Introduction Heavy‐load strength training (HLT) is generally considered the Gold Standard exercise modality for inducing gains in skeletal muscle strength. However, use of heavy external exercise loads may be contraindicative in frail individuals. Low‐load resistance exercise combined with partial blood‐flow restriction (LL‐BFR exercise) may offer an effective alternative for increasing mechanical muscle strength and size. The aim of this study was to compare the effect of LL‐BFR training to HLT on maximal muscle strength gains. Prospero registration‐id (CRD42014013382). Materials and methods A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post‐intervention changes in maximal muscle strength. A random‐effects meta‐analysis with standardized mean differences (SMD) was used. Results Of 1413 papers identified through systematic search routines, sixteen papers fulfilled the inclusion criteria, totalling 153 participants completing HLT and 157 completing LL‐BFR training. The magnitude of training‐induced gains in maximal muscle strength did not differ between LL‐BFR training and HLT (SMD of −0.17 (95% CI: −0.40; 0.05)). Low between‐study heterogeneity was noted (I2 = 0.0%, Chi2 P = 9.65). Conclusion Low‐load blood‐flow‐restricted training appears equally effective of producing gains in maximal voluntary muscle strength compared to HLT in 20‐ to 80‐year‐old healthy and habitually active adults.

The aim of the study was to determine the impact of an interdisciplinary exercise-based rehabilitation intervention on fatigue and quality of life (QOL) in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs). At the Danish Knowledge Centre for Rehabilitation and Palliative Care, a 5-day interdisciplinary exercise-based rehabilitation intervention was carried out on 48 patients with MPN. It was followed by 12 weeks of self-exercising prior to follow-up. Initially and at follow-up, participants filled out validated questionnaires; Brief Fatigue Inventory, Multidimensional Fatigue Inventory, European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire, Myeloproliferative Neoplasm Symptom Assessment Form and Hospital Anxiety and Depression Scale. Maximal oxygen uptake and muscular strength were tested as well. Paired t test was used to compare scores between baseline and follow-up. In total, 45 participants (94%) completed the follow-up. No significant differences were observed on fatigue or QOL when comparing baseline and follow-up. Mean maximal oxygen uptake increased from 27.2 to 33.6 ml O · kg ·min (p < 0.001). Handgrip strength (p = 0.01) and the 30-s chair-stand test (p < 0.001) improved as well. No changes were found regarding levels of fatigue and QOL. However, we observed a significant increase in the physical capacity. Our observations call for further studies investigating the effects of non-pharmacological approaches in patients with MPN.

No abstract

The Nordic Hamstring Exercise reduces hamstring strain injuries in football and other sports, but the exercise is not well adopted in practice. Barriers from practitioners include fear of performance decrements, due to lack of specificity of the exercise with high speed running. However, in theory, increased eccentric hamstring strength could transfer to faster sprinting due to higher horizontal force production. Studies on the effect of the Nordic Hamstring Exercise on performance have been conflicting and no synthesis of the evidence exists. We therefore pose the following question: does including the Nordic Hamstring exercise hamper sprint or jump performance in athletes? We will answer this question by performing a systematic review of the literature, critically appraise relevant studies, and GRADE the evidence across key outcomes and perform meta-analyses, meta-regression and subgroup analyses. In this protocol we outline the planned methods and procedures.

Background There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation. Methods This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework. Results Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped. Conclusions Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.

Background Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497). Methods The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments. Results A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned. Conclusion The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial. Trial registration ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.

Objectives To firstly investigate the efficacy of three different dosages of home-based, knee-extensor strength exercise on isometric knee-extensor strength in patients eligible for knee replacement due to severe knee osteoarthritis, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. Design Randomized dose-response trial. Setting Primary and secondary care. Participants One-hundred and forty patients eligible for knee replacement were included. Eligibility for surgery was assessed by an orthopedic surgeon specialized in knee arthroplasty. Interventions Patients were randomized to three groups; 2, 4 or 6 home-based knee-extensor exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks (N=47/group). Exercise instruction was given by a trained physiotherapist. Main outcome measures The primary outcome was isometric knee-extensor strength. Secondary outcomes were Oxford Knee Score, Knee Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-minute walk test, stair climbing test, exercise adherence and 'need for surgery'. The primary endpoint was after 12 weeks of exercise (before surgery) and the secondary after surgery. Outcome assessors and patients were blinded to allocation. Results After 12 weeks of exercise, data were available for 117 patients (N=39/group). Isometric knee-extensor strength increased in all groups but intention-to-treat analysis showed no difference between the three groups in change from baseline to after 12 weeks of exercise in isometric knee-extensor muscle strength: Group 2 vs. 4 (0.009 Nm/kg [95% CI -0.15 to 0.17], P=0.913), group 2 vs. 6 (-0.03 Nm/kg [95% CI -0.18 to 0.13], P=0.725) and group 4 vs. 6 (-0.04 Nm/kg [95% CI -0.20 to 0.13], P=0.668). For the secondary outcomes a significant difference before surgery was found between group 2 and group 6 for Oxford Knee Score (4.2 [95% CI 0.6 to 7.8], P=0.02) and average knee pain last week (NRS 0-10) (-1.1 [95% -2.2 to -0.1], P=0.03) in favour of group 2. No other differences were observed before and after surgery. After the 12-week exercise intervention, 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. Conclusion Knee-extensor strength increased with both 2, 4 and 6 exercise sessions per week but none of the prescribed exercise dosages were superior to the others for the primary outcome isometric knee-extensor strength after 12 weeks. Two home-based knee-extensor exercise sessions a week seems superior to six for patient-reported outcomes, and across exercise dosages, only one in three patients decided to have surgery after the coordinated home-based exercise intervention. Trial registration ClinicalTrials.gov identifier: NCT02931058, pre-registered October 10th, 2016. Protocol PubMed (PMID: 29347947).

We commend Lixandrão et al. 1 for the substantial work (i.e., additional analyses) they have put into their Letter to the Editor, containing a number of comments to our recent study published in Scand. J. Med. Sci. Sports. 3 In their initial publication, 2 Lixandrão and coworkers reported data on a change score fixed effects meta-analysis indicating that conventional high-load strength training (HLST) may be superior compared to low-load blood flow restricted (LL-BFR) exercise for causing improvements in maximal muscle strength. 2 In contrast, employing a post score (i.e., follow-up score) random-effects meta-analysis, we found that the effect of HLST and LL-BFR exercise were not different, that is eliciting strength increases of comparable magnitude. 3 We fail to agree with Lixandrão et al. that the outcome of their secondary analyses 1 can be considered supportive of an unbiased methodological approach in the initial analysis, 2 as implicitly stated in their closing comment. 1 As elaborated below, the additional work presented in the Commentary by Lixandrão et al. 1 merely underlines that the different conclusions between their review/metaanalysis 2 and our recent systematic review and metaanalysis 3 arise from differences in analytical designs and methodological approaches.In their Letter to the Editor, 1 Lixandrão et al. raise three main points of criticism: (i) The use of post scores compared to change scores analyses, (ii) bias in the selection of comparator arms (interventions/comparators), and (iii) bias in the selection of primary outcomes (which strength parameters to select for the primary analysis).