administration14. The duration of the 6 MWT renders its use impracticable in busy setting particularly if numerous elderly individuals need to be tested over a limited time span. Some individuals are unable or unwilling to complete the 6 MWT even with allowable standing rests,15 resulting
10
the null values. This fact has led to the use
12
and liver dieases . The test have
been utilized with community dwelling children,2,7
guidelines
and
adults.
Walk
tests
described in the literature range in duration from 1 to 12 minutes
2,7,13
, but the six
minute walk test is probably the most
and recommendation of shorter duration walk test most notably the 2 MWT15,8,16. 6 minute walk test (MWT) is used to assess walking distance in elderly, but can be both time consuming for the investigator and exhausting for elderly people. So
frequently used. The American Thoracic
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 22
[Research Report] shorter duration 2 MWT is used. Maximal
between 2 MWD (minute walk distance)
aerobic power is an important component
and
of physical fitness and often is used to
population.
measure the effect of physical exercise
Study protocol:
training.
assess
Study design: Comparative
cardiovascular capacity as well as the level
Study
It
is
also used to
of fitness in children and elderly people17.
6
MWD
and
oxygen
Inclusion criteria:
energy
elderly
Ahmedabad
physiotherapy college
and
in
Setting:
Heart rate has been used to estimate consumption
PCI
Sample size : 29
expenditure when it is not possible to
60 years and above
measure oxygen consumption. The energy
Stable conditioning
expenditure index cited in literature in
Co-morbidities
Physiological cost index (PCI) is a simple
Male and Female
tool used to measure energy 1990 by rose
Willing to participate
et al, is an index developed to use HR to
Exclusion criteria:
estimate the amount of energy used during
Cardiopulmonary problems
ambulation and calculation of the PCI.PCI
S.B.P. ≥180 and D.B.P≥100
was introduced by MacGregore and it is
Any surgeries of heart and lung
calculated by estimating the speed of
Osteoarthritis
walking and the increase in HR after the
Neurological problems
elderly people have walked a specified
Illness
distance at a self selected pace. The PCI,
Assistive device
19
an index of walking of efficiency, has been investigated for reliability and validity.
Methodology
The PCI has reliability (r= 0.843-0.944) and validity (r = 0.86). Energy efficiency during
exercise
and
walk
test
was
measured by O2 cost, PCI, and Baseline above beat index. PCI is a valid and reliable tool and is easy to use for measuring energy expenditure20. The aim of the study was to investigate distance walked, test-retest reliability, relationship
A comparative study included 29 elderly people,
conducted
physiotherapy,
at
college
Ahmedabad.
of
Informed
written consent was given. Participants were taken based on inclusion and exclusion criteria. Baseline Heart rate was measured by palpatory method and Blood pressure
was
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
recorded
with
Page 23
[Research Report] sphygmomanometer for both 2 MWT and
Resting heart rate (beats/min) / Walking
6 MWT. Participants walked on 25 meter
speed (meter/min).
flat, hard, long and straight course as far as possible without running over 2minute period for 2 MWT. Rest for 30 minute was given and again same participants walked on 30 meter flat, hard, long and straight
Materials used in the study: pulseoximeter, sphygmomanometer, timer, measure-tape, pencil, paper
Result
course as far as possible without running over 6 minute for 6 MWT. Distance covered in 2 MWT and 6 MWT was measured by measure tape. Subjects were asked to stop test if they have symptoms
Data analysis was done by using SPSS version 16.Mean age of the participants was 70.88 Âą4.798. There were 12 male and 17 female participants.
like chest pain, intolerable dyspnoea, leg
The statistical analysis showed that test
cramps, diaphoresis, staggering and pale
retest reliability of 6MWD (ICC = 0.87,
appearance. PCI was calculated by using
p<0.001), 2MWD (ICC=0.998, p<0.001),
fingertip oxymeter in both tests. Reliability
spearman correlation test between 2MWD
of 2 MWD and 6 MWD were determined
and 6MWD (r=0.501, p=0.021), between
by retesting the same person on second
6MWD and 6PCI (r=0.111, p=0.632),
and third day later. Post exercise HR and
between 2MWD and 2PCI (r= 0.075,
BP
p=0.745).
were
taken
for
assessing
the
hemodynamical stability. The 6 MWD and 2 MWD were carried out by counting the
Discussion
number of laps and distance .PCI was
This study documented the distance
calculated by below equation. To measure
walked by participants over 6 minutes
resting HR subjects rest in a chair for 7
during 6 MWT and 2 minutes during 2
min. Resting HR were recorded by taking
MWT, test-retest reliability of 2 MWT and
10 seconds HR for 2 minutes, and average
6 MWT and its correlation with distance
HR were taken. Post exercise HR was
covered in 2 minutes and PCI and
recorded by taking every 2 seconds HR for
minute and PCI.
6
10 seconds and average HR were taken. Level of significance was kept at 5%. PCI (beats/meter)
21
= Walking heart rate â&#x20AC;&#x201C;
In present study mean distance walked by elderly in 2 MWT is 158.24 meter, is more
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 24
[Research Report] than mean 2 MWT distance for older 8
adults in long term care .
Bowen et al established an average correlation coefficient (r=0.503 to 0.196)
Richard W Bohannon et al 2014, studied performance at 2 and 6 minutes of the 6
between O2 cost and PCI values in 5 children with spastic cerebral palsy24.
MWT, showed ICC for 6 minutes was
Present study showed that there was a
0.87 and ICC for 2 minutes was 0.998,
weak correlation between 6 MWD and 6
both are indicative of good reliability1.
PCI, 2 MWD and 2 PCI in elderly people
Present study showed excellent test retest
This result might be due to subjects with
reliability of 6 MWT and 2 MWT. This
limited aerobic capacity due to aging.
suggested that 2 minute walk test can be
Muscle performance is characterized by
used interchangeably of 6 minute walk test
strength and endurance. In elderly people,
in elderly people.
marked loss of muscle mass or decline in
Although the correlation between the 2 MWT and 6 MWT(r=0.501) is not similar to correlations reported by researchers comparing
2
MWT
and
6
MWT
performance among older adults in long 8
term care (r=0.930) .
cross â&#x20AC;&#x201C;sectional muscle area, significantly less strength in both peripheral and respiratory muscles. Decreased muscle mass and strength peripherally associated with a decrease in motor units may also reduce VO2 max with ageing25 Low exercise tolerance has been found in
Physiological cost index is a simple,
elderly people. Impaired skeletal muscle
functional and non invasive method and
performance is a strong predictor of low
found to be valid and reliable to measure
exercise capacity.
the physiological cost of walking22,23. Energy calculated
expenditure
traditionally
measuring
study included smaller sample size; more
oxygen
numbers of female, so shorter heights had
consumption which is required to collect
covered smaller distance. Individuals may
expired gases, but this method involves the
walk faster if they realize they will not
use
have to walk another 4 minutes. Present
of
by
is
This study had several limitations. Present
expensive
and
cumbersome
equipment which is unavailable in the
study
clinical environment.
consumption, blood pressure or perceived
So, PCI offers a
did
not
measure
oxygen
practical alternative.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 25
[Research Report] exertion over the course of 6 MWT and 2 MWT.
References Conclusion Study concluded that there is excellent test retest reliability between 6 MWD and 2 MWD. There is a moderate correlation found between 2 MWD and 6 MWD. There is a weak correlation between 6 MWD and 6 PCI, 2 MWD and 2 PCI. Based on distance walked, reliability & correlation between 2 MWD & 6 MWD, 2 MWT is a moderate alternative to 6 MWT for indicating functional endurance in elderly population.
Future Recommendation Similar study can be carried out in different population i.e. COPD patients, Children, more number of subjects.
Acknowledgement We would like to express our gratitude to all the elderly participants for providing us valuable information. We would give our humble thanks to our institution to provide us with all necessary resources and information that were needed throughout the course of study.
Conflict of Interest None declared
1.
Bohannon ,Richard W ,et al. Comparison of walking performance over the first 2 minutes and the full 6 minutes of the six minute walk test .BMC Research Note. 2014 ;volume 7 ,issue 1, 7:269 2. Mc Gavin CR,Gupta SP ,et al. Twelve minute walk test for assessing disability in chronic bronchitis. Br. Med J .1976 ;1: 822-823. 3. Leung ASY,Chan KK ,et al. Reliability ,validity and responsiveness of a 2 min walk test to assess exercise capacity of COPD patients. Chest .2006 ; 130 : 1119-1125 4. Bittner V,Weiner DH,et al .Prediction of mortality and morbidity with a 6 minute walk test in patients with left ventricular dysfunction JAMA. 1993 ; 270: 17021707 5. Cahalin L, Mathier MA,et al. The 6 minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.Chest. 1996 ; 110: 325-332 6. KosakM,Smith T,et al.Comparison of the 2-6 and 12 minute walk test in patients with stroke. J Rehabil Res Dev.2005 ;42 :103-108 7. Mc Dowell BC,Kerr C,et al. Validity of 1 minute walk test for children with cerebral palsy.Dev Med Child Neuro.2005 ;47 : 744-748 8. DM Connelly ,et al. Clinical utility of the 2 minute walk test for older adults living in long term care.Physiotherapy Canada.2009,volume 61,issue 2, pages 78-87 9. Brooks D, et al. The 2 minute walk test as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehabil .2001 ;82: 14781483 10. Montgomey PS ,Gardner AW,et al. The clinical utility of a 6 minute walk test in peripheral arterial occlusive disease patients . J Am GeriatrSoc.1998 ;46 : 706-711 11. FittsSS,Guthrie MR,et al. 6 minute walk by people with chronic renal failure .Assessment of effort by perceived exertion. Am J Phys Med Rehabil .1995;74: 54-58
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 26
[Research Report] 12. Carey EJ,SteidleyDE,Agel BA ,et al.6 minute walk distance predicts mortality in liver transplant candidates. Liver transpl .2010 ;16 : 1373-1378 13. Butland R JA, Prang J ,et al. 2,6 and 12 minute walking tests in respiratory disease. Br. Med J .1992 ;284 :1667-1608 14. ATS Statement : guidelines for the 6 minute walk test. AM J.RespirCrit Care Med .2002 ;166 : 111-117 15. Brooks D ,Davis AM ,et al.The feasibility of 6 minute and 2 minute walk tests in patients geriatric rehabilitation. Can J Aging .2007; 26 : 159-162 16. Brooks D, Parsons J,et al. The 2 minute walk test as a measure of functional capacity in cardiac surgery patients. Arch Phys Med Rehabil .2001 ;85: 1525-1530 17. UnnithanVB,Clifford C,et al. Evaluation by exercise testing of the child with cerebral palsy. Sports Med.1998 ;26 :239252 18. Astrand PO,Rodabl K,et al. Textbook of work physiology :Physiology bases of exercise .4 th ed. Champaign,3rd : Human kinetics,Inc ;2003. 19. Mac Gregor J,et al. The evaluation of patient performance using long term ambulatory monitoring technique in the domiciliary environment .Physiotherapy .1981;67(2) : 30-33 20. JaiyesminiAO,Fashkin OG,et al. Reliability of physiological cost index measurements department of
21.
22.
23.
24.
25.
physiotherapy. Afr J Med Sci.2007 ;36 (3) :229-234 Maggie J Bailey,et al. Reliability of physiological cost index measurement in walking normal subjects using steady state,non- steady state and post exercise heart rate recording .Physiotherapy.1995,volume 81,issue 10,pages 618-623 Thomas, Patricia,et al.Test â&#x20AC;&#x201C;retest reliability of 10 meter fast walk test and 6 minute walk test in ambulatory school aged children with cerebral palsy. Developmental medicine and child neurology. 2008;50: 367-370. GraghamRC,Smith NM,et al. The reliability and validity of the physiological cost index in healthy subjects while walking on 2 different tracks. Arch Phys Med Rehabil.2005.86;10: 2041-2046 . Bowen TR,Lennon N,et al. Variability of oxygen consumption measures in children with cerebral palsy. J PediatrOrthop 19 :pages- 133-6 Andrew C,Betik, et al .Determinants of VO2 max decline with aging: an integrated perspective. J. Applied Physiology, Nutrition and Metabolism. 2008; 33 : 130-140
Figures
Subject performing 2 MWT
Subject performing 6 MWT
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 27
[Research Report] Tables Variable 6 MWD 2 MWD 6 PCI 2 PCI
Mean 481.80 158.24 0.18 0.08
S.D. 66.531 37.323 0.048 0.029
Table 1 mean & standards deviation of variables (S.D.) Variable
Correlation coefficient(r) 0.501 6 MWD & 2 MWD 0.111 6 MWD & 6 PCI 0.075 2 MWD & 2 PCI Table 2 Descriptive data of the Subjects Distance Intraclass correlation(ICC)
p value (p) 0.021 0.632 0.745
95% Confidence interval
p value
Upper bound Lower bound 6 MWD
0.870
0.943
0.731
<0.001
2 MWD
0.998
0.999
0.995
<0.001
Table 3 Intraclass correlation values of distance (meter). Corresponding Author 1 Dr.Sweety Shah Lecturer, SBB Physiotherapy College, Ahmedabad, India Institutional affiliation:- SBB College of physiotherapy, Ahmedabad, Affiliated to Gujarat University Tel No: 9426349393 Residential Address: B-61 Soham Tower, Shyamal Cross Road, Satellite. Ahmedabad – 380 015. Gujarat. India. E-mail : sweeetyshah@yahoo.com 2 Patel Roshni Hasmukhbhai MPT (Cardiopulmonary) Student, SBB Physiotherapy College, Ahmedabad, India S.B.B. College of Physiotherapy, Ahmedabad, Affiliated To Gujarat University Tel no: (mob) 91+8980038819 C-40, Umiya Bunglows, Near Bhadreswar, Airport Road, Hansol, Ahmedabad – 382475. Gujarat. India. E-mail- drroshnipatel1990@yahoo.com © 2015 PGIP. All rights reserved
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy [Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 28
[Research Report]
Relation of PostOperative Complications of Mastectomy in Patients of Breast Cancer with Obesity Arooj Fatima DPT 1*, Mehr-un-Nisa DPT 2
Abstract Objectives The purpose of the study is to evaluate the relation of post-operative
complications of mastectomy with obesity and to find out the incidence of these complications Methodology This cross-sectional study was conducted at Mayo Hospital, Lahore and included 100 post-mastectomy patients. Interview based questionnaires were filled from the subjects. After data collection, body mass indexes (BMI) of the subjects were calculated by taking their heights and weights. The girth measurement of both arms was measured by measuring tape, to note the occurrence of lymphedema. Results The result findings showed that 16% females developed lymph edema, 17% seroma,
10% frozen shoulder, 39% muscle weakness and 18% developed no complications. The odds ratio for developing lymphedema increases with obesity (OR=1.281, p=0.676), for seroma (OR=2.205, p=0.1485), for muscular weakness (OR=1.105, p=0.8282), for frozen shoulder (OR=0.1923, p=0.1784). Conclusion This study shows that the obesity is related to the occurrence of post-operative
complications in patients after mastectomy.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 29
[Research Report] Key-words: Breast cancer. Mastectomy. Obesity.
Introduction
Lymphedema
is
a
troublesome
complication
that
A modified radical mastectomy (MRM) is
mastectomy.
Lymphedema
a procedure in which whole breast is
managed
may
effectively
occur
after
can
when
be
diagnosed
removed, including the skin, areola,
properly and early. Lymphedema can be
nipple, and most axillary lymph nodes; the
followed by recurrent infections, non-
pectoralis major muscle is spared.
6
1,2
Various complications can develop after mastectomy in patients with breast cancer such as wound infections, but it causes less
healing wounds, pain, difficulty with daily life activities, and distress or discomfort. Risk of wound infections increases after modified radical mastectomy (MRM).7
morbidity.3 Increased body mass index
Therefore, the objective of this study was
(BMI) has been be associated with a poor
to
prognosis in patients of breast cancer.4
postoperative
Several studies have shown that obesity is associated with increased risk of breast cancer in post-menopausal women.5 The relation between obesity and breast cancer
identify
the
risk
factors
complications
in
for breast
cancer patients, and to evaluate incidence of
post-operative
complications
of
mastectomy in females with breast cancer.
Methodology
may be affected by the phase of life in which a woman becomes obese. The increased risk is thought to be due to increased levels of estrogen in obese women. After menopause, when the ovaries stop releasing hormones, adipose tissue becomes the important source of
Study design: Cross-sectional study. Study setting and duration: It was a timebased study conducted at Department of Oncology, Mayo Hospital, Lahore over the period of six months. Sample Size: A sample of 100 was selected. Sampling technique: Patients were selected
estrogen. So, increased estrogen levels in
by convenient sampling.
post-menopausal females lead to rapid
Sample Selection Criteria
growth of breast tumors. These evidences
Inclusion Criteria: In this observational
suggest that there might be some relation
study, 100 female patients with breast cancer
of
treated
obesity
with
post-operative
complications after mastectomy.
with
mastectomy
followed
by
chemotherapy or radiotherapy comprised the study population.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 30
[Research Report] Exclusion criteria: Patients with local
obese. Overall, 82% (n=82) patients
recurrence and those having lymphedema due
developed post-operative complications
to local recurrence are excluded.
after surgery. The hospital frequency of
Data Collection Procedure: Data was
lymph edema was 16, seroma 17, frozen
collected by the interview based profoma
shoulder 10 and muscle weakness 39.
from the subjects by convenient sampling over the period of six months. After
The odds ratio for developing lymphedema
collection of data, BMI of the patients
increases
were calculated by taking their heights and
confidence
weights. The girth measurement of both
p=0.676),
arms was measured by measuring tape,
confidence
15cm above and below the olecranon
p=0.1485), for shoulder girdle muscular
process
weakness
to
note
the
occurrence
of
with
obesity
(OR=1.281,
interval=0.4001--4.101, for
seroma
(OR=2.205,
interval=0.742--6.551,
(OR
was
1.105=confidence
lymphedema.
interval=0.4488--2.72,
Statistical analysis:
frozen shoulder (OR=0.1923, confidence
Using SPSS 16, data had been managed
interval=0.02305--1.605, p=0.1784).
and analyzed and the p-value < 0.05 was considered statistically significant. Data was
analyzed
by using
odds
p=0.8282),
for
Discussion
ratio,
The purpose of the study was to determine
confidence intervals and p-values. The
the relation of obesity with post-operative
quantitative data had been presented in the
complications of mastectomy. The current
form of frequency tables and mean
literature related to larger breast size and
standard deviation. The qualitative data
the stage of breast cancer is controversial.
had been presented in form of frequencies
One of the studies related to obesity as a
and percentage. Odds ratio had been used
risk factor for development of breast
to find association between obesity and
cancer suggested that larger size of the
post-operative complications. Computer
breasts is more common in obese which
software used was windows 7.
are associated with poor prognosis of
Results
breast cancer in post-menopausal females.4 Our study is conducted to find the relation
In this study, 100 patients received
of
obesity
surgery, of whom 27% (n=27) subjects
complications.
with
post-mastectomy
were obese and 73% (n=73) were non-
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 31
[Research Report] Epidemiological studies show that obesity
Conclusion
which is calculated by the body mass index
(BMI)
is
a
risk
factor
for
postmenopausal breast cancer.5 A study conducted in Norway confirmed the protective effect of obesity for breast cancer in pre-menopausal women, but not
This study shows that the obesity is related to
the
occurrence
of
post-operative
complications in female patients after mastectomy.
Recommendations
for those females who have a family history of breast cancer.8
More studies should be conducted to find
The results showed that among the post-
significant
mastectomy patients, obese have 1.28
complications
times
mastectomy patients in order to reduce the
more
chance
of
developing
lymphedema, 2.205 times more chance of developing seroma, 1.105 times more risk
association and
between obesity
the
among
complications in them.
Acknowledgement
of developing shoulder girdle muscular weakness and 0.1923 times more chance
Our special thanks to Prof. Dr. Shehryar,
of developing frozen shoulder. It indicates
Head of Oncology Department, Mayo
there is strong association between these
Hospital, Lahore for his guidance and
complications and obesity in this study
supervision.
population. But there is no statistical significance found in association between
References
(for
1. Cotlar AM, Dubose JJ, Rose DM. History
lymphedema p=0.676, seroma p=0.1485,
of surgery for breast cancer: radical to the sublime. Curr Surg. May-Jun 2003;60(3):329-37.
obesity
and
the
complications
muscular weakness p=0.8282, and for
2. Loukas M, Tubbs RS, Mirzayan N, Shirak
frozen shoulder p=0.1784). Studies were conducted to find that obesity is
related
to
the
development
and
prognosis of breast cancer but more studies should be conducted to find significant association between these complications and obesity among mastectomy patients, as the literature regarding it is limited.
M, Steinberg A, Shoja MM. The history of mastectomy. Am Surg. May 2011;77(5):566-71. 3. Vitug AF, Newman LA: Complications in breast surgery. Surg Clin North Am 2007, 87(2):431-51. 4. Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev. 2006; 7:333-40. 5. Cleary MP, Maihle NJ. The role of body mass index in the relative risk of developing premenopausal versus postmenopausal breast cancer. Proc Soc Exp Biol Med 1997;216:28â&#x20AC;&#x201C;43. 6. Vinton AL, Traverso LW, Jolly PC. Wound complications after modified
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 32
[Research Report] 7.
radical mastectomy compared with tylectomy with axillary lymph node dissection. Am J Surg 1991;161:584-589. Kroner K, et al. Long-term phantom breast syndrome after mastectomy. Clin J Pain 1992;8:346-354. Weiderpass E, Braaten T, Magnusson C, Kumle M, Vainio H, Lund E, Adami HO.
A prospective study of body size in different periods of life and risk of premenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 2004;13:1121â&#x20AC;&#x201C;1127
Tables LE
LE
S
S
MW
MW
FS
FS
Obese
5
22
7
20
11
16
1
26
Non-obese
11
62
10
63
28
45
9
45
Table 1 Frequency of post-mastectomy complications in obese (n=27) & non-obese (n=73) *LE: lymphedema LE: non-lymphedema S: seroma S: non-seroma MW: muscular weakness MW: no muscular weakness FS: frozen shoulder FS: non-frozen shoulder Complications
Odds ratio
C.I
p-value
Lymphedema
1.281
0.4001,4.1011
0.676
Seroma
2.205
0.7421,6.5511
0.1485
Weakness of muscles
1.105
0.4488,2.721
0.8282
Frozen shoulder
0.1923
0.0230,1.6051
0.1784
Table 2: Descriptive statistics showing odds ratio, confidence intervals, p-values of postmastectomy complications in patients (n=100) *p=value <0.05 is considered significant
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy
Corresponding Author: Arooj Fatima, Dr. of Physiotherapy Physiotherapy Lecturer at University of Lahore, Transitional-doctor of Physical therapy, KEMU King Edward Medical University, Lahore, Pakistan, 98-H, DHA-EME sector, Lahore, Pakistan E-mail address: aruj43@hotmail.com, Mobile no.0341-4391882 Mehr-un-Nisa, Dr. of Physiotherapy, Clinical physiotherapist at National hospital, Faisalabad 13-A, Rose lane, Ayesha block, Abdullah gardens, Canal road, Faisalabad, E-mail address: mehrnoman@gmail.com Mobile no.0321-7204777 Š 2015 PGIP. All rights reserved.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 33
[Research Report]
Effects of Aerobic Dance Exercises versus Strength Training Exercises on Body Composition Parameters in Adolescent, Adult and Middle Aged Overweight / Obese Females Safa Moeed 1
Abstract Objective: The objective of this study is to determine which exercise program was more
effective for weight loss in the population under study. Design: The topic under research is a Comparative Observational Study. Setting: The study was conducted in two gym centers (Shapes, Fitness Planet). Study Duration: 12 weeks. Procedure: Total 50 subjects participated in the study in which 25 belonged to Aerobic group and 25 to Strength Training group. Pre and Post-test anthropometric measurements such as Body Weight, Height, Body Mass Index (BMI) and Waist, Hip, Forearm and Wrist Circumference were recorded by the
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 34
[Research Report] researcher of participants of both the groups. All of these measurements were assessed by using Revive Health Assessment Tool which calculated the body fat% and lean body mass% of each participant. Results: A significant decrease (p<0.05) was shown in the Body Fat percentages of the Aerobic group (pre-test 27.48±0.66, post-test 27.25±0.68) and the Strength Training group percentage (pre-test 27.67±0.67, post-test 27.58±0.66) but the percentage was higher in Aerobic group (p = 0.002) as compared to the Strength training group (p = 0.01). The Lean Body Mass percentages also decreased in Aerobic group (pre-test 112.21±10.49, post-test 109.93±9.97) but increased in the Strength Training Group (pre-test 116.16±14.90, post-test 116.21±14.37). Conclusion: Aerobic Training proved to be more effective than Strength Training for the reduction of fat and body mass, however, if increasing muscle mass and strength is the goal, a program including Strength Training can also be incorporated. Key words: Aerobic Exercises, Body Fat Percentage, Cardiovascular diseases, Revive
Health Assessment Tool.
Introduction
improving or maintaining physical fitness, physical performance, or health1.
Physical activity can be described as “any bodily
movement
contraction
of
by
the
Physical inactivity is a major public health
muscle
that
problem,
produced
skeletal
and
compelling
evidence
increases energy expenditure above a basal
suggests that it is a contributing factor in
level”. It generally refers to the subset of
several chronic diseases and conditions.
physical activity that enhances health.
Recognition of the health and functional
Exercise is the “subcategory of physical
hazards of a sedentary way of life has led
activity
numerous groups to promulgate public
that
is
planned,
structured,
repetitive, and purposive in the sense that
health
the improvement or maintenance of one or
activity. The modern way of life, which
more components of physical fitness is the
limits physical movements, leads to,
objective”.
“Exercise”
“Exercise
especially in the case of people living in
training”
frequently
used
the city, an increase in cardiovascular
and are
recommendations
diseases
physical activity performed during leisure
hypertension, and the like), diseases of the
time
intestines, an increase in body weight, an
the
primary
purpose
of
heart
physical
interchangeably and generally refer to
with
(myocardial
for
attacks,
increase in the BMI, an increase in body
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 35
[Research Report] fat2 and the high rate of obesity is one of
brisk walking, leisure cycling, swimming,
the most serious health risk factors3.
aqua-aerobics and slow dancing. Aerobic exercises that are typically performed at a
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health, leading to reduced life expectancy and/or increased health problems4, 5.
higher
intensity
and,
therefore,
are
recommended for persons who exercise regularly
include
jogging,
running,
aerobics, stepping exercise, fast dancing and elliptical exercise. The dosage of
As obesity is the leading cause of a
aerobic exercise is a function of the
number of health conditions, practitioners
frequency (F), intensity (I) and duration
and other health care workers are more
(time, T) of the exercise performed. In
concerned to promote physical fitness
combination with the type (T) of exercise
among
exercise
performed, these factors constitute the
prescription. Different types of physical
basic components of the core principle of
activities work on different health related
exercise prescription (the FITT principle)
individuals
through
components of physical fitness of which two of them will be included in this study; Aerobic Dance Exercise and Strength Training Exercise. Both are considered an essential component of the weight loss program along with diet modification.
6
.
Strength Training Exercise
Strength
Training
exercises/Strength
Training is defined as a systematic procedure of a muscle or muscle group lifting, lowering or controlling heavy loads
Aerobic Exercise
(resistance) for a relatively low number of
â&#x20AC;&#x153;Any activity that uses large muscle
repetitions or over a short period of time7,
groups, can be maintained continuously,
8, 9
. These exercises enable the muscles to
and is rhythmical in nature can be regarded
do more work than they are accustomed
as an aerobic exerciseâ&#x20AC;?. In general, aerobic
(i.e., to overload the muscles). Strength
exercises requiring little skill to perform
Training exercises count if they involve a
are more commonly recommended for all
moderate to high level of intensity and
adults
Aerobic
work the major muscle groups of the body:
exercises that require minimal skills and
the legs, hips, back, chest, abdomen,
can be easily modified to accommodate
shoulders, and arms. Strength training
individual physical fitness levels include
exercises, including weight training, is a
to
improve
fitness.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 36
[Research Report] well-known
example
muscle-
Until the mid-1980s, epidemiologic studies
strengthening exercise which could be
used self-reported occupational or leisure-
prescribed using the FITT framework. The
time physical activity as the exposure
dosage of strength training exercise is a
variable. Because self-reports of complex
function of the frequency, intensity and
and repetitive lifestyle behaviors are, of
volume
performed.
necessity, crude and imprecise, it is
Individuals who are new to strength
difficult to specify with confidence the
training
receive
exact dose of exercise, in terms of type,
instructions from trained personnel before
amount, and intensity, that is associated
engaging in these exercises10, 6.
with observed health benefits. Later
of
the
of
exercise
exercises
should
studies used cardiorespiratory fitness, an Jeremy Morris, in London, is credited with carrying
out
investigations
the of
first
the
systematic
health
hazards
associated with a sedentary lifestyle, the outcome of which was coronary heart disease (CHD). In seminal reports from prospective transport
investigations workers
and
servants, Morris et al11,
of
London
British 12
civil
documented
higher rates of CHD in men who were sedentary on the job or during leisure-time than in men who had higher levels of job or leisure-time physical activity. These observations have been confirmed and
objective and reproducible index of recent physical activity habits, as the exposure in studies of the relation of exercise to health outcomes17,
18
. Although these latter
investigations had the advantage of an objective
measure
of
exposure
and
generally showed stronger associations with health outcomes than did studies with self-reported physical activity as the exposure, they are not definitive in describing the specific amounts and types of regular physical activity required to produce
protective
levels
of
cardiorespiratory fitness.
extended by others, notably Paffenbarger et al13,
14
. At present there are dozens, if
Karnoven et al19 are generally credited
not hundreds, of published reports in the
with having carried out the first controlled
peer-reviewed literature documenting the
exercise training experiment by evaluating
health hazards of an inactive way of life
the effects of 2 different intensities of
and the benefits of being physically
exercise
active15, 16.
capacity. In that classic study, 7 male medical
on
adaptations
students
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
in
completed
exercise
a
4-wk
Page 37
[Research Report] training period, with some training at 60%
individualization of the program27. Most
of their heart rate reserve [0.6 (maximal
recently, the positive health benefits of
heart rate â&#x2C6;&#x2019; resting heart rate) + resting
physical
heart rate] and others training at â&#x2030;Ľ70% of
recognition attributable to the Surgeon
their heart rate reserve. Those who trained
General's report on health and physical
at â&#x2030;Ľ70% of their heart rate reserve showed
activity.
activity
have
gained
high
greater improvement in physical work capacity than did those who trained at
In Pakistan, prevalence of obesity (BMI > or = 25) in 25-44 year olds in rural areas
60%.
was 9% for men and 14% for women; in According to previous studies, resistance
urban areas, prevalence was 22% and 37%
training has been shown to be more
for men and women, respectively. For 45-
20,
64 year olds, prevalence was 11% for men
23
,
and 19% for women in rural areas, and
, and
23% and 40% in urban areas for men and
cross-
women, respectively28.
effective for increasing basal metabolism 21
, bone mineral density (BMD)22,
muscle strength and power24, muscle
and
connective
tissue
25
sectional area26. Overweight and obesity lead to adverse The adaptational changes and health
metabolic effects on blood pressure,
implications of strength training exercise
cholesterol,
are very dynamic and variable to each
resistance. Risks of coronary heart disease,
individual. For long-lasting change, there
ischemic stroke and type 2 diabetes
needs to be a systematic administration of
mellitus increase steadily with increasing
a sufficient stimulus, followed by an
body mass index (BMI), a measure of
adaptation of the individual, and then the
weight relative to height. Raised body
introduction of a new, progressively
mass index also increases the risk of
greater stimulus. Whether training for
cancer of the breast, colon, prostate,
sports performance or health enhancement,
endometrium, kidney and gall bladder.
much of the success of the program will be
Mortality rates increase with increasing
attributable to the effectiveness of the
degrees of overweight, as measured by
exercise prescription in manipulating the
body mass index29.
triglycerides
and
insulin
progression of the resistance stimulus, the variation in the program design and the
To achieve optimum health, the median body mass index for an adult population
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 38
[Research Report]
should be in the range of 21 to 23 kg/m2, while the goal for individuals should be to maintain body mass index in the range
18.5 to 24.9 kg/m2. There is increased risk
of co-morbidities for body mass index 25.0 to 29.9, and moderate to severe risk of co-
They were adolescent, adult and middle aged overweight/obese females. They didn’t have any mental disability. They were willing to volunteer their information for this study.
Exclusion Criteria:
morbidities for body mass index greater
than 3029.
Materials and Methods
Male individuals. Females who were not overweight/obese. They had any mental disability. They were older than 65 years.
Study Design:
Data Analysis Technique
The topic under research is a Comparative
The 16th version of SPSS, statistical
Observational Study.
software was used for the analysis of the
Study Setting:
collected data.
The study was conducted in two gym
Data Collection Instrument
centers (Shapes, Fitness Planet).
The instruments used for data collection
Study Duration:
was weight machine, measuring tape and
The study was conducted over a time
height measuring scale. Revive Health
period of 12 weeks.
Assessment Tool (a software which helps
Sample Size:
to determine the body fat and lean body
A total of 50 participants were enrolled in this study.
mass
percentages
and
the
risk
of
cardiovascular diseases in an individual)
Sampling Technique:
and
The sampling technique used for this study was paired samples t-test.
a
modified
Health
Screening
Questionnaire along with the consent form was also used.
Study Group:
Adolescent,
adult
and
middle
aged
Methodology
overweight/obese females were included in this study only if they fulfilled the inclusion criteria.
Participants:
50 out 58 participants completed the training program and participated in the
Sampling Criteria:
initial and final testing. Five participants
Inclusion Criteria:
dropped out from the Aerobic group and
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 39
[Research Report] three from the Strength training group.
on diet modifications as well. The subjects
Participants dropped out from the Aerobic
of both the groups voluntarily gave their
group due to lack of motivation to exercise
consent to participate in the study and
and lack of availability to participate in the
signed consent forms.
study; three participants in the strength training group dropped out because they could not meet the follow-up criteria. Both the Aerobic and the Strength training exercise
group
comprised
of
25
participants each. The participants were allowed to choose their exercise group according to their interest. The subjects of the Aerobic group participated in the aerobic dance exercises to music program while
the
Strength
training
group
performed strengthening exercises with different equipment in the gym. The participants of both the groups entered the training programs after complete physical examination and the approval of their respective
physician.
The
recruited
participants were not suffering from any chronic illness nor did they have any obstructions to the locomotor system which could limit their range of motion during the realization of the exercise programs. During the course of the exercise programs, the subjects did not participate in any other organized forms of physical activity. They were advised to continue their respective mode of training exercise and were given some instructions
Procedure:
The initial testing took place before the beginning of the training program and the final testing was performed after 12 weeks of intervention. The effects of both the training programs on body composition were studied on the basis that how the training affected their body fat percentage and lean body mass percentage. A modified Health Screening Questionnaire along with consent form was filled by the participants
and
anthropometric
measurements such as Body Weight, Height, Body Mass Index (BMI) and Waist,
Hip,
Forearm
and
Wrist
Circumference were recorded by the researcher. Body weight was measured in kilograms by a weighing machine which was later converted to pounds. Body height was measured in feet by using a height measuring scale. To calculate the values of BMI, a standard procedure based on the formula BMI = Body Weight [Kg]/Body Height [m²]. The waist, hip, forearm and wrist circumferences were measured in inches by using an inelastic measuring tape. All of these measurements were assessed by using a software named
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 40
[Research Report] Revive Health Assessment Tool. This tool
Lean Body Mass percentage (pre-test
calculated the body fat% and lean body
112.21±10.49,
mass% of each participant.
were numerically smaller in relation to the
Participants of both the Aerobic group and the Strength Training group performed the exercises for 60 minutes per day for 3-6 days/week30, 31. The strengthening workout was performed using different weights and gym equipment.
initial
post-test
measuring.
109.93±9.97)]
However,
for
the
Strength Training group, the calculated values of the variables [(Body Weight (pre-test
160.66±20.85,
post-test
160.31±20.13), BMI (pre-test 28.29±3.92, post-test
28.22±3.79)
,
Body
Fat
percentage (pre-test 27.67±0.67, post-test
Statistical Analysis:
27.58±0.66)] were also decreased as
The statistical analysis of the data was
compared to the initial measuring, except
prepared by using SPSS v.16. Descriptive
for the percentage of Lean Body Mass
statistics were collected of all the data.
(pre-test
Paired
116.21±14.37)
sample
comparison Qualitative
t-test
was
between data
was
the
used
for
groups.
evaluated
via
116.16±14.90, which
post-test
had
increased,
although the increase was not statistically significant.
There
was
a
significant
frequency percentage and bar charts.
decrease in the Body Fat percentages in
Quantitative data was evaluated by taking
both
mean ± SD.
percentage was higher in Aerobic group (p
the
groups
(p<0.05)
but
the
= 0.002) as compared to the Strength
Tables can be viewed here.
training group (p = 0.01).
Results Discussion The results of the measuring after the completion of the study have, for the subjects of the Aerobic group, indicated that the calculated values of all the variables
[Body
154.80±15.03, BMI
(pre-test
Weight
(pre-test
post-test 151.18±14.39), 28.0±2.15,
post-test
26.45±4.88), Body Fat percentage (pre-test 27.48±0.66, post-test 27.25±0.68) and
For some time we have been interested in how much exercise and what types (modes) are most beneficial for acquiring health effects, cognizant of the fact that not any one amount or type of exercise is likely to be best for every health benefit. Of considerable interest to both the general public and the scientific community are the
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 41
[Research Report] control of weight gain and the extent of
increase in the intake of calories. Exercises
weight
body
increase the ability to use fat and
composition induced by exercise training.
carbohydrates with an increase in fat
This research study provided a unique
reduction, which primarily takes place
opportunity to investigate the relative
during low and medium intensity exercise,
benefits of Aerobic training (AT) when
as was the case in our study. During high
compared with the Strength training (ST)
intensity exercise, it is the carbohydrates
particularly on Body Fat and Lean Body
that are used as the primary energy source.
loss
and
change
in
mass. The main findings of the study were following: (1) Body Fat percentage was decreased in both the Aerobic training and Strength training groups however the decrease was more significant in the Aerobic training group. (2) Lean Body Mass percentage decreased in Aerobic training group but increased in the Strength training group however the increase was not significant. While the two modes
of
exercise
produced
almost
statistically similar changes in body fat percentage, these changes were driven by different mechanisms, where ST increased lean body mass and AT decreased fat mass. The mechanisms which might possibly lead to the decrease in body fat during the realization of Aerobic training which leads to lipolysis, are most probably caused by the increased consumption of energy, thus reducing body fat by using it as the primary energy source, which in turn would not be compensated by a further
These data are supported by other findings that indicate AT significantly reduced visceral adipose tissue more than ST and trended toward the same result in liver fat change32. Additionally, the present study suggests
that
significantly syndrome
AT
trended
improving score
better
toward metabolic
than
ST33.
Furthermore, a recent meta-analysis of aerobic vs. resistance training effects on visceral fat concludes that there is a trend (P 0.08) toward a greater reduction in visceral fat with AT when compared with ST34. Physical exercise programs, during which the subjects are active for less than 30 minutes, three times a week, lead to small or no changes in body mass and body composition35. What this generally means is that it is necessary for the bout of exercise to last at least 30 to 45 minutes, and for the subject to exercise at least three times a week36.
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
Page 42
[Research Report] Our results confirm Gubiani & Pires Neto
Conclusion
(2006) viewpoint that aerobic dance training programs to music has significant influence (p<0.05) on the reduction of skinfolds, the regional and overall sum of skinfolds, percentage of body fat and body weight. Varess et al. (1990) have proven in their research that programmed physical activity can contribute to quantitative and qualitative changes to the anthropometric characteristics of the body, especially a decrease in volume and skinfolds.
The
data
conclusions.
support
the
Although
it
following was
more
effective for lean body mass gains, Strength Training did not significantly reduce either fat mass or total body mass. Aerobic Training was more effective than Strength Training for the reduction of fat and body mass in adolescent, young and middle aged overweight/obese females. If increasing muscle mass and strength is the goal,
a
program
including
Strength
According to another finding, Aerobic
Training is required. However, if a
training lowered cardiovascular activity
comparison is made, it appears that
levels during psychological stress and
Aerobic Training alone is the optimal
recovery in healthy young adults, implying
mode of exercise for reducing fat mass and
a
total body mass and hence the risk of
protective
role
against
age-related
increases in coronary heart disease for
cardiovascular diseases as well.
individuals who adopt aerobic exercise early in life and maintain the behavior across the life span37. It was also concluded from a study that Aerobic exercise can improve mental health and enhance
life
women
by
quality
in
middle-aged
reducing
depression
38
symptoms . These data taken together and combined
Acknowledgements I am extremely grateful for the guidance and support of Mr. Junaid Ijaz gondal, Mr. Mustafa Qamar, Mr. Rehan Khan, Mr. Moeed Ahmed and Mr. Naeem Khan.
References 1.
with the knowledge provides compelling evidence that AT is the optimal mode of exercise for improving body fat amount.
2.
Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington (DC); US Department of Health and Human Services; 2008 Hass, C. J.; Feigenbaum, M. S. & Franklin, B. A. Prescription of resistance
[Journal of Physiotherapy & Sports Medicine][Volume 4][Issue 1][June 2015]
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[Research Report] training for healthy populations. SportsMed., 31(14):953-64, 2001. 3. Saris, W.; Blair, S.; Van Baak, M.; Eaton, S.; Davies, P.; Di Pietro, L.; Fogelholm, M.; Rissanen, A.; Schoeller, D.;Swinburn, B.; Tremblay, A.; Westerterp, K. R. & Wyatt,H. How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement. Obes. Rev., 4(2):101-114, 2003 4. The World Health Report 2000- Health systems improving performance. Web address: http://www.who.int/whr/2000/en/ 5. Haslam DW, James WP (2005). "Obesity". Lancet 366 (9492): 1197– 209. doi:10.1016/S0140-6736(05)674831. PMID 16198769. 6. Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010 7. Brosky, JA, Wright, GA: Training for muscular strength, power andendurance and hypertrophy. In Nyland, J (ed) Clinical Decisions inTherapeutic Exercise: Planning and Implementation. Pearson Educa-tion, Upper Saddle River, NJ, 2006, pp 171–230 8. Bryant, CX, Peterson, JA, Graves, JE: Muscular strength andendurance. In Roitman, JL (ed) ACSM’s Resource Manual for Exercise Testing and Prescription, ed 4. Lippincott Williams & Wilkins,Philadelphia, 2001, p 460 9. Fleck, SJ, Kraemer, WJ: Designing Resistance Training Programs, ed2. Human Kinetics, Champaign, IL, 1997. 10. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report,2008. Washington (DC); US Department of Health and Human Services; 2008. 11. Morris JN, Crawford MD. Coronary heart disease and physical activity of work: evidence of a national necropsy survey. Br Med J 1958;2:1485–96. 12. Morris JN, Clayton DG, Everitt MG, Semmence AM, Burgess EH. Exercise in
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dieting individuals. Journal of translational medicine. 2012;10(1):237. Rhodes EC, Martin AD, Taunton JE, Donnelly M, Warren J, Elliot J. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. Br J Sports Med.2000;34:18–22. Romero-Arenas S, Blazevich AJ, Martinez-Pascual M, Perez-Gomez J, Luque AJ, Lopez-Roman FJ, Alcaraz PE. Effects of high-resistance circuit training in an elderly population. Exp Gerontol.2013;48(3):334–340. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle JAMA. 1990;263(22):3029–3034 Lexell J, Downham DY, Larsson Y, Bruhn E, Morsing B. Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles. Scand J Med Sci Sports. 1995;5(6):329–341 Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training on older adults. Sports Med.2004;34(5):329–348 Kraemer, W. J. (1994). General adaptations to resistance and endurance training programs. In T. Baechle (Eds.), Essentials of strength training and conditioning (pp. 127-150). Champaign: Human Kinetics. J Pak Med Assoc. 2002 Aug;52(8):3426.The obesity pandemic--implications for Pakistan. Nanan DJ1. World Health Organization (2000). Technical report series 894: Obesity: Preventing and managing the global epidemic. (PDF). Geneva: World Health Organization. Fitness Blender Total Body Cardio Workout by Daniel Alexander and Kelly Antonio (October 2010). Retreived from http://www.fitnessblender.com/ ACSM Guidelines for Exercise Testing and Prescription, 6th Edition, 2000. Sigal RJ, Kenny GP, Boule NG, Wells GA, Prud’homme D, Fortier M, Reid RD,
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Tulloch H, Coyle D, Phillips P, Jennings A, Jaffey J. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial.[see comment][summary for patients in Ann Intern Med. 2007 Sep 18;147(6):I16; PMID: 17876015]. Ann Intern Med 147: 357–369, 2007. Bateman LA, Slentz CA, Willis LH, Shields AT, Piner LW, Bales CW, Houmard JA, Kraus WE. Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise STRRIDE-AT/RT). Am J Cardiol 108: 838 –844, 2011 Ismail I, Keating SE, Baker MK, Johnson NA. A systematic review and metaanalysis of the effect of aerobic vs. resistance exercise training on visceral fat. Obes Rev 13: 68 –91, 2012. Wilmore, J. H. Body composition in sport and exercise: directions for future research. Med. Sci. Sports Exerc., 15(1):21-31, 1983 Hickson, R. C.; Foster, C.; Pollock, M. L.; Galassi, T. M. & Rich, S. Reduced training intensities and loss of aerobic power, endurance, and cardiac growth. J. Appl. Physiol., 58(2):492-9, 1985. Aerobic exercise training and cardiovascular reactivity to psychological stress in sedentary young normotensive men and women THOMAS W. SPALDING,a LEWIS A. LYON,b DONALD H. STEEL,b and BRADLEY D. HATFIELDbaDepartment of Public and Community Health, University of Maryland, College Park, Maryland, USA b Department of Kinesiology, University of Maryland, College Park, Maryland, USA (2014)
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[Research Report] 38. The effect of eight weeks of aerobic exercise on depression, anxiety and sleep disorders in middle-aged women Fatemeh Shokri, Ebrahim Khoshnam* and Asghar Nikseresht Department of Physical Education, Jahrom Branch, Islamic Azad University, Jahrom, Iran (2014)
Corresponding Author 1 Safa Moeed Address: 180-B Iqbal venue Society near Wapda Town Lahore, Pakistan. Institutional Affiliation: School of Physiotherapy, Mayo Hospital Lahore, Pakistan Š 2015 PGIP. All rights reserved.
Available online at www.pgip.co.uk/jopsm
Postgraduate Institute of Physiotherapy
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Jones MA, Rivett DA. Introduction to
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DA, eds. Clinical Reasoning for Manual
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Therapists. Edinburgh, UK: Butterworth
Petty NJ, Bach TM, Cheek L. Accuracy of
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Welcome to the Postgraduate Institute of Physiotherapy, we are the team of professional physiotherapists working in United Kingdom promoting and uplifting the physiotherapy profession in developing countries particularly in South Asia. Our well trained and qualified physiotherapists conduct postgraduate courses in various countries. The courses ranged from Musculoskeletal Manual Therapy to Sports Physiotherapy. The basic aim is to provide evidenced based way of practice and education to physiotherapy societies of developing nation so that they can uplift the profession and become the contributors to the profession. Date: 00/00/00
Time: 00:00
www.pgip.co.uk
Encouraging Better Education Ob j e ct ive s
Co ur se s:
Provision of education and training in 1. Spinal Examination and physiotherapy to the public at large Enabling patients to relieve or assist in relieving their own suffering/conditions To persons (professionally qualified or not) providing paid or voluntary care to any person in need of physiotherapy Promotion of research and the dissemination to the public at large of the results of research in the field of physiotherapy
Diagnostic Assessment 2. Management of Neck Disorders 3. Neurodynamics and Neuromatrix 4. Lumbar Spine 5. Cervical Spine 6. Treating Cervicogenic Headaches 7. Low back pain and evidence base approach 8. Spinal Manipulation 9. Evidence Based Practise 10. Clinical Reasoning 11. Professionalism, Empowerment and Autonomy 12. Sports Rehabilitation and injuryIPrevention