Lower Extremity Strength Training Research Articles

Effects of functional strength training on pain, function, and lower extremity biomechanics in patients with patellofemoral pain syndrome: a randomized clinical trial

BackgroundPatellofemoral pain syndrome (PFPS) is a common disorder affecting the lower extremity. This study aimed to compare the effects of functional strength training (FST) and standard strength training (SST) in PFPS patients.MethodsForty college students (aged 18–30 years) with PFPS and no exercise habits were randomized into FST group (n = 20) and SST group (n = 20). FST group underwent six weeks of lower extremity training focused on functional adaptations, whereas SST group focus on lower extremity strength training. Function (Kujala Patellofemoral Scale, KPS), pain (visual analog scale, VAS), peak joint angles of hip, knee, and ankle, along with muscle activation (step-down test) of Vastus medialis, Vastus lateralis, Biceps femoris, Semitendinosus, Gluteus maximus, and Gluteus medius were assessed at baseline and after intervention.ResultsFST outperformed SST in pain reduction (p = 0.026) and function (p = 0.006) post-intervention. The FST group also showed increased hip flexion (p < 0.001), gluteus maximus activation (p < 0.001), and reduced knee valgus (p = 0.032), while SST group exhibited greater knee flexion (p = 0.008), and higher activation of the lateral femoral (p < 0.001) and semitendinosus (p < 0.001).ConclusionInterventions focused on functional adaptations result in differential kinematic and muscle activation changes that may result in greater improvements in pain and knee function than lower limb muscle strengthening alone.Trial registrationchictr.org.cn. NO: ChiCTR2400087664. Date 01/08/2024.

Residual Effects of Same Day Lower Extremity Strength Training on Countermovement Jump Performance in Collegiate Women Athletes.

Balancing of strength programming intensity with sport demands is necessary to avoid excessive workloads that could inhibit performance. To expand previous jump height focused literature, this study evaluated whether countermovement jump (CMJ) movement strategies, including eccentric characteristics, might reveal CMJ execution strategy shifts to achieve similar afternoon CMJ height following a morning resistance training session (RTS). Fifteen collegiate women's soccer and volleyball athletes (18-24 years, 73.6 ± 8.4 kg, 1.74 ± 0.19 m) participating in an offseason RTS completed five CMJs during two afternoon sessions (48 h apart), one 4-6 h post morning RTS, and one on a rest day. The RTS consisted of 2 sets of 10 repetitions at 70-80% 1RM for the back squat, the front squat, and the forward lunge. Vertical ground reaction forces were recorded from which 13 outcome measures describing elements of the eccentric and concentric CMJ phases were computed. No significant differences in jump height (p = 0.427, d = 0.17) or outcome measures (p = 0.091-0.777, d = -0.07-0.21) between sessions with exception of a significant concentric phase time decrease (p = 0.026, d = 0.23) following the RTS were identified. Given the magnitude of the mean concentric phase time change (0.01 s), the result likely has limited practical meaning. As these results confirm previous CMJ height literature, practitioners have further evidence that a morning RTS does not interfere or enhance afternoon CMJ performance in athletic women.

Changes in bone mineral density and clinical parameters after stroke in elderly patients with osteopenia.

We aimed to determine the association between changes in bone mineral density (BMD) of the lumbar spine, bilateral femoral necks and clinical parameters in ambulatory older adult patients with stroke who were diagnosed with osteopenia. This retrospective study included ambulatory patients older than 65 years diagnosed with stroke between January 2019 and June 2021. Osteopenia was diagnosed within 1 month after stroke diagnosis. Subsequently, follow-up BMD was performed within 12 to 14 months. The manual muscle test and modified Barthel index were measured as clinical parameters, and bone turnover markers were measured as biochemical markers. The Wilcoxon signed-rank test was used to compare whether a significant difference in the change in BMD was noted at each site measured at 1-year intervals. The BMD of the paretic and non-paretic femoral necks decreased significantly over time, but no significant change was observed in the BMD of the lumbar spine. Bone turnover markers were significantly changed at follow-up. Patients with modified Barthel index of less than 82 had significant bone loss only on the paretic side of the femoral neck. The BMD of the paretic side of the femoral neck was significantly decreased regardless of the strength of the hip and knee extensors. Although older adult patients with stroke and osteopenia can walk independently, more active osteoporosis treatment is needed to prevent bone loss and fractures, including improvement in daily living function and bilateral lower extremity strength training.

Fitness and walking outcomes following aerobic and lower extremity strength training in facioscapulohumeral dystrophy: a case series.

Facioscapulohumeral muscular dystrophy (FSHD) is a common form of adult muscular dystrophy often resulting also in cardiorespiratory deconditioning and weakness of the lower limbs. Although previous studies examined outcomes of interventions aimed at improving either cardiorespiratory fitness or muscle strength, the potential benefits of a rehabilitation program targeting both remain unexplored. Thus, the aim of this study was to evaluate changes following participation in a rehabilitation program combining aerobic and strength exercises. We conducted a retrospective analysis of 10 subjects with FSHD who participated in our rehabilitation program during 2018 and 2019. Each of the 20 sessions consisted of aerobic training on a cycloergometer and a moderate lower limb strength exercises on an isokinetic machine in combination with conventional therapy. The primary outcomes were walking speed, aerobic performance and isokinetic strength of the knee extensors and flexors. The secondary outcomes were fatigue, insomnia. VO2max and walking speed increased significantly by 2.125 ml·kg-1·min-1 [95% confidence interval (CI): 0.75-3.62, P = 0.022] and 0.28 m/s (95% CI: 0.16-0.4, P = 0.002), respectively. The effect size was small for V02max (Hedge's g, 0.44; 95% CI: -0.5 to 1.37) and large for walking speed (Hedge's g, 0.99; 95% CI: 0.06-1.92). The knee flexor strength significantly increased at rehabilitation discharge (repeated measures analysis of variance P = 0.004). Positive changes in fatigue and insomnia were also observed. Our preliminary results provide evidence that a relatively short course of a comprehensive rehabilitation program targeting both cardiorespiratory fitness and knee muscle strength can be beneficial for people with FSHD, which warrants further prospective studies.

Multicenter Analysis of the Epidemiology of Injury Patterns and Return to Sport in Collegiate Gymnasts.

Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique. To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts. Descriptive epidemiology study. A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes. Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P = .390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P = .001; and RR, 2.08 [95% CI, 1.05-4.13], P = .036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season. For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information.

EFEITOS DO TREINAMENTO DE FORÇA SOBRE A ESTABILIDADE FÍSICA DOS DANÇARINOS

ABSTRACT Introduction: Ballroom dance has evolved from a simple self-taught part of folklore to a technical, performative, and artistic competitive dance called the International Standard Dance. Objective: Study the effects of special lower limb strength training on the physical stability of dancers. Methods: 20 volunteers, students of a university specialized in dance, were divided into experimental and control groups, undergoing training of 30 minutes daily, 3 times a week, for 3 months. The control group followed the daily training, while the experimental group received special lower limb strength training. The relevant physical data measured before and after the intervention were statistically analyzed. Results: Compared to the control group, there was a significant difference in the athletes of the experimental group (P&lt;0.05). The experimental group's lower limb strength and special skills were significantly improved. Conclusion: The lower extremity strength training protocol significantly improved the dancers’ muscle strength, proportionally increasing the stability of the sports skills. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

The Effect of Combination of Core Stability Training and Lower Extremity Strength Training on Static Standing Balance Ability in a Child with Down Syndrome

Balance is the ability to stay in one position with good control. Children with a diagnosis of Down syndrome usually have decreased muscle tone (hypotonia) or muscle weakness, so that their balance is disturbed and they are more prone to falling when standing. Core stability and lower extremity strength exercise are expected to improve the ability of static standing balance in children with a diagnosis of Down syndrome. The aim of the study is to determine the effect of giving a combination of core stability and lower extremity strength exercises on the static standing balance ability in children with Down syndrome. This study uses a single subject research on a child with a diagnosis of Down syndrome who is given core stability and lower extremity strength exercise for 4 weeks to improve the ability of static standing balance. The ability of static standing balance in this study was measured using Gross Motor Function Measure (GMFM). Measurements were taken before exercise was given (A1), follow-up (B) and final evaluation (A2). After being given exercise twice for four weeks, there was no increase in the GMFM score, so it was concluded that there was no increase in the ability of static standing balance in children with Down syndrome in this study. In conclusions, giving core stability exercise and lower extremity strength exercise twice for four weeks is considered not to be able to improve the ability of static standing balance in children with Down syndrome.

Pulmonary rehabilitation in Africa: where are we? a multimethod study.

Pulmonary rehabilitation (PR) is an integral part of the management of patients with chronic respiratory diseases. However, there is limited information available on the effectiveness and practice of PR in Africa. This study was conducted to examine the prevalence, structure, and organization of PR in Africa, as well as its substance and claimed efficacy. We conducted a multimethod study involving systematic review of PR studies (obtained from PubMed, Google Scholar, and Cochrane databases) and a web-based survey of African healthcare professionals engaged in PR (using a standardized questionnaire). The review included papers on at least one component of PR in Africa and excluded those on PR from other continents or assessing pulmonary disorders in general without PR, cardio-rehabilitation, or physiotherapy practice in general in Africa. The Cochrane risk of bias and the Newcastle Ottawa scale instruments were used to assess the quality of included studies. We narratively synthesised data across the studies to produce a holistic picture. Of the 14 studies included for qualitative synthesis, seven were randomized controlled trials on the effectiveness of PR treatments with a total number of 333 participants. Of the 39 surveys mailed to health professionals working in Africa, only 14 (35.8%) were returned. We found aerobic exercise and breathing exercises were the most used technique and that quality of life, exercise capacity, and lung function improved significantly after PR treatments. There were differences in the duration, frequency, and length of the programs across the continent. Half of the respondents indicated that their institutions had one or more PR programs for inpatient, outpatient, maintenance, and/or home-based programs. Additionally, aerobic activities, upper and lower extremity strength training were the most frequently used exercise modalities in PR programs, followed by breathing exercises. Pulmonary rehabilitation is understudied in Africa, but it has been linked to improved lung function, exercise capacity, and quality of life. There is a need to invest in techniques tailored to the continent to enhance the implementation of pulmonary rehabilitation in Africa.

Acute and 6-Month Outcomes in Recipients of Lung Transplantation Following Lower Extremity Strength Training: Pilot Study

Purpose: Individuals who receive lung transplantation (LTx) have prolonged lower extremity weakness that limits exercise capacity and function. The purposes of this pilot study were to measure whether acute, intense, gym-based rehabilitation significantly increased walking distance and lower extremity strength after LTx and to identify whether gains were retained at 6-month follow-up. Methods: Nine men (mean age =57 years) completed 4 weeks of daily (5×/wk), gym-based acute care rehabilitation after LTx. Rehabilitation included stretching, aerobic conditioning, education, and either low- or high-volume strength training. Outcomes were assessed at baseline, 4 weeks, and 6 months post-LTx and included 1-repetition maximum (1-RM) tests, isokinetic torque, isometric torque, and 6-minute walk distance. Results: Patients attended an average of 17 acute rehabilitation sessions. Following acute rehabilitation, walking distance was increased and patients achieved greater 1-RM for leg press and for knee extension. Regardless of the volume of strength training, knee extension isometric torque and isokinetic torque were significantly increased (P &lt; .05). At 6 months, subjects achieved further gains in leg press 1-RM and grip strength (P &lt; .05), while walking and other strength measures were maintained. Conclusions: Intense rehabilitation produced acute lower extremity strength improvements that were retained after 6-months. Further study is needed in a larger sample.

BeFAST or BeSTRONG: a randomized control trial comparing sports skill training to lower extremity strength training for children who have cerebral palsy

BeFAST or BeSTRONG: a randomized control trial comparing sports skill training to lower extremity strength training for children who have cerebral palsy

Ambulation and Physical Function after Eccentric Resistance Training in Adults with Incomplete Spinal Cord Injury

Strengthening the lower extremities positively influences walking mechanics for people with a neurological deficit. Eccentric resistance training (ERT) is a potent stimulus for the development of muscular strength characterized by low metabolic demand. This mode of training may serve to benefit those with incomplete spinal cord injuries (iSCI) seeking to improve ambulatory capacity. PURPOSE: Determine the effect of ERT on walking speed, mobility, independence, and at-home function in those with iSCI. A secondary goal was to evaluate the relationship of daily step activity to ambulation and physical function variables. METHODS: Training intervention with pre-, mid-, post-assessments. Adults (N = 11) with longstanding (>1 year) iSCI, with no concurrent musculoskeletal injuries or lower extremity strength training, trained twice a week for 12 weeks on a motor driven, eccentrically biased recumbent stepper. Walking speed (10 meter walk test; 10MWT), mobility (timed up and go; TUG), independence (Walking Index for Spinal Cord Injury; WISCI), and at home function (Spinal Cord Independence Measure; SCIM) were assessed at baseline, after 6 weeks, and after 12 weeks of ERT. RESULTS: There were improvements in walking mobility (p = .034, d = 0.62), speed (p = .005, d = .23), and independence (p = .004, d = .73) after 12 weeks of ERT. At home function was unchanged (p = .10, d = .12). The TUG and 10MWT were correlated with step activity at mid- and post-test whereas the WISCI was significantly related at mid-test. CONCLUSION: The ERT improved walking function in the absence of gait training. Training on an isokinetic ergometer to improve eccentric strength promoted independence and, may potentially improve exercise self-efficacy. Additionally, this mode of ERT may diminish therapist burden in programs designed to improve ambulatory capacity or strength in those with iSCI.

Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement.

To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. A experimental and longitudinal study design. The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n=100) or to receive usual care (nontraining group, n=100). Data were collected and followed up with the patients before surgery (T1) and at 2weeks (T2), 1month (T3), 2months (T4) and 3months (T5) after discharge. The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.

Gait Training in Chronic Stroke Using Walk-Even Feedback Device: A Pilot Study.

Asymmetrical gait and a reduction in weight bearing on the affected side are a common finding in chronic stroke survivors. The purpose of this pilot study was to determine the effectiveness of a shoe insole device that we developed, called Walk-Even, in correcting asymmetric gait in chronic stroke survivors. Six individuals with chronic (>6 months) stroke underwent 8 weeks of intervention with 2 sessions/week, each consisting of 20 minutes of gait training and 20 minutes of lower-extremity strength training. The 2 control participants underwent conventional gait training, while 4 participants underwent gait training using the Walk-Even. Following intervention, all the participants improved on most of the gait measures: peak pressure of the foot, time of transfer of weight from heel-to-forefoot, center of pressure (COP) trajectory, COP velocity, asymmetry ratio of stance, mean-force-heel, mean-force-metatarsals, Timed “Up and Go,” and Activities-specific Balance Scale. The improvement was more pronounced in the 4 participants that underwent training with Walk-Even compared to the control participants. This pilot study suggests that a combination of strength and gait training with real-time feedback may reduce temporal asymmetry and enhance weight-bearing on the affected side in chronic stroke survivors. A large randomized controlled study is needed to confirm its efficacy.

The Development of Rhythmic Balance Training Equipment and its Effect on Performance for Elderly

Objective: The aims of this study were 1) to develop easy-to-use rhythmic balance training equipment for the elderly and 2) to investigate the effect of training with the equipment on balance and physical function. Method: Twenty-one elderly individuals (age: 75.4±3.34 yrs, height: 152.07±4.81 cm, weight: 58.35±8.34 kg) participated in this study. Each participant underwent balance and physical function testing before and after 12 weeks of training with the equipment. Y-balance (i.e. dynamic balance) and one leg static balance tests were used for balance testing, and timed up- and-down-stairs and five times sit-to-stand tests were used for physical function testing. A paired t test was used to determine whether there was a significant pre- and post-training difference. Results: The rhythmic balance training equipment provided a fun and motivating training program with age-friendly music, dance movements for lower extremity strength training, and touch screen controls with simple features. Post-training left foot dynamic balance was significantly greater (p<.05), and static balance with eyes open was significantly improved (p<.05) compared to pre-training. Completion of the timed upand- down-stairs and the five times sit-to-stand tests was significantly shorter (p<.05) compared to pre training. Conclusion: Training using the equipment developed in this study improved balance and physical function in elderly participants.

The effects of strength and power training on single-step balance recovery in older adults: a preliminary study.

Improving muscle strength and power may mitigate the effects of sarcopenia, but it is unknown if this improves an older adult’s ability to recover from a large postural perturbation. Forward tripping is prevalent in older adults and lateral falls are important due to risk of hip fracture. We used a forward and a lateral single-step balance recovery task to examine the effects of strength training (ST) or power (PT) training on single-step balance recovery in older adults. Twenty older adults (70.8±4.4 years, eleven male) were randomly assigned to either a 6-week (three times/week) lower extremity ST or PT intervention. Maximum forward (FLeanmax) and lateral (LLeanmax) lean angle and strength and power in knee extension and leg press were assessed at baseline and follow-up. Fifteen participants completed the study (ST =7, PT =8). Least squares means (95% CI) for ΔFLeanmax (ST: +4.1° [0.7, 7.5]; PT: +0.6° [−2.5, 3.8]) and ΔLLeanmax (ST: +2.2° [0.4, 4.1]; PT: +2.6° [0.9, 4.4]) indicated no differences between groups following training. In exploratory post hoc analyses collapsed by group, ΔFLeanmax was +2.4° (0.1, 4.7) and ΔLLeanmax was +2.4° (1.2, 3.6). These improvements on the balance recovery tasks ranged from ~15%–30%. The results of this preliminary study suggest that resistance training may improve balance recovery performance, and that, in this small sample, PT did not lead to larger improvements in single-step balance recovery compared to ST.

Effect of Strength Training Exercise on Instep Kick Performance of Soccer Players

The aim of this study was to examine the effect of lower extremity strength training exercise for twelve-week on instep kick performance of soccer players. To achieve my purpose eighty (80) amateur soccer players volunteered to participate in this study after signing informed consent forms, forty players [aged 18.0 ± 1.5 years] constituted the experimental group [EG] while the remaining forty [aged 18.0 ± 1.5 years] were the control group [CG]. The independent variable for the study is strength training exercise for twelve weeks and dependent variable is soccer instep kick ability. The strength training was administered to experimental group three days (Monday, Wednesday & Friday) per week for twelve weeks. The data were collected from control and experimental groups before and after training intervention. During pre test the data is arranged in descending order and then with the help of ABBA method the players are divided into two different groups. The groups are equated with the help of equal mean. Therefore, the data was analysed with dependent t test to elicit the difference from pre to post in each groups separately. The mean and standard deviation of the experimental and control group are presented. The result of the study showed that pre and post test difference between the groups are not significant as the obtained t value is 0.349 and 1.7111 respectively. However, in experimental group before and after twelve weeks of strength training has significantly improved the kicking ability of soccer players (t = 2.95, p = 0.0052) and control group remained unaltered ( t = 0.24, p = 0.8058). It is concluded that this training programme can be administered as part of the pre-season training of soccer players. It is approximately changes in physical fitness components particularly lower extremities have been transferred to soccer kick performance in terms of ball speed as well as technique. Therefore, the application of soccer-specific strength training programs for twelve weeks as part of pre-season training programme for young soccer players is recommended

Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance

BackgroundTask-specific locomotor training has been promoted to improve walking-related outcome after incomplete spinal cord injury (iSCI). However, there is also evidence that lower extremity strength training might lead to such improvements. The aim of this randomized cross-over pilot study was to compare changes in a broad spectrum of walking-related outcome measures and pain between robot-assisted gait training (RAGT) and strength training in patients with chronic iSCI, who depended on walking assistance. We hypothesized that task-specific locomotor training would result in better improvements compared to strength training.MethodsNine participants with a chronic iSCI were randomized to group 1 or 2. Group 1 received 16 sessions of RAGT (45 min each) within 4 weeks followed by 16 sessions of strength training (45 min each) within 4 weeks. Group 2 received the same interventions in reversed order. Main outcome measures were the 10 m Walk Test (10MWT) at preferred and maximal speed. Furthermore, we assessed several measures such as walking speed under different conditions, balance, strength, and 2 questionnaires that evaluate risk of falling and pain. Data were collected at baseline, between interventions after 4 weeks, directly after the interventions and at follow-up 6 months after the interventions. Pain was assessed repeatedly throughout the study.ResultsThere were no significant differences in changes in scores between the 2 interventions, except for maximal walking speed (10MWT), which improved significantly more after strength training than after RAGT. Pain reduced after both interventions.ConclusionIn patients with chronic iSCI dependent on walking assistance, RAGT was not more effective in improving walking-related outcome compared to lower extremity strength training. However, the low sample size limits generalizability and precision of data interpretation.Trial registrationThis study was registered at Clinicaltrials.gov (NCT01087918).

Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial

BackgroundHigher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy.MethodsThis study was embedded in an unblinded randomised controlled trial. Participants had diabetes and polyneuropathy and were randomly assigned to the intervention group (n = 48) receiving strength training during 24 weeks, or the control group (n = 46) receiving no intervention. Plantar pressures were measured in both groups at 0, 12, 24 and 52 weeks. A random intercept model was applied to evaluate the effects of the intervention on peak pressures and pressure–time-integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure–time-integral-ratio.ResultsPlantar pressure patterns were not affected by the strength training. In both the intervention and control groups the peak pressure and the pressure–time-integral under the forefoot increased by 55.7 kPa (95% CI: 14.7, 96.8) and 2.0 kPa.s (95% CI: 0.9, 3.2) over 52 weeks, respectively. Both groups experienced a high number of drop-outs, mainly due to deterioration of health status and lower-extremity disabilities.ConclusionsPlantar pressures under the forefoot increase progressively over time in people with diabetic polyneuropathy, but in this study were not affected by strength training. Future intervention studies should take this increase of plantar pressure into account and alternative interventions should be developed to reduce the progressive lower extremity problems in these patients.Trial registrationThis study was embedded in a clinical trial with trial number NCT00759265.

Exercise for Patients With Osteoporosis: Management of Vertebral Compression Fractures and Trunk Strengthening for Fall Prevention

AbstractMaintenance of bone health and quality requires mechanical strain, but the mechanical force needs to be within the bone's biomechanical competence. In osteoporosis, compression of vertebral bodies can be insidious. Therefore, absence of pain does not necessarily indicate absence of vertebral microfracture and deformity. Further, patients with previous vertebral fractures are at risk for further vertebral fractures and their associated morbidity. Exercise is a part of the comprehensive management of patients with osteoporosis and has been associated with improvement of quality of life and lowered risk of future fracture. The exercise prescription needs to match the needs of the patient. If exercise is not prescribed properly, then it may have negative consequences. In general, an exercise program, therapeutic or recreational, needs to address flexibility, muscle strength, core stability, cardiovascular fitness, and gait steadiness. As with pharmacotherapy, therapeutic exercises need to be individualized on the basis of musculoskeletal status and an individual's exercise interest. In osteoporosis, axial strength and stability are of primary importance. In particular, a spinal extensor strengthening program should be performed with progressive measured resistance as tolerated. To address falls and fractures, an exercise program should also include balance and lower extremity strength training. Proper dosing of oral cholecalciferol and calcium supplements can enhance the effect of strengthening exercises. Finally, a coordinated approach, such as the Spinal Proprioception Extension Exercise Dynamic (SPEED) program, can improve back extensor strength, the level of physical activity, and locomotion, and reduce back pain and fear and risk of falls.

The Influence of Nontraditional Training Modalities on Physical Performance: Review of the Literature

The primary purpose of this effort was to review several forms of nontraditional (NT) training programs, including heavy lower extremity strength training, CrossFit training, kettlebell training, and agility training, and discuss the effects of these exercise regimens on physical performance. The secondary purpose was to evaluate NT fitness training programs for evidence that they may provide beneficial options to help airmen improve their fitness scores. A search of the literature for 1980-2010 was performed using the Franzello Aeromedical Library, Public Medicine, and Air Force Institute of Technology search engines. There were 50 articles located and the authors selected 29 articles that specifically addressed the primary and secondary purposes of this literature review. This review indicates that an NT training approach is warranted in the general Air Force population. Heavy leg strength training and agility training show promise in enhancing aerobic fitness and improving fitness scores, particularly among members who have difficulty passing a physical fitness test. Most of the nontraditional forms of physical training are not supported in the scientific literature, with the exception of heavy leg strength training and agility training. However, even these NT forms of training require further investigation.