Context:Land and aquatic plyometrics have clinical relevance for exercise, sport performance, and rehabilitation, yet study is limited comparing both.Objective:To compare the effects of land-based and aquatic-based plyometric-training programs on performance variables, muscle soreness, and range of motion (ROM).Setting:Aquatic facility and biomechanics laboratory.Subjects:Forty subjects randomly assigned to 3 groups: land (n = 13), water (n = 13), and control (n = 14).Main Outcome Measures:Performance variables, muscle soreness, and ROM were measured before and after an 8-week training period. An analysis of covariance (ANCOVA) and a Bonferroni post hoc test determined significance.Results:ANCOVA revealed significant differences between groups with respect to plantar-flexion ROM (P< .05). Pairedttest determined that the aquatic group significantly increased muscle power pretest to posttest (P< .05).Conclusions:Results indicate that aquatic plyometric training can be an alternative approach to enhancing performance.
Background Persistent poorly-controlled type 2 diabetes mellitus (PPDM), or maintenance of a hemoglobin A1c (HbA1c) ≥8.5% despite receiving clinic-based diabetes care, contributes disproportionately to the national diabetes burden. Comprehensive telehealth interventions may help ameliorate PPDM, but existing approaches have rarely been designed with clinical implementation in mind, limiting use in routine practice. We describe a study testing a novel telehealth intervention that comprehensively targets clinic-refractory PPDM, and was explicitly developed for practical delivery using existing Veterans Health Administration (VHA) clinical infrastructure. Methods Practical Telehealth to Improve Control and Engagement for Patients with Clinic-Refractory Diabetes Mellitus (PRACTICE-DM) is an ongoing randomized controlled trial comparing two 12-month interventions: 1) standard VHA Home Telehealth (HT) telemonitoring/care coordination; or 2) the PRACTICE-DM intervention, a comprehensive HT-delivered intervention combining telemonitoring, self-management support, diet/activity support, medication management, and depression management. The primary outcome is HbA1c. Secondary outcomes include diabetes distress, self-care, self-efficacy, weight, depressive symptoms, implementation barriers/facilitators, and costs. We hypothesize that the PRACTICE-DM intervention will reduce HbA1c by >0.6% versus standard HT over 12 months. Results Enrollment for this ongoing trial concluded in January 2020; 200 patients were randomized (99 to standard HT and 101 to the PRACTICE-DM intervention). The cohort has a mean age of 58 and is 23% female and 72% African American. Mean baseline HbA1c and BMI were 10.2% and 34.8 kg/m 2 . Conclusions Because it comprehensively targets factors underlying PPDM using existing clinical infrastructure, the PRACTICE-DM intervention may be well suited to lower the complications and costs of PPDM in routine practice.
Patients whose type 2 diabetes (T2D) remains persistently poorly-controlled despite receiving clinic-based care are at high risk for complications and costs. To address clinic-refractory T2D within the Veterans Health Administration, we conducted a randomized trial comparing two nurse-delivered telehealth strategies to augment clinic-based care: 1) telemonitoring and care coordination; and 2) a comprehensive intervention combining telemonitoring, self-management support, diet/activity support, medication management, and depression management. Delivery of both interventions utilized only existing clinical staff and infrastructure. Patients (n=200) with HbA1c continually ≥8.5% for ≥1 year despite receiving diabetes management from Primary Care and/or Endocrinology were randomized in a 1:1 ratio to the two 12-month intervention arms between 12/2018 and 1/2020. We analyzed our primary outcome, HbA1c collected at 0, 3, 6, 9 and 12 months, using linear mixed models. Secondary outcomes included BMI and hypoglycemia. Patients had a mean age of 58, and were mostly male (78%) and African American (72%); all patients were engaged with Primary Care prior to enrollment, and 68% with Endocrinology. Baseline characteristics were similar across arms. Estimated mean baseline HbA1c was 10.08%, which declined to an estimated 9.23% at 12 months in the telemonitoring arm and 8.67% in the comprehensive telehealth arm (estimated between-arm difference at 12 months -0.55%, 95%CI -1.06%,-0.05%, p=0.03). No difference in BMI between arms was seen. Hypoglycemia rates were low, and similar between arms. While both strategies improved HbA1c in this high-risk, clinic-refractory population, the comprehensive telehealth intervention led to a clinically and statistically significant added HbA1c benefit. Because its delivery relies solely on existing clinical resources, this comprehensive intervention may be a practical means to address clinic-refractory T2D. Disclosure M. J. Crowley: None. D. H. Jeter: None. E. Strawbridge: None. T. C. Wilmot: None. G. A. Tisdale: None. T. Marcano: None. D. L. Overby: None. M. A. Durkee: None. S. Bullard: None. M. Dar: None. A. Mundy: None. P. E. Tarkington: Stock/Shareholder; Self; Bristol-Myers Squibb Company, Eli Lilly and Company, Johnson & Johnson. S. T. Szabo: None. S. Desai: None. E. A. Kobe: None. N. Majette elliott: None. D. Edelman: None. H. B. Bosworth: Board Member; Self; Preventric Diagnostics, LLC., Consultant; Self; Novartis Pharmaceuticals Corporation, VIDYA, Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Improved Patient Outcomes, Novo Nordisk, Otsuka America Pharmaceutical, Inc., Sanofi. M. L. Maciejewski: Employee; Spouse/Partner; Amgen Inc., Stock/Shareholder; Spouse/Partner; Amgen Inc. K. Steinhauser: None. A. S. Jeffreys: None. C. Coffman: None. V. Smith: None. S. Danus: None. Funding U.S. Department of Veterans Affairs (IIR 16-213); Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13-410)
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