Low-impact Exercise Research Articles

INFLUENCE OF LONG-TERM TAI-CHI CHUAN TRAINING ON STANDING BALANCE IN THE ELDERLY

Tai-Chi Chuan (TCC) is thought to be a low-impact and effective exercise to improve balance capability in the elderly. However, the effects of TCC exercise on balance improvement remain controversial. The purpose of the current study was to investigate the effects of long-term Yang-Style TCC training on balance variables such as stable standing time and center of pressure (COP) movement patterns. Fifteen long-term Yang-Style TCC practitioners and fifteen age-matched adults performed different static balance tests each for 30 seconds. For each test, the time-varying COP positions were measured by two forceplates. The sway area of the COP was described by an equivalent ellipse, the two principal axes of which were obtained by using principal component analysis. The results showed that elderly subjects with long-term Yang-Style TCC training were able to maintain stable standing longer than those without TCC training, with reduced COP sway area during challenging tasks such as single-leg stance and tandem stance. It is suggested that long-term TCC exercise is a good choice in a training program aimed at reducing the risk of falling in the elderly.

The ACL Dilemma

The ACL Dilemma

Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials

The purpose of the study was to assess the effects of exercise interventions with different impact loading characteristics on lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) in older adults. We searched electronic databases and hand searched selected journals up to February 2011 for randomized controlled trials (RCTs) investigating the effects of impact exercise interventions on LS and FN BMD in older adults. Exercise protocols were categorized according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials and publication bias was tested. Random-effects models were applied. Trial quality assessment was also undertaken. Nineteen RCTs, including 1577 subjects, met the inclusion criteria. Twenty-two study group comparisons reported BMD data at the LS. Meta-analysis showed a significant change in BMD at this site (WMD 0.011 g/cm(2), 95% CI 0.003 to 0.020; p = 0.007), although results were moderately inconsistent (I(2) = 52.2%). BMD data at the FN were available from 19 study group comparisons among older adults. Results were inconsistent (I(2) = 63.6%) in showing a significant positive effect of exercise on BMD at this site (WMD 0.016 g/cm(2), 95% CI 0.005 to 0.027; p = 0.004). Combined loading studies of impact activity mixed with high-magnitude joint reaction force loading through resistance training were effective at LS (WMD 0.016 g/cm(2), 95% CI 0.002 to 0.036; p = 0.028), and no inconsistency existed among these trials. Odd-impact protocols were also effective in increasing BMD at LS (WMD 0.039 g/cm(2), 95% CI 0.002 to 0.075; p = 0.038) and FN (WMD 0.036 g/cm(2), 95% CI 0.012 to 0.061; p = 0.004), although heterogeneity was evident (I(2) = 87.5% and I(2) = 83.5%, respectively). We found consistency among results for low-impact and resistance exercise studies on LS and FN, although non-significant BMD changes were evident amongst these types of protocols at any site and amongst the RCTs that provided a combined loading impact exercise at FN. Funnel plots showed no evidence of publication bias. Trial quality was moderate to high. The findings from our meta-analysis of RCTs support the efficacy of exercise for increasing LS and FN BMD in older adults.

Tai Chi Exercises Benefit Even Oldest Adults

Tai Chi Exercises Benefit Even Oldest Adults

Commentaries on Viewpoint: Control arms in exercise training studies: transitioning from an era of intervention efficacy to one of comparative clinical effectiveness research

# PHYSICAL ACTIVITY—WHAT DO WE REALLY KNOW? {#article-title-2} to the editor: It was with great interest that I read the Journal of Applied Physiology Viewpoint on control arms in exercise training studies: transitioning from an era of intervention efficacy to one of comparative clinical

P2-379 Effectiveness of a low-impact exercise program in Lebanese marginalised postmenopausal women with psychological distress: a randomised controlled trial

BackgroundPsychological distress (PD) is common worldwide. Physical exercise is usually recommended by physicians to relieve PD among older adults. However, there is not yet strong enough evidence to support this...

Leg Pain in an Adolescent Female - Basketball

HISTORY: A 13-year old female basketball player presented with a 3-month history of progressive left lateral leg pain. She had sprained her left ankle 1 year earlier, though this had resolved with 1 month of relative rest. Her more recent leg pain began insidiously as she began the subsequent basketball season. She described throbbing pain, localized diffusely over the lateral lower leg. Pain was worse with walking, but was present even when not weightbearing. Concurrent symptoms included intermittent swelling and purplish mottling of the leg, as well as occasional toe numbness. She was initially treated with a 3-week trial of relative rest and a walking boot, but her leg pain continued to worsen. PHYSICAL EXAMINATION: Initial examination revealed an obese, otherwise healthy appearing adolescent female with normal gait. The left ankle was slightly edematous, and mild purplish mottling of the left leg was noted. She was diffusely tender to palpation over the left lateral calf and fibula. Left ankle ROM was normal. Strength was normal, but her pain was exacerbated with activation of the left ankle evertors and plantarflexors. In a subsequent examination, the slump test and left straight leg raise both reproduced her left lateral leg pain. Neurologic testing was otherwise unremarkable. DIFFERENTIAL DIAGNOSIS: Fibular stress fracture Calf muscle strain Deep vein thrombosis Complex regional pain syndrome Lumbosacral radiculopathy TESTING: Left tibia/fibula radiographs: No fracture. Lower leg MRI: No fracture or stress reaction. Increased T2 signal throughout left extensor digitorum, gastrocnemius, and soleus, suggestive of muscle strain. Similar, less severe findings in right leg. Left leg ultrasound: No venous thrombosis. Lumbar spine MRI: Left paracentral disc protrusion at L4-L5, impinging the traversing L5 nerve root. Congenitally narrow spinal canal. FINAL DIAGNOSIS: Left L5 radiculopathy TREATMENT AND OUTCOMES: 1. Physical therapy - dynamic lumbar stabilization program. 2. Gabapentin titrated to 300 mg three times daily. NSAIDs used as needed. 3. At 6 months, resumed strength training and low-impact endurance exercise. 4. Leg pain improved, but intermittent flare-ups continued. Refused epidural steroid injection. 5. At 1 year, still unable to return to competitive basketball.

Exertional Rhabdomyolysis: Link To Live Influenza Vaccine In A 29 Year Old Athlete

HISTORY: 29 year old female soldier presented with 2 day history of diffuse muscle pain associated with dark urine following a workout 2 days prior. Patient reported typical workout consisting of squats, push-ups, sit-ups, and shoulder press. The following morning she noted increasing diffuse muscle pain with severe upper arm and leg pain exacerbated by movement. She denied any recent heat exposure, medications, or supplements. PMH: none. She takes oral contraceptives. She does not smoke, and drinks alcohol occasionally. She recently completed a Half Ironman triathlon and does weight training 3 times weekly. Family history is significant for an older sister who passed away 1 month prior from H1N1 complications. Patient reports receiving the live influenza vaccine 3 weeks prior. Patient was admitted for exertional rhabdomyolysis without renal complications. After CK peaked, the patient was discharged home with aggressive oral hydration & recommended physical rest. 2 months later, after resuming low-impact exercise, patient developed symptoms again. This time, she reported that she had received the H1N1 vaccine 3 weeks prior. Due to the recurrence of symptoms, an exercise intolerance mutation panel was done. The patient opted to have a muscle biopsy for further evaluation. PHYSICAL EXAMINATION: Exam significant for diffusely tender muscles and pain on passive ROM. DIFFERENTIAL DIAGNOSIS: Exertional rhabdomyolysis TEST AND RESULTS: First episode: CK: 66,000; BUN 8; Cr 0.8; AST 441, ALT 220, UA: 1.006, small blood, no RBCs. Second episode: CK: 1,300; BUN 8, Cr 0.8; AST 99, ALT 40. UA: 1.001, small blood, no RBCs. Exercise Intolerance Mutatuin Panel showed no mutations for myophysphorylase deficiency, carnitine palmitoyltransferase II deficiency, or myoadenylate deaminase defiency. Muscle biopsy: negative FINAL/WORKING DIAGNOSIS: Exertional Rhabdomyolysis TREATMENT AND OUTCOMES: As this patient was used to eccentric exercise, it seems rare that she would develop unprecipitated symptoms of rhabdomyolysis without a predisposing factor. Given the timeline of live-virus influenza vaccines 3 weeks prior to each episode of symptoms, as well as a negative genetic work-up, it is hypothesized that the live influenza virus vaccine in combination with eccentric exercise caused rhabdomyolysis.

Joint forces and torques when walking in shallow water

This study reports for the first time an estimation of the internal net joint forces and torques on adults' lower limbs and pelvis when walking in shallow water, taking into account the drag forces generated by the movement of their bodies in the water and the equivalent data when they walk on land. A force plate and a video camera were used to perform a two-dimensional gait analysis at the sagittal plane of 10 healthy young adults walking at comfortable speeds on land and in water at a chest-high level. We estimated the drag force on each body segment and the joint forces and torques at the ankle, knee, and hip of the right side of their bodies using inverse dynamics. The observed subjects' apparent weight in water was about 35% of their weight on land and they were about 2.7 times slower when walking in water. When the subjects walked in water compared with walking on land, there were no differences in the angular displacements but there was a significant reduction in the joint torques which was related to the water's depth. The greatest reduction was observed for the ankle and then the knee and no reduction was observed for the hip. All joint powers were significantly reduced in water. The compressive and shear joint forces were on average about three times lower during walking in water than on land. These quantitative results substantiate the use of water as a safe environment for practicing low-impact exercises, particularly walking.

Lifestyle changes for the prevention and management of lower urinary tract symptoms in women

Lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on the well-being and quality of life. Patients should receive counselling on the behavioural changes for promoting healthy lifestyle in the prevention and optimal treatment of LUTS. In obese women, weight loss should be advised as one of the first-step interventions. Smoking cessation is recommended considering the relationship between smoking and lower urinary tract complaints in addition to its general health risks. Caffeine consumption should be limited to <200 mg/d (two cups of coffee) because of its potential effects on urgency and frequency of symptoms. The products which are thought to be bladder irritants should be removed one by one from the diet, and the change in the symptoms must be monitored separately for some time. Fluid intake restriction in the evening can be useful especially in the elderly women. The amount of daily fluids should be approximately 30 mL/kg (eight cups) according to the body weight. Changing high-impact exercise with low-impact exercise and avoiding activities that require recurrent, chronic intra-abdominal pressure may be useful especially in stress incontinence. Dietary changes and other recommendations for maintaining healthy bowel movements should be provided for the prevention of constipation. In conclusion, using lifestyle changes is viewed effective and recommended to be used to treat urinary incontinence, especially in combination with other behavioural techniques.

Effects of martial arts on health status: A systematic review

To systematically summarize the evidence for the effects of martial arts on health and fitness, to show the strengths of different types of martial arts, and to get a more complete picture of the impacts of martial arts on health, and also to provide a basis for future research on martial arts as an exercise prescription in exercise therapy. We searched for "martial arts""health" and "random" in eight databases (n= 5432). Randomized controlled trials and controlled clinical trials on the health effects of martial arts were included in the study. The final analysis included 28 papers (one general martial arts, one kung fu, sixteen tai chi, six judo, three karate, and one taekwondo). Among the disciplines of martial arts, tai chi was the most well-studied, followed by judo, karate, and taekwondo. Research topics varied widely, and included health, injuries, competition, morals and psychology, and herbal medicine. Most found positive effects on health. Tai chi is no-contact, low-impact, soft body and mindfulness exercise, which has been widely adopted by elderly people and proven to be a beneficial health promotion exercise. Research on judo, karate, and taekwondo mainly focused on improvements to athletes' competitive abilities, rather than on health effects. We did not find any published randomized controlled trials or controlled clinical trials on aikido, kendo, sumo, kyudo, qi gong, or other disciplines. Since martial arts are widely practiced, their effects on physiology, morphology, immunology, and neurology should be further studied in order to help people to select the best discipline or style to accomplish their purposes. This necessitates categorizing and classifying the disciplines and styles according to their effects on different body systems and levels of contact, as well as standardizing evaluation criteria for martial arts. Martial arts as an exercise prescription can then move from an experience-based to an evidence-based treatment.

FUNCTIONAL ASSESSMENT OF OLDER ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE LIVING AT HOME

FUNCTIONAL ASSESSMENT OF OLDER ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE LIVING AT HOME

Tai chi for lowering resting blood pressure in the elderly: a systematic review

To assess the evidence for tai chi in reducing resting blood pressure (BP) in the elderly. Databases were searched up to February 2009. All randomized clinical trials (RCTs) testing the effects of tai chi on resting BP in the elderly were considered. The selection of studies, data extraction and validation were performed independently by two reviewers. Methodological quality was evaluated using the Jadad score. A total of 329 potentially relevant articles were identified and four RCTs met the inclusion criteria. One study suggested a significant BP reduction compared with no treatment or wellness education programme, while the others showed no effects compared with resistance exercise and usual activity. Two RCTs failed to show a reduction of resting BP compared with aerobic exercise, low impact exercise and no exercise control. The evidence for tai chi in reducing BP in the elderly individuals is limited. Whether tai chi has benefits over exercise is still unclear. The number of trials and the total sample size are too small to draw any firm conclusions. Further rigorous RCTs are warranted.

Leg Injury In A 66-year-old Runner - Distance Running

HISTORY: A 66-year-old female avid distance runner complained of anterior right thigh pain for four months. She was diagnosed with a quadriceps strain and restricted her running for several weeks. Further evaluation revealed a healing stress fracture of the right proximal femur. After seven weeks of low impact exercise and radiographic evidence of a healed stress fracture, the patient began a gradual return to running. In the first week of this program, the patient fell at home and fractured her right proximal femur. Past history was notable for a stress fracture of the right proximal femur five years earlier which healed with six weeks of low impact exercise. Since then she continued to run 10k and half marathon races without right thigh pain and even qualified for the senior Olympics. Patient was treated with bisphosphonates for over five years. Her DEXA scan from the previous year revealed osteopenia of the spine (T-score= -2.3) but normal bone mineral density of her femurs (T-scores of -0.7 left and 0.0 right). PHYSICAL EXAMINATION: On initial presentation, the patient appeared healthy and athletic. Her lower extremities showed no gross deformities and had full active range of motion. There was tenderness to palpation along the middle third of the right thigh, and pain with single leg standing on the right. DIFFERENTIAL DIAGNOSIS: Completed femoral stress fracture from incomplete healing Femoral fracture secondary to osteoporosis Pathologic femoral fracture Low-energy mid shaft femoral fracture associated with longstanding bisphosphonate use TEST AND RESULTS: Initial right femur radiographs (7 weeks prior to fracture): - 2 cm sclerotic cortical lesion at the lateral proximal femur consistent with prior stress fracture Three phase bone scan (7 weeks prior to fracture): - Increased activity in the proximal shaft of the right femur mainly in the cortical region Follow up right femur radiograph (1 week prior to fracture): - Increased callus formation in the area of previously noted sclerosis in proximal femur FINAL WORKING DIAGNOSIS: Low-energy femoral fracture possibly complicated by long-term bisphosphonate use TREATMENT AND OUTCOMES: 1. Intramedullary nailing of femur for acute displaced fracture management 2. Stop bisphosphonate 3. Gradual return to running after adequate rest and rehabilitation

A Cross-Sectional Study of Balance-Related Measures with Older Adults Who Participated in Tai Chi, Yoga, or No Exercise

ABSTRACTPurpose: This cross-sectional study compared balance-related measures in older adults who perform Tai Chi, yoga, or no exercise. Methods: A convenience sample of 52 healthy, older adults (>65 years old) was categorized according to their current participation in Tai Chi (n = 21), yoga (n = 11), or no exercise (n = 20). Each participant was measured on one occasion with the following balance-related measures: Single Limb Stance (SLS), the Multidirectional Reach Test (MDRT), the Fullerton Advanced Balance Scale (FAB), the Activities-Specific Balance Confidence Scale (ABC), and the Timed Floor Transfer (TFT). The data were examined using multiple one-way analysis of variance (ANOVA) procedures followed by Tukey's HSD post-hoc analysis. Results: There were no significant differences between the groups for SLS and ABC scores. The Tai Chi and yoga groups scored significantly higher on the FAB ( p = 0.001) than the no-exercise group. The Tai Chi group scored significantly higher than both the yoga and no-exercise groups on all directions of the MDRT ( p < 0.01), and the yoga group scored significantly higher than the no-exercise group on the MDRT left ( p = 0.004) and MDRT right ( p = 0.008). For the TFT, percentage rates for those able to complete the task were as follows: Tai Chi group = 76.1%, yoga group = 54.5%, and no-exercise group = 30.0%; those not tested were either unable or unwilling to perform the test. Conclusion: Both the Tai Chi and yoga exercise groups demonstrated better balance performance than the no-exercise group. Tai Chi and yoga are both economical and effective methods of low impact exercise that can be incorporated into a fall-prevention program for older adults in many settings.

Evaluation of commercial activity monitors for quantification of high- and low-impact exercise

Evaluation of commercial activity monitors for quantification of high- and low-impact exercise

Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings

The association of long-term sport-specific exercise loading with cross-sectional geometry of the weight-bearing tibia was evaluated among 204 female athletes representing five different exercise loadings and 50 referents. All exercises involving ground impacts (e.g., endurance running, ball games, jumping) were associated with thicker cortex at the distal and diaphyseal sites of the tibia and also with large diaphyseal cross-section, whereas the high-magnitude (powerlifting) and non-impact (swimming) exercises were not. Bones adapt to the specific loading to which they are habitually subjected. In this cross-sectional study, the association of long-term sport-specific exercise loading with the geometry of the weight-bearing tibia was evaluated among premenopausal female athletes representing 11 different sports. A total of 204 athletes were divided into five exercise loading groups, and the respective peripheral quantitative computed tomographic data were compared to data obtained from 50 physically active, non-athletic referents. Analysis of covariance was used to estimate the between-group differences. At the distal tibia, the high-impact, odd-impact, and repetitive low-impact exercise loading groups had approximately 30% to 50% (p < 0.05) greater cortical area (CoA) than the referents. At the tibial shaft, these three impact groups had approximately 15% to 20% (p < 0.05) greater total area (ToA) and approximately 15% to 30% (p < 0.05) greater CoA. By contrast, both the high-magnitude and repetitive non-impact groups had similar ToA and CoA values to the reference group at both tibial sites. High-impact, odd-impact, and repetitive low-impact exercise loadings were associated with thicker cortex at the distal tibia. At the tibial shaft, impact loading was not only associated with thicker cortex, but also a larger cross-sectional area. High-magnitude exercise loading did not show such associations at either site but was comparable to repetitive non-impact loading and reference data. Collectively, the relevance of high strain rate together with moderate-to-high strain magnitude as major determinants of osteogenic loading of the weight-bearing tibia is implicated.

Golf After Total Knee Arthroplasty

Background Golf provides an opportunity for relatively low-impact exercise for nearly all age groups and is considered a recommended activity for patients after total knee arthroplasty. Hypothesis We hypothesized that total knee arthroplasty would afford patients increased ability to participate in and enjoy golf, allowing a large percentage of these patients to walk the golf course. Study Design Case series; Level of evidence, 4. Methods Surveys were sent to 151 golfers who had undergone primary total knee arthroplasty from 1995 to 2000. The detailed survey included 33 questions specific to the patients’ golf performance, enjoyment of golf, frequency of participation, timing of return to play, presence of pain, use of a cart, and related golf-specific issues. Results We received and evaluated 93 responses (62%). Fifty-seven percent reported they had returned to golf within 6 months after total knee arthroplasty. Eighty-one percent of respondents reported golfing as frequently, or more frequently, than before knee replacement. Notably, golfers reported less pain while golfing after total knee arthroplasty than before (13% vs 83%; P < .0001), and 94% of respondents reported currently enjoying golf as much as or more than before surgery. Twenty-eight percent of respondents stated that they walked the course, rather than using a motorized golf cart, before surgery, while only 14% walked the course after surgery (P = .02). Conclusion In this population of golfers, total knee arthroplasty reliably relieved pain that had been previously experienced while golfing, and increased or maintained this group’s enjoyment of playing golf. However, 86% of these patients reported using a cart while golfing. Further patient education is needed regarding the potential health benefits of walking during golf after total knee arthroplasty.

Qigong: Bio-Energy Medicine

Dear Editor: Qigong is a subtle energy-based practice for healing and preventing diseases and improving the quality of practitioners' lives. The fundamental qigong practice is the activation, development, and application of “qi.” Qi is bio-energy in different subtle energy forms such as electricity, magnetic force, far-infrared radiation, etc.1,2 These forms of subtle energies function through an energetic network in the body for coherent communication between all the body's organs, tissues, and cells; between the mind and the body; as well as between the body and the living environment. The increased subtle energy strength through qigong practice2 plays an important role in restoring the functions of the body and in addressing the miscommunications between the internal organs, tissues, and cells, thereby preventing and healing diseases and promoting the health and quality of practitioners' lives. In a recent editorial, Shinnick wanted to create a new “–ology” such as “qigongology” with the specific purpose of studying qigong.1 In another Letter to the Editor, Hankey suggested using the term “qi-ology” as a new science of life instead of qigongology.3 It is essential to develop a basic concept for scientific qigong study. In the perspective of Shinnick, “at its core qigong is the manipulation of the regulation of the body, breath, and mind into an integrative whole, with the breath as the key regulator practice to make this happen.”1 Following Shinnick's definition of qigong, qigong could be viewed as “breathing therapy.” Hankey stresses the broad meaning of qi and defines qigong as “a multifaceted Chinese system of sitting and moving meditation practices, aiming to improve every aspect of a person's life, including health, by increasing the flow of qi through the body.”3 One might ask, what is the difference between qigong and yoga, between qigong and relaxation techniques, or between qigong and conventional low-impact exercise? Qigong consists primarily of internal energy activating and developing exercises, breathing exercises, meditation, stretching, and physical movements, all pursued with a heightened sense of feeling, focus, and awareness of qi-subtle energy. This is what differentiates qigong from the other abovementioned modalities. This state of being present with the qi, in turn, plays a key role in healing and health care. Because the most unique aspect of qigong practice is the activation, development, and application of “qi,” the subtle energy at the core of qigong practice, why don't we consider qigong as bio-energy medicine?

Pilot Study of Peripheral Muscle Function in Primary Biliary Cirrhosis: Potential Implications for Fatigue Pathogenesis

Primary biliary cirrhosis (PBC) is characterized in 95% of patients by autoantibody responses directed against the mitochondrial antigen pyruvate dehydrogenase complex (PDC). Although anti-PDC inhibits PDC function in vitro, mitochondrial function in vivo in PBC has not been examined. (31)P magnetic resonance spectroscopy was performed in PBC patients (n = 15) and fatigued (chronic fatigue syndrome/myalgic encephalomyelitis, n = 8), cholestatic (primary sclerosing cholangitis [PSC], n = 4), and normal (n = 8) controls to define mitochondrial function and pH regulation in peripheral muscle during exercise at 25% and 35% of maximum voluntary contraction. Normal, chronic fatigue syndrome/myalgic encephalomyelitis, and PSC subjects all showed close correlation between kinetics of adenosine diphosphate (ADP) and phosphocreatine (PCr) recovery after low-impact exercise, reflecting the normal tight regulation of PCr "response" by mitochondria to ADP "drive." This relationship was lost in PBC patients, indicating mitochondrial dysfunction (normal r(2) = 0.78, P < .005; PBC r(2) = 0.007, P = ns). Ratio between PCr and ADP recovery half-times (constant in controls, indicating normal mitochondrial responsivity) was significantly elevated in PBC patients (but not PSC) and was associated with anti-PDC levels. At higher levels of exercise PBC (but not PSC) patients showed excess muscle acidosis, with pH correlating with elevation of PCr/ADP recovery ratio, indicating a link to mitochondrial dysfunction. PBC patients alone also showed significant prolongation of muscle pH recovery time after exercise (unrelated to mitochondrial function), which correlated with clinical fatigue. PBC patients exhibit a variable degree of muscle mitochondrial dysfunction that manifests as excess acidosis after exercise. The extent to which patients can recover rapidly from acidosis appears to determine whether they are clinically fatigued.