Functional Lower Limb Strength Research Articles

The IntegraPark Study: An Opportunity to Facilitate High-Intensity Exercise with Immersive Virtual Reality in Parkinson’s Disease Patients

Background: high-intensity exercise is a feasible and effective modality in the early stages of Parkinson’s disease (PD). However, there are only a few studies that have carried out this type of intervention in customizable immersive virtual reality (IVR) environments. We explore the feasibility and effects of IVR-based high-intensity training through rowing and cycling exercises on the functional capacity, quality of life, and progression of PD. Methods: a total of 12 participants (61.50 ± 10.49 years old; 41.7% female, 58.3% male; stages I–III) were part of the study, which consisted of interventions of rowing and cycling in an IVR commercial exergame (25 min; twice per week for 14 weeks). The main variables measured were functional capacity, handgrip strength, functional mobility (TUG), functional lower-limb strength (FTSST), aerobic capacity (2-min step test), quality of life (PDQ-39), and Parkinson’s disease progression (MDS-UPDRS). Results: the results showed a general improvement in handgrip strength in both hands (p = 0.008; d = 0.28), FTSST (p = 0.029; d = 0.96), and TUG times (p = 0.152; d = 0.22). Aerobic capacity, assessed by a 2-min step test, showed enhanced scores (p = 0.031; d = 0.78). Related to the PDQ-39, all dimensions of the scale were enhanced, highlighting activities of daily living (p = 0.047; d = 0.29) and bodily discomfort (p = 0.041; d = 0.37). Finally, the main symptoms of the disease were reduced, with an improvement in the parameters that show a better incidence of disease progression, such as Part IA and IB (p = 0.013; d = 0.29 and p = 0.021; d = 0.25, respectively), Part II (p = 0.021; d = 0.23), Part III (p = 0.040; d = 0.39), and Part IV (p = 0.013; d = 0.39). Conclusions: the therapeutic exercise (rowing and cycling), when carried out at a high intensity and in a personalized IVR scenario, appear to be a feasible and safe modality for patients with stages I–III of PD, improving their functional capacity, quality of life, and disease progression.

Immediate effects of TECAR therapy on lower limb to decrease hypertonia in chronic stroke survivors: a randomized controlled trial

Purpose To analyze immediate effects of TECAR therapy (TT) to reduce lower limb hypertonia and improve functionality in chronic post-stroke. Materials and methods It is a single-blind randomized controlled clinical trial. A total of 36 chronic stroke survivors were divided into two groups. The experimental group received a single 30-minute session of TT with functional massage (FM) on lower limb. The control group received a single 30-minute session sham treatment of TT plus FM. The primary outcome measure was hypertonia (Modified Ashworth Scale, MAS). Secondary outcomes were gait speed (4-Meter Walk-Test), standing knee-flexion (Fugl-Meyer Assessment Scale IV-item), change in weight bearing ankle dorsiflexion (Ankle Lunge Test, ALT), and functional lower limb strength (5-Times Sit-to-Stand Test). All measurements were performed at baseline, immediately and 30-minutes after treatment. Results There was a group–time interaction in MAS-knee (p = 0.044), MAS-ankle (p = 0.018) and ALT (p = 0.016) between T1 and T0 (p<.0001) and T2 and T0 (p<.0001) for the experimental group. There was a significant increase in ALT between T1 and T0 (p = 0.003) in the control group. Conclusions A single session of TT performed at the same time as FM immediately reduces plantar-flexors and knee-extensor muscle hypertonia and increases change in weight bearing ankle dorsiflexion in chronic stroke survivors.

Impaired muscle parameters in adults with mild to severe types of osteogenesis imperfecta: a cross-sectional study.

Impaired muscle parameters may further compromise the already compromised skeleton in individuals with OI. This cross-sectional study aimed to compare muscle function and body composition in adults with various OI types and healthy controls. Sixty-eight adults with OI (mean age 42.2yr; 27 men) and 68 healthy age- and sex-matched controls were recruited. Maximal isometric muscle force was assessed by handheld dynamometry (hand grip, hip flexors, shoulder abductors, and ankle dorsiflexors), muscle endurance by posture maintenance tests (shoulder abduction, hip flexion, and wall sit), and functional lower limb strength by 30-s chair rise test. In a sub cohort, dynamic muscle function (peak power and force) was assessed by a ground reaction force plate, and lean and fat mass, muscle and fat cross-sectional area (CSA), and muscle density by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Multiple linear regression models were fitted with group (OI type I, III, IV/V, or controls), country, sex, and age in the fixed effects part. Overall, adults with various types of OI had lower isometric, endurance, and functional muscle strength (mean difference [MD] = OI type I: 19-43%, OI type IV/V: 25-68%, OI type III: 20-72%) compared to controls. Furthermore, adults with OI type I had lower dynamic muscle function (peak force [MD = 25-29%] and power [MD = 18-60%]), lean mass (MD = 10-17%), muscle CSA (MD = 9-21%), and muscle density (MD = 2-3%) but higher adiposity indices (MD = 24-42%) compared to controls. Functional lower limb strength and maximal muscle force were significantly different between OI types, whereas muscle endurance was not. To conclude, adults with OI present with markedly impaired muscle function which may partially be explained by their altered body composition. Our findings emphasize the need for proper assessment of various muscle parameters and (research into) appropriate and safe muscle strengthening approaches in this population.

Effect of virtual running with exercise on functionality in pre-frail and frail elderly people: randomized clinical trial

BackgroundVirtual mirror therapies could increase the results of exercise, since the mirror neuron system produces an activation of motor execution cortical areas by observing actions performed by others. In this way, pre-frail and frail people could use this system to reach an exercise capacity threshold and obtain health benefits.AimThe aim of this study is to evaluate the effects of a virtual running (VR) treatment combined with specific physical gait exercise (PE) compared to placebo VR treatment combined with PE on functionality, pain, and muscular tone in pre-frail and frail older persons.MethodsA single blinded, two-arm, randomised controlled trial design was employed. Thirty-eight participants were divided into two intervention arms: Experimental Intervention (EI) group, in which VR and gait-specific physical exercises were administered and Control Intervention (CI) group, in which a placebo virtual gait and the same exercise programme was administered. Functionality, pain, and tone were assessed.ResultsEI group improved in aerobic capacity, functional lower-limb strength, reaction time, and pain, while CI group remained the same. Regarding static balance and muscle tone, no differences were found for either group. Further analysis is needed to asses VR effectiveness for improving gait, stand-up and sit-down performance and velocity.ConclusionsVirtual running therapy appears to enhance capacities related with voluntary movements (i.e., aerobic capacity, functional lower-limb strength, and reaction time) and reduce pain.

Physical Function In Breast, Prostate, And Colorectal Cancer Survivors: The Effects Of Circuit, Interval-based Exercise

Cancer survivors experience many treatment-related side effects, including physical impairments. Declines in physical function are highly prevalent after cancer diagnosis and can persist many years after treatment. Low physical functioning is associated with morbidity and poorer survival rates in cancer survivors. PURPOSE: This pilot study aimed to assess the effects of a 16-week circuit, interval-based aerobic and resistance clinical exercise intervention on physical function in survivors of breast, prostate and colorectal cancers. METHODS: Breast, prostate, and colorectal cancer survivors with overweight or obesity were randomized 2:1 to an exercise intervention (n=60) or into usual care (n=30). The exercise intervention consisted of a 16-weeks circuit interval-based supervised and periodized program, training 3 days per week at moderate to vigorous aerobic (65-85% VO2max) and resistance (65-85% 1-repetition maximum) exercise. Physical function (functional power, functional lower limb strength, balance, gait speed, mobility and fall risk) was measured at baseline and post-intervention (week 17) using validated tests and batteries. Repeated measures ANCOVA was conducted to assess between and within-group differences. RESULTS: Participants were older cancer survivors (63.2 ± 10.8 years old), mostly obese (87%) and that had undergone chemotherapy + radiation therapy (75%). Adherence to the intervention was 92% and post-intervention assessments were available on 100% of participants. No differences were reported at baseline between groups. Compared with controls, sixteen weeks of circuit, interval-based aerobic and resistance exercise resulted in statistically significant improvements in functional power (32%, p<0.01), functional lower limb strength (42%, p<0.01), balance (18%, p<0.01), gait speed (14%, p<0.01), mobility and fall risk (21%, p<0.01). CONCLUSIONS A 16-week supervised circuit, interval-based aerobic and resistance exercise program produces improvements in physical function. Given the importance of physical function on quality of life and health-related outcomes, clinical exercise interventions should be implemented in cancer survivors to prevent physical impairment, morbidity and ultimately, mortality.

Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial

Background: Dance therapy is increasingly reported in neurological diseases for improving several motor and cognitive functions, but was mostly studied in partner dance. No individual choreo-based dance program has ever been reported in MS. Objectives: The aim of this pilot study is to investigate effects of a ten-week choreo-based dance intervention on different impairments in MS. Participants: Seventeen participants with MS were allocated to a dance group (DG) or an art group (AG) for a ten-week intervention program, with a public live performance at the end of the intervention. Methods: The DG received choreo-based dance courses twice a week for 90 min, while the active control AG weekly contributed to the production by painting, music, spoken word and photo- or videography. Measurements for fatigue and fatigability, physical capacity and coordination, sensory function, cognitive capacity, quality of life and dual task performance took place before and after the intervention. Differences were analysed with Wilcoxon Signed Rank test. Results: Both groups improved significantly on executive cognitive performance during dual task and fatigue. Only the DG improved significantly on functional lower limb strength, hand function, coordination, self-reported balance and walking, and showed a trend towards improving on cognition (PASAT). The AG showed significant improvements in on cognitive function (SDMT). Conclusion: A ten-week multimodal dance intervention has positive effects on impact of fatigue, physical capacity and coordination, and cognitive performance during a dual task. Larger samples, follow-up measurements and research in different disability groups is recommended.

Inter-rater and intra-rater reliability of the Brief-BESTest in people with chronic obstructive pulmonary disease

Objective: To investigate the inter-rater and intra-rater reliability of the Brief Balance Evaluation System Test (Brief-BESTest) in people with chronic obstructive pulmonary disease and its correlation between the Brief-BESTest score and lung function, functional exercise capacity, functional lower limb strength, and fear of falling. Design: Prospective, single-group, observational study. Setting: Outpatient pulmonary rehabilitation program. Subjects: People with chronic obstructive pulmonary disease who were attending a pulmonary rehabilitation program. Intervention: Participants performed three Brief-BESTests on two separate days, assessed by two independent physiotherapists. Participants also performed a lung function test, two 6-minute walk tests, the five sit-to-stand test and completed the Fall Efficacy Scale International questionnaire. Results: Thirty participants (mean (SD) age was 72 (7), forced expiratory volume in 1 second % predicted was 47 (16%), and baseline 6-minute walk distance was 427 (90) meters) completed the study. The interclass coefficients of the inter-rater and intra-rater reliability were 0.86 and 0.96, respectively. The Brief-BESTest score was moderately correlated with the 6-minute walk distance (r = 0.49, P < 0.01) and the five sit-to-stand test time (r =−0.54, P < 0.01). No adverse events were reported after the completion of 90 tests in this study. Conclusion: The Brief-BESTest was shown to have good inter- and intra-rater reliability for measuring balance in people with chronic obstructive pulmonary disease. A moderate correlation was demonstrated between the Brief-BESTest balance score with functional exercise capacity and functional lower limb strength in this population.

A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program

Objective: To assess the effectiveness of a 12-week self-management and exercise intervention (the PLE2NO program) in elderly individuals with knee osteoarthritis. Design: Randomized controlled trial. Setting: Four different community settings. Subjects: Eighty individuals aged 60 years or older with clinical and radiographic knee osteoarthritis enrolled in the study. Intervention: A combined self-management and exercise intervention (treatment group) and an educational intervention (control group). Main measures: The primary outcomes were pain and other knee osteoarthritis symptoms (swelling, crackling, limitation on movement, and stiffness), self-management behaviors (communication with physician and cognitive symptom management), and functional lower limb strength. Secondary outcomes were knee osteoarthritis–specific health-related quality of life, self-perceived health, aerobic capacity, lower and upper limb flexibility, and handgrip strength. Results: In all, 67 participants, mean age 69.1 ± 5.8 years, completed the study: 32 in the Educational Group and 35 in the Self-Management and Exercise Group. A significant group effect favorable to the Self-Management and Exercise Group was observed in the following variables: communication with the physicians (P = .048), aerobic capacity (P = .035), and functional lower limb strength (P = .015). Although no significant group effect was detected, clinical improvements in pain (31%) and knee osteoarthritis symptoms (29%) were observed in the experimental group. No improvements regarding cognitive symptom management, self-perceived health, lower limb flexibility, and handgrip strength were found. Conclusion: This study supports the importance of a combined self-management and exercise intervention to improve functional lower limb strength and aerobic capacity in a Portuguese sample. Additionally, pain and other symptoms have improved clinically.

Effects of Combined Exercise Training on Functional Performance in Children With Cerebral Palsy: A Randomized-Controlled Study.

The purpose of this study was to investigate the effects of combined exercise training on functional performance in participants with cerebral palsy. Fifteen participants with spastic cerebral palsy were randomly allocated into either exercise or control groups. Participants in the exercise group participated in a combined strength and endurance training program for 70 minutes per day, 3 days per week, for 8 weeks, whereas those in the control group did not participate in an exercise program. Study participants in both groups continued with their regular physical therapy during the study. After the 8-week training, a 6-minute walk, 30-second sit-to-stand, 10-m walk, and Functional Reach Tests, participants in the exercise group had significant improvement over their baseline values and were significantly higher than those in the control group. Combined exercise training improved walking ability, functional lower limb strength, and balance in participants with cerebral palsy.

No effect on gait function of progressive resistance exercise in adults with cerebral palsy – A single-blind randomized controlled trial

Muscular weakness has long been recognized as a problem in individuals with cerebral palsy (CP), but has been ignored therapeutically until recently. The purpose of this study was to examine the effects of a progressive resistance exercise (PRE) programme of seated leg press (SLP) on gait function in adults with spastic diplegic CP, Gross Motor Function Classification System (GMFCS) level II and III, who experience reduced walking ability, using a single-blind randomized controlled trial. Twelve individuals were included, 6 in the training and 6 in the control group. The training group completed a PRE programme consisting of a 10-min warm-up, followed by SLP 1215 repetitions maximum (RM) in 4 sets, 3 days a week, for the first 2 weeks, progressing to 6RM in 4 sets, 3 days a week, for the following 6 weeks. Six-RM tests in the SLP machine were performed to determine the training load. The control group continued individual treatment or training as usual. The primary outcome measure was the 6-Minute Walk Test (6MWT). Secondary outcome measures were the Ten-meter Walk Test (10 m), stair climbing, the Timed Stands Test (TST) and isokinetic muscle strength of the quadriceps. There was no significant change, or difference in change between the groups, in any of the outcome measures from baseline to 8 weeks. Adults with CP, participating in an 8-week PRE, did not improve their walking, functional lower limb strength or isokinetic strength. The training group did improve their performance in SLP.

The Reliability of the Lateral Step Test

Functional strength measures correlate more closely with functional performance than non-functional strength measures. To determine the reliability of the lateral step test as a measure of maximal strength. Intertester repeated measures. Research laboratory. Twenty four healthy, pain free subjects. Two protocols (A and B) were evaluated. The protocols were identical except protocol B involved a three second pause. Participants performed a one repetition maximum (1RM) for each protocol on two occasions separated by one week. Step height (nearest cm) representing 1RM. Both protocols demonstrated excellent reliability, protocol A: ICC = 0.94 (95% CI, 0.87 to 0.97), SEM = 1.47 cm. Protocol B: ICC= 0.94 (95% CI, 0.85 to 0.97). Percent close agreement within 2 cm was 83.3% for protocol A and 79.1% for protocol B. Both protocols demonstrated excellent inter-tester reliability as measures of functional lower limb strength.