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Findings support the long-term effectiveness of CR on exercise capacity irrespective of the delivery model. However, participation in CR program, whether it be a traditional or fast-track CR exercise program, may not lead to long-term PA behavior change. Thus, CR participants may benefit from structured strategies that promote long-term PA adherence in addition to facilitating exercise capacity improvement.

Although at the 1-year followup exercise capacity decreased in the center-based group, the observed decline did not seem to be clinically significant. The present findings indicate that when the patients were given a choice as to the delivery model (center- vs home-based) used for their CR program, they were relatively successful in retaining the improvement in exercise capacity 1 year post-CR irrespective of the exact location for their exercise training.

Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s − 1 ), functional walking speed (1.3 m s − 1 ), a relatively challenging speed (1.6 m s − 1 ) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO 2peak ). Objectives: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Methods: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE _arm and RPE _respiration ) and oxygen uptake (VO 2 ) and heart rate were recorded during each exercise. Results: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1 ± 0.2 m s − 1 . Speeds of 1 m s − 1 and 1.3 m s − 1 are typical of everyday functional propulsion. The corresponding RPE_ respiration and RPE_ arm ranged from 7 to 13 on the Borg scale; the %VO 2peak measured in these trials ranged from 37 to 80% VO 2peak. For propulsion intensities used in the present study-low, moderate, high and graded exercise intensity-no difference could be observed between RPE _respiration and RPE _arm . There were no significant differences between RPE _arm and RPE _respiration at the termination of the GXT. Conclusion: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.

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Background Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes. Methods In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery. Results Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01). Conclusions A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.