Mean Muscle Strength Research Articles

Assessing Scapular Muscle Strength and Force Couple Ratios in Stroke Patients: A Cross-Sectional Study

Introduction: This study quantifies the differences in individual scapular muscle strength in both arms along with obtaining a force couple ratio of scapula stabilizers to gain values in terms of the strength of muscles. Materials and Methods: A quantitative cross-sectional study was done on 30 stroke patients to assess the muscle strength of the serratus anterior, rhomboids, and upper, middle, and lower trapezius (in both shoulders) using a suspension scale. Meanwhile, the muscle force couple ratios were calculated. Results: The results showed significant strength differences between both arms for upper trapezius (P=0.0020), serratus anterior (P=0.018), rhomboids (P=0.001), middle trapezius (P=0.0068), and no difference for lower trapezius (P=0.1746). The mean muscle strength in the non-affected arm is greater than the affected arm. The middle trapezius strength is lowest in the affected arm (0.574 kgf) and the lower trapezius strength is lowest in the non-affected arm (0.767 kgf). The mean force couple ratio for upper trapezius versus lower trapezius was higher in the affected side (10.08) and the non-affected side (7.74). The remaining force couples were similar for both arms. Conclusion: Overall muscle strength of the scapula stabilizers is greater in the non-affected arm than in the affected arm. The strength of the force couple between the upper and lower trapezius is greater in both arms which shows considerable incoordination between the muscles.

The Effect of Planovalgus on Balance and Motor Function in Children With Cerebral Palsy

Objective Lower limb deformity in children with cerebral palsy (CP) is a common musculoskeletal problem and planovalgus is the most prevalent, characterized by talus median subluxation, calcaneal valgus, and supinated forefoot. According to studies, one issue in orthopedics and pathology is the accurate diagnosis and proper treatment of planovalgus deformity in children with bilateral spastic cerebral palsy, which has attracted researchers’ attention. Accordingly, the present study investigates the effect of planovalgus deformity on the motor performance and balance of these children. Materials & Methods This cross-sectional study employed a descriptive-analytical design. The convenient sampling method was used among children with bilateral spastic cerebral palsy, diagnosed with unilateral planovalgus, who were referred to the clinics of the University of Social Welfare and Rehabilitation Sciences (Nezam Mafi) and occupational therapy clinics from September 2022 to February 2023 in Tehran City, Iran. Meanwhile, all participants were willing to cooperate in this research. A total of 27 participants were evaluated by an occupational therapist based on the specified criteria and gross motor function classification system (GMFCS), which included the assessments of balance, muscle strength, range of motion, and pain. Data analysis was done using the SPSS software, version 16. Results The results revealed a statistically significant difference between the mean range of motion of ankle dorsiflexion and knee extension between the two limbs (P<0.001). The mean muscle strength of the quadriceps and ankle plantar flexors indicated a statistically significant difference in the affected limb (P<0.001). Additionally, the mean displacement of the center of pressure of the foot also demonstrated a statistically significant difference regarding topographical involvement (P<0.001). Conclusion Planovalgus deformity is one of the most common ankle deformities, which is of great concern for children with cerebral palsy. The results obtained from the assessments of the child’s balance and motor function demonstrated the importance of assessment strategies and early interventions to achieve better rehabilitation outcomes for children with CP and planovalgus deformity.

#2786 Effect of intradialytic virtual reality exercise program on lower limb muscle strength in patients on hemodialysis

Abstract Background and Aims In patients on hemodialysis, muscle weakness is highly prevalent and may lead to frailty, limitation of mobility and functional impairment. Moreover, low muscle strength was associated with an increase in mortality risk in these patients. Despite the fact that some studies showed that resistance training improves muscle strength in patients on hemodialysis, the effects of virtual reality (VR) exercise should be confirmed. Therefore, the aim of this study was to evaluate the effects of an intradialytic non-immersive VR exercise program, performed at different times during the hemodialysis session, on lower limb muscle strength in patients on hemodialysis. Method A randomized clinical trial was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least 3 months. Patients were randomized into 2 protocols of exercise at different times during the hemodialysis session (first 2 hours and last two hours) for 3 months. The intradialytic exercise program in both groups consisted of a non-immersive VR game (Treasure Hunting) in which the patients try to catch treasures and avoid bombs by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension), with a progressive duration of 6 to 36 minutes. The difficulty level of the game was graduated according to the characteristics of each patient. The muscle strength of the hip flexion (HF), hip abduction (HA) and ankle extension (AE) was evaluated using a portable handheld dynamometer during hemodialysis session. Patients were advised to perform a 5 s maximum isometric contraction, and the peak values were recorded for 3 repetitions in both lower limbs. The mean muscle strength of 3 trials was recorded. Data were expressed as the median (interquartile range). The Mann‒Whitney U test was used for between-group comparisons. The Friedman test was conducted to evaluate the differences in medians among the muscle strength data at baseline, after 1, 2 and 3 months of exercise program. Results This study included 11 patients in the exercise within the first 2 hours group [50 (55-75) years, 55% male] and 11 patients in the exercise within the last 2 hours group [64 (58-72) years, 64% male]. Table 1 shows that muscle strength of the HA and AE increased significantly in the exercise within the first 2 hours group. Muscle strength of HF, HA and AE improved significantly in the exercise within the last 2 hours group. There were no significant differences between two groups. Conclusion This study suggests that an intradialytic non-immersive VR exercise program can improve lower limb muscle strength in patients on hemodialysis.

Higher dietary methyl donor micronutrient consumption is associated with higher muscle strength in adults: a cross-sectional study.

Methyl donor micronutrients might affect muscle strength via DNA methylation. We aimed to evaluate the combined relationship of dietary methyl donor micronutrients containing betaine, choline, methionine, vitamin B12, vitamin B6 and folate on muscle strength. This cross-sectional study was conducted on 267 subjects including 113 men and 154 women. Dietary intake of micronutrients was assessed utilising a validated 168-item semi-quantitative FFQ, and methyl donor micronutrient score (MDMS) was calculated. The muscle strength of the participants was measured using a digital handgrip dynamometer. The association was determined using linear regression analysis. The mean age of participants was 36·8 ± 13·2 years. After taking into account potential confounding variables, there was no significant association between dietary methyl donor micronutrient score (MDMS) and the mean left-hand muscle strength (β: 0·07, se: 0·05, P = 0·07); however, the changes were significant in the mean right-hand muscle strength (β: 0·09, se: 0·04, P = 0·03). There was also a significant positive relationship between mean muscle strength and methyl donors' intake after fully adjusting for potential confounders (β: 0·08, se: 0·04, P = 0·04). In conclusion, our findings revealed that higher dietary methyl donor micronutrient consumption is associated with enhanced muscle strength. As a result, advice on a higher intake of methyl donor-rich foods including grains, nuts, dairy products and seafood might be recommended by dietitians as a general guideline to adhere to. Additional prospective studies are needed to confirm the findings.

Intra-session reliability of isometric muscle strength of the bilateral standing press in female handball players.

Systematizing reliable protocols and procedures for strength assessment in handball has allowed for a more thorough kinetic analysis and increased precision in detecting training-induced changes in muscular strength. The evaluation of upper limb strength with a bilateral standing press (BSP) exercise in handball players approximates blocking actions in the defensive phase, pushing and fixation. The aim of this study was to analyze the relative and absolute reliability of intra-session comparisons in an isometric peak muscle strength protocol in a bilateral standing press (BSP) exercise among female handball players. Sixteen young female handball players at an international level, aged between 22 ± 4 years, with no prior experience in using functional electromechanical dynamometers (FEMD) participated in this study. The participants initiated the assessment of maximum isometric force in a bipedal stance with a forward projection of the dominant foot between 20 and 30 cm. The knees were kept semi-flexed, and the hip extension of the non-dominant limb ranged from 15 to 20°. Bilateral anterior push of the upper limb was performed with shoulder abduction and elbow flexion at 90°, maintaining a pronated hand position. Participants were instructed to exert three sets of maximal force for 5 s in BSP exercise. Relative reliability was assessed using the model intraclass correlation (ICC) and absolute reliability was assessed using the coefficient of variation (CV) and standard error of measurement (SEM). For this study, the parameters of maximum and mean muscle strength were considered. The results demonstrated high relative reliability (ICC 0.93-0.97) and absolute reliability (SEM 0.19-2.79) y (CV 4.78-9.03) for both mean force and peak force, with no significant differences between the sets (p > 0.05), indicating a negligible effect size (0.01-0.12). The mean and peak isometric muscle strength for the BSP exercise controlled with FEMD in female handball players exhibits high relative and absolute reliability between series.

Muscle strength and endurance in COPD patients and healthy individuals – A comparative study

Background: Many studies have been done with COPD patients focusing on the impairment of lung function in these patients. However, only few studies were done focusing on the impairment of skeletal muscle strength and endurance in COPD patients which if occurs will affect their quality of life. Aim and Objective: The aim of this study is to compare the skeletal muscle strength and endurance between COPD patients and age gender and body mass index (BMI)-matched healthy subjects. We also assessed the association between decrease in FEV1 and muscle strength and endurance. Materials and Methods: 40 male COPD patients and age and body mass index-matched healthy male subjects were studied. Dominant hand-forearm muscle strength and endurance were measured using handgrip dynamometer. FEV1, FVC, and FEVI/FVC were measured using spirometer. Muscle strength and endurance between two groups were compared and the correlation between FEV1 and muscle strength and endurance was analyzed. Results: Mean muscle strength and endurance were significantly lower in COPD patients (P < 0.001) compared to healthy subjects. Significant positive correlation between decrease in FEV1 and decrease in muscle strength (P < 0.001) and endurance (P < 0.05) was observed. Conclusion: This study shows that there is decrease in muscle strength and endurance in COPD patients. Hence, early intervention to improve muscle strength is needed for better quality of life in these patients.

Chronic Ankle Instability and Neuromuscular Performance in Prerecruitment Infantry Soldiers.

Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined. To examine the prevalence of 8 ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers. Cross-sectional study. Military infantry basic training base. A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years). Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training. For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001). A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.

P08.09.B EFFECTS OF A ONE-WEEK SKIING INTERVENTION ON LOWER LIMB MUSCLE STRENGTH IN BRAIN TUMOR PATIENTS AND THEIR CAREGIVERS

Abstract BACKGROUND Due to fatigue or feelings of insecurity, many brain tumor patients are not sufficiently active. Among other things, this puts patients at higher risk for sarcopenia predicting overall survival. Exercise interventions of various kinds could effectively counteract this problem. Here, we aim to present the impact of a one-week skiing intervention on leg muscle strength in brain tumor patients and their caregivers as well as feasibility and safety of the intervention. MATERIAL AND METHODS Ten brain tumor patients and their families participated in this one-week skiing intervention in a self-catering lodge at 1400m altitude. Daily 4-hour ski sessions (including approx. 1 hour rest) with professional ski instructors were performed in small groups (≤5 participants) divided by proficiency level. Participants could choose between downhill and cross-country skiing. Adverse events were noted daily. Muscle strength was determined 3-10 days pre- and postintervention on 5 different gym machines (knee extension, knee flexion, adductors, abductors, leg press) using Brzycki's equation. RESULTS 20 adults (10 patients, 10 caregivers) and 7 children participated in the ski-based intervention. All patients were surgically treated at least once and received chemo- and/or radiotherapy (ongoing chemotherapy in 6 patients). No severe adverse events were recorded throughout the week. 15 adults (9 patients, 56% female; 6 caregivers, 67% female) aged 21-69 years (mean 50 years) completed the muscle strength tests. Of those, most patients suffered from grade 4 brain tumors (67%), followed by grade 2 (22%) and grade 1 (11 %) tumors. Mean muscle strength increased in all muscle groups tested (knee extension +13.5%, p=.024, CI 95%: -0.5 - 29.1; knee flexion +7.1%, p=.048 CI 95%: -1.0 - 14.0; adductors +6.6%, p=.039, CI 95%: 1.3 - 13.4; abductors 20.0%, p=.004, CI 95%: 6.9 - 35.7; leg press +19.5%, p=.050, CI 95%: -5.6 - 44.6). Tumor grade, gender, type of ski intervention, and age did not affect the RESULTS . CONCLUSION During one week of intensive ski training, positive effects on leg muscle strength could be shown in both brain tumor patients and their families regardless of age, gender, downhill/cross-country ski, or WHO grading. Furthermore, this study demonstrates feasibility and safety of ski-based exercises in this patient population. Interventions such as these could help patients overcome (gait) insecurities and motivate them to become more physically active in their daily lives. In the longer term, this may lead to better management of everyday life and improved quality of life.

Radial or Focal Extracorporeal Shock Wave Therapy in Lateral Elbow Tendinopathy: A Real-Life Retrospective Study.

Lateral elbow tendinopathy (LET) is characterized by pain, poor muscle strength of the wrist ex-tensors, and disability. Among the conservative rehabilitative approaches, focal as well as radial extracorporeal shock wave therapy (ESWT), are considered effective in LET management. The objective of this study was to compare the safety and effectiveness of focal (fESWT) and radial (rESWT) in terms of LET symptoms and the strength of wrist extensors, taking into account potential gender differences. This is a retrospective longitudinal cohort study of patients with LET treated with ESWT that had received a clinical and functional evaluation, including visuo-analogic scale (VAS), muscle strength using an electronic dynamometer during Cozen's test, and the patient-rated tennis elbow evaluation (PRTEE) questionnaire. Follow-ups were carried out weekly in four visits after enrollment, and at 8 and 12 weeks. During the follow-ups, the VAS score decreased in both treatments, even if patients receiving fESWT reported early pain relief compared to those treated with rESWT (time for treatment p-value < 0.001). Additionally, peak muscle strength increased independently of the device used, and again more rapidly in the fESWT group (time for treatment p-value < 0.001). In the stratified analysis for sex and for the type of ESWT, rESWT appears to be less effective in female participants in terms of mean muscle strength and PRTEE scores, without differences according to the type of device used. The rESWT group reported a higher rate of minor adverse events (i.e., discomfort, p = 0.03) compared to fESWT. Our data suggest that both fESWT and rESWT might be effective in improving LET symptoms, even if the higher rate of painful procedures were reported in patients treated with rESWT.

Abductor recovery after muscle-sparing periacetabular osteotomy using a lateral approach.

To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; P = 0.25 and 38.5° versus P = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; P = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (P = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.

Association of dietary and lifestyle inflammation scores with muscle strength and muscle endurance among Tehranian adults

Diet and lifestyle as modifiable factors play an effective role in muscle strength and muscle endurance. In addition, inflammatory reactions may have an association with the etiology of a a lower muscle strength and muscle endurance. We aimed to investigate the association of dietary and lifestyle inflammation scores (DLIS) with muscle strength and muscle endurance in a sample of Iranian adults. In this cross-sectional study, 270 adults aged 20 to 59 years (55.9% female) were selected. The dietary intakes were collected using a 168-item semi-quantitative food frequency questionnaire. The DLIS was calculated using the dietary inflammatory score (DIS), and lifestyle inflammatory score (LIS). Muscle endurance and muscle strength were measured by a digital-handgrip-dynamometer. Multivariate adjusted means for muscle strength and endurance across quartiles of the DIS, LIS, and DLIS were determined by the ANCOVA test. Multiple linear regression analysis was used to evaluate the association between inflammation scores (i.e., DIS, LIS, and DLIS), and muscle strength, muscle endurance. The DLIS ranged between −2.94 and 3.09. The adjusted P-value of muscle strength of the right hand (MSR) along quartiles of DIS was significantly lower (P = 0.024). MSR (β: −1.19; P-value: 0.020) and mean muscle strength (MMS) (β: −0.95; P-value: 0.047) had significant association with DIS. MSR (β: −0.85; P-value: 0.050) had a marginally significant association with DLIS. Overall, we found that a high adherence to a pro-inflammatory diet might be associated to a lower muscle strength. However, a lifestyle with greater inflammatory potential was not related to any components of muscle endurance. Further studies with prospective designs are needed to confirm the present findings in further details.

Comparison of the Effect of Creatine and Ginseng Supplementations on the Aerobic Power, Anaerobic Power, and Muscle Strength of the Male Players of the Iran National Epee Team

Background: Measuring physical fitness by studying aerobic metabolism, anaerobic metabolism, and muscular strength in most sports research is one of the important indicators of professional athletes. Objectives: The aim of the present study was to compare six weeks of creatine supplementation and ginseng on the aerobic and anaerobic strength and muscle strength of the male players of the Iran national epee fencing team. Methods: This quasi-experimental study with a pretest-posttest design was performed on two experimental groups of creatine and ginseng as a double-blind study. A total of 14 male players of the national epee fencing team were assigned to two groups’ creatine supplement and ginseng supplement. The statistical significant difference was determined at P ≥ 0.05, and ANCOVA test was used to assess the differences between groups. All data were analyzed by the SPSS software version 25. Results: The results showed that the mean aerobic power in the creatine supplement group was significantly different from the ginseng supplement group (P = 0.001). In addition, the mean anaerobic control within the creatine supplement group is significantly higher than the ginseng supplement group (P = 0.001). The mean muscle strength in the creatine supplement group is significantly different from the ginseng group (P = 0.001). Higher mean aerobic power, anaerobic power, and muscle strength in the creatine supplement group, compared to the ginseng group, showed the more significant role of this supplement in raising aerobic power. Conclusions: It can be concluded that the role of creatine supplements in improving aerobic and anaerobic power and muscle strength could be more remarkable than the ginseng supplement.

Strength of scapular elevation in women with TMD and asymptomatic women

Temporomandibular disorder (TMD) is recognized for its high prevalence, presenting characteristic signs and symptoms. Cervical spine pain is present in 70% of diagnosed TMD cases. Aim: To verify if women with TMD present changes in isometric muscle strength in the scapula elevation. Methods: This is an observational, cross-sectional study. Thirty-five women, aged 22.89±2.04 years, were divided into the TMD group (TMDG), diagnosed with TMD according to the DC/TMD, and control group (CG), with asymptomatic individuals. The volunteers accessed a online link by the smartphone in order to answer questions on personal data, the Fonseca Anamnestic Index (FAI), Neck Disability Index (NDI), and Masticatory preference. In all participants, evaluation of the force of the scapula elevation muscles was performed, using a load cell model MM-100 (Kratos® SP, Brazil). Data were analyzed descriptively using the maximum, mean, and standard deviation and a two-way ANCOVA test was applied for all variables. A significance level of 5% was considered. Results: There were no statistically significant differences between the TMDG and CG for the maximal and mean muscle strength of scapular elevation. There were statistically significant differences in FAI (p &lt;0.001*) between the CG and the TMDG. Conclusion: Based on the results, it was not possible to confirm the hypothesis that women diagnosed with TMD present lower isometric strength during scapular elevation (right/left).

Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit.

Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery. This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1month postpartum-faecal incontinence andstress, urgency and mixed urinary incontinence-as well as pelvic floor muscle strength scores based on the modified Oxford scale. Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p= 0.70, difference in prevalence [forceps - vacuum]: 5.4%, 95% CI -0.25, +0.15), frequency (p= 0.40) and amount (p= 0.48) of urine leakage or mean muscle strength scores (p= 0.89). In our maternity unit, we observed that type of operative vaginaldelivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.

Relative Hand Grip and Back Muscle Strength, but Not Mean Muscle Strength, as Risk Factors for Incident Metabolic Syndrome and Its Metabolic Components: 16 Years of Follow-Up in a Population-Based Cohort Study

Muscle strength is associated with health outcomes and can be considered an important disease predictor. There are several studies examining the relationship between hand grip strength (HGS) and metabolic syndrome (MetS). However, no results have been reported for long term longitudinal studies. In this study, we investigated the relationship between mean HGS, back muscle strength (BMS), relative HGS and BMS, and MetS. A total of 2538 non-MetS subjects aged 40–69 years (1215 women and 1323 men) in the Korean Genome and Epidemiology Study (KoGES) Ansan cohort were followed for 16 years. The relationships between incident MetS (iMetS) and muscle strength were estimated using Cox proportional hazard regression models after adjusting for the confounding factors. Increases in standard deviation (SD) and the lower quartile groups for relative HGS and BMS were significantly associated with iMetS in men and women. Moreover, increases in SD and high quintile groups (decreased HGS group) for the delta change in the mean and relative HGS were significantly associated with iMetS in men only. In addition, SD increases for the relative HGS and BMS were significantly associated with iMetS components in men and women. The present study suggests that lower relative HGS and BMS are associated with high risk for the future development of MetS.

The association between healthy lifestyle score with cardiorespiratory fitness and muscle strength.

The association of individual behaviours such as diet, tobacco use, body mass index (BMI) and physical activity have been investigated separately in relevance to cardiorespiratory fitness (CRF) and muscle strength. The purpose of this study is to investigate the combined association of the four mentioned lifestyle factors with cardiorespiratory fitness and muscle strength. This cross-sectional study was conducted on 271 Iranian adults, aged 18-70years. We developed a healthy lifestyle score (HLS) that ranged from 0 to 103 (higher score reflecting better adherence to healthier lifestyle) and included four lifestyle behavioural components (diet, physical activity, smoking and BMI). The relationship between HLS, CRF and muscle strength was determined using linear and non-linear regression analysis. HLS score was not significantly associated with VO2max (mL/kg/min) P=.43; VO2max (Lmin) P=.14; VO2max (LBM) (P=.79) and mean muscle strength (MMS) (kg) (P=.11), muscle strength of right hand (MSR) (kg) (P=.10) and muscle strength of left hand (MSL) (kg) (P=.16) in the unadjusted model. After adjustment for potential confounders, we found a significant association between HLS and Vo2max (L/min), MMS (kg), MSR (kg) and MSL (kg) (P<.001 for all). Also HLS and MMS (r=.06, P=.31), MSR (r=.07, P=.25), MMS (r=.05, P=.39), VO2max (mL/kg/min) (r=.01, P=.77), VO2max (Lmin) (r=.05, P=.35) and VO2max (LBM) (r=.002, P=.91) have no statistically significant linear relationship. Adherence to healthy lifestyle may be associated with increased CRF and muscle strength after adjusting for potential confounding variables.

Combined Transpedicular-Transarticular Approach for Ventrally Located Thoracic Intradural Meningiomas.

Background:The ventrally located intradural meningiomas in the thoracic spine are still considered a challenge for all spine surgeons. Many surgical approaches were developed to excise the lesion without violating the neural structures. They differ in their invasiveness, safety, and efficacy. One of these approaches is the postero-lateral combined transpedicular-transarticular approach (TPA-TAA).Patients and Methods:From January 2016 to December 2018, all patients with ventrally located thoracic meningiomas were operated on using the combined TPA-TAA. We evaluated all the patients preoperatively, immediate postoperative, and 6 months later. Clinical and functional outcomes were assessed using the muscle strength grade and the Nurick grading system. Magnetic resonance imaging was obtained for all patients postoperative and at 6 months later.Results:After 6 months, all patients experienced clinical and functional improvement. The mean muscle strength grade rose from 3.8 preoperatively to 4.8 after 6 months. According to the Nurick grading system, the mean preoperative grade was 4.4 and dropped to 1.8 after 6 months. Minor transient complications such as superficial wound infection and the cerebrospinal fluid leak were observed in 1 patient for each. Gross total tumor excision was achieved in all patients. No cases of tumor recurrence were noted during the follow-up period.Conclusions:This combined TPA-TAA is considered a safe and effective approach in excising ventrally located intradural thoracic meningiomas with minimal postoperative morbidities.

CLINICAL OUTCOME OF ARTHROSCOPIC ROTATOR CUFF REPAIR IN PATIENTS 2 AGED 70 YEARS AND OLDER

Aim: The purpose of this study was to evaluate the outcome of arthroscopic rotator cuff 13 repair in patients aged 70 years or older and report our results in terms of pain, range of 14 motion, muscle strength, and functional outcome. 15 Materials and Methods: We performed retrospective data review and identified 97 16 shoulders (94 patients) of our interest with minimum 24 months of follow-up. All patients 17 were evaluated with Visual Analogue Scale (VAS), Range of motion (ROM), Manual 18 Muscle Strength, and Oxford Shoulder Score (OSS) preoperatively and at final follow-up. 19 Patient satisfaction was determined by asking patients whether they were satisfied (yes 20 or no). Statistical analysis was performed using paired t test to compare pre and 21 postoperative measures and Mann-Whitney U test to see the effect of age and gender on 22 the final outcome. 23 Results: Of 97 shoulders, 70 (67.9%) shoulders were available for final evaluation with 24 a mean age of 73.56 years (70 to 81) and mean follow-up of 57.52 months (24 to 122). 25 Mean VAS for pain was improved from 8.4 (6 to 10) to 1.04 (0 to 5) (P < 0.001) at final 26 follow-up. Mean forward flexion, abduction, external rotation increased from 112.50o to 27 165.43o (P < 0.001), 114.36o to 166.86o (P < 0.001), 45.14o to 73.64o (P <0.001) 28 respectively, as well as, Internal rotation also improved in 55 patients (78.5%, n = 70) at 29 final follow-up. Mean muscle strength of Supraspinatus (SSP) and Infraspinatus (ISP) 30 according to MRC scale was significantly improved (P < 0.05) from 2.84 (2 to 4) to 4.67 31 (4 to 5) and from 2.77 (2 to 4) to 4.64 (3 to 5) at the final follow-up respectively. Mean 32 OSS was improved from 11.49 to 44.40 (P < 0.001) and only three patients (4.28%, n = 33 70) were subjectively less than satisfied at final follow-up. 34 Conclusions: There was a significant improvement in shoulder function with a low 35 complication rate. Hence, we have no hesitation to recommend repair in this age group. 36 Provided the rotator cuff is not grossly wasted, and patient is fit to undergo surgery, age 37 should not be the criteria for determining repairability.

Do the Loss of Thigh Muscle Strength and Tibial Malrotation Cause Anterior Knee Pain after Tibia Intramedullary Nailing?

Purpose Anterior knee pain (AKP) is a common complication after tibia intramedullary nailing surgery, but yet the etiology is not fully revealed. Our study had two hypotheses. The first one is “after tibia intramedullary nailing with transtendinous approach, thigh muscles strength decreases and this loss of muscle strength causes AKP.” Secondly, “lower extremity rotational profile is affected after tibia intramedullary nailing.” Methods. Our study was planned retrospectively and included 40 patients, who underwent tibia intramedullary nailing surgery. Mean follow-up time was 22.5 months. Tegner Lysholm knee scoring scale was applied to evaluate postoperative functional outcomes of all patients. Isometric muscle strengths of bilateral knee extensor and flexor muscle groups were compared with hand-held dynamometer. In addition, bilateral lower extremity Staheli rotational profile angles (foot progression angle (FPA), thigh-foot angle (TFA), and transmalleolar angle (TMA)) were compared. Results Lysholm knee score was evaluated as excellent in 28 patients. AKP were detected in 15 patients and there was no significant difference between the injured limb with contralateral quadriceps mean muscle strength (injured limb mean (ILM) = 201.97 Newton (N) – contralateral mean (CM) = 205.4 N). However, there was a significant difference (p<0,05) between injured limb with contralateral extremity hamstring mean muscle strength (ILM = 153.2 N– CM=158.95 N). Although there was a significant difference between the two extremities' rotational profile angles, there was no significant correlation between the rotational profile angles and knee pain. Conclusion As a result of our study, AKP appears to be significantly related to the loss of hamstring muscle strength. We suppose that hamstring exercises will gain importance in rehabilitation programs of tibia intramedullary nailing surgery in future.

Distal Femoral Extension Osteotomy with 90° Pediatric Condylar Locking Compression Plate and Patellar Tendon Advancement for the Correction of Crouch Gait in Cerebral Palsy.

Background:Various treatment modalities are available for the correction of crouch gait, ranging from hamstring lengthening to a combination of soft-tissue and bony procedures. We report the results of distal femoral extension osteotomy (DFEO) fixed with 90° pediatric condylar locking compression plate (LCP) and patellar tendon advancement (PTA) for crouch gait in children with cerebral palsy.Materials and Methods:A total of 26 patients (52 knees) with a mean age of 14.36 years (range 11.6–20 years) who presented with crouch gait were treated with DFEO and PTA. Patients were analyzed prospectively using clinical (knee flexion deformity, knee range of motion, extensor lag), functional (modified Ashworth, Tardieu scores, muscle strength, gross motor functional classification system [GMFCS], functional mobility scale [FMS], gross motor functional measure [GMFM]) and radiological (Koshino Index) outcome measures and followed up at a mean of 22 months (range 12–53 months).Results:There was an improvement in all outcome measures postoperatively, with improved function and independence. The mean knee flexion deformity improved significantly from 20.7° ± 6.59 to 0.67° ± 2.62, mean muscle strength of quadriceps improved from 3.01 ± 0.5 to 3.5 ± 0.54 and mean extensor lag improved from 20° ± 7.14 to 4.13° ± 4.16. The mean Koshino Index improved from 1.4 ± 0.16 to 1.0 ± 0.08. The mean GMFM-D improved from 15.58 ± 6.2 to 26.31 ± 5.8 and mean FMS for 5 m improved from 2.9 ± 1.09 to 3.6 ± 0.84, indicating significant improvement in household ambulation. There were four complications; transient peroneal nerve palsy in 3 patients, which recovered completely and 1 superficial wound dehiscence. There was no loss of fixation, tendon pull-out or deep infection.Conclusion:The combined procedure of DFEO and PTA can correct knee flexion deformity, restore knee extensor strength, and improve function in patients with crouch gait. The pediatric condylar LCP provides stable fixation to allow early mobilization and faster rehabilitation.