Exercise Muscle Strength Research Articles

Osteoarthritis

Osteoarthritis is a common form of arthritis characterized by degeneration of articular cartilage and pathologic changes in surrounding bone and periarticular tissue. The disease process results in pain and dysfunction of affected joints and is a major cause of disability in the general population. Prognosis is variable; greater muscle strength, mental health, self-efficacy, social support, and aerobic exercise are associated with better outcomes. This review outlines the classification of osteoarthritis (primary and secondary) and its epidemiology and etiologic factors, including risk factors, normal articular cartilage, and pathologic changes. Diagnosis is reviewed in terms of general considerations and specific joint involvement and related complications. The differential diagnosis is discussed. Management of osteoarthritis includes nonpharmacologic measures, pharmacologic therapy, surgery, and disease-modifying or chondroprotective therapy. This review contains 6 figures, 8 tables, and 84 references. Keywords: Knee, hand, hip, osteoarthritis, joint pain, synovial fluid, inflammation, weight-bearing

Osteoarthritis

Osteoarthritis is a common form of arthritis characterized by degeneration of articular cartilage and pathologic changes in surrounding bone and periarticular tissue. The disease process results in pain and dysfunction of affected joints and is a major cause of disability in the general population. Prognosis is variable; greater muscle strength, mental health, self-efficacy, social support, and aerobic exercise are associated with better outcomes. This review outlines the classification of osteoarthritis (primary and secondary) and its epidemiology and etiologic factors, including risk factors, normal articular cartilage, and pathologic changes. Diagnosis is reviewed in terms of general considerations and specific joint involvement and related complications. The differential diagnosis is discussed. Management of osteoarthritis includes nonpharmacologic measures, pharmacologic therapy, surgery, and disease-modifying or chondroprotective therapy. This review contains 6 figures, 8 tables, and 84 references. Keywords: Knee, hand, hip, osteoarthritis, joint pain, synovial fluid, inflammation, weight-bearing

Osteoarthritis

Osteoarthritis is a common form of arthritis characterized by degeneration of articular cartilage and pathologic changes in surrounding bone and periarticular tissue. The disease process results in pain and dysfunction of affected joints and is a major cause of disability in the general population. Prognosis is variable; greater muscle strength, mental health, self-efficacy, social support, and aerobic exercise are associated with better outcomes. This review outlines the classification of osteoarthritis (primary and secondary) and its epidemiology and etiologic factors, including risk factors, normal articular cartilage, and pathologic changes. Diagnosis is reviewed in terms of general considerations and specific joint involvement and related complications. The differential diagnosis is discussed. Management of osteoarthritis includes nonpharmacologic measures, pharmacologic therapy, surgery, and disease-modifying or chondroprotective therapy. This review contains 6 figures, 8 tables, and 84 references. Keywords: Knee, hand, hip, osteoarthritis, joint pain, synovial fluid, inflammation, weight-bearing

Survivors of Acute Lung Injury Have Greater Impairments in Strength and Exercise Capacity Than Survivors of Other Critical Illnesses as Measured Shortly After ICU Discharge.

To compare the physical function on ICU discharge in adults who survived an ICU admission for acute lung injury (ALI) with those admitted for a critical illness other than ALI. Two groups were recruited, (i) those who survived an ICU admission for ALI and, (ii) those who survived an ICU admission for a critical illness other than ALI. Within 7 days of discharge from ICU, in all participants, measures were collected of peripheral muscle strength, balance, walking speed and functional exercise capacity. Recruitment was challenging and ceased prior to achieving the desired sample size. Participants with ALI (n = 22) and critical illness (n = 33) were of similar median age (50 vs. 57 yr, p = 0.09), sex proportion (males %, 45 vs. 58, p = 0.59) and median APACHE II score (21.5 vs. 23.0, p = 0.74). Compared with the participants with critical illness, those with ALI had lower hand grip (mean ± SD, 18 ± 9 vs. 13 ± 8 kg, p = 0.018) and shoulder flexion strength (10 ± 4 vs. 7 ± 3 kg, p = 0.047), slower 10-meter walk speed (median [IQR], 1.03 [0.78 to 1.14] vs. 0.78 [0.67 to 0.94] m/s, p = 0.039) and shorter 6-minute walk distance (265 [71 to 328] vs. 165 [53 to 220] m, p = 0.037). The Berg balance scores were similar in both groups. Compared with survivors of a critical illness that is not ALI, those with ALI are likely to have greater physical impairment when measured shortly after discharge to the ward.

A six-week inspiratory muscle training and aerobic exercise improves respiratory muscle strength and exercise capacity in lung cancer patients after video-assisted thoracoscopic surgery: A randomized controlled trial

Objective: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A parallel-group, single-blind randomized clinical trial Setting: Thoracic surgery ward and outpatient clinic in a teaching hospital Subjects: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. Intervention: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. Main measures: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. Results: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). Conclusion: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.

Effects of the 4‐week high intensity interval physical exercise intervention on physical fitness, cognitive function and electroencephalogram patterns in 6 Korean elderly

AbstractBackgroundThis is a preliminary study to research the efficacy of a multicomponent and structured high intensity interval physical exercise intervention (PEI) on cognitive function in the not‐demented Korean elderly.MethodWe enrolled 6 not‐demented participants over the age of 70 from a community health center (77.0±4.7 years, 33.3% female). The PEI was conducted at the community health center for 4 weeks, 3 times a week, and 1 hour a day. It was a multicomponent structured physical exercise program consisting of muscle strength, flexibility, balance and aerobic exercises using elastic bands and ladder‐shaped floor plate, which was also a high intensity interval exercise program that allowed participants to maintain a 75 percent increase in their heart rate during exercise rather than the heart rate measured at rest. The outcome of this study was the effect of our PEI and was intended to be verified by conducting the physical fitness, cognitive function evaluation and electroencephalography, which were analyzed by paired t‐tests.ResultAfter the PEI, some items of participants' physical fitness and cognitive function evaluation were improved: 30‐seconds sit‐stand test (16.2±7.0 vs 24.8±5.5, p&lt;0.05), 2‐minutes stationary march (98.3±27.2 vs 143.7±36.9, p&lt;0.05), literacy independent cognitive assessment (LICA) memory domain score (89.6±21.6 vs 111.0±19.1, p&lt;0.05), LICA executive domain score (33.3±5.3 vs 37.0±5.1, p&lt;0.05) and LICA total score (214.6±30.6 vs 241.6±22.8, p&lt;0.05). In addition, the relative theta and delta power on temporal brain region were decreased and the relative beta power on frontal brain region was increased (p&lt;0.05) after the PEI.ConclusionThis study suggests that our high intensity interval PEI program could be helpful for the elderly with cognitive brain function as well as physical fitness, lower extremity muscular and cardiopulmonary endurance.

Effects of Muscle Strength Training on Muscle Mass Gain and Hypertrophy in Older Adults With Osteoarthritis: A Systematic Review and Meta-Analysis.

To investigate the effect of muscle strength exercise training (MSET) on lean mass (LM) gain and muscle hypertrophy in older patients with lower extremity osteoarthritis (OA). A comprehensive search of online databases was performed on April 20, 2019. Randomized controlled trials (RCTs) that reported the effects of MSET on LM, muscle thickness, and cross-sectional area (CSA) in older patients with OA were identified. A risk of bias assessment and meta-analysis were performed for the included RCTs. We included 19 RCTs with a median Physiotherapy Evidence Database score of 6 of 10 (range 3-7). In total, data from 1,195 patients (65% women, 85% with knee OA) with a mean age of 62.1 years (range 40-86 years) were analyzed. MSET resulted in significantly higher LM gain (standardized mean difference [SMD] 0.49 [95% confidence interval (95% CI) 0.28, 0.71], P < 0.00001) than did the nonexercise controls. Meta-analysis results revealed significantly positive effects of MSET on muscle thickness (SMD 0.82 [95% CI 0.20, 1.43], P = 0.009) and CSA (SMD 0.80 [95% CI 0.25, 1.35], P = 0.004) compared with nonexercise controls. No significant effects in favor of MSET were observed for any muscle outcome compared with exercise controls. Five RCTs reported nonsevere adverse events in response to MSET, whereas no RCTs reported severe events. MSET is effective in increasing LM and muscle size in older adults with OA. Clinicians should incorporate MSET into their management of patients at risk of low muscle mass to maximize health status, particularly for older individuals with OA.

ANALYSIS OF MUSCLE STRENGTH EFFECTS ON EXERCISE PERFORMANCE USING DYNAMIC STABILIZATION EXERCISE DEVICE

Muscle strength may vary depending on the pathological issues and static life habits. These conditions lead to abnormal spinal loads and change muscle strength as well as activation patterns, thereby causing spinal disorders. In this study, the effects of muscle strength on the spine stabilization exercise were analyzed using a whole-body tilt device. Musculoskeletal modeling was performed and the results were validated through a comparison with the electromyography (EMG) analysis results. Based on the validated basic model, modeling was performed for the whole-body tilt device. To examine the exercise effect and muscle activation while the maximum muscle force capacity (MFC) was varied from 30[Formula: see text]N/cm2 to 60[Formula: see text]N/cm2 and 90[Formula: see text]N/cm2, the muscle force was predicted through inverse dynamics analysis. When MFC was 30[Formula: see text]N/cm2, the posterior direction of the tilt could not be analyzed (no solution found). When MFC was 60[Formula: see text]N/cm2, it could be analyzed, but the muscle force was predicted to be higher compared to when MFC was 90[Formula: see text]N/cm2. It was confirmed that muscle strength is a very important element for maintaining postural activities and performing exercise. Therefore, for rehabilitation patients and elderly people with weak muscle strength, hard or extreme exercise may cause musculoskeletal injuries.

Kinematic Calibration of a Parallel 2-UPS/RRR Ankle Rehabilitation Robot.

In order to better perform rehabilitation training on the ankle joint complex in the direction of dorsiflexion/plantarflexion and inversion/eversion, especially when performing the isokinetic muscle strength exercise, we need to calibrate the kinematic model to improve its control precision. The ankle rehabilitation robot we develop is a parallel mechanism, with its movements in the two directions driven by two linear motors. Inverse solution of positions is deduced and the output lengths of the two UPS kinematic branches are calibrated in the directions of dorsiflexion, plantarflexion, inversion, and eversion, respectively. Motion of each branch in different directions is fitted in high-order form according to experimental data. Variances, standard deviation, and goodness of fit are taken into consideration when choosing the best fitting curve, which ensures that each calibration can match the most appropriate fitting curve. Experiments are conducted to verify the effectiveness of the kinematic calibration after finishing the calibration, and the errors before and after calibration of the two kinematic chains in different directions are compared, respectively, which shows that the accuracy after calibration has been significantly improved.

Inspiratory Muscle Training Improves Inspiratory Muscle Strength and Functional Exercise Capacity in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: A Pilot Randomised Controlled Study

Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poorer prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. We sought to investigate the effects of inspiratory muscle training (IMT) to improve exercise capacity in PAH. Adults with PAH were prospectively recruited and randomly assigned to either IMT or a control group. At baseline and after 8 weeks, assessment of respiratory muscle function, pulmonary function, neurohormonal activation, 6-minute walk distance and cardiopulmonary exercise testing variables were conducted. Inspiratory muscle strength was assessed by maximal static inspiratory pressure (PImax). The IMT group performed two cycles of 30 breaths at 30-40% of their PImax 5 days a week for 8 weeks. Twelve (12) PAH patients (60±14 years, 10 females) were recruited and randomised (six in the IMT group and six in the control group). After 8 weeks, the IMT group improved PImax by 31 cmH2O compared with 10 cmH2O in controls, p=0.02. Following IMT, 6-minute walk distance improved by 24.5 m in the IMT group and declined by 12 m in the controls (mean difference 36.5 m, 95% CI 3.5-69.5, p=0.03). There was no difference in peak oxygen uptake between-groups (mean difference 0.4 mL/kg/min, 95% CI-2.6 to 3.4, p=0.77). There was no difference in the mean change between-groups in neurohormonal activation or pulmonary function. In this pilot randomised controlled study, IMT improved PImax and 6-minute walk distance in PAH patients.

The Effects Of Contrast With Compression Therapy On Muscle Recovery Post Exercise

Intense eccentric exercise causes muscle damage that leads to a decrease in subsequent performance. Accelerating muscle recovery between bouts of exercise minimizes the risk of injury and is essential for optimal athletic competitive performance. PURPOSE: The purpose of this study was to determine if the contrast with compression (CwC) therapy proprietary device by Solid State Inc was able to improve muscle recovery post intense eccentric exercise. METHODS: Ten physically active men (age = 21.3+2.1 years; height = 182 +8.5cms; weight = 88 + 19.5kg; body fat = 17.2+7%) completed two separate single-arm elbow flexor workouts on an isokinetic dynamometer. After one workout each participant received contrast with compression (CwC) therapy immediately after, 24h and 48h after the workout. After the other workout the same person received no treatment(CON). Post-exercise recovery of selected characteristics were measured at 1h, 24h, 48h and 72h. Comparisons were made between the CwC and CON groups using a Mixed Model ANOVA with repeated measures to identify time effects and an ANCOVA was used to identify interaction effects. A Bonferroni post-hoc test was used to assess timepoint differences in between interventions in recovery post eccentric exercise. A p≤0.05 was used for all analysis. RESULTS: CwC therapy post exercise resulted in a significantly faster recovery rate of strength and power to baseline levels (p=0.00) as well as a greater recovery of overall relative strength (p=0.004). Treatment with CwC significantly suppressed the post-exercise inflammatory response (p=0.05) and significantly reduced the secondary muscle damage response as measured by levels of Creatine Kinase post exercise. CwC therapy also resulted in a significantly quicker recovery of the maximal elbow flexion range of motion (p=0.00) within the hour post exercise. Lastly, participants experienced significantly less soreness 48 hours and 72 hours post-exercise with CwC therapy. CONCLUSION: Contrast with compression therapy significantly increases the recovery rate of muscle strength and power post eccentric exercise. CwC is also effective at reducing exercise associated muscle damage, delayed onset muscle soreness and mitigates the loss of range of motion post intense exercise.

The effectiveness pre-operative exercise of muscle strength for early ambulation on lower limb fracture with measurement tool – The Modified Iowa Level of Assistance Scale (MILAS) – in hospital inpatients

To evaluate the effectiveness of pre-operative exercise of muscle strength before surgery, maintains muscle strength and prepare early postoperative ambulation lower limb fracture. Design research was a quasi-experiment with control and post-test only (unpaired t-test) with 28 respondents (14 respondents intervention group and 14 respondents control group). The intervention group was given muscle strength exercise before surgery, for ±1 week. Every day patients do strength exercise 3 times a day, for ±5-10min. The post-operative assessment was conducted in both groups with Modified Level of Assistance Scale (MILAS), to find out the difference in the ability to do early ambulation. The results of the independent t-test were significant differences of ambulation ability of the intervention group were better than the control group. The difference in average ambulation ability after operation between the intervention group and the control group, the average ambulation ability of respondents in the intervention group was 14.14 with a standard deviation (SD=2.93), while for the control group, the average ambulation ability was 18.50 with the standard deviation (SD=5.56). Statistical test results obtained p-value of 0.017 (α<0.005), meaning that at alpha 5% a significant difference was seen in the average ability of early ambulation between respondents in the intervention group and the control group. There is evidence to suggest that pre-operative exercise of muscle strength is beneficial to early ambulation postoperative lower limb fracture.

The β-arrestin-biased β-adrenergic receptor blocker carvedilol enhances skeletal muscle contractility

A decrease in skeletal muscle strength and functional exercise capacity due to aging, frailty, and muscle wasting poses major unmet clinical needs. These conditions are associated with numerous adverse clinical outcomes including falls, fractures, and increased hospitalization. Clenbuterol, a β2-adrenergic receptor (β2AR) agonist enhances skeletal muscle strength and hypertrophy; however, its clinical utility is limited by side effects such as cardiac arrhythmias mediated by G protein signaling. We recently reported that clenbuterol-induced increases in contractility and skeletal muscle hypertrophy were lost in β-arrestin 1 knockout mice, implying that arrestins, multifunctional adapter and signaling proteins, play a vital role in mediating the skeletal muscle effects of β2AR agonists. Carvedilol, classically defined as a βAR antagonist, is widely used for the treatment of chronic systolic heart failure and hypertension, and has been demonstrated to function as a β-arrestin-biased ligand for the β2AR, stimulating β-arrestin-dependent but not G protein-dependent signaling. In this study, we investigated whether treatment with carvedilol could enhance skeletal muscle strength via β-arrestin-dependent pathways. In a murine model, we demonstrate chronic treatment with carvedilol, but not other β-blockers, indeed enhances contractile force in skeletal muscle and this is mediated by β-arrestin 1. Interestingly, carvedilol enhanced skeletal muscle contractility despite a lack of effect on skeletal muscle hypertrophy. Our findings suggest a potential unique clinical role of carvedilol to stimulate skeletal muscle contractility while avoiding the adverse effects with βAR agonists. This distinctive signaling profile could present an innovative approach to treating sarcopenia, frailty, and secondary muscle wasting.

The Mediating Effect of Different Exercise Programs on the Immune Profile of Frail Older Women with Cognitive Impairment.

Frail individuals experience an accelerated immunosenescence, and exercise has been identified as a therapy to promote a better inflammatory environment. To analyze the effects of 28-weeks of two different exercise protocols on the functional fitness and immune profiles of institutionalized pre-frail and frail women with mild cognitive impairment. Participants residing in care homes (n=60, 81±7.84 years old) were randomized into three groups: a chair elastic band muscle-strength exercise (CSE, n=21; 81±4.79), a chair multimodal exercise (CME, n=20; 80±8.19), and a control non-exercise (CGne, n=19; 80±10.01). Both CME and CSE groups performed progressive circuit-training exercise sessions. The controls did not change their usual lifestyle. The Fried protocol and the Mini-Mental State Examination questionnaire were used to identify the frail subgroups and the participants with mild cognitive impairment. Data for anti and pro-inflammatory markers and physical fitness were analyzed pre and post-interventions. After the intervention, a significant effect of time and time by group for sIgA and time by group for IL- 10 levels were found (p > 0.05). Within-group analysis showed a significant moderate decrease in the TNF-α to IL-10 ratio for the CME group and an increase in the controls (p > 0.05) and a slight reduction in the IL-6 and IL- 1β concentrations. The controls showed a negative trend towards a decrease in physical fitness and a trend for increased levels in the pro-inflammatory markers IL-6 and IL-1β. The evidence regarding the use of systematic and moderate long-term exercise as therapy for promoting a better balance between pro- and anti-inflammatory environments and a decrease in the inflammatory index for the CME group were the most promising results from this study.

Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study.

The authors aimed to understand how physical therapists used practice guidelines to manage patients with knee osteoarthritis (OA) in Australia. This study used a concurrent triangulation mixed-method approach to explore how physical therapists applied clinical guidelines when managing patients with knee OA in an outpatient setting via completion of a semi-structured interview. Interviews were thematically analyzed by 2 investigators using an inductive approach. Themes were then triangulated to the results of an audit that evaluated the level of adherence to respective areas in the clinical guidelines among physical therapists at the participating site. One main theme and 3 subthemes were identified from 18 participants: (1) physical therapists were most confident in applying guidelines to improving range of movement and strength; (2) lack of knowledge in prescription of aerobic exercise, weight, and pain management; (3) pain is a bigger barrier in areas where knowledge is lacking; and (4) lack of clarity around the scope of practice. Themes converged with the reported level of adherence to guidelines. Physical therapists commonly include range of movement and muscle strength exercises when managing people with knee OA. However, they were less confident in prescribing aerobic exercise and recommending weight and pain management strategies. Apart from the need to upskill physical therapists in the aforementioned areas of clinical practice, the role of a physical therapist in the management of people with knee OA requires further clarification.

MRI Assessment of Swallow Muscle Activation with the Swallow Exercise Aid and with Conventional Exercises in Healthy Volunteers: An Explorative Biomechanical Study.

Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.

Clinical predictors of pulmonary functions, respiratory/peripheral muscle strength and exercise capacity at discharge in adults with burn injury

Purpose To identify clinical predictors of pulmonary functions, respiratory and peripheral muscle strength and functional exercise capacity in burn injury patients, and to compare these parameters with healthy subjects. Methods The study included 47 burn injury patients aged 20–49 years, and 47 age and gender-matched healthy subjects. The patients were evaluated on the day of discharge from hospital. Pulmonary functions and respiratory muscle strength were assessed with a spirometer (Cosmed Pony FX). Hand grip and pain were evaluated with a Jamar dynamometer and visual analog scale, respectively. The six-minute walk test (6-MWT) was performed to determine the functional exercise capacity of the participants. Results With the exception of FEV1/FVC, all the parameters of pulmonary functions test, respiratory and peripheral muscle strength and 6-MWT distances were lower in the burn injury patients than in the healthy subjects (p < 0.05). Significant predictors for these parameters were age, gender, height, body mass index, total burn surface area, burn injury type, the presence of trunk burn, hand burn, lower limb burn, inhalation injury, and intubation in the burn group (p < 0.05). Conclusions Burn injury and the demographic characteristics of the patients are important determinants of clinical parameters. These results are clinically important as they can be of guidance in creating a personalized rehabilitation program. Clinical trial registration number NCT03780218. Implications for rehabilitation Burn patients have impaired pulmonary functions and exercise capacity at discharge. Assessment of respiratory muscle strength should be added into clinical practice in adults with burn injury. Lung functions and exercise capacity should be evaluated in burn patients at discharge. It is important to monitor lung functions of burn patients after discharge.

Test-retest reliability and validity of the timed up and go test and 30-second sit to stand test in patients with pulmonary hypertension

BackgroundTimed up and go (TUG) and sit to stand (STS) tests that required less space and easier to be performed in respiratory and cardiac diseases for assessing functionality. Aim was to test the reliability of TUG and 30-second STS (30STS) tests and determine the validity of TUG and 30STS tests in patients with Pulmonary Hypertension (PH). MethodsThirty-eight patients with diagnosed PH were included. We collected TUG, 30STS, quadriceps muscle strength, physical activity level, and 6MWT. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability and correlations with quadriceps muscle strength, physical activity level and 6MWT for validity of the TUG and 30STS tests. ResultsThe TUG and 30STS tests were associated with age, functional class, muscle strength, physical activity and functional exercise capacity in patients with PAH (p < 0.05). 6MWT was associated with age, functional class, muscle strength, physical activity and functional exercise capacity (p < 0.05). ICC (95%) for TUG test and 30STS were 0.96 (0.93–0.98) and 0.95 (0.90–0.97), respectively. ConclusionsThe TUG and 30STS tests were reliable and valid tests for measuring physical performance in PH. This study supports using the TUG and 30STS tests as practical assessment tools in patients with PH.

Chair-based exercise programs in institutionalized older women: Salivary steroid hormones, disabilities and frailty changes.

Many people experience aging-related losses in different physical domains, which leads to a condition often called physical frailty (PF). The aim of this study was to analyse the effects of two different, 28-weeks, class chair-exercise protocols on salivary steroid hormones (SH), PF, and functional disabilities (FD) in frail older women. A sample of older frail individuals (n=60, 817.84years) participated in the study and were divided into three groups: chair elastic-band muscle strength exercises (CSE), n=20), chair-multimodal exercise (CME, n=21) and a control non-exercise group (CGne, n=19). Both exercise programs consisted of 45min of supervised chair-based exercise group classes, carried out 3 times/week. CME participants performed a progressive training using walking, mobility and body weight resistance exercises. The CSE participants exercised using an elastic-band system of progressive exercises. Both CSE and CME followed a circuit training protocol. The controls did not change their usual lifestyle. The indicators of PF, FD and SH concentrations were analyzed before and after the intervention. Both exercise programs diminished the PF status showing significant time and time versus treatment interactions (p<.01). An increase in the CME group, between baseline and 14-weeks, and in the CSE group, after 28weeks, for Testosterone concentrations was observed (p<.01). Dehydroepiandrosterone (DHEA) increased after 28-weeks in the CME group and decreased in the CGne after the same period (p<.05). Both exercise programs decreased the negative scores of several FD domains, specially fear of falling that showed significant effects with time (p<.01), and time vs intervention (p<.05). Both chair-exercise based programs were effective in stimulating positive changes in physical health and in steroid hormone responses, especially in DHEA. The control group did show a negative trend towards an increased PF status and decreased levels of SH. It is crucial for public health to identify the main factors associated with Functional Disability and Physical Frailty that underlie the development of new methods for complementary therapies, such as the use of low doses of hormonal supplementation combined with long-term exercise interventions.

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

BackgroundPeople with migraine often experience disability with serious consequences for their social life and work productivity. The pharmacological prophylactic management of migraine is effective in reducing migraine attacks. However, many people are reluctant to use daily prophylactic medication, leading to a demand for non-pharmacological treatment options. We present the design for and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine.MethodsEligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises and mobilization of the cervical and thoracic spine.The trial will consist of a 12-week treatment period and follow-up measurements at 12, 26 and 52 weeks. The primary outcome measure is the number of migraine days per 4 weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect.DiscussionThe results of the trial will show whether a multimodal MT intervention is an effective non-pharmacological treatment option for people with migraine.Trial registrationDutch Trial Register, NL7504. Registered on 7 February 2019.