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A better understanding of pain in rheumatic diseases is warranted [4]. Several lines of evidence suggest that mechanisms within the central nervous system CNS are implicated and facilitate pain persistence [3]. The CNS undergoes plastic changes that in turn alter nociceptive processing and increase sensitivity of neurons. The hyper-excitability of the CNS also referred to as central sensitization is reflected in the clinic by the responses to external stimuli [4].

People with RA show widespread reduction in thermal and mechanical pain thresholds. Such hypersensitivity to noxious stimuli is not only reported in inflamed joints, but also in healthy joints [2]. In line with it, people with RA often refers widespread pain, that is not limited to the inflamed joints. Although only a few studies have focussed on treating central sensitization in RA, much more data are available from other conditions where central sensitization is a predominant feature, such as fibromyalgia [3].

People with fibromyalgia indeed show widespread pain, pain thresholds reduction, and symptoms of central sensitization [5]. Besides, they refer sleep disturbances, fatigue, and psychological distress. This same clinical picture is arising in RA too. A recent study demonstrated how a mechanism-based reasoning might detect clinically relevant subgroups of patients with RA [6]. Clinicians treating people with inflammatory disease need to take into account this recent evidence and consider treatments that target central mechanisms.

Centrally acting drugs pregabalin, gabapentin, selective serotonin- and noradrenaline- reuptake inhibitor, etc. Rheumatoid arthritis. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia.

Arthritis Res Ther. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Staud R, Domingo M. Evidence for abnormal pain processing in fibromyalgia syndrome. Pain Med. Subgrouping of patients with rheumatoid arthritis based on pain, fatigue, inflammation, and psychosocial factors. Arthritis Rheumatol. Treatment of central sensitization in patients with 'unexplained' chronic pain: an update. Expert Opin Pharmacother. The reason for this stress is not immediately understood because scoliosis is not a mortal disease, it does not cause disability and it has a quite low prevalence.

Starting a rehabilitation treatment, the gold objective we intend is the healing of the patient. We can obtain this when we know the aetiology and we can treat the cause, or when our body is able to self-nurse itself maybe with our help.

In case of scoliosis we have no one of these options. The self-healing of scoliosis never had been observed. If the spinal misalignment is evolutive, the only type of evolution is the worsening. How can we proceed? These secondary targets are the opposition to the misalignment and the increasing of the capacity of the spine to hold this correction. Why is this action so important? This depends on our ignorance about the aetiology. The second objective is reached by improving the function of the stabilizing muscles of the spine to counter the postural collapse.

The tools to reach this are the specific exercises. These exercises will be used not to improve the strength of the stabilization muscles of the trunk but to challenge the holding of the correction, putting the patient in a difficult postural situation to obtain the automatic involvement of these muscles.

Braces for idiopathic scoliosis in adolescents. Spine Phila Pa Exercises for adolescent idiopathic scoliosis. Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools. Scoliosis Spinal Disord. SEAS Scientific Exercises Approach to Scoliosis : a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Introduction: In Italy about 10, children are affected by rheumatic diseases RD every year.

The most widespread is Juvenile Idiopathic Arthritis JIA , followed by different forms of inflammation of the connective tissue such as Systemic Lupus Erythematosus SLE , Dermatomyositis and ultimately, the less frequent but equally disabling Fibromyalgia. The clinical and operational framework of paediatric RD varies widely in its manifestations but always presents a limited participation in motor activities of the everyday life, such as recreational and sporting activities, which are typical of school-aged children.

To date, there are few scientific studies concerning the importance and effectiveness of the rehabilitative-educational and self-management aspects of the disease. Moreover, there are no clinical studies concerning the adaptation to physical activity in groups.

Materials and Methods: Subjects: 18 paediatric patients with RD aged 7 to During the same meeting, JAMAR, a questionnaire on the quality of life, was given out together with a prospective diary to record any activity during the study period. A second assessment was conducted at 9 months from the end of the treatment. Based on the outcome of the T1, a plan of the activities that small groups of evenly aged children sharing the same functional impairment had to carry out in the "rehabilitation garden" and the school's gyms was designed.

The patients performed functional, aerobic and muscular strengthening exercises and received guidance on ergonomics and physical education and recreational activities calibrated to the characteristics of the group. Prior to intervening with the patients, sessions with the school were organized for the coordination and definition of the planned initiatives and for teacher training.

Results: Sample size calculated: 46 subjects. We proposed the project to 27 eligible patients, 18 enrolled and 11 completed the whole treatment. The main diagnosis was JIA, with mild to moderate functional involvement. The project and treatment were well accepted and tolerated by patients and their families; both of them asked for additional meetings. Teachers contributed actively in designing and developing each session. There was no statistically significant difference in each test at the end of the project, probably due to the insufficient size and heterogeneity of our sample.

Furthermore, we consider this model easily exportable and reproducible in other healthcare institutions. Psychological profile in children and adolescents with severe course Juvenile Idiopathic Arthritis. Klepper SE. Exercise in pediatric rheumatic diseases. Curr Opin Rheumatol. Promoting the participation of children with disabilities in sports, recreation, and physical activities. The role of exercise therapy in the management of juvenile idiopathic arthritis.

Exercise therapy in juvenile idiopathic arthritis. ATS statement: guidelines for the six-minute walk test. A new approach to clinical care of juvenile idiopathic arthritis: the Juvenile Arthritis Multidimensional Assessment Report. J Rheumatol. Efficacy of a land-based home exercise programme for patients with juvenile idiopathic arthritis: a randomized, controlled, single-blind study. J Rehabil Med. Background: In Italy the prevention program called "Okkio alla Salute" has been active for many years.

This program aims to study the distribution of excess weight and risk behaviors in primary school children. Recent literature, related to the correlation between body mass index BMI and trunk asymmetry, shows that most overweight people also have trunk asymmetry. Another aim of the project is to implement prevention and health promotion programs in the school context.

Materials and Methods: Screening was done between April and May in five days. The children of 12 classes fourth and fifth grade in the province of Frosinone were evaluated. The evaluation team consisted of a school doctor, a nurse and three physiotherapists. The materials used for the postural assessment were: an evaluation form created specifically for screening, an anthropometer, measuring tape. The card was composed of: a medical part filled in by the doctor personal data, weight, height, any relevant news, treatments in progress, sports and a physiotherapeutic part pain, dysmetria, ligamentous laxity, the characteristics of walking.

It was noted: the visual impression of impact that is, if the child appeared frankly asymmetric or symmetrical the posture in anterior, posterior and lateral view and the result of the bending test. At the end of the card the indications of the team were noted regarding the need for an orthopaedic or nutritional visit, subsequently handed over to the families.

In conclusion, a meeting was held with parents to discuss the screening result and to provide information on scoliosis and its treatment. No correlation between overweight and alteration to bending test or between overweight and evident postural asymmetries was found. This means that a specialized assessment is required for all school-age subjects, to identify the cases at risk that could also be among those apparently symmetrical. In this vision, it is essential to implement screening programs in schools.

Conclusion: The strong point of this project were the multidisciplinary team, the respect of the correct institutional path to school-aifi-pediatric specialist interest group, the low cost for families both economic and time, the serenity of children in visiting, in a protected environment like school.

The aspects to be improved relate to the evaluation form by inserting more sensitive measuring instruments scolio meter. A path of this kind promoted by local health authorities and local public administrations is desirable. Nutritional status in idiopathic scoliosis. Relatively lower body mass index is associated with an excess of severe truncal asymmetry in healthy adolescents: Do white adipose tissue, leptin, hypothalamus and sympathetic nervous system influence truncal growth asymmetry?

Body mass index in relation to truncal asymmetry of healthy adolescents, a physiopathogenetic concept in common with idiopathic scoliosis: summary of an electronic focus group debate of the IBSE. Now, we have a large press review of that project but, unfortunately, no scientific data to start a wider research project.

This opportunity was also propitious to review the most up-to-date scientific literature on the spinal deformity and to make a comparison with what happens, especially for the prevention of such deformities, in the world. Except for some Eastern countries China, Japan [2], Australia and Sweden, in other countries, including Europe, the school screening programmes are not compulsory, on an exclusively voluntary basis for physiotherapists and without fees for educational institutions.

These projects are very interesting for schools but not very reproducible over time. The problem of data collection, the roles to be established and the times to be met must be added to the problem of costs. Systematic Review of School Scoliosis Screening. Spine Deform. Malays Orthop J. This Project will be included into health care educational and promotional regional projects, as low back pain prevention and intervention during school age: it is addressed to children in their sixth grade.

The first meeting lasting two hours will provide: collection of questionnaires proposed to the parents; an interactive practical and theoretical path, aimed to the spine knowledge: sitting posture in the classroom, how to pack, prepare and carry a backpack; the delivery of a warrant surrender of a poster synthesizing the concepts: its scope is to take part to a contest providing a great prize.

During a second meeting, lasting one hour, the students will fill up a learning form - during the meeting the learnt concepts will be reminded and the poster is delivered. The final party will take place in Turin: it is the conclusive event where the results emerging from the forms are presented, the posters are displayed and the winners of the contest are declared.

From through four editions took place: again the project was started during the school year keeping the same structure - it was carried forward by some physiotherapists on personal initiative backed by AIFI PVD. The results: along these years the project has involved schools, students, physiotherapists.

Besides the direct work with the students in their school, the project might evolve: a useful route for both teachers and parents can be provided, in order to considerably improve the lifestyle of the boys. Moreover, a more accurate mode of data collection should be identified in order to better calibrate any future interventions.

The Memorandum of Understanding with the Institutions is useful to yield visibility to the project: on the other side, it requires much struggle and is conditioned by several variables. To carry on the project on an individual basis, directed by AIFI PVD, currently seems to be the easy way to ensure continuity in our region.

Scientific research articles provide a method for scientists to communicate with other scientists about the results of their research but without a complete description of the intervention other researchers cannot replicate or build on research findings or it is not clear to decision makers how to reliable implement the intervention 1.

In order to deal meaning and development of the checklists regarding the well writing of a scientific article, the reporting of the experimental studies has been considered in this presentation. Articles were divided in Introduction, Methods, Results and Discussion 2. Introduction is dedicated to provide the context of the study and to define its objective, Methods are addressed to provide details to allow researchers to do the same experiment, Results have to synthetically show the results arising from methods, and Discussion have to discuss the results inside the context introduced at the beginning of the article.

Reporting a scientific article should retrace the questions which have led the researcher to promote the study: why Introduction , how Methods , what Results and so what Discussion. This edition had subheadings and descriptors able to detail how trial was performed.

In Hopewell 4 published an interesting comparative study about the differences in reporting methodological items in journals indexed on PubMed in the years and The trend showed a significant increase in following the CONSORT checklist, although: the situation remained sub-optimal; did not involve all items as, for example, the blinding; did not involve all scientific journals.

Similar results were reported in in a systematic review with meta-analysis published on the Cochrane Database of Systematic Review 5. In Boutron 6 highlighted that the CONSORT checklist was not entirely applicable to non-pharmacologic trials as it forecast interventions involving several components; items as blinding are more difficult to achieve; experimental designs relies on more complex methods.

This checklist stressed some aspects linked to the role and the intervention modalities of people involved in the studies. Physiotherapy intervention are multimodal; involve the use of manual techniques, consumable materials, equipment, education, training and feedback.

Moreover, the dose or intensity of treatment may be progressed over time 8. Its main characteristic is that all the details inherent every possible sources of variability in determining the results of the study have to be described.

It is even more clear that to correctly report an experimental study is not only a favor to other researchers but also a modality to improve own methodological skills. J Med Libr Assoc. Altman DG. The quality of reports of randomised trials in and comparative study of articles indexed in PubMed. Reporting methods of blinding in randomized trials assessing nonpharmacological treatments.

PLoS Med. Ann Intern Med. How completely are physiotherapy interventions described in reports of randomised trials? Better reporting of interventions: template for intervention description and replication TIDieR checklist and guide. Background: The individual variability among people presenting motor impairments often leads to the difficulty to obtain an adequate sample size in the conduction of trials in physiotherapy.

Furthermore, in clinical practice, it is often difficult to recognize the relationship between the administration of a treatment and its expected results. Psychological and educational sciences often use single-subject design SSD studies to explore behaviours under experimental conditions. This study design allows to test the relationship between an independent variable, the treatment, and a dependent variable, the main outcome of interest.

The purpose of this work is to present researchers and clinicians the methodology of the SSD studies and their application in physiotherapy both in research context and everyday practice [1]. A-phase measurements serve as a standard of performance that can be compared to B-phase measurements in terms of change in the mean level, change in trend or change in variability of measure, depending on the nature of the assessed outcome. Conclusions: SSD studies offer an option for the identification of an individual response to a specific intervention when traditional between-group designs would not be appropriate both in clinical and research contexts.

SSD studies result in acceptable internal validity but in very low external validity. Single-subject research designs in pediatric rehabilitation: a valuable step towards knowledge translation. Dev Med Child Neurol. Small sample research designs for evidence-based rehabilitation: issues and methods. Arch Phys Med Rehabil. The rehabilitation protocols of anterior cruciate ligament reconstruction ACLr , should follow the criteria of evidence based practice.

There is no evidence in the literature to support the use of post-operative brace. Several biomechanical studies have shown the effectiveness in reducing the loads on the ACL, while some clinical studies reported that bracing does not protect against post-operative injury, does not decrease pain, produce changes in rom , or improve knee stability [2]. Extension loss results in abnormal joint arthrokinematics at both the tibiofemoral and patellofemoral joints.

This in turn leads to abnormal articular cartilage contact pressures and quadriceps inhibition. In a randomized controlled trial, Ito et al. A randomized trial compared the efficacy of immediate weight-bearing versus a delay of 2 weeks following autograft patellar tendon ACLr [4] and reported no deleterious effects and decreased incidence of anterior knee.

While a third of SIGASCOT surgeons allow patients to load the operated knee as much as tolerated within the first 2 weeks, other surgeons limited the loading at different timing. The quadriceps are an important dynamic knee joint stabiliser during closed kinetic chain CKC activities [5].

Early CKC quadriceps exercise are associated with significantly more high clinical scores while average knee laxity was not significantly affected. The ACL strain responses produced during CKC exercises are equal and similar to those produced during other rehabilitation exercises i. In one study [7] early start of OKC quadriceps exercises after hamstring ACLr resulted in significantly increased anterior knee laxity in comparison with late start and with early and with late start after bone —patellar tendon— ACLr.

There was no general trend of increased anterior knee laxity over time between 3 and 7 months. Gokeler et al. This findings suggest that the majority of patients 6 months after ACLr require additional rehabilitation to pass RTS criteria. Web-based survey results: surgeon practice patterns in Italy regarding anterior cruciate ligament reconstruction and rehabilitation. Knee Surg Sports Traumatol Arthrosc.

Sports Health. A prospective study of 3-day versus 2-week immobilization period after anterior cruciate ligament reconstruction. The effect of immediate weightbearing after anterior cruciate ligament reconstruction. Clin Orthop Relat Res. Bodor M. Quadriceps protects the anterior cruciate ligament. J Orthop Res. A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med. Heijne A, Werner S.

Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study. Epub Jan Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Return to sport RTS is often considered in different meanings, but the choice of a "limited" definition can largely influence therapeutic success. These percentages are also much higher in subjects younger than 25 years old.

Furthermore, the likelihood of developing osteoarthritis appears to be higher in the ACL reconstruction than in subjects with ACL injury who instead opted for a conservative approach. In light of these data, it is necessary to re-evaluate the role of ACL surgical reconstruction and pay close attention to the RTS criteria proposed in the various studies, to identify the appropriateness of these and to address the rehabilitative treatment with greater specificity.

The most common criterion for RTS is time, that is usually around 6 months, but recent systematic reviews and more recent publications now consider it too short to really reach appropriate treatment goals. In addition, a review on the recovery times of the professional athletes of the American Premier Leagues, indicates an average RTS of about 1 year, with some athletes who recover even beyond that period Mai, The likelihood of recurrence of injury is higher in the first two years after ACL reconstruction, and it is not even possible to discriminate against the most risky athletes based on performance, since athletes with recurrence of injury are frequently those with better performance and shorter RTS.

It is therefore necessary to modify the RTS criteria, increasing the minimum time for the resumption of sporting activity, which must be a choice shared by more professionals, which foresees a process of gradual exposure, which follows objective criteria, with high quantitative values and takes into account also qualitative and psychological factors Dingenen, Clin Sports Med.

Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Dingenen B, Gokeler A.

Groin pain in athletes is one of the most difficult to treat clinical problems in sports medicine [1]. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited sport participation.

In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial [2]. There was a significant correlation between lower study quality and higher treatment success [3]. Having an adductor-related groin injury doubles the recovery time compared to injuries with no adductor and no abdominal pain.

If it is combined with an abdominal-related injury, the recovery time is more than quadrupled. For athletes with long-standing adductor related groin pain there is moderate evidence that active exercises improve treatment success compared with passive treatments, that multimodal treatment with a manual therapy technique shortens the time to return to sports RTS compared with active exercises, and that adductor tenotomy improves treatment success over time [5].

Conservative treatment has demonstrated a superior RTS time when compared to surgery, while little difference between the two treatments in the abdominal and adductor groupings in RTS rate and RTS time [6]. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Review: imaging of groin pain in the athlete. Skeletal Radiol. Groin pain in athletes.

Incidence and clinical presentation of groin injuries in sub-elite male soccer. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes.

Anterior ankle impingement is a very common injury in athletes. The pain is anterior, anteromedial o anterolateral and it is common after acute ankle sprain, recurrent ankle sprain o microtrauma. Patients decrease their dorsiflexion and change their gait, they are unable to run, squat, walk on inclined superficie or play sports, ADL impairment decrease from moderate to severe. There is tenderness in anterior and anterolater of ankle [10].

Functional tests are knee to wall, Y balance test, squat test, single leg squat test and low limb symmetry index [1, 3, 9]. Rehabilitation starts immediately after injury to decrease pain, improve local and distal load. The specific knowledge of the athlete's sport is very important.

The road to recovery is not simple. The first phase consists in conservative treatment, even if there are few evidences. In the second phase FT can use corticosteroid injection. After months, if the conservative treatment doesn't leed to results, surgery is required. The aims of rehabilitation are improve ROM, strength, endurance and maintaining vascular capacity by manual therapy, mobilization with or without movement, talar stability tape, flexibility static or dynamic, use of theraband, proprioceptive exercise, strength and endurance exercise, sport specific exercise [4, 6].

Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Validity of the lower extremity functional movement screen in patients with chronic ankle instability. J Phys Ther Sci. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Moustafa El-Sayed AM. Arthroscopic treatment of anterolateral impingement of the ankle.

J Foot Ankle Surg. Ankle impingement. Diagnosis of anterolateral ankle impingement. Comparison between magnetic resonance imaging and clinical examination. Synovial impingement in the ankle. A new physical sign. J Bone Joint Surg Br.

Y-balance test: a reliability study involving multiple raters. Mil Med. Anterior ankle impingement: diagnosis and treatment. J Am Acad Orthop Surg. Ankle impingement may be due to a conflict collision between soft or bony structures in the peripheral borders of the joint. In the anterior aspect of the ankle impingements can be identified in three different locations: lateral to the third peroneus tendon antero-lateral impingement , between the third peroneus and the tibialis anterior tendon central impingement or medial to the tibialis anterior tendon anteromedial impingement.

The anterolateral impingement is a soft-tissue impingement. An inversion sprain can cause lesions of the capsule and the synovia with hematoma that can determine hypertrophic fibrous tissue. Repetitive movements or inadequate rehabilitation can induce the formation of a hypertrophic synovial tissue that can create impingement. The central impingement is typically a bony impingement. Osteophytes on the anterior edge of tibia and talus can impinge in dorsiflexion producing pain.

It has been demonstrated that these osteophytes are due to direct traumas on the anterior aspect of the ankle with ossification of perichondral and periosteal membranes [1]. The anteromedial impingement is also a bony impingement. It is due to an osteophytes formation on the anterior edge of medial malleolus and the medial aspect of the talus at the junction between cartilage and bone.

Repetitive collisions of these areas during inversion sprains have the effect to produce reparative tissue formation and subsequent ossification of it causing these types of osteophyte. The diagnosis of the soft anterior ankle impingement is clinical, while it is both clinical and radiographic for the bony impingements. Direct digital palpation of the site of impingement lateral, central or medial causes pain, lateral xray of the ankle is diagnostic for the central impingement, a medial oblique view of the ankle can show the presence of medial osteophytes in case of anteromedial impingement [2].

For the diagnosis of a soft anterolateral impingement only the clinical history and the clinical examination are helpful: MRI is not diagnostic but can only rule out other pathologies [3]. Sometimes an intraarticular carbo-test can be helpful in the diagnosis of this kind of soft tissue impingement. Surgical treatment is performed after a minimum six- month period of physical, manual, infiltrative therapy and eventually orthotic procedures. Currently the arthroscopic procedures have been demonstrated to have less complications, better results and shorter times of recovery than open surgery [4].

Arthroscopic treatment of anterior impingement in the ankle. Oblique radiograph for the detection of bone spurs in anterior ankle impingement. Donovan A, Rosenberg ZS. MRI of ankle and lateral hindfoot impingement syndromes. Niek van Dijk C. Anterior and posterior ankle impingement. Foot Ankle Clin. Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome.

Cartilage lesions in anterior bony impingement of the ankle. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Several studies demonstrated that physical activity has positive effects from a biological, functional, psychological, emotional, and social point of view [1, 2]. The EE facilitates exploration, cognitive activity, social interaction, and active physical exercise in animal models [3].

The EE also influences the expression of several factors considered essential to brain plasticity, including the Brain-derived neurotrophic factor BDNF , a neurotrophin particularly relevant to neuroplasticity [4]. In a recent review, Zoladz and Pilc [5] concluded that physical exercise could be able to facilitate the activation of BDNF in some regions of the brain, and that such facilitation, induced by the exercise, could play a role in increasing the cognitive functions.

In elderly rats, Bherer et al. In humans, brain-imaging studies and brain electrophysiological measurements, in addition to angiogenesis, synaptogenesis and neurogenesis, reported that physical exercise has structural and functional effects, providing transient and permanent changes in brain aging [2]. Sofi et al. In this meta-analysis [6], however, only the Mini Mental State Examination was used as outcome measure, The review of Angevaren et al.

Moderate effects were also observed for speed and visual attention. On the other hand, other cognitive functions do not seem to be influenced by the exercise. Finally, Sumic et al. Effects on cognitive functions have also been identified for patients with Mild Cognitive Impairment MCI [9] and for patients with dementia [10]. Many pyramidal and extrapyramidal motor impairments affect a substantial portion of patients with dementia, even at an early stage of the disease, and progressively worsen along with cognitive impairment [11].

MCI may be associated with motor impairment, maily in balance and deambulation [12], sometimes in a subclinical phase [13]; some authors suggested that the presence of motor impairment may be an early indicator of a cognitive disorder, since motor impairment may precede the onset of cognitive impairment for dementia by a decade and longer [11, 14].

The effects of physical training of functional capacity in adults. Ages 46 to a meta-analysis. J Sports Med Phys Fitness. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. J Aging Res. Enrich the environment to empower the brain. Trends Neurosci. Nurturing brain plasticity: impact of environmental enrichment. Cell Death Differ. Zoladz JA, Pilc A. The effect of physical activity on the brain derived neurotrophic factor: from animal to human studies.

J Physiol Pharmacol. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Physical activity and the risk of dementia in oldest old. J Aging Health. Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials.

Exercise programs for people with dementia. At the interface of sensory and motor dysfunctions and Alzheimer's disease. Alzheimers Dement. Motor function and incident dementia: a systematic review and meta-analysis. Age Ageing. The motor signature of mild cognitive impairment: results from the gait and brain study.

In patients with cognitive impairment CI , to have suitable measurement tools plays a fundamental role because their prevalence will drastically increase in the next few years [1], and because these patients are generally excluded in randomized clinical trials RCTs , due to the lack of appropriate measuring instruments.

Therefore, the RCTs external validity is missing. Recently, a call for inclusion [2] was proposed to encourage researchers to include these patients in RCTs. Then, researchers need to have tools with robust psychometric properties even in patients with CI. A systematic review [4] reported that only one of 16 study showed a greater post-intervention improvement than MDC value for TUG. This finding suggests that improvements over MDC are hardly achievable in clinical practice; therefore, these tests are unsuitable to quantify the effects of treatment within this population.

Therefore, Bossers et al. The Groeningen Meander Walking Test is an evolution of the F8W; the itinerary was replaced by a path with curves alternated to right and left. This modification is intended to make the task more intuitive, to require simpler instructions, and to avoid the intersection of the path that may be a critical moment for patient with CI. Intra-rater reliability has been studied in a sample of 42 subjects with CI. MDC values are still high, but better than the original test.

The measurement of latent variables requires the subjective judgement of a person, such as the patient using a Patient Reported Outcome Measures or such a relative or caregiver utilising an Observer Reported Outcome Measures [ObsOMs]. Regarding patients with CI, it is not appropriate to consider their judgment, as the psychometric properties could be affected by their pathology. Therefore, it is more appropriate to use the ObsROMs. However, any other psychometric properties considered crucial in selecting an appropriate outcome measure i.

Therefore, not all information are available to select the appropriate tool for patients with CI. In conclusion, in selection of an appropriate outcome measure, clinicians and researchers have to consider all the psychometric properties; not only the reliability but also the measurement error to understand if the change presented by the patient is real or due to the intrinsic error of the measurement instrument.

Finally, in the choice of the assessment scale, clinicians and researchers do not only consider cross-cultural and construct validity, but analyse other psychometric properties, as the content and structural validity. How many dementia cases in France and Europe?

Alternative projections and scenarios Eur J Neurol. Epub Oct 1. Systematic review on the inclusion of patients with cognitive impairment in hip fracture trials: a missed opportunity? Can J Surg. Reliability of six physical performance tests in older people with dementia. Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dement Geriatr Cogn Disord. The Groningen Meander Walking Test: a dynamic walking test for older adults with dementia.

Functional disability in early Alzheimer's disease — a validation study of the Italian version of the disability assessment for dementia scale. Functional abilities and cognitive decline in adult and aging intellectual disabilities. Psychometric validation of an Italian version of the Alzheimer's Functional Assessment Tool AFAST : analysis of its clinical significance with linear statistics and artificial neural networks.

J Intellect Disabil Res. Ageing is characterized by a progressive decline in immune function referred to as immunosenescence IS , which increases the susceptibility of elderly persons to infection, autoimmune disease, and cancer[1, 2]. There are strong indications that physical exercise in elderly persons may prevent the age-related decline in immune response without significant side effects[4]. Consequently, exercise is being considered as a safe mode of intervention to reduce IS[3, 5, 6].

The aim of this review was to appraise the existing evidence regarding the impact of exercise on surface markers of cellular IS in either young and old humans or animals. PubMed and Web of Science were systematically screened and 29 relevant articles in humans or animals were retrieved[7, 8]. We found 2 categories of study: studies reporting the acute effects of exercise and studies showing exercise-induced effects on basal levels.

The findings concerning the influence of exercise on NK cells were sometimes contradictory, some studies showed the increase in NK cell activity while the others recorded the opposite or no effect. Few studies have been conducted so far to investigate the effects of exercise on markers of IS in elderly persons.

Exploring data from our ongoing randomized controlled trial Senior Project Intensive Training SPRINT , we sought to address the effect of strength training at different intensities on the changes of cellular IS in elderly. The CON performed flexibility training consisting of 3 sets of sustained 30 sec passive, static stretching exercises of the large muscle groups.

The surface markers of senescence were determined before and after 6 weeks 24hh after the last training using flow cytometry. Absolute blood counts were measured by a dual platform methodology flow cytometry and the Cell-Dyn Sapphire hematology analyzer. We report for the first time that 6 weeks of SET decreased significantly the resting percentage and absolute blood count of senescence-prone T-cells in older women.

Conceivably, training protocols with many repetitions - at a sufficiently high external resistance - seem to be necessary for the reduction of senescence-prone cells in older persons. We can conclude that exercise has considerable effects on markers of cellular aspects of the immune system. Recent results from our study provide evidence to current cellular concepts indicating that exercise training may have an anti-IS effect.

Further research is highly needed to fully elucidate the mechanism of lymphocyte IS following exercise. Pawelec G. Immunosenescence: impact in the young as well as the old? Mech Ageing Dev. Castle SC. Clinical relevance of age-related immune dysfunction. Clin Infect Dis. Simpson RJ. Aging, persistent viral infections, and immunosenescence: can exercise "make space"? Exerc Sport Sci Rev. Immunity in frail elderly: a randomized controlled trial of exercise and enriched foods.

Turner JE. Exercise and the aging immune system. Ageing Res Rev. Calcif Tissue Int. Impact of a half marathon on cellular immune system, pro-inflammatory cytokine levels, and recovery behavior of breast cancer patients in the aftercare compared to healthy controls. Eur J Haematol. It has been shown that physical activity reduces the risk of dementia and enhances the cognitive function in people with dementia and cognitively impaired older adults [1].

However, some authors believe that a wide type of exercise programs are not appropriate for people with cognitive impairments [2]. Aerobic training is the most frequently type of exercise used in clinical studies [1], while progressive resistance training and balance training are less extensively studied [3].

In general, combinations of these type of exercise seems to be able to improve balance in people with cognitive impairment [4], activities of daily living both in people with mild cognitive impairment [4] and with dementia [5], and general functional performance in cognitively impaired people [2]. Positive effects of exercises were also found in terms of strength, physical fitness, endurance, and positive behaviour [6, 7]. In people with neurological conditions, e.

To perform a program of exercises in old participants with cognitive impairments, it should be taken into account the presence of comorbidity especially cardiac and respiratory comorbidities , drug therapy, musculoskeletal lesions, hydration, nutrition, sleep, and risk of falling [9].

Additional caution and safety adaptations should also be provided for this type of population [9]. However, some questions remain unanswered [1]. For example, it is not clear which are the optimal frequency, duration, type of cognitive commitment that provide a positive outcome with the exercise. The use of aerobic, strength and balance exercises or a mix of these approaches makes informations very heterogeneous.

Finally, it is unclear how the changes induced by the exercise vary taking into account the age, disease and presence of brain injury. Further studies are needed to assess the characteristics of exercises in order to adapt them to people with cognitive deficits and dementia. Bridging animal and human models of exercise-induced brain plasticity.

Trends Cogn Sci. Long-term home and community-based exercise programs improve function in community-dwelling older people with cognitive impairment: a systematic review. J Physiother. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis.

J Nutr Health Aging. Kafri M, Dickstein R. External validity of post-stroke interventional gait rehabilitation studies. Top Stroke Rehabil. Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med. Perfetti could be included in the "Science of Narrative Medicine", one of the three "circles" of Evidence-Based Medicine. According to the NCR, the quality of recovery is determined by the activation of cognitive processes and by the modality of their activation.

Furthermore, it states that the action of creating knowledge activates those plastic processes, that represent an instrument to reorganize the injured system. The commitment to know, with all its components pedagogical and biological , is essential to modify the central nervous system and the organization of the whole body.

The study of knowledge and its repercussion on the therapeutic exercise has gone through different stages. The projects investigate the patient's conscious experience, underlines the importance of the " first person descriptions ", in all phases of the rehabilitative intervention. In another problem was addressed: the organizational autonomy of the patient who was in some cases excessively dependent on the rehabilitation set.

A critical rereading of the instruments was carried out: the therapist's verbal instructions used by the therapist and the patient as a substitution of his own mental operations , and the role of "motor image", introduced in neurocognitive rehabilitation since The motor image turned out to be too specific and partial, too far for the patient from the real action.

The patient cannot make an aware "immediate comparison" between the representation of the exercise experience a "map" and its meaning within the real action "the territory". Gentner D, Schmidt LA. Lurija AR. Le funzioni corticali superiori. Giunti Firenze Perfetti C.

Perfetti C. Immagine motoria, rappresentazione mentale ed esercizio terapeutico, Riabilitazione cognitiva Il linguaggio della riabilitazione. Un percorso di studio. Riabilitazione Neurocognitiva. Quali implicazioni riabilitative? In the last years, next to the interest in good clinical decisions made on the basis of EBM, the interest of medicine has developed also for what is unknown and imponderable, for the self, and for the patient's life, for the story of the disease.

This approach is also known as patient-centered work, conscious practice, care focused on the relationship, or narrative medicine. So we have to consider Narrative Medicine as a methodological tool for the evaluation of patients, useful for choosing and programming therapeutic interventions and outcomes; it is an approach that influences the compliance, being the basis of communication, mutual understanding and establishing a relationship of trust.

Today scientific research is carried out in two forms: quantitative approach or qualitative approach. Quantitative approach is about reducing to numbers and statistics, find final scores from measurement scales and it allowes to calculate the changes with statistical analysis. The qualitative approach focuses on the "process" of carrying out an action rather than the final "product": research focuses on «how», «why» and «when» things happen and not only the fact that they occur.

It gives answers about exploration, description, explication, reasoning and it helps to develop of theories. The construction of narrations in clinical practice leads to the union between Narrative Medicine and Evidence Medicine in order to create a clinical practice based on scientific evidence, but also on the values to which the patient refers and to his preferences. The qualitative dimension allow to get important information about the patient's way to live the disease illness , his feelings, objectives, critical issues and fears.

Important tools for the physiotherapists are the data collection for the construction of a personalized treatment plan , the analysis of perceived quality, and the patient's diary, in which he has to write everyday about what he felt and experienced during the rehabilitation session and what has changed in his ways of experiencing the body in his life outside the rehabilitation context.

That's important to understand what he learned and therefore how he modified his behaviour and how he was able to integrate the experiences of the exercises in his life. Narrative evidence based medicine. Giarelli G. Storie di cura: medicina narrativa e medicina delle evidenze: l'integrazione possibile. Angeli, Bert G.

Medicina narrativa: storie e parole nella relazione di cura. Il Pensiero Scientifico Editore, Qualitative research and evidence-based physiotherapy practice. Physiotherapy, , By its very nature, the ICF Classification is a tool that requires the involvement of different disciplines and skills, and must guarantee the multidimensional bio-psycho-social approach to disability, a work strategy that characterizes the Classification itself.

Therefore, in the context of a care process, when the different professionals integrate their skills using the ICF as an analysis tool, they must treat in advance how to organize relations within the working group and how to standardise the support process, with a multidimensional evaluation. This kind of evaluation must guarantee the taking charge identifying a specific methodology, an assumption of responsibility predefining the organisation of the assistance process for each professional involved, a multi-disciplinary and multidimensional path essential to maintain the communication and effective relationship.

These conditions can be ensured by standardizing and structuring an organized and shared path regarding the "evaluation survey" of all the professionals involved. Because of its "universal" language, the ICF Classification is adopted by each professional, allowing to enhance the effectiveness of communication and of the relationship between the members of the working group.

The adoption of a single and shared model also provides useful guidance for the use of a single reference method for the management of the care process, characterizing and expressing the assumption of responsibility of each through the formalization of their own specific contribution. Conversely, nondiabetic patients with preserved MFR had the lowest probability of events. The probability of events was comparable in nondiabetic patients with reduced MFR and diabetic patients with preserved MFR.

Diabetes represents an increasing problem and cardiovascular disease is the most common cause of death in diabetic population. Both macro- and microvasculature involvement in diabetic cardiovascular disease have been demonstrated. In agreement with previous studies, we found a higher prevalence of cardiac events in diabetic compared to nondiabetic patients.

Recently, in a population of patients with low-intermediate risk of CAD it has been demonstrated that both the extent of coronary atherosclerotic burden and the presence of coronary vascular dysfunction are associated with increased risk of adverse cardiac events during a long-term follow-up, even after adjustment for cardiovascular risk factors.

Naya et al 24 in consecutive patients with suspected CAD and normal MPI showed that MFR but not CAC provides significant incremental risk stratification over clinical risk score for prediction of major adverse cardiac events. However, no separate analysis in diabetic patients has been performed to assess the prognostic role of imaging variables in this cohort. Prognostic role of the presence of coronary vascular dysfunction in patients with suspected or known CAD have been already investigated.

Importantly, the authors demonstrated that diabetic patients without known CAD with impaired coronary vascular function experienced a rate of cardiac death comparable to, and possibly higher than that for nondiabetic patients with known CAD. As compared to previous published data 4 , 24 in our study we evaluated only diabetic and nondiabetic patients with suspected CAD and normal MPI in a longer follow-up period of about 4 years.

From our data it emerged that impaired MFR was able to identify diabetic patients at higher risk of events. Moreover, nondiabetic patients with reduced MFR and diabetic patients with preserved MFR showed similar values of annualized event rate, confirming that presence of diabetes also with preserved MFR represents a strong prognostic factor.

It has already been demonstrated that diabetes is an important predictor of hard event in patients with suspected and known CAD. Considering that impairment of MBF in diabetic patients may be an important reason for the higher event rates, aggressive statin therapy in such patients would be important also in term of primary prevention. Moreover, from our data it emerged that diabetic patients with preserved MFR have the same event rate as nondiabetics with reduced MFR.

These results support the concept of CAD equivalence for diabetic patients and confirm that after a normal stress MPI, diabetic patients are at higher risk for cardiac events than nondiabetics also after balancing clinical characteristics and stress type by propensity score analysis. In the present study, to overcome bias deriving from the presence of others cardiovascular risk factors, we used a propensity score-matched analysis of a cohort of diabetic and nondiabetic patients with normal MPI findings.

As already demonstrated in a previous paper, 8 we found that after propensity matching diabetic patients still have lower values of MFR, while CAC score values were not different compared to nondiabetic patients. Thus, controlled hypertension seems to have no impact on the number of patients with reduced MFR in the absence of diabetes. This result supports the notion that coronary risk factors have a synergistic and multiplicative effect rather than a simply additive effect on global cardiovascular risk.

In the present study, after matching patients according to clinical variables, we found that diabetic patients with reduced MFR showed the worst outcome and the major risk acceleration at parametric analysis, while nondiabetic patients with preserved MFR had the lowest probability of events. This acceleration confirms the need to identify subset of patients who can derive the most benefit from the intensive prevention measures with aggressive risk factor modification and a retesting strategy.

Noninvasive measure of coronary vascular dysfunction could represent a powerful predictor of adverse cardiac events and may helpful to better stratify diabetic patients. The implications of our observations deserve further investigation and specifically, whether impaired MFR can identify diabetics who will benefit from targeted medical interventions.

Unfortunately, in the present investigation angiographic data were not available. Thus, despite our population was characterized by subjects at low-intermediate risk of CAD and normal MPI we cannot exclude that presence of significant CAD associated with microvascular disease may have influenced the cardiac event rates.

In particular, the study highlighted that noninvasive measure of coronary vascular dysfunction by MFR may help to better stratify diabetic patients. Diabetic patients with reduced MFR showed a higher event rate and lower event-free survival compared to those with preserved MFR and to nondiabetic patients with preserved or reduced MFR.

Interestingly, event rate and event-free survival was similar in patients with diabetes and normal MFR and subjects without diabetes and reduced MFR. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of prospective studies. Lancet ; Article Google Scholar. Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes. J Am Coll Cardiol ; Diabetologia ; Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus.

Circulation ; Coronary atherosclerotic plaque detected by computed tomographic angiography in subjects with diabetes compared to those without diabetes. J Nucl Cardiol ; Coronary atherosclerotic burden vs coronary vascular function in diabetic and nondiabetic patients with normal myocardial perfusion: A propensity score analysis. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease.

Eur Heart J ; Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Intra- and inter-operator repeatability of myocardial blood flow and myocardial flow reserve measurements using rubidium PET and a highly automated analysis program.

Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med ; Quantification of coronary artery calcium using ultrafast computed tomography. Fourth universal definition of myocardial infarction. Circulation ;e An overview of the objectives of and the approaches to propensity score analyses. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med ; Leuven E, Sianesi B.

Statistical Software Components S Kannel WB. Lipids, diabetes, and coronary heart disease: Insights from the Framingham Study. Am Heart J ; Myocardial perfusion imaging for diabetes: Key points from the evidence and clinical questions to be answered [published online ahead of print, Aug 13]. Prognostic interplay of coronary artery calcification and underlying vascular dysfunction in patients with suspected coronary artery disease.

Impaired myocardial flow reserve on rubidium positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease: A systematic review and meta-analysis. Int J Cardiol ; Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis [published online ahead of print, Dec 24].

Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. Warranty period of normal stress myocardial perfusion imaging in diabetic patients: A propensity score analysis. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.

Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Wanda Acampa. Assante, C. Mainolfi, E. Zampella, V. Gaudieri, C. Nappi, T. Mannarino, A. Arumugam, M. Petretta, A. Cuocolo and W. Acampa have indicated that they have no financial conflict of interest.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

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