Upper-limb Exercise Research Articles

Moving the Arms to Activate the Legs

Recent studies on neurologically intact individuals and individuals with spinal cord injury indicate that rhythmic upper limb muscle activation has an excitatory effect on lower limb muscle activation during locomotor-like tasks. This finding suggests that gait rehabilitation therapy after neurological injury should incorporate simultaneous upper limb and lower limb rhythmic exercise to take advantage of neural coupling.

Acute Effects of Arm-Crank Exercise on Artery Stiffness

Endurance exercises including cycling, running or walking are useful for improving artery stiffness in elderly men. Subjects suffering from partial paralysis or arthritis are not able to conduct lower-limb exercises. It is not known whether upper-limb exercise is as effective as lower-limb exercise. PURPOSE: This study investigated the acute effects of arm-crank exercise on artery stiffness. METHODS: Eight healthy recreationally active adult men were studied under three experimental trials on 3 separate days. The order of experiments was randomized among arm-crank exercise (A; 60%VO2max for 30 min), bicycle exercise (B; 60%VO2max for 30 min), and control (C; seated rest while reading). Before and after each trial, brachial to ankle pulse wave velocity (baPWV), brachial systolic and diastolic blood pressure (SBP, DBP) were obtained while in supine position. RESULTS: Baseline hemodynamic values were not different among the three trials. SBP and DBP increased immediately after A trials, followed by a decline to base line after 10-min recovery. In A trial, baPWV increased significantly immediately after the trial (1305.4±113.6cm/sec), after 10-min recovery (1225.0±92.4cm/sec) and 20-min recovery (1182.9±88.9cm/sec) compared with rest (1109.9±76.8cm/sec). In B trial, baPWV decreased significantly immediately after the trial (1040.9±34.9cm/sec), after 10-min recovery (1034.4±41.6cm/sec) and 20-min recovery (1061.9±67.0cm/ sec) compared with rest (1123.1±36.6cm/sec). In C trial, there were any changes through the trial. There were significant differences of baPWV among the three trials immediately after trial, 10- and 20-min recovery. CONCLUSIONS: These results indicate that acute 60%VO2max-arm-crank exercise increased baPWV, which was the opposite reaction of same intensity bicycle exercise. Therefore, for subjects suffering from partial paralysis or arthritis, arm-crank exercise may not contribute to improving artery stiffness.

One Session of Resistance Training May Increase Serum Testosterone and Triiodetironine in Young Men?

Hormonal response is related to training intensity and volume as acute adaptation to the exercise stress in trained subjects. PURPOSE: The purpose of this study was to determine the effect of pre and post one session resistance training on serum testosterone and Triiodotironine (T3) in young men. METHODS: We evaluated eight healthy male (22.1±2.06 years old), with at least 12-month practice time on resistance training (RT). Anthropometric variables were assessed throughout body weight (78.4±9.97 Kg) and body height (176.25±5.49 cm). Resistance training protocol included exercises for lower (leg press, leg extension and leg curl) and upper limbs (bench press, lat pull down and military press), in circuit training until the exhaustion with 3 sets; 6–8RM and alternating upper and lower limbs exercise. Rest time between sets and exercises was 10–20s, with 15 minutes as total training session. The study design assessed the work load for 6RM one day before test for each exercise. Serum hormone was determined PRE and POST training immediately after exercises (T0), 20 (T20), 40 (T40) and 60 minutes (T60) respectively. No change on diet was suggested as well no training was recommended before test. Absolute values were analyzed by One Way Anova (p <.05), post hoc Sheffé test and A% as follow in table bellow:TableRESULTS: Results analysis evidenced significant increase on serum testosterone (29.42%) immediately exercise (REST-T0), with progressive decrease 26.47% between T0 and T60 after exercise. No significant difference was found from REST to T20 T40 and T60 after training. Also no significant change was observed on T3 at all measurements that tended to stability PRE and POST training. CONCLUSION: Data suggest positive effect of resistance training on testosterone level, what allow us to hypothesize that short training stimulus may contribute to muscle anabolic responses.

The rehabilitation of a professional Rugby Union player following a C7/T1 posterior microdiscectomy

Rugby Union is a popular international sport [ Bathgate, A., Best, J., Craig, G., & Jamieson, M. (2002) with a high incidence of cervical injury. A prospective study of injuries to elite Australian rugby union players. British Journal of Sports Medicine 36, 265–269.] with a high incidence of cervical injury. The purpose of this case study was to explore the rehabilitation of a professional rugby union player following a cervical disc injury affecting the C8 nerve root and subsequent microdiscectomy. The isometric strength of the cervical musculature was measured using 1 Repetition Maximum (1RM). A 10-week rehabilitation programme was then commenced whereby the player performed periodised upper limb and Maximal Isometric Voluntary Muscle Contraction (IVMCmax) neck exercises with a graduated return to contact training and playing. Re-tests of the cervical musculature were performed after Phases 1, 2, 3 and 4 of the 10-week rehabilitation programme. The results show a dramatic improvement in the strength of the cervical musculature acting in the four directions of movement tested (cervical flexion, extension and left and right side flexion). The player returned to professional club rugby 16 weeks post-operation and returned to International duty 2 weeks later. At the time of writing this case study, the player had not missed any game time due to cervical symptoms.

Supported Arm Training in Patients Recently Weaned From Mechanical Ventilation

To evaluate the effects of early exercise training in patients recovering from acute respiratory failure needing mechanical ventilation (MV). Prospective, randomized, and controlled study. Three respiratory intermediate ICUs (RIICUs). Of 228 patients admitted to an RIICU, 66 patients weaned from MV from > 48 to < 96 h were considered eligible and enrolled in the study. Sixty-six patients were randomized to either supported arm exercise training plus general physiotherapy (gPT) [group 1, 32 patients] or to gPT alone (group 2, 34 patients). Twenty-five patients in each group completed the protocol. Group 1 showed a greater improvement in exercise capacity, as assessed by an arm incremental test (IT) [p = 0.003] and an endurance test (ET) [p = 0.021], compared to group 2. Posttraining maximal inspiratory pressure (MIP) significantly improved in both groups (p < 0.001 and p = 0.003 in groups 1 and 2 respectively; not significant). IT isoworkload dyspnea improved significantly in both groups (p = 0.005 and p = 0.009 in groups 1 and 2, respectively; not significant between groups), whereas IT isoworkload peripheral muscle fatigue (p < 0.001), ET isotime dyspnea (p < 0.01), and ET isotime muscular fatigue (p < 0.005) improved significantly in group 1 but not in group 2. IT improvers (chi2 = 0.004) and ET improvers (chi2 = 0.047) were more frequently observed in group 1 than in group 2. Baseline MIP could discriminate for IT (p = 0.013; odds ratio [OR], 1.116) and ET improvers (p = 0.022; OR, 1.067). Early upper-limb exercise training is feasible in RIICU patients recently weaned from MV and can enhance the effects of gPT. Baseline inspiratory muscle function is related to exercise capacity improvement.

Arm Exercise and Hyperinflation in Patients With COPD: Effect of Arm Training

Background Unlike studies on leg exercise, reports on the regulation of dynamic hyperinflation during arm exercise are scanty. We ascertained the following in patients with COPD: (1) whether and to what extent upper-limb exercise results in dynamic hyperinflation, and (2) the mechanism whereby an arm-training program (ATP) reduces arm effort and dyspnea. Patients Twelve patients with moderate-to-severe COPD were tested during incremental, symptom-limited arm exercise after a nonintervention control period (pre-ATP) and after ATP. Methods Exercise testing (1-min increments of 5 W) was performed using an arm ergometer. Oxygen uptake ( V ˙ o2), carbon dioxide output, minute ventilation ( V ˙ e), tidal volume, and respiratory rate (RR) were measured continuously during the tests. Inspiratory capacity (IC), exercise dyspnea, and arm effort using a Borg scale were assessed at each step of exercise. Results Arm exercise resulted in a significant decrease in IC and significant positive relationships of IC with an increase in V ˙ o2 and exercise dyspnea and arm effort. The results of ATP were as follows: (1) a significant increase in exercise capacity (p < 0.001); (2) no change in the relationships of exercise dyspnea and arm effort with V ˙ e and IC, and of IC with V ˙ o2; (3) at a standardized work rate, V ˙ e, exercise dyspnea, and arm effort significantly decreased, while the decrease in IC was significantly less (p < 0.01) than before the ATP; the decrease in V ˙ e was accomplished primarily by a decrease in RR; and (4) at standardized V ˙ e, exercise dyspnea and arm effort decreased significantly. Conclusions Arm exercise results in the association of dynamic hyperinflation, exercise dyspnea, and arm effort in COPD patients. An ATP increases arm endurance, modulates dynamic hyperinflation, and reduces symptoms. Unlike studies on leg exercise, reports on the regulation of dynamic hyperinflation during arm exercise are scanty. We ascertained the following in patients with COPD: (1) whether and to what extent upper-limb exercise results in dynamic hyperinflation, and (2) the mechanism whereby an arm-training program (ATP) reduces arm effort and dyspnea. Twelve patients with moderate-to-severe COPD were tested during incremental, symptom-limited arm exercise after a nonintervention control period (pre-ATP) and after ATP. Exercise testing (1-min increments of 5 W) was performed using an arm ergometer. Oxygen uptake ( V ˙ o2), carbon dioxide output, minute ventilation ( V ˙ e), tidal volume, and respiratory rate (RR) were measured continuously during the tests. Inspiratory capacity (IC), exercise dyspnea, and arm effort using a Borg scale were assessed at each step of exercise. Arm exercise resulted in a significant decrease in IC and significant positive relationships of IC with an increase in V ˙ o2 and exercise dyspnea and arm effort. The results of ATP were as follows: (1) a significant increase in exercise capacity (p < 0.001); (2) no change in the relationships of exercise dyspnea and arm effort with V ˙ e and IC, and of IC with V ˙ o2; (3) at a standardized work rate, V ˙ e, exercise dyspnea, and arm effort significantly decreased, while the decrease in IC was significantly less (p < 0.01) than before the ATP; the decrease in V ˙ e was accomplished primarily by a decrease in RR; and (4) at standardized V ˙ e, exercise dyspnea and arm effort decreased significantly. Arm exercise results in the association of dynamic hyperinflation, exercise dyspnea, and arm effort in COPD patients. An ATP increases arm endurance, modulates dynamic hyperinflation, and reduces symptoms.

Use of Upper Limb Exercise to Assess Breathlessness in Patients with Cancer: Tolerability, Repeatability, and Sensitivity

We report the development of an arm exercise test to assess breathlessness in patients with lung cancer who are breathless at low levels of exertion. Exercise consisted of raising the arm over 40 cm, either the dominant arm only (n = 10) or both arms alternating at minute intervals (n = 12). Subjects breathed through a mouthpiece, and ventilation ( V ˙ E) and oxygen uptake ( V ˙ O 2) were measured. Following familiarization, three tests were performed over one week to explore repeatability, and sensitivity was assessed in a fourth test. Arm exercise was generally well tolerated and increased breathlessness, V ˙ E, and V ˙ O 2. The commonest factor limiting exercise was arm fatigue, although four patients in the two-arm test also reported breathlessness. Repeatability for breathlessness score and V ˙ E was best in the two-arm test. The added resistance used to assess sensitivity could not be detected. The two-arm test offers a potential means of assessing the effects of an intervention on breathlessness and E in patients for whom a cycle or treadmill exercise test is unsuitable.

Reliability Of Unsupported Upper Limb Exercise Test Performance For Patients With Multiple Sclerosis

Reliability Of Unsupported Upper Limb Exercise Test Performance For Patients With Multiple Sclerosis

Reliability Of Unsupported Upper Limb Exercise Test Performance For Patients With Multiple Sclerosis

Reliability Of Unsupported Upper Limb Exercise Test Performance For Patients With Multiple Sclerosis

Does Unsupported Upper Limb Exercise Training Improve Symptoms and Quality of Life for Patients With Chronic Obstructive Pulmonary Disease?

Many patients with chronic obstructive pulmonary disease (COPD) report dyspnea and fatigue when performing upper limb activities. Unsupported upper limb training has been shown to improve upper limb endurance, but its effects on symptoms and quality of life have not been examined. The aim of this study was to compare the effects of upper limb and lower limb training with lower limb training alone on exercise capacity, symptoms, and quality of life with COPD. For this study, 38 patients with moderate to severe COPD were randomly allocated to unsupported upper limb endurance training or to a control group that completed a sham training task. All the patients underwent lower limb endurance training. The 6-minute walk test, the Incremental Unsupported Upper Limb Exercise Test, and the Chronic Respiratory Disease Questionnaire (CRQ) were completed before training and then 6 weeks afterward. Both patients and assessors were blinded to group allocation. All the patients reported symptoms associated with upper limb activities on the initial CRQ. Both groups showed significant improvements in all domains of the CRQ and in the 6-minute walk test after training. Only the upper limb training group showed improvement in upper limb endurance time (57 +/- 75 vs 2 +/- 58 seconds; P = .02). There were no significant differences between the groups for 6-minute walk test or any domain of the CRQ. Unsupported upper limb training for patients COPD improves upper limb exercise capacity, but has no additional effect on symptoms or quality of life, as compared with leg training alone. This type of upper limb training may not adequately address the complex interaction between respiratory mechanics and upper limb function.

Standing with assistance of a tilt table in intensive care: A survey of Australian physiotherapy practice

Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt); prevent muscle contractures (86%); improve lower limb strength (81%); and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.

A six-week, resource-efficient mobility program after discharge from rehabilitation improves standing in people affected by stroke: Placebo-controlled, randomised trial

Although intervention is effective in reducing the disability associated with stroke, limited resources mean that physiotherapy services often cease by six months after stroke. The purpose of this clinical trial was to investigate the efficacy of resource-efficient physiotherapy services in improving mobility and quality of life after stroke. Twenty-six people with residual walking difficulties after stroke were randomised into an experimental or control group after discharge from physiotherapy services. The experimental group participated in a six-week, home-based mobility program. The control group participated in a six-week, home-based program of upper-limb exercises (i.e. 'sham' mobility exercises). Subjects met with the therapist for prescription of exercises only three times during the six weeks. Strategies used to offset potential problems associated with minimal subject-therapist interaction included videotaped instructions to encourage correct performance of exercises, modification of the environment and involvement of carers to enhance safety, and telephone contact and self-monitoring to promote compliance. Standing (Functional Reach), walking (MAS Item 5) and quality of life (SA-SIP30) were measured prior to, immediately after, and two months after intervention ceased by an assessor who was blinded to group allocation. Subjects in the experimental group demonstrated significant improvement in standing compared to the control group (p = 0.01) which was maintained two months after the cessation of intervention (p = 0.04). There was no difference between the groups in walking (p = 0.50) or quality of life (p = 0.70). The six-week, resource-efficient mobility program was effective in improving some of the mobility in people after discharge from stroke rehabilitation. The provision of resource-efficient programs is recommended wherever possible so that people affected by stroke may continue rehabilitation for longer.

348 Muscle ergoreflex contribution to the respiratory control is active during both upper and lower limb exercise in heart failure patients

348 Muscle ergoreflex contribution to the respiratory control is active during both upper and lower limb exercise in heart failure patients

Effects of prior concentric training on eccentric exercise induced muscle damage

Background: Exercise induced muscle damage (EIMD) from strenuous unaccustomed eccentric exercise is well documented. So too is the observation that a prior bout of eccentric exercise reduces the severity of...

Secondary and tertiary prevention in the management of low-trauma fracture

A significant risk factor for osteoporotic fracture is a previous atraumatic fracture. The objective of this study was to investigate whether patients with Colles fracture from minimal trauma were subsequently identified, assessed and treated for their elevated risk of fracture. Medical records at Sir Charles Gairdner Hospital in Perth, Western Australia, from August 1999 to July 2000 were audited and 111 patients who had sustained a Colles fracture from minimal trauma were identified. Questionnaires were subsequently posted to participants to determine whether any assessment or treatment was undertaken outside the hospital system. According to documentation in the medical records, 9% (10/111) had their bone mineral density assessed, 15% (17/111) were receiving medical therapy for osteoporosis, 7% (8/111) had their falls risk assessed and 51% (58/111) were seen by a physiotherapist. Of the 58 who received physiotherapy, 76% (44/58) received upper limb exercises and 19% (11/58) received lower limb or balance exercises. Follow-up questionnaires one to two years after the fracture were returned by 43% (48/111) of the sample. By this time, 37% (18/48) had BMD assessed and 27% (13/48) were receiving medical therapy for osteoporosis. Thirty-five per cent (17/48) of patients recalled being advised to increase their calcium intake. Of those who reported more than one fall during the past 12 months, 62% (8/13) had been seen by a physiotherapist, 46% (6/13) reported having their balance assessed and 54% (7/13) reported having a home visit for assessment of rails etc. Despite the availability of effective treatments, a substantial proportion of patients with Colles fracture from minimal trauma are not all being identified, assessed or treated for their elevated risk of subsequent osteoporotic fracture.

健常者における非支持上肢運動負荷試験（UIULX test）と上肢使用日常生活活動時の運動負荷の関連

健常者における非支持上肢運動負荷試験（UIULX test）と上肢使用日常生活活動時の運動負荷の関連

呼吸リハビリテーション

Pulmonary rehabilitation is one of the most important components of compre-hensive treatment for patients with chronic pulmonary diseases. Pulmonary rehabilitation improves muscle fatigue, dyspnea scores for activities of daily living. Pulmonary rehabilitation now has also become an established treatment for those patients to improve quality of life. Pulmonary rehabilitation includes elements of physical therapy, exercise training, education. Exercise training especially lower-limb exercise (e. g., walking, cycling) improves dyspnea sensation after exercise, prolongs walking distance. Upper-limb exercise training improves arm activity with greater increases in unsupported arm training than in supported arm training. Education program decreases the number of hospitalization in patients with asthma but not with chronic obstructive pulmonary diseases (COPD). Some rehabilitation programs contain inspiratory muscle training. However, evidence of clinically important benefits of the inspiratory muscle training has been shown only in inspiratory resistance more than 30% of maximal inspiratory mouth pressure. Pulmonary rehabilitation has these great benefits on patients with chronic pulmonary disease. However, the benefits after the pulmonary rehabilitation program tend to diminish over time and are absent 1 to 2 years. To keep the benefits, home care and/or outpatient pulmonary rehabilitation program are necessary.

The inflammatory response to upper and lower limb exercise and the effects of exercise training in patients with claudication

Purpose: We have previously shown that a program of upper limb exercise training can induce significant improvements in walking distance in patients with claudication. This study assessed whether upper limb exercise avoids the systemic inflammatory responses associated with lower limb exercise and also whether the inflammatory response to acute lower limb exertion is modified by a program of supervised exercise training. Methods: Fifty-two patients with stable intermittent claudication were randomized into two groups who underwent 6 weeks of supervised upper (n = 26) or lower (n = 26) limb cardiorespiratory exercise training. A parallel control group (n = 15) was provided with lifestyle advice only. Neutrophil activation markers (CD11b and CD66b) and plasma levels of von Willebrand factor (marker of endothelial damage) in response to an acute bout of sustained upper and lower limb exercise were assessed before and after the period of training. Plasma levels of soluble E-selectin (marker of endothelial activation) were also determined before and after the training period. Results: An acute bout of sustained lower limb exercise significantly increased the intensity of CD11b and CD66b expression by peripheral blood neutrophils in all groups, whereas upper limb exercise had no effect. Resting neutrophil expression of CD11b and CD66b and circulating von Willebrand factor levels were unaffected by the training program, as were the inflammatory responses to an acute bout of sustained upper and lower limb muscular work, despite the fact that both training programs significantly increased walking distances. Conclusions: These findings indicate that upper limb exercise training programs may offer certain advantages over currently prescribed lower limb programs. Our results show that exercising nonischemic muscles in a way that promotes improved cardiorespiratory function and walking capacity can avoid the potentially deleterious systemic inflammatory responses associated with lower limb exertion in patients with stable intermittent claudication. (J Vasc Surg 2001;33:392-9.)

周術期のリハビリテーション中に発生した致死的肺塞栓症

Fatal pulmonary embolism is a well known complication of various disorders, including orthopedic surgical cases. We present two cases of pulmonary embolism occurring in the perioperative periods. Case 1: A 66-year-old woman suffering from intraduralextramedullary tumor at the level of Th 9 complained of gait disturbance. On the sixth day after tumor resection, cardiopulmonary arrest occurred immediately after muscle manual test of lower limb. She expired despite resuscitation. Pulmonary embolism was suggested. Case 2: A 80-year-old woman suffered from right hip fracture. Six days after admission, she experienced dyspnea and chest pain during muscle strengthening exercise of upper limb. Pulmonary embolism was diagnosed based on defective images in the right upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent anticoagulation therapy (with heparin). Special attention should be paid to prophylaxis of pulmonary embolism in patients in the perioperative periods. Intermittent pneumatic compression and therapeutic exercises offers advantages over pharmacological prophylaxis against venous thromboembolism-namely, safety, absence of bleeding complications, and efficacy in reducing calf thrombosis. Early rehabilitation should be recommended by means of thromboprophylaxis.

Effects of Bilateral Upper-Limb Exercise on Trunk Muscles.

We recommend the following movements for low back pain patients dependent on their stage of impairment. In the early stage of exercise, the pull-down exercise in a sitting position with handgrip width adjustments for exercise of the front muscles. With advance of stage, the handgrip width can be narrowed and the exercise can start in the standing position. For the back muscles, pull-up movement can be performed in a sitting position in the early stage, and pull-up movement in a standing position can be performed in subsequent stage. The handgrip width does not influence the pull-up exercises.