Baş Editör (Editor in Chief) Aynur Ayşe KARADUMAN. Editör Yardımcıları (Associate Editors) Teknik Editör (Technical Editor)

Transkript

1 ISSN: e-issn: TÜRKİYE FİZYOTERAPİSTLER DERNEĞİ nin bilimsel yayın organı ve süreli yayınıdır. (The official scientific journal of Turkish Physiotherapy Association) Sahibi (Owner) Türkiye Fizyoterapistleri Derneği adına (On Behalf of Turkish Physiotherapy Association) Bülent ELBASAN Editör ve Yazı İşleri Müdürü (Editor in Chief and Editorial Manager) Aynur Ayşe KARADUMAN Tasarım (Design) Merdiven Reklam Tanıtım Telefon: Baskı (Printing) Ankara Ofset Büyük Sanayi 1. Cadde Necatibey İş Hanı Alt Kat No: 93/43-44 İskitler - Ankara Türk Fizyoterapi ve Rehabilitasyon Dergisi ; Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO, Excerpta Medica EMBASE), AMED Physiotherapy Index, SPORT Discus, Türkiye Atıf Dizini ve Ulakbim Türk Tıp Dizini nde yer almaktadır. Turkish Journal of Physiotherapy and Rehabilitation is listed in Cumulative Indexto Nursing and Allied Health Literature (CINAHL), EBSCO, Excerpta Medica (EMBASE), AMED Physiotherapy Index, SPORT Discus, Turkey Citation Index and Ulakbim Medical Index. Açık Erişim Dergi Yılda 3 kez (Nisan, Ağustos, Aralık) yayınlanır. Open Access Journal Published three times (April, August, December) a year. İletişim (Correspondence) Türkiye Fizyoterapistler Derneği Genel Merkezi Adres: Kültür Mah. Mithatpaşa Cad. 71/13 Kızılay/ANKARA Telefon : (0312) Fax : (0312) Gsm : (0507) editor@turkjphysiotherrehabil.org Dergi Basım tarihi:??????? TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ Baş Editör (Editor in Chief) Aynur Ayşe KARADUMAN Editör Yardımcıları (Associate Editors) Semin AKEL Hacettepe Üniversitesi (İng. ED) İpek ALEMDAROĞLU Bezmialem Vakıf Üniversitesi (İng. ED) Ummühan BAŞASLAN Pamukkale Üniversitesi Gürsoy COŞKUN Hacettepe Üniversitesi İlkim ÇITAK KARAKAYA Muğla Sıtkı Koçman Üniversitesi (İng. ED) İrem DÜZGÜN Hacettepe Üniversitesi Bülent ELBASAN Gazi Üniversitesi Tüzün FIRAT Hacettepe Üniversitesi Arzu GENÇ Dokuz Eylül Üniversitesi Mehmet Gürhan KARAKAYA Muğla Sıtkı Koçman Üniversitesi Defne KAYA Hacettepe Üniversitesi Akmer MUTLU Hacettepe Üniversitesi (İng. ED) Çiğdem ÖKSÜZ Hacettepe Üniversitesi (İng. ED) Zübeyir SARI Marmara Üniversitesi Ela TARAKCI İstanbul Üniversitesi Emine ASLAN TELCİ Pamukkale Üniversitesi Semra TOPUZ Hacettepe Üniversitesi Baki Umut TUGAY Muğla Sıtkı Koçman Üniversitesi (İng. ED) Emine Handan TÜZÜN Kırıkkale Üniversitesi İpek YELDAN İstanbul Üniversitesi Öznur YILMAZ Hacettepe Üniversitesi Gül Deniz YILMAZ Turgut Özal Üniversitesi Nuray YOZBATIRAN Texas Üniversitesi (İng. ED) Teknik Editör (Technical Editor) Numan DEMİR Hacettepe Üniversitesi Yardımcı Teknik Editörler (Associate Technical Editors) Selen SEREL Hacettepe Üniversitesi Elif ÇAMCI Hacettepe Üniversitesi Orkun Tahir ARAN Hacettepe Üniversitesi Şulenur SUBAŞI Hacettepe Üniversitesi Özgün KAYA KARA Hacettepe Üniversitesi Bioistatistik Editörü (Biostatistics Advisor) Levent EKER Sağlık Bak. Sağlık Araştırmaları Genel Müdürlüğü Ulusal Danışma Kurulu (National Advisory Board) Esra AKI Candan ALGUN Berna ARDA Hülya ARIKAN Sinan BEKSAÇ Uğur CAVLAK Arzu DAŞKAPAN Mahmut Nedim DORAL Hakan GÜR Nilgün GÜRSES Hülya HARUTOĞLU Serap İNAL Özgür KASAPÇOPUR Hülya KAYIHAN Uluslararası Danışma Kurulu (International Advisory Board) Peter C. BELAFSKY (USA) Ayşenur TUNCER (USA) Richard Wallace BOHANNON (UK) Michael CALLAGHAN (UK) Victor DUBOWITZ (UK) John A. NYLAND (USA) Barbara H. CONNOLY (USA) Michelle EAGLE (UK) Ayşe EDEER (USA) Christa EINSPIELER (AT) Web Tabanlı Danışma ve Hakem Kurulu Listesi adresinde yer almaktadır. Nilüfer ÇETİŞLİ KORKMAZ Feza KORKUSUZ Mahmut KÖMÜRCÜ Mehtap MALKOÇ Arzu RAZAK ÖZDINÇLER Levent ÖZTÜRK Gülden POLAT Cem SARAÇ Sema SAVCI Bilsen SİRMEN Haluk TOPALOĞLU Mine UYANIK Özlem ÜLGER Sibel AKSU YILDIRIM Andre FARASYN (BEL) P. Senthil KUMAR (India) Sheila LENNON (AU) Carole B. LEWIS (USA) Rusu LIGIA (RO) Jerilyn A. LOGEMANN (USA) Jarmo PERTTUNEN (Fi) Paul ROCKAR (USA) Guy G. SIMONEAU (USA) Deborah Gaebler SPIRA (USA) (2)

2 YAZARLARIN DİKKATİNE Yazım Kuralları ve Genel Bilgiler Türk Fizyoterapi ve Rehabilitasyon Dergisi, Türkiye Fizyoterapistler Derneği nin yayın organı olup, yılda 3 kez (Nisan, Ağustos ve Aralık) Türkçe ve İngilizce olarak yayınlanmaktadır. Dergi fizyoterapi ve rehabilitasyon konuları ile ilişkili özgün araştırmalar, çağrılı derlemeler, olgu sunumları, editöre mektupları değerlendirmek üzere kabul eder. Türk Fizyoterapi ve Rehabilitasyon Dergisi yayınladığı makalelerin konu ile ilgili en yüksek etik ve bilimsel standartlarda olması ve ticari kaygılarda olmaması şartını gözetmektedir. Derginin yazım kurallarında Uniform Requirements for Manuscripts Submitted to Biomedical Journals - International Committee of Medical Journal Editors ( adlı belge temel alınmıştır. İletişimden sorumlu yazar makalenin sunum aşamasından basımına kadar olan süreçlerde her türlü yazışmayı gerçekleştiren yazardır. İletişimden sorumlu yazar makaleyi dergiye Yayın Hakları Sözleşmesi ve Çıkar Çatışması Formu nu tamamlayarak göndermelidir. Makalenin sunum yazısı e-imza ile imzalanarak ya da çıplak imza ile imzalandıktan sonra taranarak gönderilmelidir. Dergi gerektiğinde çıplak imzalı sunum yazısını isteme hakkına sahiptir. Makalede kitap ya da dergilerde daha önce yayınlanmış alıntı yazı, tablo, şekil vs. mevcut ise makale yazarı, yayın hakkı sahibi ve yazarlarından yazılı izin almak ve bunu makalede belirtmek zorundadır. Bilimsel toplantılarda sunulan bildiler özet şeklinde daha önce sunulmuş ve/veya basılmış ise başlık sayfasında belirtilmesi koşulu ile kabul edilir. Yazıların bilimsel içeriği ve etik kurallara uygunluğu yazar(lar)ın sorumluluğundadır. Dergiye Etik kurul onayı almış ve Helsinki Bildirgesi ne uygun yazılar kabul edilir. Çalışmada Hayvan öğesi kullanılmış ise yazar(lar), makalenin Gereç ve yöntem bölümünde Guide for the Care and Use of Laboratory Animals ( prensipleri doğrultusunda çalışmalarında hayvan haklarını koruduklarını ve kurumlarının etik kurullarından onay aldıklarını belirtmek zorundadır. Yazar(lar), araştırmaya katılan bireylerden Bilgilendirilmiş Onam Formu (informed consent) alındığını yazılarında belirtmeli ve gerektiğinde onam formlarını belgeleyebilmelidir. Dergiye gönderilen makale biçimsel esaslara uygun ise editör ve editör yardımcılarına ek olarak en az iki hakemin incelemesinden geçip, gerek görüldüğü takdirde, istenen değişiklikler yazarlarca yapıldıktan sonra yayınlanır. Makale bilimsel değerlendirme için işleme alındıktan sonra yayın hakları devir sözleşmesinde belirtilmiş olan yazar isimleri ve sıralaması esas alınır. Bu aşamadan sonra hiçbir aşamada makaleye yayın hakları devir sözleşmesinde imzası bulunanlar dışında yazar ismi eklenemez ve yazar sırası değiştirilemez. Makale yazarlarından herhangi birinin isminin makaleden çıkartılması için konuyla ilgili tüm yazarların açıklamalı ve yazılı izinleri alınır. Yayın hakları devir sözleşmesinde ismi belirtilmiş olan yazarların gönderilen makalede doğrudan katkısının olması gerekir. Yazar olarak belirlenen isim aşağıdaki özelliklerin tümüne sahip olmalıdır. Çalışmanın planlanmasına ve verilerin toplanmasına veya verilerin analizine ve yorumlanmasına katkısı olmalıdır. Makale taslağının hazırlanması veya revize edilmesine katkıda bulunmalıdır. Makalenin dergiye gönderilecek ve yayınlanacak son halini okuyup kabul etmelidir. Yazım Kuralları Türkçe makalelerde Türk Dil Kurumu nun Türkçe Sözlüğü esas alınmalıdır. İngilizce makaleler ve İngilizce özetler, dergiye gönderilmeden önce dil uzmanı tarafından değerlendirilmelidir. Makaleyi İngilizce yönünden değerlendiren yazarlardan biri değil ise bu kişinin ismi makalenin sonunda TEŞEKKÜR (Acknowledgement) bölümünde belirtilmelidir. Makaleler, sayfa A4 boyutunda olacak şekilde, PC uyumlu Microsoft Word programı ile Times New Roman yazı tipi kullanılarak 12 punto ile makalenin tüm bölümlerinde çift aralıklı olarak yazılmalıdır. Sayfanın her iki kenarında 2.5 cm boşluk bırakılmalı, sayfalar numaralandırılmalıdır. Orijinal araştırma makaleleri 3000 kelime, derlemeler 5000 kelime, olgu sunumları 1000 kelime ve editöre mektuplar ise 500 kelimeyi aşmamalıdır. Makale dergiye yayımlanmak üzere gönderilmeden önce, Yazar için Son Kontrol Listesi ne göre gözden geçirilmelidir. Başlık Sayfası Makalenin başlığı kısa fakat içeriği tanımlayıcı ve amaçla uyumlu olmalıdır. Başlıkta kısaltma kullanılmamalıdır. Makale başlığının hem Türkçe hem de İngilizcesi yazılmalıdır. Ayrıca yazının 40 karakterlik kısa bir başlığı da hem Türkçe hem de İngilizce olarak başlık sayfasında belirtilmelidir. Yazarların açık adları, soyadları ve akademik unvanları, çalıştıkları kurum, çalışmanın yapıldığı klinik, bölüm, enstitü, hastane veya üniversitenin açık adı ve adresi belirtilmeli ve her yazar için üst numaralandırma kullanılmalıdır. İletişimden sorumlu yazarın iletişim bilgileri ayrıca belirtilmelidir. İletişim bilgileri, adres, güncel e-posta adresi, faks ve GSM numaralarını içermelidir. Yazı özet ve/veya bildiri şeklinde daha önce sunulmuş ise sunum yeri, tarihi ve basılmışsa basımı yapılan yayın organı bu sayfada belirtilmelidir. Ayrıca dergiye gönderilen yazı ile ilgili herhangi bir kuruluştan destek alınıp alınmadığı, alınmışsa bu desteğin kapsamı başlık sayfasında belirtilmelidir. Özetler Her makale hem Türkçe hem de İngilizce özet içermelidir. Türkçe Özet ve Anahtar Kelimeler Türkçe özet ayrı bir sayfadan başlamalı ve 250 kelimeden fazla olmamalıdır. Türkçe özet bölümü çalışmanın amacını, uygulanan yöntemi, temel bulguları ve sonucu içermelidir. Özet, Amaç, Yöntemler, Sonuçlar, Tartışma alt başlıklarına ayrılmalıdır. Anahtar kelimeler 3 ten az, 5 ten çok olmamalıdır. Anahtar kelimeler Türkiye Bilim Terimleri listesinden seçilmelidir ( Türkiye Bilim Terimleri, MeSH (Medical Subject Headings) terimlerinin Türkçe karşılıklarının bulunduğu bir anahtar kelimeler dizinidir. MeSH listesinde henüz yer almamış yeni bir kavram için liste dışı kelimeler kullanılabilir. Anahtar kelimeler noktalı virgül ile birbirinden ayrılmalıdır. Yazı içerisinde kullanılacak kısaltmalar için org/ ltwa.php adresinden yararlanılabilir. İngilizce Özet (Abstract) ve Anahtar Kelimeler (Key Words) İngilizce özet ayrı bir sayfadan başlamalı ve 250 kelimeden fazla olmamalıdır. İngilizce özet Purpose, Methods, Results, Discussion alt başlıklarına ayrılmalıdır. İngilizce özet ve anahtar kelimeler, Türkçe özet ve anahtar kelimelerin birebir aynısı olmalıdır. Anahtar kelimeler MeSH (Medical Subject Headings) terimlerinden seçilmiş olmalıdır. MeSH listesinde henüz yer almamış yeni bir kavram için liste dışı kelimeler kullanılabilir. Anahtar kelimeler noktalı virgül ile birbirinden ayrılmalıdır. Araştırma Makalelerinin Bölümleri Makale metni Giriş, Yöntemler, Sonuçlar ve Tartışma bölümlerinden oluşur. Metin içinde kısaltma kullanılacak ise 5 defadan fazla tekrar eden ifadeler için kullanılmalıdır. Kısaltmalar standart ifadeler şeklinde olmalıdır. Giriş Çalışma konusuyla ilgili önceki yayınlardan elde edilen temel bilgilerin özetini içermelidir. Çalışmanın yapılmasındaki gereklilik ve amaç kısaca belirtilmelidir. Yöntemler Çalışmadaki klinik, teknik veya deneysel yöntemler açıkça belirtilmelidir. Yöntemler için uygun kaynaklar verilmelidir. İstatistiksel analiz, alt başlık halinde belirtilmelidir. İstatistik çözümlemede herhangi bir istatistik program kullanılmış ise kullanılan programın adı ve sürüm numarası belirtilmeli ve istatistik çözümleme yöntemleri gerekçeleri ile birlikte sunulmalı, gerektiğinde kaynaklarla desteklenmelidir. Sonuçlar Bulgular yorum yapmadan tanımlanmalıdır. Tablolarda sunulan verilerin metin içinde tekrar edilmesinden kaçınılmalı, en önemli bulgular vurgulanmalıdır. Tartışma Giriş ve Sonuçlar bölümündeki ifadelerin tekrarı olmamalıdır. Çalışmadan elde edilen sonuçlar yorumlanmalı ve önceki çalışmaların sonuçları ile ilişkilendirilmelidir. Bu bölümde çalışmanın kısıtlılıkları alt başlık halinde belirtilmelidir. Kısıtlılıklar çalışmanın amacıyla uyumlu olmalıdır. Tartışma bölümü çalışmanın literatüre olan katkısını da içermelidir. Sonuçlar bölümünde ve tablolarda yer alan bulguların, detayları ile tartışma bölümünde tekrar edilmesinden kaçınılmalıdır. Araştırmada elde edilmeyen veriler tartışılmamalıdır (Tip III hata). Teşekkür Makalenin sonuna, yazının hazırlanmasında emeği geçen kişi ve kuruluşlar için teşekkür notu eklenebilir. Teşekkür bölümü referanslardan sonra ayrı bir sayfada olmalıdır. Kaynaklar Kaynakların sunumuna makalenin giriş, gereç ve yöntem, sonuçlar ve tartışma bölümlerinin oluşturduğu ana metinden hemen sonra başlanılmalıdır. Kaynaklar yazıda geçiş sırasına göre numaralandırılmalıdır. Kaynaklar metinde cümle sonunda parantez içinde Arabik numaralarla gösterilmelidir (Örnek:...meydana geldiği bulunmuştur (21).). Birden çok kaynağa atıf varsa: (3,7,15-19) şeklinde olmalıdır. Burada 15-19, 15. kaynaktan 19. kaynağa kadar olan beş yayını kapsamaktadır. Ayrıca, kaynaklar arasına virgül konulmalı, virgülden önce ve sonra boşluk bırakılmamalıdır (Örnek: 21,34,37). Dergi adları Index Medicus ta gösterilen şekilde kısaltılmalıdır. Yayınlanmamış gözlem ve kişisel görüşme lerin ve kitapların (en fazla 2-3 kitap) kaynak olarak kullanılmasından kaçınılmalıdır. Standart dergide yazar sayısı 6 ve daha az ise tüm yazarların adı yazılmalı, 6 dan çok ise ilk 6 yazar yazılmalı ve diğerleri Türkçe kaynaklarda ve ark. İngilizce kaynaklarda ise et al. olarak belirtilmelidir. Endnote kullanacak yazarlar Endnote programı içerisinde bulunan VANCOUVER stilini kullanmalıdır. Vancouver stilinde verilen bir referansta mutlaka olması gereken bilgiler aşağıda belirtilmiştir: - Yazar(lar) ad(ları) - Makale adı - Dergi adı (Medline kısaltmalarına uygun olarak) - Basım yılı - Dergi seri numarası (volume) - Dergi sayısı (issue) - Sayfa aralığı (10-15 vb) Kaynak yazım örnekleri aşağıdaki gibidir: Makale Örneği - Yazarlı yayınlar Brooks C, Siegler JC, Cheema BS, Marshall PW. No relationship between body mass index and changes in pain and disability after exercise rehabilitation for patients with mild to moderate chronic low back pain. Spine. 2013;38(25): Makale Örneği - Araştırma grupları veya organizasyon yayınları Diabetes Prevention Program Research Group. Hypertension, insulin, and proinsulin in participants with impaired glucose tolerance. Hypertension. 2002;40(5): Dergi İlavesi Geraud G, Spierings ELH, Keywood C. Tolerability and safety of frovatriptan with short- and long-term use for treatment of migraine and in comparison with sumatriptan. Headache. 2002;42:Suppl 93-p9. Kitap Bölümü Kılınç M, Atay Yılmaz S, Aksu Yıldırım S. İnme. In: Karaduman A, Aksu Yıldırım S, Tunca Yılmaz Ö, editors. İnme sonrası fizyoterapi ve rehabilitasyon. Ankara: Pelikan Kitapevi, 2013; p Kitap Murtagh J. John Murtagh s General practice. 4th ed. Sydney: McGraw-Hill Australia Pty Ltd; Kongre Bildirisi Suttrup I, Hamacher C, Oelenberg S, Dziewas R, Warnecke T. Assessment of laryngeal movement during swallowing to detect dysphagia in parkinson s disease. In: Reza S, editor. 2nd Congress of European Society for Swallowing Disorders; 2013 October 25-27; Barcelona: Dysphagia; p Online Dergi Makalesi Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [serial on the Internet] Jun [cited 2002 Aug 12];102(6):[about 3 p.]. Available from: Online Kitap Foley KM, Gelband H, editors. Improving palliative care for cancer [monograph on the Internet]. Washington: National Academy Press; 2001 [cited 2002 Jul 9]. Available from: edu/books/ /html/ Web Sayfası American Medical Association [homepage on the Internet]. Chicago: The Association; c [updated 2001 Aug 23; cited 2002 Aug 12]. AMA Office of Group Practice Liaison; [about 2 screens]. Available from: Tablolar, Şekiller ve Grafikler Tablolar, her biri farklı sayfada olacak şekilde makalenin sonunda Microsoft Word dosyası olarak yer almalıdır. Her kolona kısa bir başlık yazılmalıdır. Tablo başlığı tablonun üst kısmında, notlar alt kısmında yer almalıdır. Tabloda kullanılan tüm kısaltmaların açıklamaları tablonun alt kısmında yazılmalıdır. Ayrıca, tabloda kullanılan verilerin birimleri, verilerin yanında parantez içinde belirtilmelidir (Örnek: yaş (yıl), vücut ağırlığı (kg), vb). Belirli bir aralığı kapsayan birimler aralık dilimi ile sayısal olarak ifade edilmelidir (Örnek: VAS (0-10 cm)). Şekiller profesyonel olarak çizilmeli, fotoğraflanmalı veya fotoğraf kalitesinde dijital baskı olarak sunulmalıdır. Şekil isimleri şeklin altında yer almalıdır. Makale içinde kullanılan fotoğraflar net olmalıdır. Fotoğraf, tablo ve çizimler metin içinde geçiş sırasına göre numaralandırılmalıdır. İnsan öğesinin bulunduğu fotoğraflarda kişinin kimliğini gizleyecek önlemler alınmalı, makalede fotoğrafı kullanılacak kişiden yazılı izin alınarak sunum yazısı ile birlikte dergiye gönderilmelidir. Makale Gönderme Formatı Makalelerin yazar adlarını içeren ve içermeyen kopyaları aynı içerik olmak şartıyla iki ayrı Microsoft Office Word dosyası olarak editor@turkjphysiotherrehabil.org adresine, yazışmaların yapılacağı yazarın güncel e-posta adresinden gönderilmelidir. Yazar adlarını içeren kopyada yazar bilgileri başlık sayfasında yer almalıdır. Yazar adlarını içermeyen kopyada ise yazarlara ait herhangi bir bilgi yer almamalı ve metnin içinde çalışmanın yapıldığı yeri veya yazarların kimliğini açığa çıkarabilecek herhangi bir ifade yer almamalıdır. Makale Değerlendirme Süreci Makaleler derginin yayın kriterleri doğrultusunda değerlendirmeye alınacaktır. Dergiye gönderilen her makaleye bir takip numarası verilecek ve e-posta yoluyla ilgili yazara bildirilecektir. Gerek görüldüğü takdirde, yazardan ilk teknik düzeltmeler istenecek, daha sonra hakem değerlendirme süreci başlayacaktır. Makaleler ilgili alanda uzman hakemler tarafından çift kör değerlendirmeye tabi tutulacak ve hakem raporları ilgili yazara bildirilecektir. Telif Hakkı Dergimizde yayınlanan yazıların tüm telif hakları Türkiye Fizyoterapistler Derneği ne aittir. Makale gönderimi ile ilgili aksaklıklardan dergimiz sorumlu değildir.

3 Information and Instructions for Authors Turkish Journal of Physiotherapy and Rehabilitation is the official journal of the Turkish Physiotherapy Association, and is published in Turkish and English, three times per year (April, August and December). The journal welcomes original articles, invited reviews, case presentations and letters to the editor that are relevant to the science or practice of physiotherapy and rehabilitation. Turkish Journal of Physiotherapy and Rehabilitation stipulates that its published articles comply with the highest ethical and scientific standards, and are free from commercial concerns. Submission guidelines of the journal are based on the document entitled Uniform Requirements for Manuscripts Submitted to Biomedical Journals, issued by the International Committee of Medical Journal Editors ( The corresponding author is the one who carries out all correspondence of the paper from submission to publishing process. The corresponding author should submit the manuscript to the journal after completing the Copyright Agreement Form and Conflict of Interest Form. A cover letter, which is electronically signed, or the scanned version of the cover letter after being originally signed, should be submitted to the journal. The journal holds the rights for asking the originally signed cover letter, when required. If the paper includes extracted statements, tables, figures, etc. from previously published journals or books, the authors should specify in the paper that they have obtained the written permission from the copyright owner and the authors of the related publications. The presentations of scientific meetings can be accepted, if they had been previously presented and/or published as an abstract, and if this statement is included in the title page. The scientific content of the paper and its accordance with the ethical principles are under the responsibility of the author(s). The journal accepts papers which; have been approved by the relevant Ethical Committees; and are in accordance with ethical principles stated in the Declaration of Helsinki. In case of involving animals in the study, the author(s) should state in the Methods section that they have; protected the rights of the animals in accordance with the principles of Guide for the Care and Use of Laboratory Animals ( and obtained approval from the relevant Ethical Committees. The authors should state in their paper that they have obtained informed consent from the participants of the study, and also should be able to present informed consent forms, if required. If submitted papers are in accordance with the formal principles of the journal, they are subjected to peer-review of at least two reviewers, as well as the Editor s and Editor Assistants, and are published after being revised by the authors, if required. 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5 EDİTÖRDEN EDITORIAL Değerli meslektaşlarım, Türk Fizyoterapi ve Rehabilitasyon Dergisi nin Ağustos 2014 sayısını 5 araştırma makalesi ve Protez Ortez 2014 Kongresi nin bildiri özetlerini kapsayan bir içerikle sizlere sunuyoruz. Fizyoterapi ve Rehabilitasyon alanındaki süregelen gelişmeler, ülkemizde her geçen yıl sayısı yükselen fizyoterapi bölüm/okulları ile büyüyen akademisyen ihtiyacı, bilimsel çaĺışmaların ve projelerin sayısında artışa yol açmıştır. Klinik çalışmaların makaleye dönüştürülmesi genellikle zordur çünkü farklı bir akademik çaba ve teknik bilgiyi de gerektirir. Türk Fizyoterapi ve Rehabilitasyon Dergisi olarak misyonumuz yalnızca nitelikli bilimsel makaleleri yayınlamak değil, aynı zamanda makale yazımı konusunda genç akademisyenlere yol göstermektir. Dergimizin web sayfasında yayınlanan, istatistik editörümüz Dr. Levent Eker tarafından hazırlanan Makale yazımında kilit noktalar başlıklı sunudan yararlanabilirsiniz. Ayrıca Ulakbim in web sayfaları da bu konuda yararlı olacaktır. Çevrim içi makale sistemine geçilmesi ile birlikte dergimize yapılan üye başvuruları ve değerlendirilmek üzere gönderilen makale sayısı artmıştır. Yayın kurulu olarak gönüllülük ve özveri ile yürüttüğümüz çalışmalarımızda, bu ilginiz en büyük motivasyon kaynağımızdır. İlgi ve desteğinize en içten teşekkürlerimizi sunarım. Saygılarımla, Prof. Dr. A. Ayşe KARADUMAN Baş Editör

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7 EDITORIAL EDİTÖRDEN Dear Colleagues, We are presenting the August 2014 issue of Turkish Journal of Physiotherapy and Rehabilitation with a content of 5 research articles and abstract presentations of the 2014 Prostethics and Orthotics Congress. The ongoing developments in physiotherapy and rehabilitation area, the increasing number of physiotherapy departments/schools in our country, and hence, the increasing demand of academicians, has led to a growing number of scientific researches and projects. Transformation of clinical studies into research articles is usually difficult, since it also necessitates an academic effort and technical knowledge. Our mission as Turkish Journal of Physiotherapy and Rehabilitation is not only to publish qualified scientific researches, but also to guide young academicians for article writing. You can benefit from the presentation entitled Key points in article writing by Levent Eker, PhD., published in our journal s web site. Also, Ulakbim (Turkish Academic Network and Information Center) web sites can be helpful for this subject. By transferring into online article submission system, the numbers of member applications and submitted articles to our journal have increased. Your growing interest to our journal is the main source of motivation in our works, which we carry on voluntarily and devotedly, as the Editorial Board. I present our sincere thanks to your interest and support. Kind regards, Ayşe Karaduman, PT. PhD. Prof. Editor-in-Chief

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9 TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ (2) İÇİNDEKİLER (CONTENTS) (2) ARAŞTIRMA MAKALELERİ (RESEARCH ARTICLES) EFFECTS OF LONG-TERM CALISTHENICS ON PHYSICAL FITNESS AND QUALITY OF LIFE IN OLDER WOMEN YAŞLI KADINLARDA UZUN SÜRELİ KALİSTENİK EGZERSİZLERİN YAŞAM KALİTESİ VE FİZİKSEL UYGUNLUĞA ETKİSİ Lamia PINAR, Bilge KARA, Ömer KOZAN DİSMENORESİ OLAN KADINLARDA MENSTRUASYONA YÖNELİK TUTUM VE STRES ALGISI DEĞİŞİKLİKLERİ CHANGES OF MENSTRUAL ATTITUDE AND STRESS PERCEPTION IN WOMEN WITH DYSMENORRHEA Emel SÖNMEZER, Hayri Baran YOSMAOĞLU TÜRKİYE DE FARKLI ENGELLERE SAHİP ÇOCUKLARIN ANNELERİNİN YAŞAM KALİTESİNİN VE PSİKOSOSYAL DESTEK İHTİYAÇLARININ ARAŞTIRILMASI: PİLOT ÇALIŞMA INVESTIGATION OF THE QUALITY OF LIFE AND PSYCHOSOCIAL SUPPORT NEEDS OF THE MOTHERS HAVING CHILDREN WITH DIFFERENT DISABILITIES IN TURKEY: A PILOT STUDY Semra TOPUZ, Özlem ÜLGER, Bülent ELBASAN, Hatice YAKUT, Yavuz AYHAN FARKLI NÖROMUSKÜLER HASTALIKLARDA AYAK BİLEĞİ LİMİTASYONUNUN YÜRÜME BECERİSİ ÜZERİNE ETKİSİ EFFECT OF ANKLE JOINT LIMITATION ON WALKING ABILITY IN DIFFERENT NEUROMUSCULAR DISEASES Pınar KAYA, İpek ALEMDAROĞLU, Öznur YILMAZ, Ayşe KARADUMAN, Haluk TOPALOĞLU DUCHENNE MUSKÜLER DİSTROFİ DE ÜST EKSTREMİTE DİNAMİK EGZERSİZİNİN SOLUNUM FONKSİYONU VE YAŞAM KALİTESİ ÜZERİNE ETKİSİ EFFECTS OF UPPER EXTREMITY DYNAMIC EXERCISE ON RESPIRATORY FUNCTION AND QUALITY OF LIFE IN DUCHENNE MUSCULAR DYSTROPHY İpek ALEMDAROĞLU, Ayşe KARADUMAN, Öznur YILMAZ, Haluk TOPALOĞLU TABANLIK KULLANIMININ PLANTAR TEMAS ALANLARI VE BASINÇ DAĞILIMINA ETKİSİ EFFECTS OF THE INSERT TO PLANTAR CONTACT AREA AND PRESSURE DISTRIBUTION Banu ÜNVER, Nilgün BEK PROTEZ ORTEZ KONGRESİ S1-28

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11 Pınar L, Kara B, Kozan Ö. Effects Of Long-Term Calisthenics On Physical Fitness and Quality Of Life In Older Women, Turk J Physiother Rehabil. 2014; 25(2): RESEARCH ARTICLE Türk Fizyoterapi ve Rehabilitasyon Dergisi (2)47-55 Lamia PINAR, Prof. Dr. Bilge KARA, Prof. Dr. Ömer KOZAN, Prof. Dr. EFFECTS OF LONG-TERM CALISTHENICS ON PHYSICAL FITNESS AND QUALITY OF LIFE IN OLDER WOMEN ABSTRACT Purpose: Investigate the effects of long-term regular aerobic exercise to physical fitness and quality of life in older women. Methods: The volunteer subjects were selected between a hundred older people who were the members of a solidarity center. Fulfilling the international criteria for exercising standards for the aged, forty-five female volunteers with a mean age of 68.04±5.56 years (range, years) participated to the study. After the cardiovascular and general health care evaluation, the older women were evaluated for exercise indication. An aerobic program of submaximal-level calisthenics was designed and the older women gathered at three times a week for exercising, min a day for 4 months under a physiotherapist s supervision. Before and after the 4-month exercise program, subjects underwent tests including a set of physical fitness and a quality of life assessment (short form-36). Results: Four month submaximal-level aerobic calisthenics led to a significant improvement (p<0.05) in body composition (fat weight, waist-to-hip ratio); cardiopulmonary fitness (VO- 2max); musculoskeletal fitness (vertical jumping, dynamometer test and flexibility); and motor fitness (equilibrium). Life quality of subjects improved significantly (p<0.05). Discussion: Four month regular calisthenics enhanced physical fitness and parameters of quality of life such as physical functioning, bodily pain, general health perceptions, vitality, social functioning, role limitation of emotional, role limitation of physical, mental health in elderly women. Key words: Aging, calisthenics, physical fitness, quality of life ARAŞTIRMA MAKALESİ Geliş Tarihi: (Received) Kabul Tarihi: (Accepted) İletişim (Correspondence): Prof. Dr. Bilge KARA Dokuz Eylül Üniversitesi Fizyoterapi ve Rehabilitasyon Yüksekokulu İnciraltı - İzmir - TÜRKİYE Tel: e-posta: bparlaksteer@gmail.com YAŞLI KADINLARDA UZUN SÜRELİ KALİSTENİK EGZERSİZLERİN YAŞAM KALİTESİ VE FİZİKSEL UYGUNLUĞA ETKİSİ ÖZET Amaç: Uzun süreli aerobik egzersizlerin, yaşlı kadınlarda, fiziksel uygunluk ve yaşam kalitesine olan etkilerini incelemektir. Yöntem: Gönüllü katılımcılar, bir yaşlı dayanışma merkezinin 100 üyesi arasından seçilmiştir. Yaşlılar için saptanmış Uluslararası, Standart Egzersiz Kriterleri ne uygun ve yaş ortalaması 68.04±5.56 olan kırk beş kadın çalışmaya katılmıştır. Kardiyovasküler ve genel sağlık taramasından geçen yaşlılar, egzersiz indikasyonu açısından değerlendirilmiştir. Submaksimal seviyede kalisteniklerden oluşmuş bir aerobik egzersiz program hazırlanmış ve yaşlı kadınlar 4 ay boyunca, haftada 3 gün, dakika olacak şekilde, bir fizyoterapist gözetiminde egzersize alınmıştır. Katılımcılara bu 4 aylık eğitim sürecinin başında ve sonunda fiziksel uygunluk ve yaşam kalitesini (short form-36) ölçen testler uygulanmıştır. Sonuçlar: Dört ay süre ile uygulanan submaksimal aerobik kalistenikler, vücut kompozisyonunda (yağ ağırlığı, kalça-bel oranı); kardiyopulmoner uygunlukta (VO 2 max); muskuloskeletal uygunlukta (vertikal sıçrama, dinamometre testi ve fleksibilite) ve motor uygunlukta (denge) anlamlı (p<0.05) iyileşmeler sağlamıştır. Yaşam kalitelerinde anlamlı düzelmeler saptanmıştır (p<0.05). Tartışma: Dört ay süresince uygulanan düzenli kalistenik egzersiz, yaşlı kadınlarda fiziksel uygunluğu arttırmış; fiziksel fonksiyon, ağrı, genel sağlık algısı, canlılık, sosyal fonksiyon, emosyonel rol güçlükleri, fiziksel rol güçlükleri, mental sağlık gibi bazı yaşam kalitesi parametrelerinde iyileşmeler sağlamıştır. Anahtar Kelimeler: Yaşlanma, kalistenikler, fiziksel uygunluk, yaşam kalitesi 47

12 Effects Of Long-Term Calisthenics On Physical Fitness And Quality Of Life In Older Women INTRODUCTION The number of people over 60 years of age is projected to double in the next 20 years; hence, reducing age-related disability is an essential public health goal. Declining physical function is associated with institutionalization, morbidity and mortality (1,2). Older adults have the highest rates of disability, functional dependence and use of healthcare resources, so effective interventions for older individuals are of special interest (3,4). Regular physical activity has many health benefits for older people, contributing to a healthy and independent lifestyle and improvements in functional capacity, quality of life, and body composition (5,6). Paterson et al suggested that increasing physical activity levels is the most important intervention to improve health in populations. For older adults, extending life is an important factor, but the maintenance of functional independence is also of high importance, both to maintain quality of life and to manage health resources (7). Various modalities of exercise have been demonstrated to improve physical function and quality of life in older adults. These exercises consist of strengthening of muscles, improving cardiovascular capacities, training of flexibility and equilibrium. Exercises can also minimize the physiological effects of an otherwise sedentary lifestyle by reducing the development and progression of chronic disease and disabling conditions (1,8-10). The exercise models that are most suitable for the elderly are walking, running, swimming, cycling, aquatic type exercise, weightlifting and yoga-type aerobic and dynamic exercises (11). Calisthenics are aerobic exercises and are suitable for older people. They are rhythmic, smooth, enjoyable exercises that are easy to perform alone or in group format, and can be modified according to subjects fitness levels (12). Exercise program must improve physical activity in health care and cause to change the life style of subjects. To set up physiological adaptations, the exercises must be applied regularly at least for 3 days a week for 12 weeks. After 3 months, exercise is called as long-term exercises (13). Although calisthenics are claimed to be as suitable exercises for older people, there are not much knowledge for the effects of these exercises on physical activities and quality of life of elderly. Our aim in this study was to assess whether a 12- week calisthenics increases the endurance, muscular strength and balance and helps to improve health-related quality of life (HRQL) of elderly women. Methods Subjects About 100 women and men attending a solidarity center for the aged for daily activities were willing to participate to the exercise training. First, the subjects were chosen from both genders, although the number of men was lower than that of the women. After clinical examinations in Cardiology Department and exercise tests, only 48 women and men out of 100 subjects met the physical and mental health conditions mentioned below (fig1); therefore, only women subjects were enrolled in this program to provide standardization. We followed internationally agreed criteria for the selection of older subjects for exercise studies designed both for safety and to define degrees of freedom from diseases that might affect the exercise performance (14). According to these criteria; subjects who had any form of acute cardiovascular, pulmonary, cerebrovascular, metabolic, psychotic, rheumatic or infectious illness, severe obesity, systemic diseases such as rheumatoid arthritis, severe osteoarthritis; bone fracture or history of joint surgery or high systolic blood pressure (>200 mmhg) or high diastolic blood pressure (>100 mmhg) were excluded from the study. As a result, 45 volunteered elderly women aged between years participated to the study. Each subject enrolled in the study was informed about the purpose of the study, and gave a written informed consent. The study was approved by the Dokuz Eylul University, Faculty of Medicine Ethics Committee. Study population and design A standardized 4-month calisthenic group exercise program was designed for the elderly women. The participants body composition, musculoskeletal fitness, motor fitness and quality of life were assessed during a week before the initiation of the exercise program and during a week following the 3 months program. 48 TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ 2014; 25(2)

13 Pınar L, Kara B, Kozan Ö. Figure 1. The Flow of Participants Through Each Stage of the Study Calisthenics Calisthenics are consists of exercises aiming to improve the muscle and cardiovascular endurance (15). The intensity of the calisthenics depends on the numbers of sets and repetitions, and on the length of resting periods. In the exercise program, a training session began at a low level of intensity and was gradually increased to the training zone; that is, the state where target heart rate was reached and sustained. Each person s target heart rate was estimated by subtracting one s chronological age from 220 and multiplying this value by 60-70%. This provides a safe target heart rate for exercise (16). In our study, each subject followed her own initial and target heart rate during the warming exercise and tried to stabilize her heart rate in target heart rate. The exercise program was applied as min in a day, three days a week, for 3 months. To prevent injury, each workout contained warm-up and cool down phases at the beginning and at the end of trial, for 5 to 10 minutes. After warm-up, the exercise program consisted of spine lateral flexion, spine twisting, neck rotation, neck flexion and extension, trunk flexion and extension, trunk lateral flexion and arm circles. Then, the subjects performed the strengthening exercises including sit-ups/crunches and push-ups. Sit-up exercise was started with the back on the floor, knees bent, bottoms of feet against the floor. The shoulders were lifted off the floor by tightening abdominal muscles bringing the chest closer to the knees to strengthen the abdominal muscles. Push-up exercise was performed with face down on floor, keeping the back straight, palms tight on the back. Then, the head and shoulders were raised off the floor. This movement aims to strengthen the back extensor muscles. Each model of the exercises was repeated about ten times. When there was lack of continuity for several excuses, women were encouraged to make up the program in another day of that week. INTERVENTIONS Assessment of body composition In terms of body composition, body mass index (BMI), skinfold thickness, body fat ratio, fat weight, fat-free mass, and waist-to-hip ratio were evaluated. BMI was calculated as body weight in kilograms divided by the square of height in meters (kg/m 2 ). Skinfold thickness was measured using calipers (Croswell, Crymych, Dyfed SA41 3UF.U.K.) and values for the biceps, triceps, subscapular area, abdominal area, suprailiac region, and thigh were noted. Three measurements were carried out at each site and averaged. Assessments of skinfold were done by the formula below (17-19). Body fat ratio Assessment: J-P (Jackson-Pollock) Method For female (sum of the three areas) triceps + suprailiac + thigh = sum of skinfolds (ST) Body density = ( x ST) + ( x ST2) - ( x age) % Body Fat = (495 /Body density) Body fat ratio was expressed as the proportion of fat relative to total body weight. It was assessed using the skinfold values as described above (20). Fat weight was calculated using the following equation: Total Body Weight [lb] Body Fat Ratio 100 (1 pound [lb]= kg). Then, the fat-free mass was calculated by subtracting the fat weight TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION 2014; 25(2) 49

14 Effects Of Long-Term Calisthenics On Physical Fitness And Quality Of Life In Older Women from the total body weight. Waist-to-hip ratio was calculated by dividing the circumference of waist just above the belly button, by the circumference of the hip at the widest part of the buttocks. Evaluation of the VO 2 max for aerobic capacity VO 2 max as the measure of aerobic capacity or fitness was evaluated at baseline before the initiation of the exercise program and following the 4-month training session. We used 6-minute walk (6MWT) test in order to predict peak oxygen uptake simply. This test is used both for healthy adults and older people. We tested subjects in a 30-m length corridor with vinyl flooring in a warm (22-24 C) environment. The subjects were asked to walk as fast as she could, up and down the course, in a 6-min period. Systolic and diastolic blood pressure measurements were performed daily just before the group exercise session and after the recovery period in relaxed and sitting position. Following formula was used for the calculation of VO 2 max (21). VO 2 max = (0.02 D [m] ) (Age [yrs] ) (W [kg] ) (H [cm] ) (RPP [ 10-3] ) D is distance walked, W is body weight, H is height, and RPP is the rate pressure product (calculated as heart rate systolic blood pressure/1000). The participants also noted their perception of the exercise intensity before and after the program using the Borg scale (recording of perceived exertion), with higher values indicating 20 points and lower values indicating 6 points (22). Assessment of musculoskeletal fitness Musculoskeletal fitness involving endurance, muscular strength, and flexibility was tested by collecting data for vertical jumping ability, muscle strength, and flexibility, respectively (23). Vertical jumping ability test The subject was asked to stand with her legs straight and body slightly separated in front of a wall with knees unlocked. The subject jumped three times as high as possible and the distance she jumped was measured. Vertical jumping test is one parameter of Eurofit test battery. The mean jumping distance was calculated (23,24). Jump and reach height = Take off Height + Flight Height + Reach Height Loss Height These tests were performed using a back and leg strength dynamometer (Takai Back and Leg Dynamometer, Japan). Back strength was recorded with the subject in upright position with legs extended and the leg strength was measured with the legs flexed (25). Flexibility tests The extent of lateral flexion of the thoracic and lumbar spine was measured. The subject was asked to stand upright against a wall with feet placed on two parallel lines that were 15 cm apart and oriented at right angles to the wall. The body was positioned with the scapulae and buttocks contacting the wall and the heels slightly away from the wall, so that a comfortable upright stance could be maintained. The subject was asked to hold her arms in relaxed natural position straight down beside the body. The position of the middle finger on each lateral thigh area was marked with a horizontal line. Then, the subject was instructed to flex as far as possible to each side and the position of the middle finger at maximum flexion was marked. The distance between the markings on each thigh was then recorded (26). The lesser distance between the top of the middle finger and the floor shows increase of the flexibility. Assessment of motor fitness We assessed body balance by testing each subject s ability to balance on one leg on a flat firm surface with eyes closed and eyes open. For each subject, we recorded three attempts that were needed to achieve 30 continuous seconds of balance on dominant leg with eyes open, and then with eyes closed. After measurement of the length of time the subjects stayed on one leg with eyes open and eyes closed with a chronometer, the mean of three attempts succeeded by the subject was calculated (23,27). Assessment of quality of life The short Form 36 Health Survey (SF-36) was used to measure HRQOL and perceived changes in health status before and after the exercise program. The SF-36 questionnaire covers eight scales: physical functioning, role limitation because 50 TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ 2014; 25(2)

15 Pınar L, Kara B, Kozan Ö. of physical health, bodily pain, general health perceptions, vitality, social functioning, role limitation because of emotional health problems, and mental health. These scales were scored from 0 (poorest health) to 100 (optimal health) (28). Statistical analysis Descriptive statistics including frequency distributions of categorical variables and means and standard deviations for continuous variables. Statistical analyses were performed using the software program SPSS for Windows version Parametric comparisons between the measurements for body composition, aerobic fitness, musculoskeletal fitness, motor fitness and the parameters of quality of life were made using paired-samples t test. P values <0.05 were considered to indicate statistical significance. Pre-and post-exercise mean values were all calculated in 95% confidence interval (CI). Results were analyzed using both p and CI values. Even paired sample t-test results were significant, results with close CI intervals have been considered as statistically non-significant. Results Data indicating physical fitness including four main parameters as body composition; aerobic fitness; musculoskeletal fitness and motor fitness are shown in Tables 1, 2, 3 and 4. Evaluation of body composition The mean values for body composition parameters such as body fat ratio, fat weight, fat-free body weight and skin-fold values were significantly lower after exercise compared to pre-exercise values (Table1). Although the difference between BMI were significant after two-tailed paired sample t-test, it has been considered as non-significant since 95% CI limits were overlap to each other (95% CI limits, pre-exercise= , 95% CI limits, post-exercise= ). Pre-and post-exercise waistto-hip ratio were statistically insignificant (p>0.05). Evaluation of aerobic fitness A summary of the aerobic fitness parameters have been shown in Table-2. The mean distances recorded for the 6-min walking test between preand post-exercise were not significantly different (Table 2). Pre-and post-exercise V0 2 max and Borg Scale data were significantly different in 95 % CI. VO 2 max showed a significant increase after the exercise program (p<0.001) Comparing before and after 3 month exercise program, there was a significant decrease in Borg scale points (p<0.05). Evaluation of musculoskeletal and motor fitness The changes in the parameters showing musculoskeletal and motor fitness which are the components of the physical fitness are demonstrated in Table 1. Parameters of body composition and skinfold of the study population pre-and-post-exercise program Pre-exercise Post-exercise Standard deviation of the difference p value BODY COMPOSITION SKIN FOLD BMI (kg/m 2 ) 26.96± ± ± Body fat ratio (%) 35.76± ±3.21-0,64± Fat weight (kg) 24.03± ± ± Fat-free body weight (kg) 42.10± ±5.18 0,001± Waist-to-hip ratio 0.75± ± ± Biceps (mm) 11.97± ± ± Triceps (mm) 15.22± ± ± Subscapular (mm) 18.78± ± ± Suprailiac (mm) 17.92± ± ± Abdominal (mm) 25.75± ± ± Thigh (mm) 21.84± ± ± TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION 2014; 25(2) 51

16 Effects Of Long-Term Calisthenics On Physical Fitness And Quality Of Life In Older Women Table 2. Parameters of aerobic fitness of the study population pre-and-post-exercise program AEROBIC FITNESS Pre-exercise Post-exercise Standard deviation of the difference p value Walking distance (m) ± ± ± SBP (mmhg) ± ± ± DBP (mmhg) 90.22± ± ± Heart rate (pulse/min) 84.00± ± ± Respiration rate (breath/min) 24.84± ± ± VO2max (ml/kg/min) 12.24± ± ± Borg scale score 14.20± ± ± Data are given as mean±sd. BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure Table 3. There was a significant improvement in vertical jump, back muscle strength, leg muscle strength, flexibility (right lateral flexion, left lateral flexion) after the exercise program (p<0.05). Preand post-exercise comparisons for musculoskeletal and motor fitness parameters were done using paired sample T test and results have been found as statistically significant in 95 % CI. Evaluation of life quality As given in Table 4, post-exercise scores; role limitations due to emotional problems (Role Emotional) (p=0.002) physical function, role limitation due to physical problems, bodily pain, general health, vitality, social activity, and general mental health demonstrated significant improvement (p=0.001). According to the scale of health-related quality of life HRQOL, the difference between pre- and post-exercise values was significantly different in 95% CI (p<0.05). DISCUSSION Aging is associated with declines in physical and mental functioning that may be altered by exercise. In addition to the well-documented health benefits of regular exercise, this type of activity is also known to improve mood, and reduce depression and anxiety (29). In our study, our elderly women showed statistically significant increase in much of the parameters of body composition related with Table 3. Parameters of musculoskeletal and motor fitness of the study population pre-and-post-exercise program Pre-exercise Post-exercise Standard deviation of the difference p value MUSCULOSKELETAL FITNESS Vertical jump test (cm) 13.64± ± ± Dynamometer tests Flexibility tests Back (kg) 41.12± ± ± Leg (kg) 43.12± ± ± Right lateral flexion (cm) Left lateral flexion (cm) 47.53± ± ± ± ± ± MOTOR FITNESS Eyes open (s) 18.30± ± ± Eyes closed (s) 3.50± ± ± TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ 2014; 25(2)

17 Pınar L, Kara B, Kozan Ö. Table 4. Quality of life as indicated by SF-36 results pre-and post-exercise program Pre-exercise Post-exercise Standard deviation of the difference p value Physical functioning 48.33± ± ± Role physical 53.44± ± ± Bodily pain 52.91± ± ± General health 49.48± ± ± Role emotional 47.26± ± ± Vitality 52.00± ± ± Social functioning 58.60± ± ± Mental health 55.91± ± ± Data are listed as mean±sd their physical fitness. Their cardiovascular, motor and musculoskeletal fitness improved significantly after 4-month calisthenics. Calisthenics, asone of the aerobic submaximal exercise are considered an appropriate, effective, entertaining and safe exercise model for older people. Aerobic exercise is necessary to ensure cardiovascular health. Even low-level activity decreases deposition of visceral adipose tissue and reduces blood glucose and lipid levels (1,30,31). In our study, we found that the older women s skinfold value changed significantly at all sites tested. Participants lost 2% of their body weight in average during the 4-month exercise period. However because the values were evaluated in the 95 % confidence interval, we couldn t find significant difference in their BMI after 4-month training. There was no significant difference in waist-hip ratios of the women after 4-month exercise program. On the other hand, the assessments of body fat ratio, fat weight and fat free body weight of elderly women decreased significantly after 4-month exercise period. In our study, only long-term exercise training was applied to elderly women. We didn t recommend any program related with weight control. We evaluated that, the period of exercise for 4-month was rather short for significant weight loss. The most important findings of our study were that regular aerobic activity increased the women s exercise capacity. It is shown that in elderly, a peak aerobic capacity for walking is closely linked with decreasing indices of lifestyle-related diseases (32). The most fundamental measurement of fitness is VO 2 max, which represents the individual s maximum capacity to transport and use oxygen during physical activity (33). Some investigations have demonstrated that VO 2 max declines with age at a rate of approximately 1% per year. It was postulated that part of the decline associated with aging might be due to sedentary life-style rather than aging itself. Following the 4-month calisthenics, we found that our subjects had increased their aerobic capacity significantly. We observed no remarkable change in the distance the women were able to walk in 6 min, possibly because of existing walking habits; however, drops in the other parameters that comprise the formula resulted in significantly increased VO 2 max at the end of the training period. These results are in line with those of Pierce et al. (34) who noted a 16% increase in their elderly subjects with mild hypertension in VO 2 max after a 4-month exercise program. The exercises also had positive effects on joint flexibility, muscle strength and balance. Exercise programs for older adults can delay age-induced impairment of personal mobility that is needed to perform routine activities (35). It is suggested that exercising elderly perceived control and mastery of a given activity, in conjunction with overall satisfaction and enjoyment of that activity. It has also been stated that self-esteem and a generally positive outlook provides a compliment effect on life satisfaction (36-39). It was reported that a 2-month program of resistance training once a week for elderly men and TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION 2014; 25(2) 53

18 Effects Of Long-Term Calisthenics On Physical Fitness And Quality Of Life In Older Women women led to reduced anxiety and greater muscle strength (40). As noted above, physical activities that improve muscle strength, endurance, and flexibility in older people also enhance their ability to perform the tasks of daily living (41). Similarly in our study, 4-months calisthenics improved muscle strength and the flexibility of the bodies in elderly women (Table 3). Balance is another important factor in providing mobility (37). Furthermore, deficits in postural control and muscle strength represents important risk factors to fall (38) and this fear prevents older people to be independent in the basic activities of daily living (39). In our study, an improvement in balance was observed by the end of the training program in elderly women. The increase in daily activities, also can affect the quality of life in older people. Measures of quality of life have been increasing in popularity because they have been shown to be positively associated with objective health outcomes (e.g., body mass index and number of chronic conditions) and mortality (42, 43). For example, it was observed that men who reported poor health had an eightfold increase in total mortality as compared with those reporting excellent health. Nowadays, researchers intend to better understand which factors are determinant in perception of quality of life for elderly people. Personal habits such as smoking and sedentarism, seems to play a major role in the etiology of the diseases of civilization. On the other hand, it is believed that promotion of physical activity is a viable pathway of public health intervention, which includes increasing or maintaining quality of life. In accordance with this idea, Lorraine et al. have suggested that physical activity is associated with self-rated health, one indicator of quality of life (44). In support of these results, it was previously demonstrated a positive association between physical activity and self reported quality of life among older adults. Over a 5-year period, Leinonen et al. observed that decreases in physical activity levels were related with decline in self-assessment of health (45). Rejeski and Mihalko, in a review of physical activity and quality of life in older adults, concluded that physical activity could lead to improved perception of physical function and mental health in older adults (12). According to these authors, physical activity may provide a global indicator of health and functioning through which deterioration in health and functional performance can be perceived and reflected in everyday life. Although some studies showed associations between physical activity and perceived quality of life; there is not much study about the relationships between fitness and perceived quality of life. Also there is not much researches about the effects of calisthenics applied to elderly people. Our study revealed that, after 4-month calisthenics, all parameters of quality of life of elderly woman improved significantly (Table 4). The increased self-esteem and positive feelings that came from the exercise program seemed to help the participants engage more effectively in their daily activities. Because integration to a social networks independently effect mood and wellbeing and prevent their feelings of loneliness in the elderly. As a conclusion, simple performed regular aerobic exercise in the form of calisthenics has shown a positive impact on physical fitness and quality of life of our older women. They also declared their well-being feelings in all aspects of daily activities after exercise program. The Limitations of the Study This study did not have a control group consisting of elderly people. We evaluated the bodily and emotionally fitness only in older women, not in older men, because of the least number of the men fulfilled the inclusion criteria. Exercise periods longer than this 4-month could be more effective. We need more researches related with calisthenics applied to elderly people with wide contributions and wide parameters. REFERENCES 1. Baker MK, Atlantis E, Fiatarone Singh MA. Multi-modal exercise programs for older adults. Age Ageing. 2007;36(4): Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M Nylen ES, Kokkinos P, Myers J, Faselis C. Prognostic effect of exercise capacity on mortality in older adults with diabetes mellitus. J Am Geriatr Soc. 2010;58(10): Ouslander JG, Griffiths PC, McConnell E, Riolo L, Kutner M, 54 TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ 2014; 25(2)

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20 Sönmezer E, Yosmaoğlu HB. Dismenoresi Olan Kadınlarda Menstruasyona Yönelik Tutum ve Stres Algısı Değişiklikleri, Turk J Physiother Rehabil. 2014; 25(2): ARAŞTIRMA MAKALESİ Türk Fizyoterapi ve Rehabilitasyon Dergisi (2)56-62 Emel SÖNMEZER, Dr. Fzt. Hayri Baran YOSMAOĞLU, Doç. Dr. DİSMENORESİ OLAN KADINLARDA MENSTRUASYONA YÖNELİK TUTUM VE STRES ALGISI DEĞİŞİKLİKLERİ ÖZET Amaç: Bu çalışma dismenoresi olan ve olmayan kadınların menstruasyona yönelik tutumlarını ve stres düzeylerini karşılaştırmak böylece dismenore ile menstruasyona yönelik tutum arasındaki ilişkiyi belirlemek amacıyla planlandı. Yöntemler: Çalışmaya 18 yaş üzeri, 52 dismenoreli, 48 sağlıklı toplam 100 kadın öğrenci dahil edildi. Kadınların menstruasyon dönemindeki tutum ve davranışları Menstruasyon Tutum Ölçeği, yaşantılarındaki stres vericilerin algılanış düzeyi ise Algılanan Stres Ölçeği kullanılarak menstruasyon esnasında ve menstruasyondan 15 gün sonra değerlendirildi. Menstruasyon sırasında oluşabilen karın krampları, mide bulantısı, kusma, ishal, iştah kaybı, baş dönmesi, güçsüzlük, baş, bacak ile sırt ağrıları gibi ek semptomlar sorgulandı. Sonuçlar: Menstruasyon tutum ölçeğinin sadece menstruasyonu doğal bir olgu olarak görme alt ölçeği skorları dismenoreli grupta kontrol grubuna göre istatistiksel açıdan anlamlı olarak düşüktü (p<0.05). Ancak diğer alt ölçeklerinde iki grup arasında istatistiksel bir fark yoktu (p>0.05). Algılanan stres ölçeği skorları menstruasyon sırasında dismenoreli grupta kontrol grubuna göre anlamlı olarak yüksek iken (p<0.05), menstruasyondan 15 gün sonra algılanan stres ölçeği skorlarında her iki grup arasında istatistiksel bir fark yoktu (p>0.05). Menstrüel semptomlardan karın krampları, mide bulantısı ve güçsüzlük şiddeti dismenoreli grupta istatistiksel olarak yüksekti (p<0.05). Tartışma: Bu çalışma dismenoresi olan kadınların menstruasyona yönelik bazı önemli tutum değişiklikleri olduğunu göstermektedir. Özellikle menstruasyonu doğal bir süreç olarak kabul etmede problem yaşamaktadırlar. Aynı zamanda dismenoreli kadınlarda normal menstruasyon geçiren kadınlara oranla daha fazla iştah kaybı, kramp, güçsüzlük gibi fizyolojik ya da psikolojik kaynaklı semptomlar görülmektedir. Bu kişilerde uygulanacak bilişsel davranış ve algı terapisi gibi uygulamalar menstruasyona yönelik algıyı değiştirmesi durumunda dismenore tedavisine katkı sağlayabilir. Anahtar kelimeler: Dismenore; tutum; stres RESEARCH ARTICLE Geliş Tarihi: (Received) Kabul Tarihi: (Accepted) İletişim (Correspondence): Dr. Fzt. Emel Sönmezer Başkent Üniversitesi Sağlık Bilimleri Fakültesi Fizyoterapi ve Rehabilitasyon Bölümü Bağlıca Kampüsü Eskişehir yolu 20. km Etimesgut/Ankara, Tel: Fax: Başkent Üniversitesi Sağlık Bilimleri Fakültesi Fizyoterapi ve Rehabilitasyon Bölümü Bağlıca Kampüsü Eskişehir yolu 20. km Etimesgut/Ankara, CHANGES OF MENSTRUAL ATTITUDE AND STRESS PERCEPTION IN WOMEN WITH DYSMENORRHEA ABSTRACT Purpose: This study was planned to compare the attitudes toward menstruation and stress levels of women with and without dysmenorrhea. Methods: A total of 100 female students (52 subjects with and 48 subjects without dysmenorrhea, respectively) over 18 years old were enrolled in this study. The attitude of women was assessed during menstruation by Menstruation Attitude Questionnaire. Level of perceived stress was evaluated with Percieved Stress Scale during menstruation and 15 days after menstruation. Additional menstrual symptoms such as abdominal cramps, nausea, vomiting, diarrhea, loss of appetite, dizziness, weakness, headache, back pain, leg symptoms were questioned during menstruation. Results: Only menstruation as a natural event subscale scores of Menstuation Attitude Questionnaire were significantly lower in women with dysmenorrhea than controls. Perceived Stress Scale scores during menstruation were significantly lower in the group with dysmenorrhea than the control group; however, Perceived Stress Scale scores 15 days after menstruation were not significantly different between two groups. The severity of menstrual symptoms such as abdominal cramps, nausea, loss of appetite, dizziness, and weakness were significantly higher in the group with dysmenorrhea. Discussion: This study shows that women with dysmenorrhea have some important changes in attitude towards menstruation. Especially they have problems to accept menstruation as a natural event. At the same time, physiological or psychological symptoms such as loss of appetite, muscle cramps, weakness were seen more in women with dysmenorrhea. Applications such as cognitive behavior therapy and perception therapy changing perception of menstruation can contribute to the treatment of dysmenorrhea. Key Words: Dysmenorrhea; attitude; stress 56 TÜRK FİZYOTERAPİ VE REHABİLİTASYON DERGİSİ 2014; 25(2)