Efficacy And Mechanisms Of Exercise Training In Diastolic Heart Failure
Funder
National Health and Medical Research Council
Funding Amount
$385,250.00
Summary
Heart failure is modern epidemic which presents a significant public health burden, due to a high mortality, frequent hospital admissions and impaired functional capacity. Although the typical heart failure patient presents with a reduced contractile function, many patients have typical heart failure symptoms but with normal contraction. The problem in these patients seems to relate to the heart's ability to fill with blood, and this entity is known as diastolic heart failure (DHF). This syndrom ....Heart failure is modern epidemic which presents a significant public health burden, due to a high mortality, frequent hospital admissions and impaired functional capacity. Although the typical heart failure patient presents with a reduced contractile function, many patients have typical heart failure symptoms but with normal contraction. The problem in these patients seems to relate to the heart's ability to fill with blood, and this entity is known as diastolic heart failure (DHF). This syndrome is most frequently due to ischemic or hypertensive heart disease, and most commonly occurs in the elderly. The optimal management of DHF is not well defined, although some drug trials are currently in progress. A number of studies have shown exercise training to improve functional capacity by 15-20% in typical heart failure. However, training has not so far been trialled in DHF. In this multicenter, multi-disciplinary study, we will study a training and control group to determine whether exercise capacity and DHF symptoms are responsive to exercise training. This work will teach us about the optimum exercise prescription, in terms of the duration and nature of training, as well as the safety and effectiveness of exercise training. By using a number of sensitive measurements of heart and vessel function (in which our group has special expertise), we will identify whether exercise training exerts its effect through improvement in vascular function and myocardial properties. If successful, the clinical implications of this study are that; 1. Exercise training will be adopted to improve functional capacity and symptoms of DHF 2. The merits of aerobic and strength training will be identified in DHF 3. Abnormal blood vessel function will be identified as a major and reversible contributor to DHFRead moreRead less
Targeted Strength Training To Improve Functional Walking Capacity Of Adolescents And Young Adults With Cerebral Palsy
Funder
National Health and Medical Research Council
Funding Amount
$263,449.00
Summary
Cerebral palsy is the most common cause of disability in children. Caused by damage to the brain in early childhood cerebral palsy leads to muscle weakness and difficulties in walking. There is no cure for cerebral palsy, but we can help the weak muscles . The purpose of this trial is to establish that exercises to strengthen the weakest muscles will help the walking ability of teenagers and young adults with cerebral palsy, as they make the transition to independence and adulthood.
Assessment Of Physical Therapies To Improve Secretion Clearance In Patients With Cystic Fibrosis
Funder
National Health and Medical Research Council
Funding Amount
$302,310.00
Summary
People with cystic fibrosis (CF) produce thick mucus that is not cleared normally from the lungs. This retained mucus often becomes infected, which progressively damages the lungs. Various physical therapies which may help clear secretions are being used in CF. These include several types of devices which provide positive pressure to the airways. However, it is not known to what extent these devices, or other interventions such as manual chest physiotherapy and exercise, enhance mucus clearance. ....People with cystic fibrosis (CF) produce thick mucus that is not cleared normally from the lungs. This retained mucus often becomes infected, which progressively damages the lungs. Various physical therapies which may help clear secretions are being used in CF. These include several types of devices which provide positive pressure to the airways. However, it is not known to what extent these devices, or other interventions such as manual chest physiotherapy and exercise, enhance mucus clearance. As a result, it is not currently possible to scientifically prescribe intervention(s) to enhance mucus clearance in CF. This is partly because much of the research that has been performed in this area has been poorly-designed or has used inaccurate measures. Also, recent research has shown that these therapies may have significant effects beside their effect on mucus clearance. For instance, bacterial infection and the exchange of oxygen and carbon dioxide between the blood supply and air in the lung may all be affected by these interventions. Notably, the extent of benefit or detriment seen in these parameters does not always correlate with the effect on mucus clearance. We therefore believe a series of experiments is necessary to provide evidence upon which the scientific selection of mucus clearance therapies may be based. We have developed a new technique which allows clearance of mucus from the airways to be objectively measured in three-dimensions (3D). We intend to use the 3D technique to examine the effects of three different positive pressure devices, exercise, and manual chest physiotherapy on mucus clearance. Based on the outcomes of this research, we intend to compare the most appropriate therapy to performing no mucus clearance therapy in a short term trial. This trial will assess changes in the following: bacterial infection, mucus plugging in the airways, how well the lungs move air and exchange oxygen and carbon dioxide, and the patient's quality of life.Read moreRead less
Individual Nutrition Therapy And Exercise Regime: A Controlled Trial Of Injured, Vulnerable Elderly (INTERACTIVE Trial).
Funder
National Health and Medical Research Council
Funding Amount
$572,542.00
Summary
Hip fractures are a common and growing problem for older Australians. Unfortunately recovery is incomplete in most people. In this study two factors believed to be important for recovery will be investigated - exercise and nutrition. After a hip fracture the ability to walk is severely compromised, as are appetite and dietary intake. These factors are likely to contribute to the loss of muscle mass and strength frequently observed amongst this patient group. There is considerable evidence to sug ....Hip fractures are a common and growing problem for older Australians. Unfortunately recovery is incomplete in most people. In this study two factors believed to be important for recovery will be investigated - exercise and nutrition. After a hip fracture the ability to walk is severely compromised, as are appetite and dietary intake. These factors are likely to contribute to the loss of muscle mass and strength frequently observed amongst this patient group. There is considerable evidence to suggest that this loss has serious consequences in terms of ability to return to pre-injury levels of function, restriction in independence and ultimately transfer into a hostel or nursing home. Given these facts it makes sense that an exercise program incorporating strength and functional activities, and a nutrition program aimed at achieving nutritional requirements, will improve ability to walk, but there is no conclusive evidence that this is so. Only a small number of studies have tested whether an exercise program improves recovery after a hip fracture and these have mostly commenced weeks or months after the injury when it is likely that there has been irreversible decline in muscle mass and strength. In contrast, most of the nutrition studies commence soon after the injury but provide protein and calories insufficient to meet requirements, provide supplements that patients find difficult to drink or provide the supplements for only a short duration. This study will use the best quality research methods to test whether providing a 6-month individualised exercise and nutrition program to hip fracture patients soon after injury improves walking and other important health outcomes. Patients will be followed for 12 months to determine what difference the exercise and nutrition programs make. If they help then health services will have the evidence they need to recommend this type of program to the growing number of older Australians that suffer a hip fracture.Read moreRead less
A Randomised Controlled Trial Of A Promising New Treatment For Chronic Whiplash
Funder
National Health and Medical Research Council
Funding Amount
$620,556.00
Summary
Following a whiplash injury about one third of people develop persisting pain and disability i.e. chronic whiplash. In a series of pilot trials we have developed a new physiotherapy treatment for chronic whiplash. Initial results are very promising. We now propose to definitively establish the effectiveness of this new treatment in a large clinical trial. At the same time we will evaluate the cost-effectiveness of the treatment.
Randomised Controlled Trial Of Stretching For Contracture After Ankle Fracture
Funder
National Health and Medical Research Council
Funding Amount
$55,220.00
Summary
Restricted ankle motion (contracture) commonly occurs after cast immobilisation following ankle fracture. The prevalence of contracture could be as high as 77% immediately following cast removal. This interferes with tasks such as walking and stair climbing, and can result in significant disability. While physiotherapists regularly treat contracture after ankle fracture, the efficacy of specific treatment programs has not been established. This project aims to determine the effectiveness of two ....Restricted ankle motion (contracture) commonly occurs after cast immobilisation following ankle fracture. The prevalence of contracture could be as high as 77% immediately following cast removal. This interferes with tasks such as walking and stair climbing, and can result in significant disability. While physiotherapists regularly treat contracture after ankle fracture, the efficacy of specific treatment programs has not been established. This project aims to determine the effectiveness of two commonly used stretching programs for contracture after ankle fracture initially treated with cast immobilisation. Stretches of short and long duration will be compared to a no stretch condition. The study will determine the effects of these interventions on ankle flexibility, ability to perform everyday tasks (eg, walking), self-ratings of disability and pain.Read moreRead less
Is Physiotherapy Beneficial For People With Hip Osteoarthritis?
Funder
National Health and Medical Research Council
Funding Amount
$629,508.00
Summary
Hip osteoarthritis (OA) is a chronic joint disease that causes pain and reduced function. There is currently no cure so safe, effective treatments are needed. Physiotherapy plays a role in the management of hip OA but there is little evidence of its effectiveness. This project will determine the effects of a 12 week physiotherapy program on pain and function in 148 people with hip OA. The results will help with recommendations as to the best ways to treat this chronic condition.
A RCT Of Power Training And Treadmill Training To Improve Walking Ability In Sub-acute Stroke Patients.
Funder
National Health and Medical Research Council
Funding Amount
$403,041.00
Summary
Stroke causes weakness, incoordination, and reduced aerobic fitness, all of which impact significantly on walking ability and other related functions, such as balance. The current management of stroke patients is inadequate in improving patients' walking ability to a level that promotes independence in the community, as it does not address the impairments at the physiological level necessary to implement significant change. A relatively new approach to walking following stroke is the use of trea ....Stroke causes weakness, incoordination, and reduced aerobic fitness, all of which impact significantly on walking ability and other related functions, such as balance. The current management of stroke patients is inadequate in improving patients' walking ability to a level that promotes independence in the community, as it does not address the impairments at the physiological level necessary to implement significant change. A relatively new approach to walking following stroke is the use of treadmill walking. However, this form of training does not address the weakness following stroke. Therefore we propose to demonstrate the efficacy of a relatively new modality 'treadmill training with power training', at higher intensity over a greater number of sessions than would be received currently with 'usual care' or treadmill training only. To ensure that persons continue to maintain the level of improvement from an intensive exercise program, we will also implement a behavioural change for long-term maintenance of exercise behaviour in a less supervised environment. A randomized, single-blinded, control trial will be used. Subjects will be randomly allocated to 'treadmill training + power training', 'treadmill training', or usual care (i.e. control). Subjects in the two training groups will also receive 'usual care'. Subjects in the treadmill and treadmill + power training groups will attend training sessions for 10 weeks, with 3 sessions per week. Subjects will then be provided with a home exercise package to continue with their exercises. The findings from this study are critical in identifying whether, by addressing the 3 major impairments following stroke at doses which are known to produce physiological change in other frail populations, the stroke patient can achieve independence in walking and walk sufficient distances, both of which are important to the stroke patient.Read moreRead less
Foot Orthotics In The Treatment Of Patellofemoral Pain Syndrome: A Randomised Control Trial In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$192,625.00
Summary
Musculoskeletal conditions account for the third leading cause of health systems expenditure in Australia. Patellofemoral pain syndrome or pain about the knee cap is such a condition and is often treated in primary care. Both the individual and community are affected by this condition with an estimated 1 in 4 suffers still having problems and pain up to 20 years after first being afflicted. Importantly it interferes with activities such as walking, jogging, gym classes and aerobics, which are of ....Musculoskeletal conditions account for the third leading cause of health systems expenditure in Australia. Patellofemoral pain syndrome or pain about the knee cap is such a condition and is often treated in primary care. Both the individual and community are affected by this condition with an estimated 1 in 4 suffers still having problems and pain up to 20 years after first being afflicted. Importantly it interferes with activities such as walking, jogging, gym classes and aerobics, which are often prescribed to prevent serious conditions of the heart, diabetes and obesity. Hence it negatively impacts on the health and well being of our nation. Two popular treatment options that are commonly prescribed for the management of patellofemoral pain syndrome are physiotherapy and foot orthotics. To date there is some evidence supporting physiotherapy, especially current best practice methods such as a combined program of therapeutic exercise, manual therapy and kneecap taping. There is a lack of evidence for the use of orthotics in treating patellofemoral pain syndrome. This project will conduct a randomised clinical trial to evaluate the relative benefits of orthotics as the sole treatment of patellofemoral pain syndrome and also when combined with physiotherapy. Factors associated with predicting the results of orthotic therapy will be studied to see if there are any tests that a health care practitioner can perform to provide information early on in a consultation regarding possible treatment outcomes. A cost-benefit analysis will also be conducted to calculate the relative economic merits of the treatments. A tangible outcome of this project will be the development of clinical guidelines for the most effective method of treating patellofemoral pain syndrome in primary health care.Read moreRead less