Benefits for Intense Exercise Started 3 Months Post-TKR
By medpagetoday.com
A comprehensive behavioral intervention (CBI) that incorporates intensive physical activity starting 3 months after total knee replacement (TKR) relieves knee pain and improves physical function and physical activity compared with a standard exercise program.
In the pilot study, patients randomized to CBI were faster in stair-climb and chair-stand tests from baseline to 6 months, while controls showed no change in the stair-climb test and only a slight increase in the chair-stand test, found Sara R. Piva, PT, PhD, co-director of the Physical Therapy Clinical and Translational Research Center of the University of Pittsburgh Medical Center-Rehabilitation Institute, and colleagues.
Writing online in Arthritis Care & Research, the team said, "The CBI is feasible and appears to be effective in improving physical function and physical activity as compared to a standard of care exercise program at a later stage, post-TKR. Larger pragmatic randomized trials should confirm the results of this study."
Persistent functional limitations combined with physical inactivity post-TKR "are major public health concerns and precursors of further comorbidities," the researcher noted.
The team developed a CBI that combines intense exercises with promotion of physical activity to be implemented 3 months post-TKR. The CBI was developed to be used after surgical healing to enable the performance of sufficiently intensive exercise to reverse long-lasting functional limitations that persist after TKR.
In the two-group, single-blind study, the CBI program was tested in a randomized manner in 44 patients ages 50 and older. CBI consisted of high-intensity exercise comprised of endurance, lower extremity strengthening, and skilled exercises (i.e., chair rises, stair climbing, and bilateral and unilateral mini-squats) in addition to interactive education. Endurance training consisted of 20 minutes of treadmill walking, maintaining the intensity between 50% and 75% of the age-estimated maximal heart rate. Strength training was performed at 60% to 80% of one-repetition maximum.
The standard-care group program was similar, without the education component, but endurance training was performed at 40% to 50% of the age-estimated maximal heart rate and strength training at 40% to 50% of one-repetition maximum.
Time commitments between the two groups were comparable, the researchers reported, and attendance at the supervised exercise sessions was similar in both groups, with an average adherence of 11.5 out of the 12 sessions (96%) in each group.
The CBI group had a greater reduction in pain score on the 5-item Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale compared with the control group; the change in WOMAC pain score was -1.7 (95% CI -3.0 to -0.4) in the CBI arm versus -0.3 (95% CI -1.5 to 1.0) in the control arm (P= 0.035).
The CBI group also had more improvement compared with the standard exercise group in physical function as measured by the RAND-Physical Function (20.2 versus 6.8, P=0.017), which assesses physical function based on 10 activities, and on the single-leg stance test (2.0 versus -1.9, P=0.037). "From baseline to 6 months the CBI group became 4.6 and 2.2 seconds faster in the stair-climb and chair-stand tests, respectively, while the standard-care exercise group showed no change in the stair-climb test (0.1 seconds) and a slight increase in the chair-stand test (0.6 seconds)," the investigators wrote. Other outcome measures between the two groups were not significantly different.
More participants in the CBI group had their physical function increased above the minimum clinically important improvement compared with the standard-care exercise group. The rates of increase above the minimum clinically important improvement in the CBI group ranged from 24% on the 6-minute walk test and gait speed to 76% on the WOMAC-Physical Function, whereas the rates in the standard-care group ranged from 5% on the single-leg stance test to 60% on the WOMAC-Physical Function.
Almost half (47%) of participants in the CBI arm had an improvement in physical activity above the minimum clinically important improvement compared with 26% in the standard-exercise group.
More patients in the CBI group were classified as responders of physical function compared with the standard-care exercise group (81% versus 45%, respectively). Moreover, 38% of those in the CBI group were responders of the combined domains of physical function and physical activity compared with 15% of the standard-care exercise group.
Among the limitations noted by the authors were the lower body mass index of the study sample compared with the general population undergoing TKR (30.3 versus 32.4, respectively), and the lack of blinding to the group assignments. In addition, the session length was not recorded and may not have been equal between the two groups, the researchers stated.
Source: http://www.medpagetoday.com/rheumatology/arthritis/63561
Saturday, June 13, 2026
Treating Anxiety And Weight Loss With Wellbutrin: Key Facts
When a person is diagnosed with anxiety and weight loss or seeks relief from it, selecting the most appropriate medication requires weighing multiple factors: the severity of symptoms, the patient's age and health history, and whether other medications are already being taken. A thoughtful treatment choice improves outcomes and reduces unnecessary side effects. Antidepressant medications have been central to depression treatment for decades. The first antidepressants developed, the monoamine oxidase inhibitors and tricyclic antidepressants, were effective but had significant side effect profiles that limited their use. The introduction of selective serotonin reuptake inhibitors in the 1980s represented a major advance, offering comparable efficacy with substantially improved tolerability. Today there are multiple antidepressant classes available, allowing treatment to be tailored to the individual patient's needs and tolerability. Among the medications available for antidepressant medications, Wellbutrin provides a well-studied option that many patients discuss with their doctors. The clinical evidence supporting wellbutrin for anxiety and weight loss shows that it can be effective for managing this condition when used appropriately under medical supervision. Wellbutrin contains the active ingredient bupropion, which works by acting on the biological pathways responsible for producing the symptoms associated with anxiety and weight loss. Understanding the mechanism helps patients appreciate why consistent use is often more effective than taking it only when symptoms become severe, as maintaining steady levels allows for more stable control. Patients managing anxiety and weight loss long-term should keep regular follow-up appointments to assess whether their treatment plan is still the best fit for their situation. As conditions change and new evidence emerges, treatment adjustments may be worthwhile. The https://mednewwsstoday.com/antidepressants/ resource section provides a helpful reference for staying current on medication options in this area.
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