Significant Improvement In Muscle Strength Research Articles

Reducing Resistance Training Volume during Ramadan Improves Muscle Strength and Power in Football Players

We aimed to examine the effect of maintaining or reducing resistance training volume during Ramadan-intermittent-fasting (RIF) on short-term maximal performances. 20 footballers (age: 18.4 ± 0.8 years; body-mass: 72.4 ± 4.1 kg; height: 183.4 ± 4.6 cm) were matched and randomly assigned to a normal-training-group (G1) or a tapering-group (G2). They were tested for muscular strength (maximal-voluntary-contraction) and power (squat-jump and counter-movement-jump) 1 month before RIF (T0), 1 week before RIF (T1), after 2 weeks of fasting (T2) and at the end of RIF (T3). From T1 to T2, subjects performed a whole-body resistance training program (8-repetitions × 4-sets with 4-min recovery in-between). During RIF, G1 maintained the same training program, while G2 performed a period of reduced training volume (3 sets/exercise; - 22%). Muscle strength and power increased significantly from T0 to T1, from T0 to T2 and from T0 to T3 in G1 and G2 and from T1 to T2 and from T1 to T3 only in G2 (p<0.05). Performance was higher in G2 than G1 during T2 (p<0.01). Moreover, the ∆-change of performance between T0 and T2 and T3 was significantly higher in G2 than G1 (p<0.05). For young soccer players, a tapering period characterized by a reduced training volume during RIF may lead to significant improvement in muscle strength and power.

Creatine for treating muscle disorders.

Progressive muscle weakness is a main symptom of most hereditary and acquired muscle diseases. Creatine improves muscle performance in healthy individuals. This is an update of our 2007 Cochrane review that evaluated creatine treatment in muscle disorders. Previous updates were in 2009 and 2011. To evaluate the efficacy of creatine compared to placebo for the treatment of muscle weakness in muscle diseases. On 11 September 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2012, Issue 9 in The Cochrane Library), MEDLINE (January 1966 to September 2012) and EMBASE (January 1980 to September 2012) for randomised controlled trials (RCTs) of creatine used to treat muscle diseases. RCTs or quasi-RCTs of creatine treatment compared to placebo in hereditary muscle diseases or idiopathic inflammatory myopathies. Two authors independently applied the selection criteria, assessed trial quality and extracted data. We obtained missing data from investigators. A total of 14 trials, including 364 randomised participants, met the selection criteria. The risk of bias was low in most studies. Only one trial had a high risk of selection, performance and detection bias. No new studies were identified at this update.Meta-analysis of six trials in muscular dystrophies including 192 participants revealed a significant increase in muscle strength in the creatine group compared to placebo, with a mean difference of 8.47%; (95% confidence intervals (CI) 3.55 to 13.38). Pooled data of four trials including 115 participants showed that a significantly higher number of participants felt better during creatine treatment compared to placebo with a risk ratio of 4.51 (95% CI 2.33 to 8.74). One trial in 37 participants with idiopathic inflammatory myopathies also showed a significant improvement in functional performance. No trial reported any clinically relevant adverse event.In metabolic myopathies, meta-analyses of three cross-over trials including 33 participants revealed no significant difference in muscle strength. One trial reported a significant deterioration of activities of daily living (mean difference 0.54 on a 1 to 10 scale; 95% CI 0.14 to 0.93) and an increase in muscle pain during high-dose creatine treatment in McArdle disease. High quality evidence from RCTs shows that short- and medium-term creatine treatment increases muscle strength in muscular dystrophies. There is also evidence that creatine improves functional performance in muscular dystrophy and idiopathic inflammatory myopathy. Creatine is well tolerated in these people. High quality but limited evidence from RCTs does not show significant improvement in muscle strength in metabolic myopathies. High-dose creatine treatment impaired activities of daily living and increased muscle pain in McArdle disease.

SAT0589-HPR Benefits of Strengthening Exercises with the Aid of Swiss Ball in Patients with Fibromyalgia: a Randomized Controlled Trial

BackgroundFibromyalgia isa painful syndrome that determines global reduction in physical capacity. Exercises are essential in the treatment of FM, and currently, muscle strengthening have shown promising results.ObjectivesTo evaluate the effectiveness...

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation

Objective. We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery in patients after subacute stroke. Methods. Forty patients with ischemic stroke undergoing rehabilitation were randomly assigned to 1 of 3 groups: Anodal, Cathodal (over-affected and unaffected hemisphere, respectively), and Sham. Each group received tDCS at an intensity of 2 mA for 25 minutes daily for 6 consecutive days over of the motor cortex hand area. Patients were assessed with the National Institutes of Health Stroke Scale (NIHSS), Orgogozo’s MCA scale (OMCASS), the Barthel index (BI), and the Medical Research Council (MRC) muscle strength scale at baseline, after the sixth tDCS session and then 1, 2, and 3 months later. Motor cortical excitability was measured with transcranial magnetic stimulation (TMS) at baseline and after the sixth session. Results. By the 3-month follow-up, all groups had improved on all scales with P values ranging from .01 to .0001. Improvement was equal in the Anodal and Cathodal groups. When these treated groups were combined and compared with Sham, significant interactions were seen for the OMCASS and BI scales of functional ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being greater in the real versus sham groups. There were borderline significant improvements in muscle strength. Conclusion. A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.

Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial

Introduction and hypothesisThe aim of this study was to evaluate the results of conservative treatment of urodynamic stress urinary incontinence (SUI) using transvaginal electrical stimulation with surface-electromyography-assisted biofeedback (TVES + sEMG) in women of premenopausal age.MethodsOne hundred and two patients with SUI were divided into two groups: active (n = 68) and placebo (n = 34) TVES + sEMG. The treatment lasted for 8 weeks and consisted of two sessions per day. Women were evaluated before and after the intervention by pad test, voiding diary, urodynamic test, and the Incontinence Quality of Life Questionnaire (I-QOL).ResultsMean urinary leakage on a standard pad test at the end of 8th week was significantly lower in the active than the placebo group (19.5 ± 13.6 vs. 39.8 ± 28.5). Mean urinary leakage on a 24-h pad test was significantly reduced in the active group at the end of 8th and 16th weeks compared with the placebo group (8.2 ± 14.8 vs. 14.6 ± 18.9 and 6.1 ± 11.4 vs. 18.2 ± 20.8, respectively). There was also a significant improvement in muscle strength as measured by the Oxford scale in the active vs the placebo group after 8 and 16 weeks (4.2 vs 2.6 and 4.1 vs 2.7, respectively). No significant difference was found between groups in urodynamic data before and after treatment. At the end of 8th week, the mean I-QOL score in the active vs the placebo group was 78.2 ± 17.9 vs 55.9 ± 14.2, respectively, and at the end of 16th week 80.8 ± 24.1 vs. 50.6 ± 14.9, respectively.ConclusionOur study showed that TVES + sEMG is a trustworthy method of treatment in premenopausal women with SUI; however, its reliability needs to be established.

Intensive exercise and a patient in acute phase of polymyositis

Polymyositis (PM) is an idiopathic inflammatory myopathy manifested by proximal limb muscles weakness, elevated creatinin kinase, electromyography changes, and muscle inflammation in biopsy. We report an instance of intensive rehabilitation therapy in a patient with clinically active polymyositis. A 19-year-old female patient, diagnosed with 'electromyography and biopsy proven' polymyositis for 5 years, suffered from worsening limbs weakness and dysphagia. In her history, she had upper and lower limbs weakness accompanied by dysphagia which was further complicated by right bronchial aspiration 9 months ago. A four-week trial of intensive training and exercise rehabilitation, concurrently accompanied by medications was prescribed for this patient. At the end of therapy she achieved significant improvement in muscle strength, activities of daily living, and ambulation without any disease exacerbation. We concluded that short-term intensive training and exercise may lead to improvements in patients with PM, without causing a progress in the disease. Due to the rarity of PM and difficulty of conducting well-controlled studies to examine the risks and benefits of exercise in these patients, further research is necessary to investigate benefits of exercise training in active phase of disease.

Efectos del láser de baja potencia en el tratamiento de la parálisis facial periférica aguda

IntroductionPeripheral facial paralysis is a very pathological condition that may generate disabling complications. There is no unique treatment for it. Infrared low power laser is effective in recovering the structure and function of peripheral nerves, although few studies have been conducted on its clinical use in peripheral facial paralysis. Material and methodsWe performed a randomized double-blind controlled trial. Inclusion criteria were patients older than 18 years with a diagnosis of idiopathic peripheral facial paralysis of less than 7 days duration, with no previous treatment. The patients were randomized into two groups, one with conventional rehabilitation treatment plus placebo and another with GaAsAl of λ 830nm laser at doses of 20 joules/cm2 in the emergence of the facial nerve. Muscle strength, disacusia, dysgeusia and epiphora were evaluated in a blinded way at 0, 15, 30 and 60 days. ResultsTwenty-one patients were included, 10 in the control group and 11 in the experimental one. Both groups showed significant improvement in muscle strength before and after treatment (P<.001). When a comparison was made between the groups, the laser group achieved recovery of 94.84% vs 87.83% in the control group (P=.24). Regarding dysgeusia, disacusia and epiphora, both groups showed 100% improvement. ConclusionLow-power laser was safe and had a moderate clinical effect on the recovery of muscle strength, but not for the epiphora, dysgeusia and disacusia.

IL-6 signaling blockade increases inflammation but does not affect muscle function in the mdx mouse

BackgroundIL-6 is a pleiotropic cytokine that modulates inflammatory responses and plays critical roles in muscle maintenance and remodeling. In the mouse model (mdx) of Duchenne Muscular Dystrophy, IL-6 and muscle inflammation are elevated, which is believed to contribute to the chronic inflammation and failure of muscle regeneration in DMD. The purpose of the current study was to examine the effect of blocking IL-6 signaling on the muscle phenotype including muscle weakness and pathology in the mdx mouse.MethodsA monoclonal antibody against the IL-6 receptor (IL-6r mAb) that blocks local and systemic IL-6 signaling was administered to mdx and BL-10 mice for 5 weeks and muscle function, histology, and inflammation were examined.ResultsIL-6r mAb treatment increased mdx muscle inflammation including total inflammation score and ICAM-1 positive lumens in muscles. There was no significant improvement in muscle strength nor muscle pathology due to IL-6r mAb treatment in mdx mice.ConclusionsThese results showed that instead of reducing inflammation, IL-6 signaling blockade for 5 weeks caused an increase in muscle inflammation, with no significant change in indices related to muscle regeneration and muscle function. The results suggest a potential anti-inflammatory instead of the original hypothesized pro-inflammatory role of IL-6 signaling in the mdx mice.

Clinical and biochemical improvement following HSCT in a patient with MNGIE: 1-year follow-up

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an inherited and almost invariably fatal disorder due to thymidine phosphorylase (TP) deficiency leading to a general increase in its substrates, deoxythymidine (dThd) and deoxyuridine (dUrd), in urine and serum. Typically, MNGIE phenotype is characterized by severe gastrointestinal dysmotility, ophthalmoplegia, peripheral neuropathy, and leukoencephalopathy [1–3]. Allogeneic hematopoietic stem cell transplantation (HSCT) seems to halt its clinical course by restoring biochemical abnormalities, but clinical evidence is still very limited [4]. Here we report the successful treatment with allogeneic HSCT in a 23-year-old MNGIE woman with mild clinical phenotype carrying a novel homozygous c.1249dupC mutation of TYMP gene, already described in detail by Cardaioli et al. [5] in this journal. In brief, the patient complained of frequent diarrhea, abdominal pain, recurrent episodes of vomiting, and fatigability. Neurological signs included mild palpebral ptosis, limb weakness, and absent deep-tendon reflexes. Sensitivity was normal. Following the decision to perform HSCT, the healthy, 30-year-old, HLA-A, -B, -C, -DR, and -DP matched brother without TYMP gene mutations was identified as the donor. The patient was infused with bone marrow from her brother (4.14 9 10 mononucleated cells) after a myeloablative conditioning regimen with busulfan 12.8 mg/kg and fludarabine 150 mg/m, chosen for their reduced mitochondrial toxicity. Graft versus host disease prophylaxis consisted of cyclosporin (1 mg/kg/day in continuous infusion from day -6 to -1; 2 mg/kg/day from day 0 to ?2; 3 mg/kg/day from day ?3 to ?20 and subsequently 3 mg/kg/day orally) and methotrexate (10 mg/m/day ?1, and 8 mg/m days ?3 and ?6). Engraftment was prompt with an absolute neutrophil count of [500/ll on day ?17 and a platelet count [20,000/ll on day ?14. Chimerism studies using polymorphic STR genes on day 30 showed 100 % marrow cells of donor origin. One month after transplant, the patient reported complete normalization of all aforementioned gastrointestinal symptoms and, 3 months later, she referred reduced susceptibility to fatigue. Clinical assessment 1 year after HSCT revealed mild increase in body weight (37.7 vs. 37 kg before transplant) and significant improvement in muscle strength measured by the Medical Research Council (MRC) score (Fig. 1a). Palpebral ptosis and areflexia were unchanged. Sensitivity examination was still normal. Electromyography at baseline showed sensorymotor demyelinating neuropathy. One year after transplant, proximal motor conduction velocities improved, especially in the upper limbs. Sensory conduction velocities and F. Sicurelli and M. A. Carluccio contributed equally to this manuscript.

An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery

This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR) surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT) programme led to significant improvement in muscle strength and function if the intervention was carried out early (< 1 month following surgery) in a centre (6/11 centre-based studies used PRT), or late (> 1 month following surgery) in a home based setting (2/2 home based studies used PRT). In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies), with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR.

The comparison of resistance and balance exercise on balance and falls efficacy in older females

ObjectivesThe purpose of this study is to compare the effectiveness of resistance and balance exercise in reducing the risk of falls for females 65-years-old or older. DesignThe study was a single blind, controlled trial, conducted over a period of 12-weeks with pre- and post-exercise assessment. Patients and methodsNinety-five participants were randomly assigned to one of three groups: resistance-training group, balance training group, control group. Resistance training group were trained to increase strength of upper, lower. Balance training group were trained to improve balance, coordination and proprioception. Outcome measurement consisted of balance ability, muscle strength, proprioception and fall efficacy. ResultsThe resistance and balance exercise group showed a statistically significant improvement in balance ability compared to the control group (P<0.01). The resistance exercise group showed significant improvement in muscle strength compared to the balance exercise group (P<0.01). The balance exercise group showed significant improvement in proprioception compared to the resistance exercise group (P<0.01). Both resistance and balance exercise showed a significant improvement in fall efficacy than the control group (P<0.01). ConclusionsWe conclude that the resistance and balance exercise have significant effects on balance ability and falls efficacy in older females.

Efficacy of Progressive Resistance Training Interventions in Older Adults in Nursing Homes: A Systematic Review

To provide a synthesis of the evidence from clinical trials to determine whether progressive resistance training, as a single exercise intervention, improves strength and functional performance in older institutionalized adults. A comprehensive systematic database search for randomized controlled trials was performed, including AMED, CINAHL, COCHRANE, and all EMB reviews: Cochrane DSR, ACP Journal Club, DARE, MEDLINE, PREMEDLINE, and PsycINFO, completed in July 2011. Studies were then assessed for potential inclusion. Study quality indicators, cohort characteristics, training intervention, muscle strength, and functional performance outcomes were extracted. Thirteen studies were reviewed; the mean cohort age range was 80 to 89 years. In general, the quality of the reviewed studies was moderately robust; an average of 9 of 11 quality criteria were accounted for in the reviewed literature. Significant improvements were found in muscle strength outcomes and functional performance outcomes, including chair to stand time, stair climbing, gait speed, balance, and functional capacity following progressive resistance training interventions. Significant improvements in muscle strength and functional performance occur in response to progressive resistance training exercise, despite advanced age, presence of chronic diseases, extremely sedentary habits, and functional disabilities in older institutionalized individuals. Therefore, the incorporation of a progressive resistance training exercise program is an effective means to preserve independence levels by maintaining or improving the ability to perform activities of daily living and the implementation of this type of exercise program should be promoted and incorporated into the recreational schedules of long term care institutions.

Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol

Background:Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated.Study Design:Case series.Hypothesis:A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery.Methods:Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests.Results:The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation.Conclusions:Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Vitamin D-Dependent Rickets Type 1: A Rare, but Treatable, Cause of Severe Hypotonia in Infancy

Vitamin D-dependent rickets type 1 is an autosomal recessive disorder caused by an inactivating mutation of the 25-hydroxyvitamin-D-1α-hydroxylase (CYP27B1) gene. Clinical presentation is characterized by early onset of severe rickets and can include severe hypotonia. Here, we report a 16-month-old white male who presented with severe muscle weakness, failure to thrive, renal tubular dysfunction, and skeletal deformities, including osteopenia and multiple fractures. At presentation, he had severe hypocalcemia, hypophosphatemia, hypomagnesemia, and elevated alkaline phosphatase and parathyroid hormone levels, although normal 25-hydroxyvitamin D levels. DNA sequencing of the CYP27B1 gene revealed a novel mutation in exon 2 (c286_300de115) and a previously reported mutation in exon 7 (c.1166G>A). Once calcitriol therapy was initiated, the patient showed significant improvement in muscle strength and linear growth. Serum calcium, phosphorous, and alkaline phosphatase returned to normal range. Organic aciduria resolved and aminoaciduria significantly improved 2 months after parathyroid hormone levels normalized.

Effects of exercise treatment with or without heat and steam generating sheet on urine loss in community‐dwelling Japanese elderly women with urinary incontinence

To determine the effects of exercise treatment with or without heat and steam generating sheet (HSGS) on reducing urine loss in community-dwelling elderly women with urinary incontinence (UI). One hundred and forty-seven community-dwelling women aged 70years and older with stress, urge and mixed UI were randomly assigned to exercise+HSGS (n=37), exercise only (n=37), HSGS only (n=37) or an education group (n=36). Exercise+HSGS, and exercise groups received exercise training twice a week for 3months. When the HSGS was placed on the lower back, the temperature of the skin surface rose to 38-40°C and it continued to generate heat and steam for over 5h. The HSGS group used one sheet per day continuously for 3months. Urine loss and fitness data were collected at baseline and after intervention. The intervention groups showed significant improvements in muscle strength and walking speed compared to the education group. Exercise and HSGS showed urine loss cure rates of 54.1%, exercise 34.3% and HSGS 21.6% after treatment; whereas, the education group (2.9%) showed no significant improvement (χ(2) =21.89, P<0.001). Combining the HSGS to the exercise intervention showed a 61.5% cure rate for stress UI, 50.0% urge UI and 40.0% mixed UI. This data suggests that exercise treatment with HSGS is more effective for treating urine loss regardless of UI type. The HSGS can be used as a supplementary treatment method to enhance the effects of exercise on women with urge, mixed and stress UI.

Influência do alongamento muscular e da mobilização neural sobre a força do músculo quadríceps

Introdução: A mobilização neural e o alongamento muscular estático têm o objetivo de promover a amplitude de movimento. Objetivo: Comparar a influência do alongamento muscular e da mobilização neural na força isométrica de quadríceps. Metodologia: Participaram 39 voluntários, gênero masculino, entre 18 e 27 anos. Foram divididos aleatoriamente em três grupos com 13 indivíduos cada. Um grupo submetido ao alongamento estático de 30 segundos (GAE), um à mobilização neural (GMN) e um grupo controle (GC) que não fez nenhuma intervenção. O nível de significância estatística adotado foi p≤0,05. Resultados: Houve melhora significativa da força muscular no GMN e diferença importante na força antes e após os atendimentos, comparando-se o grupo movimentação neural com o alongamento e com o controle. Conclusões: A mobilização neural foi efetiva para aumentar a força muscular de quadríceps e após a realização do alongamento estático houve redução da força.

태극권 운동이 중년비만여성의 혈액성분과 체력변인에 미치는 영향

본 연구는 12주 규칙적인 태극권 운동이 중년비만 여성의 혈액성분과 체력요인에 미치는 영향을 분석하여 다음과 같은 결과를 얻었다. 1. 태극권 운동 전, 후 신체적 특성 중 양식(YS) 그룹이 12 건식(12KS) 그룹에 비해 체중, 체지방률, 수축기 및 이완기 혈압이 높았지만 유의한 차이는 나타내지 못했다. 2. 태극권 운동 전, 후, 혈액변인 중 양식 그룹(YS)의 중성지방(TG)을 제외하고 모두 감소함을 나타냈지만 통계적 차이는 나타내지 못했다. 또한 12건식(12KS) 그룹은 혈액변인 모두 감소하였지만 통계적으로 유의하지는 못했다. 두 그룹 모두 감소함을 나타냈지만 유의한 차이를 나타내지 못해 결과적으로 혈액변인의 개선은 나타내지 못했다. 3. 태극권 운동 전, 후 체력요인은 두 그룹 모두에서 유의하게(p<0.05) 증가함을 나타냈으나 양식 그룹(YS)의 평형성 (Balance)은 유의한 차이를 나타내지 못했고 12 건식(12KS) 그룹에서는 민첩성과 평형성이 유의한 차이를 나타내지 못했다. 따라서 본 연구는 대상으로 12주 태극권 운동이 비만여성의 혈액성분 개선에는 크게 영향을 미치지 못한데 반해 체력요인에 긍정적인 영향을 미치는 것으로 나타났다. Tai Chi is a slow and gentle exercise which is suitable for obese women with chronic diseases. Tai Chi can improve the health of a senior without exacerbating existing impairments, including obese patients. The purpose of this study was to evaluate the effects of different types of Tai Chi exercise on blood variables (glucose, cholesterol, TG, HDL, LDL, cortisol) and physical fitness (muscle strength, flexibility, muscle endurance, agility, balance). Thirty obese women were recruited from a public health center. They were divided into Yang style (YS: n=15) and 12 (12KS: n=15). The Tai Chi exercise group participated in a training program for 12 weeks (3times/week). There was significant improvement in muscle strength, flexibility, and muscle endurance in both groups. Agility was significantly increased in YS, more than in 12KS. However, there was no improvement in balance in both groups. There was significant improvement in cholesterol, HDL, LDL, and cortisol in both groups. However there was no improvement in blood glucose levels in either group. From the results, there was no significant difference in either Tai Chi exercises. The Tai Chi exercise program was effective in improving cholesterol related variables and physical fitness, except balance, in both groups. Further study is needed in this area.

Effects of Neuromuscular Electrical Stimulation of Muscles of Ambulation in Patients With Chronic Heart Failure or COPD: A Systematic Review of the English-Language Literature

Despite optimal drug treatment, many patients with congestive heart failure (CHF) or COPD still experience disabling dyspnea, fatigue, and exercise intolerance. They also exhibit significant changes in body composition. Attempts to rehabilitate these patients are often futile because conventional exercise-training modalities are limited by the severity of exertional dyspnea. Therefore, there is substantial interest in new training modalities that do not evoke dyspnea, such as transcutaneous neuromuscular electrical stimulation (NMES). In this article, we systematically review the literature that addresses the effects of NMES applied to the muscles of ambulation. We focused on the effects of NMES on strength, exercise capacity, and disease-specific health status in patients with CHF or COPD. We also address the methodological quality of the reported studies as well as the safety of NMES. Manuscripts published prior to December 2007 were identified by searching the Medline/PubMed, Embase, Cochrane Controlled Trials Register, CINAHL, and Physiotherapy Evidence Database (PEDro) databases. Fourteen trials were identified (nine trials that examined NMES in CHF patients, and five in COPD patients). PEDro scores for methodological quality of the trials were generally moderate to good. Many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. Nonetheless, the limited number of studies, the disparity in patient populations, and the variability in NMES methodology prohibit the use of metaanalysis. Yet, from the viewpoint of a systematic review, NMES looks promising as a means of rehabilitating patients with CHF and COPD. There is at least sufficient evidence to warrant more large prospective, randomized, controlled trials.

Arthroscopic Biceps Augmentation for Avoiding Undue Tension in Repair of Massive Rotator Cuff Tears

The purpose of our study was to evaluate the outcome of massive rotator cuff tears repaired by use of an arthroscopic biceps augmentation technique, interpositioning the tenotomized biceps tendon to bridge the gap between the torn edges of the cuff tendon. Sixty-eight shoulders with massive rotator cuff tears were included in this study. Arthroscopic rotator cuff repairs with the biceps augmentation technique were performed in 37 patients (group A), whereas 31 patients underwent repair without biceps augmentation (group B). The mean follow-up period was 21 months (range, 14 to 78 months) in group A and 20 months (range, 13 to 63 months) in group B. The mean University of California, Los Angeles score improved from 14.1 points (range, 6 to 21 points) in group A and 13.9 points (range, 7 to 22 points) in group B preoperatively to 32.6 points (range, 22 to 35 points) and 30.3 points (range, 20 to 35 points) postoperatively, respectively (P < .001 and P < .001, respectively). However, the difference between the postoperative scores was not statistically significant (P = .198). At the last follow-up, group A showed better results than group B in forward flexion, external rotation, and internal rotation strength, with statistically significant differences (P = .017, P = .001, and P < .001, respectively). According to the postoperative repair integrity analyzed by use of magnetic resonance imaging, 58.3% of group A cases (14/24) and 26.3% of group B cases (5/19) had complete healing (P = .036). An arthroscopic augmentation technique using the tenotomized biceps tendon was effective in achieving fewer structural failures, equivalent clinical outcomes, and significant improvement in muscle strength in comparison traditional arthroscopic repairs by avoiding undue tension in cases with massive rotator cuff tear.

Thymoglobulin induction and steroid avoidance in cardiac transplantation: results of a prospective, randomized, controlled study

Chronic use of corticosteroids (CS) following transplantation is associated with significant long-term morbidities. Minimizing exposure to CS to improve long-term outcomes, without compromising allograft function, remains an important goal in transplantation. This single-center, prospective, randomized, open-label study was designed to evaluate the efficacy of Thymoglobulin as part of a CS-sparing regimen in cardiac transplantation. Thirty-two low-risk cardiac transplant patients were randomized in a 1:1 ratio to receive either a Thymoglobulin-based CS-avoidance regimen (CS-avoidance group; n = 16) or a long-term CS-based regimen with no antibody induction (control group; n = 16). Pulse CS therapy was used for the treatment of acute cellular rejection in both groups. Baseline characteristics were similar between groups. At one yr, there was no significant difference in the mean incidence of acute cellular rejection (>or=3A) episodes between the CS-avoidance and control groups, 0.81+/-1.05 and 1.07+/-1.03, respectively. Importantly, the CS-avoidance patients had significant improvement in muscle strength and less bone loss compared with the control patients during the first six months post-transplant. CS-avoidance regimen with Thymoglobulin induction appeared to be safe and effective in cardiac transplantation. Further studies are required to demonstrate the long-term safety and benefits of such a regimen.