Janet Wright looks at exercise to control blood pressure for pregnant women and training people with cancer needs firm evidence.
Exercise can control blood pressure in pregnancy
Women who follow an exercise programme throughout pregnancy reduce their risk of developing high blood pressure, a pioneering study has found.
Obese women are at risk of developing hypertension while pregnant, as are pregnant women of any body mass index (BMI) who gain excessive weight.
Hypertension can cause complications endangering both mother and baby.
It is also linked with both low birth weight and macrosomia, or excessively high birth weight.
‘No large randomised controlled trial with high adherence to an exercise programme has examined pregnancy-induced hypertension and these associated issues,’ say the authors.
Ruben Barakat, of the Technical University of Madrid, and colleagues divided 765 pregnant women into an exercise group and a group receiving normal care only.
The intervention group did three exercise sessions a week, starting in week 9-11 and continuing till week 38-39. The sessions, lasting nearly an hour, included aerobic exercise, muscular strength and flexibility training.
‘High attendance to the exercise programme, regardless of BMI, showed that pregnant women who did not exercise are three times more likely to develop hypertension and are 1.5 times more likely to gain excessive weight if they do not exercise,’ say the authors.
‘Maternal exercise may be a preventative tool for hypertension ... and may [reduce] comorbidities related to chronic disease risk,’ the authors conclude. Barakat R et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial, American Journal of Obstetrics and Obstetrics and Gynecology 2016; 214: 649.e1–649.e8.
Training people with cancer needs firm evidence
Exercise may counteract the weakening effects of chemotherapy, say researchers in the Netherlands. But what sort of exercise, at what intensity and for how long?
‘There are no clear guidelines concerning which type of training and which training dose are effective,’ say Christel van Moll, of Elisabether-TweeSteden hospital in Tilburg, and colleagues.
Chemotherapy treatments for cancer have the side effect of reducing patients’ muscle strength and endurance capacity. Numerous studies have investigated exercise to alleviate this: the team found more than 800 randomised controlled trials (RCTs).
But the team could not draw any overall conclusions from these, because the RCTs had been carried out with such a wide variety of methods, criteria, participants and interventions.
The 14 they found suitable to review showed that the exercisers increased their muscle strength and endurance capacity compared with the control groups.
‘This review indicates that training during chemotherapy may help in preventing the decrease in muscle strength and endurance capacity,’ say the authors.
But the quality of the studies was generally low, they add. They call for more good-quality research to help create effective training programmes and set international guidelines.
‘It is important to know which training intensity and duration is the most effective, to provide a training programme suitable for every cancer patient,’ they say. Van Moll CCA et al. The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: a systematic review, Acta Oncologica 2016; 5: 539-546.
How can breath training help after a stroke?
Respiratory muscle training can play a useful role in rehabilitation after a stroke, say physiotherapy researchers.
Mansueto Gomes-Neto, of the department of physical therapy at the Federal University of Bahia in Brazil, and colleagues investigated its effects on respiratory function, respiratory muscle strength and exercise tolerance.
The team searched databases for randomised controlled trials of people in post-stroke rehabilitation, comparing those who took the training with those who didn’t.
The eight studies they reviewed showed that the training was effective on all counts, with no serious adverse effects reported.
Respiratory muscle training should be considered an effective method of improving those measures in post-stroke patients, say the authors.
However, they noted that more research was needed to establish how much training would be most effective, and how long the effects would last. Gomes-Neto M et al. Effects of respiratory muscle training on respiratory function, respiratory muscle strength and exercise tolerance in post-stroke patients: a systematic review with meta-analysis, Archives of Physical Medicine and Rehabilitation 2016.
Comments and conclusions
- People who have weight-loss surgery are more likely to break a bone – either before or after surgery – than obese or normal-weight people who don’t have surgery. After the operation, the fractures are more likely to happen in places associated with osteoporosis, say researchers who analysed Canadian data on 12,676 bariatric patients and more than 160,000 obese and non-obese controls. Rousseau C et al. BMJ 2016 - open access.
- A 16-week low-intensity wheelchair training proved insufficient to provide any substantial benefits to inactive people with long-term spinal cord injury, a randomised controlled trial of 29 wheelchair-users reports. Van der Scheer JW et al. Journal of Rehabilitation Medicine 2016.
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