Upper-limb Exercise Research Articles

Exaggerated pressor responses, but unaltered blood flow regulation and functional sympatholysis during lower limb exercise in young, non-Hispanic black males.

Young non-Hispanic black (BL) males have displayed lower blood flow (BF) and vascular conductance (VC), but intact functional sympatholysis, during upper limb exercise when compared to non-Hispanic white (WH) males. This study sought to explore if similar differences were also present in the lower limbs. Thirteen young BL males and thirteen WH males completed one visit comprised of rhythmic lower limb (plantar flexion) exercise as well as upper limb (handgrip) exercise for a limb-specific comparison. Limb BF, mean arterial pressure (MAP), and VC were evaluated at three submaximal workloads (8, 16, and 24kg). To determine potential limb differences in functional sympatholysis, the impact of sympathetic nervous system activation (via cold-pressor test (CPT)) was evaluated at rest and during steady state exercise (30% of maximal voluntary contraction) on a subsequent visit. MAP responses to lower and upper limb exercise were elevated in young BL males (vs WH males), resulting in significantly lower VC responses in the upper limb, but not the lower limb. Further, BL males, when compared to WH males, revealed no differences in functional sympatholysis, evident by similar responses in both the exercising leg and arm VC during CPT. The findings of the current study indicate that although elevated MAP responses were observed during both lower and upper limb exercise in young BL males, vascular conductance was only hindered in the upper limbs. This may potentially highlight enhanced compensatory mechanisms in the lower limb (vs upper limb) to maintain perfusion in young BL males.

The effects of upper limb exercise training on upper limb muscle strength in people with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials.

Upper limb (UL) muscle dysfunction is a common extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD). UL muscle dysfunction is associated with muscle weakness, dyspnea, and exercise intolerance. Although upper limb exercise training (ULET) is typically incorporated in pulmonary rehabilitation programs, its effects on UL muscle strength remains unclear. The purpose of this systematic review was to investigate the effectiveness of ULET, in UL muscle strength of people with COPD. This is systematic review and meta-analysis study. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2020 guidelines were used for this study. PubMed, Cochrane, CINAHL Plus and SPORTDiscus and clinicaltrials.gov registry were searched from inception to July 2022. Included studies were randomized controlled trials, assessing the effectiveness in muscle strength of ULET, compared with other types of upper or lower limb exercise or no exercise. The quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and certainty of evidence with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Treatment effects of ULET were calculated using standardized mean differences and 95% confidence intervals. Twenty-four studies, with a total sample of 882 patients, were included. Most studies were of moderate quality and high risk of bias. Very low to low certainty evidence indicates a significant difference in UL muscle strength in favor of resistance ULET, compared with lower limb exercise alone or no exercise. No significant differences were found in different types of ULET comparisons. The results of this review showed that resistance ULET could improve UL muscle strength in people with COPD. Most studies, however, were of moderate quality and high risk of bias. Further studies with larger sample sizes, better methodological quality, and standardized training protocols are needed to confirm these findings.

Usefulness of an Easy, Structured, and Home-Based Exercise Program to Improve Physical Performance and Quality of Life in a Patient’s Cohort with Obesity

Introduction: The benefits of exercise in patients with obesity are clear; physical performance and quality of life improve after exercise programs in patients with obesity. Our aim was to evaluate the usefulness of an easy, structured, and home-based exercise program to improve physical performance and quality-of-life in patients with obesity. Methods: A cohort of patients with obesity (BMI ≥30 kg/m²) was recruited during 2017–2020. Patients who met the inclusion criteria were invited and those who accepted signed informed consent. Patients were evaluated by the same team of physicians who performed the 6-min walking test and collected the clinical and biochemical variables, also applied quality-of-life questionnaire at baseline and 3 months after starting the exercise program that was divided in two levels: level 1: active mobilization of four limbs (15 min) + cardiovascular exercise (15 min walking), 5 days/week; level 2: eight strengthening exercises for upper and lower limbs with an elastic band + cardiovascular exercise (15 min walking), 5 days/week. This study used means (SD), frequencies (percent), Student's t test, and Pearson correlation test. Results: We included 151 patients, mostly women (81.5%), age 46.3 ± 9.8 years old, BMI 40.3 ± 8.56 kg/m², 34.4% performed some type of exercise, and the most frequents comorbidities were dyslipidemia and diabetes. After 3 months, 86 patients (57%) remained in the study and attended the final evaluation. Evident changes in physical performance were reported (distance traveled, speed walking and VO_2max); however, improvement in quality of life was remarkable. Conclusion: An easy, structured, and home-based exercise program improves physical performance and quality of life in patients with obesity, without losing its benefits for the health.

Effect of Motor Relearning Program with Obstacle Walking on Dynamic Gait Performance and Functional Mobility in Subacute Stroke Subjects

Background: Gait difficulties are common post-stroke due to muscle weakness and postural imbalance. Motorrelearning program is known to improve motor skills through task oriented practice, appropriate feedback andactive participation of subjects. Obstacle walking helps in improving gait parameters, stepping over objects,walking endurance and reduces fall risk.Objectives: To determine effect of Motor Relearning Program with obstacle walking on dynamic gait performanceand functional mobility in sub-acute stroke subjects.Materials and Methods: 30 sub-acute stroke subjects were assigned to one of the two groups. Group-A receivedMotor Relearning Program and Group-B received Motor Relearning Program with obstacle walking for 30 minutes,5 days a week for 4 weeks. Both groups received 15 minutes of conventional exercises for upper limb. Dynamicgait performance and functional mobility were assessed pre- and post-intervention at 4 weeks using Dynamic GaitIndex and Motor Assessment Scale.Results: Pre-test scores of DGI and MAS were 11.53±3.53 and 3.83±0.48 in Group-A, 12.43±4.12 and 3.67±0.81in Group-B which improved to 15.80±3.82 and 4.07±0.59 in Group-A, 18.67±4.86 and 4.73±0.96 in Group-B, postintervention.Within group comparison of pre to post-test scores of DGI and MAS was found to be statisticallysignificant in both groups. When post-test scores of DGI and MAS were compared in between groups, Group-Bwas found to be statistically significant than Group-A (p<0.05).Conclusion: Both interventions were individually effective but Motor Relearning Program with obstacle walkingwas better than Motor Relearning Program alone to improve dynamic gait performance and functional mobilityin sub-acute stroke subjects.

Effectiveness, safety and patients' perceptions of an immersive virtual reality-based exercise system for poststroke upper limb motor rehabilitation: A proof-of-concept and feasibility randomized controlled trial.

This study aimed to examine the effectiveness, safety and patients' perceptions of an immersive virtual reality (VR)-based exercise system for poststroke upper limb rehabilitation. A proof-of-concept, 2-week randomized controlled trial was conducted. Fifty stroke patients were randomly assigned to either use the immersive VR-based exercise system to perform upper limb exercises for 2 weeks (intervention) or play commercial games (control). Effectiveness, safety and patients' perceptions of the exercise system were assessed at baseline and at 1- and 2-week follow-ups. Intention-to-treat analysis revealed that after 2 weeks, statistically significant improvements in shoulder flexion active range of motion (AROM), shoulder abduction AROM, perceived upper limb motor function and quality of life (QoL) were observed in one or both groups, but not between the groups. Per-protocol analysis showed that after 2 weeks: (i) statistically significant improvement in shoulder abduction AROM was obtained in the intervention group, and the difference in the mean changes between the groups was statistically significant; (ii) statistically significant improvements in coordination/speed (Fugl-Meyer Assessment for Upper Extremity), shoulder flexion AROM, perceived upper limb motor function and QoL were obtained in one or both groups, but not between the groups. The immersive VR-based exercise system is a potentially effective, safe and acceptable approach for supporting poststroke motor rehabilitation. These findings can serve as a basis for larger-scale studies on the application of VR for poststroke exercises.

Resistance training does not change glucose and cardiac autonomic function of patients with type 2 diabetes

Objective: to evaluate the influence of a RT protocol on the function autonomic heart rate and cardiovascular variables in patients with DM-2. Methods: 9 patients with DM-2 participated in the study. After initial evaluation, data collection was performed regarding the RR intervals (iR-R) of the frequency heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressures while performing Function Tests Autonomic Cardiac Respiratory Sinus Arrhythmia Accentuating Maneuver (ABR), Active Postural Maneuver (APM), Valsalva Maneuver (ValM), Handgrip Test and the HR, SBP, DBP and double product (DP) data were also analyzed under the pre and post RT. RT was applied with moderate intensity of 60% of 1RM, exercises for lower and upper limbs, twice a week for 12 weeks. Results: the variations of the calculated indices for the TFACs did not show differences significant statistics (p>0.05). PAS, PAD and FC also showed no difference However, the PD showed a decrease at rest (∆= -990.55 ±1154.91) Conclusions: the moderate RT with 12 weeks, in patients with DM-2, does not promote any change in the function autonomic cardiac output but decreases myocardial overload by attenuating PD at rest.

Fat Oxidation during Exercise in People with Spinal Cord Injury, and Protocols Used: A Systematic Review.

The aim of this study was to summarize evidence on energy metabolism through peak fat oxidation (PFO) and maximum fat oxidation (Fatmax), as well as to analyze the protocols used in people with spinal cord injury (SCI) and to examine the main factors related to fat oxidation ability (i.e., age, sex, level of physical activity, and level and degree of injury). Studies to determine PFO and Fatmax using indirect calorimetry with an arm exercise protocol for SCI patients were included after a systematic search. Other endpoints included study design, sample size, control group, demographic data, level of injury, physical condition, protocol, outcomes measured, and statistical findings. Eight studies (n = 560) were included. The mean value of VO2peak was 1.86 L∙min-1 (range 0.75-2.60 L∙min-1) (lowest value in the tetraplegic subjects). The PFO ranged between 0.06 and 0.30 g∙min-1 (lowest rates: the non-trained subjects with cervical SCI; highest: the tetraplegic subjects). Two types of exercise protocol were found: arm cycle ergometer, and wheelchair propulsion with a computerized ergometer. Five studies used an incremental protocol (2-3 min/stage, different load increments); the rest performed tests of 20 min/stage at three intensities. There are few existing studies measuring fat oxidation in SCI, many of which used small and heterogeneous samples. PFO was lower in SCI subjects when compared with non-injured people performing lower-limb exercise; however, comparing upper-limb exercise, people with SCI showed higher values.

Aerobic Upper-Limb Exercise-Induced Hypoalgesia: Does It Work?

Background: Aerobic exercise reduces pain sensitivity, a phenomenon known as exercise-induced hypoalgesia (EIH); however, little is known about EIH when the upper limbs are aerobically exercised. This study aimed to test the acute effect of a single aerobic upper-limb exercise on pain threshold and pain intensity in healthy participants, with two different protocols for controlling intensity. Methods: 31 participants performed two 20 min exercise sessions a week apart. In each session, the intensity was controlled by a target heart rate (THR) of 60% of heart rate reserve or by a rate of perceived exertion (RPE) of 7/10 on the Borg scale. Pain threshold for pressure (PPT) heat (HPT) and pain intensity in response to Tonic Heat Pain (THP) were measured pre- and post-exercise. To examine the effect of exercise in each protocol on pain sensitivity, rmANOVA was conducted. Results: Pain sensitivity remained unchanged following arm exercise in both protocols (PPT, p = 0.67; HPT, p = 0.56; and THP p = 0.39). Higher HR in the THR protocol was demonstrated with a significant protocol X time, interaction effect (F(3) = 11.194 p < 0.004). Conclusions: Moderate–high-intensity upper-limb aerobic exercise did not affect pain sensitivity in healthy individuals. Exercise intensity when controlled by THR showed a higher mean heart rate compared to exercise intensity based on RPE.

Upper limb exercise for arteriovenous fistula maturation in people requiring permanent haemodialysis access.

The failure of arteriovenous fistulas (AVF) to mature is a major problem in patients with kidney failure who require haemodialysis (HD). Preoperative planning is an important factor in increasing functional AVF. Upper limb exercise has been recommended to gain AVF maturation. Studies of pre- and post-operative upper limb exercises in patients with kidney failure patients have been reported; however, the optimal program for this population is unknown due to inconsistent results among these programs. We aimed to determine if upper limb exercise would be beneficial for AVF maturation (prior to and post AVF creation) in patients with kidney failure and to improve AVF outcomes. This review also aimed to identify adverse events related to upper limb exercise. We searched the Cochrane Kidney and Transplant Register of Studies up to 15 March 2022 through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov, and other resources (e.g. reference list, contacting relevant individuals, and grey literature). We included randomised controlled trials (RCTs) and quasi-RCTs, comparing upper limb exercise training programs with no intervention or other control programs before or after AVF creation in patients with kidney failure. Outcome measures included time to mature, ultrasound and clinical maturation, venous diameter, blood flow in the inflow artery, dialysis efficacy indicator, vascular access function (functional AVF), vascular access complications, and adverse events. Study selection and data extraction were taken by four independent authors. Bias assessment and quality assessment were undertaken independently by two authors. The effect estimate was analysed using risk ratio (RR) with 95% confidence intervals (CI) for dichotomous data, or mean difference (MD) or standardised mean difference (SMD) for continuous data. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Nine studies (579 participants) were included, and seven studies (519 participants) conducting post-operative exercise training could be meta-analysed. Three comparisons were undertaken: (i) isotonic exercise training versus no intervention; (ii) isometric versus isotonic exercise training; and (iii) isotonic (high volume) versus isotonic exercise training (low volume). Due to insufficient data, we could not analyse pre-operative exercise training. Overall, the risk of bias was low for selection and reporting bias, high for performance and attrition bias, and unclear for detection bias. Compared to no intervention, isotonic exercise training may make little or no difference to ultrasound maturation (2 studies, 263 participants: RR 1.09, 95% CI 0.94 to 1.25; I² = 0%; low certainty evidence), but may improve clinical maturation (2 studies, 263 participants: RR 1.14, 95% CI 1.02 to 1.27; I² = 0%; low certainty evidence). Compared to isotonic exercise training, isometric exercise training may improve both ultrasound maturation (3 studies, 160 participants: RR 1.56, 95% CI 1.21 to 2.00; I² = 22%; low certainty evidence) and clinical maturation (3 studies, 160 participants: RR 1.80, 95% CI 1.18 to 2.76; I² = 53%; low certainty evidence). Venous diameter (3 studies, 160 participants: MD 0.84 mm, 95% CI 0.45 to 1.23; I² = 0%; low certainty evidence) and blood flow in the inflow artery (3 studies, 160 participants: MD 140.62 mL/min, 95% CI 38.72 to 242.52; I² = 0%; low certainty evidence) may be greater with isometric exercise training. It is uncertain whether isometric exercise training reduces vascular access complications (2 studies, 110 participants: RR 2.54, 95% CI 0.38 to 17.08; I² = 47%; very low certainty evidence). It is uncertain whether high volume isotonic exercise training improves venous diameter (2 studies, 93 participants: MD 0.19 mm, 95% CI -0.75 to 1.13; I² = 34%; very low certainty evidence) or blood flow in the inflow artery (1 study, 15 participants: MD -287.70 mL/min, 95% CI -625.99 to 60.59; very low certainty evidence) compared to low volume isotonic exercise training. None of the included studies reported time to mature, dialysis efficacy indicator, vascular access function, or adverse events. Our findings suggest that the current research evidence examining upper limb exercise programs is of low quality, attributable to variability in the type of interventions used and the overall low number of studies and participants.

A study on brain neuronal activation based on the load in upper limb exercise (STROBE).

This study aimed to determine the level of brain activation in separate regions, including the lobes, cerebellum, and limbic system, depending on the weight of an object during elbow flexion and extension exercise using functional magnetic resonance imaging (fMRI). The study was conducted on ten male undergraduates (22.4 ± 1.2 years). The functional images of the brain were obtained using the 3T MRI. The participants performed upper limb flexion and extension exercise at a constant speed and as the weight of the object for lifting was varied (0 g and 1000 g). The experiment consisted of four blocks that constituted 8 minutes. Each block was designed to comprise a rest phase (1 minute) and a lifting phase (1 minute). The results showed that, in the parietal lobe, the activation was higher for the 0 g-motion condition than for the 1000 g-motion condition; however, in the occipital lobe, cerebellum, sub-lobar, and limbic system, the activation was higher for the 1000 g-motion condition than for the 0 g-motion condition. The brain region for the perception of object weight was identified as the ventral area (occipital, temporal, and frontal lobe), and the activation of the ventral pathway is suggested to have increased as the object came into vision and as its shape, size, and weight were perceived. For holding an object in hand, compared to not holding it, the exercise load was greater for controlling the motion to maintain the posture (arm angle at 90°), controlling the speed to repeat the motion at a constant speed, and producing an accurate posing. Therefore, to maintain such varied conditions, the activation level increased in the regions associated with control and regulation through the motion coordination from vision to arm movements (control of muscles). A characteristic reduced activation was observed in the regions associated with visuo-vestibular interaction and voluntary movement when the exercise involved lifting a 1000-g object compared to the exercise without object lifting.

Preliminary feasibility and acute physiological effects of a single session of upper limb vibration training for persons with spinal cord injury

Context Strong upper limb musculature is essential for persons with spinal cord injury (SCI) to operate a manual wheelchair and live independently. Targeted upper limb vibration may be a viable exercise modality to build muscle efficiently while eliminating some of the barriers associated with exercise for persons with SCI. Objective The purpose of this study was to assess preliminary feasibility of completing a single exercise session of upper limb vibration and compare the acute physiological effects to a single session of standard dumbbell resistance exercise. Methods Individuals with SCI performed seven upper limb exercises (1) isometrically using a vibrating dumbbell at 30 Hz for 60 s (n = 22) and (2) using a standard isotonic resistance protocol (n = 15). Results Nineteen (86.4%) of 22 participants were able to perform all vibration exercises at 30 Hz but hold time success rates varied from 33% (side flies and front raises) to 95% (internal rotation). No significant differences were found between vibration exercise and standard resistance protocol for blood lactate, power output, and heart rate (P > 0.05). Perceptions of the training were positive, with most participants (>70%) expressing interest to train with vibration in the future. Conclusions Vibration training was not feasible for all participants, suggesting an individualized approach to starting weight and progression may be necessary. Similar acute physiological changes were seen between vibration exercise and standard resistance protocol, suggesting they could have similar benefits. Additional research is needed to determine if vibration exercise is feasible and beneficial to incorporate into a long-term training program.

Exercise guide to help on arteriovenous fistula maturation and maintenance.

The arteriovenous fistula is the main vascular access in hemodialysis. Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its surgery, however, exercise programs may begin earlier for improving outcomes. Therefore, we propose this guide with simple, but potentially effective exercises, using low-cost materials that can be safely performed by the patients at home or in the dialysis center. It also provides to the dialysis staff team a starting point for implementing an upper-limb exercise program that may facilitate arteriovenous fistula maturation and maintenance. This exercise routine for arteriovenous fistula maturation can be performed three to four times a day, every day, from 2 to 4 weeks. After its maturation, it can be performed on every non-dialysis day for conventional treatment and every other day, before dialysis, for short daily treatment. Based on the available evidence, we have gathered some exercises, in a very easy and understandable language, that may potentially help arteriovenous fistula maturation and maintenance for hemodialysis patients.

Combined Upper Limb Exercise and Creatine Monohydrate Supplementation Improved Musculoskeletal Function in NSCLC Patients

Background: Lung cancer is a chronic respiratory disease that causes muscle dysfunction. Giving creatine monohydrate supplementation combined with exercise has efficacy in increasing lean body mass (LBM), muscle strength, and physical function. This study aims to analyze the effect of a combination of creatine monohydrate supplementation and upper limb exercise on skeletal muscle dysfunction in NSCLC patients.Methods: A quasi-experimental study with a pretest-posttest study on NSCLC patients given epidermal growth factor receptor (EGFR) – tyrosine kinase inhibitors (TKIs) from outpatient at RSUD Dr. Moewardi Surakarta in September - October 2021. The combination group of creatine monohydrate supplementation with upper limb exercise (n=15), the group with creatine monohydrate supplementation only (n=16), and the control group (n=15). Lean body mass in kilograms and percentages, 6-minute walk test (6MWT), and quality of life were assessed after 8 weeks of treatment.Results: The increase in LBM in the combination group was 4.22±1.81kg and 6.38±2.48% (P=0.0001). The combination groups have a greater increase in the 6MWT was 104±20.07 meters. The increase in quality of life in the combined creatine monohydrate supplementation group with upper limb exercise was 20.80±10.75. Changes in the value of LBM, 6MWT, and quality of life (QoL) in the creatine monohydrate supplementation combined with upper limb exercise were significantly different compared to the creatine monohydrate supplementation only group and the control groups.Conclusion: There is a greater effect of giving a combination of creatine monohydrate supplementation and upper limb exercise on LBM, 6MWT, and QoL in NSCLC patients.

Path analysis of the roles of age, self-efficacy, and TAM constructs in the acceptance of performing upper limb exercises through immersive virtual reality games

ObjectiveWe aimed to assess whether individuals accept performing upper limb exercises using immersive VR games, indicated by behavioral intention, and the roles of age, self-efficacy, and technology acceptance model (TAM) constructs in the acceptance. MethodsSixty healthy participants aged 20–79 years were examined for their perceptions and acceptance of VR game-based exercises using a questionnaire. Participants were instructed to perform upper limb exercises by playing five immersive VR games in a laboratory. A theoretical model delineated the roles of the focal constructs in the acceptance was formulated and tested using path analysis. ResultsAt least 76.6% of participants (n = 46) expressed their intention to perform upper limb exercises through immersive VR games in the future. Overall, the model explained 83% variance in behavioral intention. Significant associations were observed, as follows. Age was positively associated with perceived usefulness (β = 0.27, p = 0.01), which positively influenced attitude (β = 0.64, p < 0.001); in turn, attitude positively affected behavioral intention (β = 0.84, p < 0.001). Moreover, self-efficacy positively affected perceived ease of use (β = 0.84, p < 0.001). ConclusionsFactors such as age, perceived usefulness, attitude, and self-efficacy were found to play significant roles in the acceptance of immersive VR games for upper limb exercises. In the future, strategies should be devised to meet the requirements of end users of different ages and promote usefulness, attitude, and self-efficacy in performing upper limb exercises through immersive VR games.

Age-related difference in muscle metabolism patterns during upper limb's encircling exercise: a near-infrared spectroscopy study.

Aging is usually accompanied by decrease in limb motor function and change in muscle metabolism patterns. However, few studies have investigated the aging effect on muscle hemodynamics of the upper extremity. This study aims to explore the aging effect on muscle metabolism patterns during upper limb's exercise. Twelve middle-aged and elderly subjects and 12 young subjects were recruited, and muscle oxygenation signals from these subjects' biceps brachii muscles were collected during active and passive upper limb's encircling exercise with near-infrared spectroscopy (NIRS). The old group showed stronger muscle hemodynamic metabolism than the young group. The multiscale fuzzy approximate entropy and multiscale transfer entropy analyses indicated higher complexity and stronger interlimb coupling of the muscle oxygenation signals for the old group. Based on the selected muscle metabolism features, the constructed support vector machine model showed a high accuracy rate for classifying the two groups of subjects: 91.6% for the passive mode and 87.5% for the active mode. Our results proved the specific muscle metabolism patterns in the upper limb's exercise for old subjects, promoting the understanding of the aging effect on muscle hemodynamics.

Automating provision of feedback to stroke patients with and without information on compensatory movements: A pilot study.

Providing effective feedback to patients in a rehabilitation training program is essential. As technologies are being developed to support patient training, they need to be able to provide the users with feedback on their performance. As there are various aspects on which feedback can be given (e.g., task success and presence of compensatory movements), it is important to ensure that users are not overwhelmed by too much information given too frequently by the assistive technology. We created a rule-based set of guidelines for the desired hierarchy, timing, and content of feedback to be used when stroke patients train with an upper-limb exercise platform which we developed. The feedback applies to both success on task completion and to the execution of compensatory movements, and is based on input collected from clinicians in a previous study. We recruited 11 stroke patients 1–72 months from injury onset. Ten participants completed the training; each trained with the rehabilitation platform in two configurations: with motor feedback (MF) and with no motor feedback (control condition) (CT). The two conditions were identical, except for the feedback content provided: in both conditions they received feedback on task success; in the MF condition they also received feedback on making undesired compensatory movements during the task. Participants preferred the configuration that provided feedback on both task success and quality of movement (MF). This pilot experiment demonstrates the feasibility of a system providing both task-success and movement-quality feedback to patients based on a decision tree which we developed.

A novel equation that incorporates the linear and hyperbolic nature of the force-velocity relationship in lower and upper limb exercises.

The purpose of this study is to provide a force-velocity (F-V) equation that combines a linear and a hyperbolic region, and to compare its derived results to those obtained from linear equations. A total of 10 cross-training athletes and 14 recreationally resistance-trained young men were assessed in the unilateral leg press (LP) and bilateral bench press (BP) exercises, respectively. F-V data were recorded using a force plate and a linear encoder. Estimated maximum isometric force (F0), maximum muscle power (Pmax), and maximum unloaded velocity (V0) were calculated using a hybrid (linear and hyperbolic) equation and three different linear equations: one derived from the hybrid equation (linearhyb), one applied to data from 0 to 100% of F0 (linear0-100), and one applied to data from 45 to 100% of F0 (linear45-100). The hybrid equation presented the best fit to the recorded data (R2 = 0.996 and 0.998). Compared to the results derived from the hybrid equation in the LP, significant differences were observed in F0 derived from linear0-100; V0 derived from linearhyb, linear0-100 and linear45-100; and Pmax derived from linearhyb and linear45-100 (all p < 0.05). For the BP, compared to the hybrid equation, significant differences were found in F0 derived from linear0-100; and V0 and Pmax derived from linearhyb, linear0-100 and linear45-100 (all p < 0.05). An F-V equation combining a linear and a hyperbolic region showed to fit adequately recorded F-V data from ~ 20 to 100% of F0, and overcame the limitations shown by linear equations while providing relevant results.

Infographic: Type of physical exercises recommended to improve balance and gait in older adults with a history of falls

Aging is a dynamic process associated with declining physical performance and progressive impairment of muscle strength, balance and mobility. A common result of these impairments is falling, important event that leads to activity limitations, restriction of social participation and a worse quality of life for the older adults. The systematic review made by Teng, Gomersall, Hatton and Brauer (2020) 1 shows that impaired gait and balance are risk factors for falling, but their effects can be reduced by exercise. Therefore, the aim of the infographic is to recommend the main exercise to improve balance and gait in older adults with a history of falls and its benefits. For the selection of exercises indicated in the infographic, four systematic reviews of randomized controlled trials were used. Multicomponent exercises seem to be able to reduce the rate and risk of falls in the older adults 2-4, as well as to improve gait. The exercises must involve gait training, such as, walking multidirectional and obstacle negotiation exercises with different levels of difficulty throughout the training 2-4. Moreover, it is important to include functional activities, for example, gait with different speeds, sit and get up, walking upstairs training and dancing exercise 2-4. It's interesting to include motor coordination exercises, through the ball games and team games, strengthening for abdomen, upper, and lower limb muscles and exercises using body weight 4 as well as balance training, like standing on the one leg, balance-jumping and agility training 2-4. Yet, balance exercises that involve unstable bases also appear to reduce the risk and rate of falls, as a consequence, it improves gait speed in older people with a history of falls 1. Moreover, the recommended intensity for exercise training is moderate (defined as any physical activity that consume 3 to 5.9 METs) and the duration of each training session proposed is one hour 3,4. As for the prescription, it is recommended significant doses of exercises, with a frequency per three hours or more for a week for a period of 6 months. Yet, it is necessary the constant practice of physical exercise to maintain the benefits acquired by the training 3. For future studies, a relativization of dose-response effect adjusted for age, comorbidities and past falls can be necessary. Finally, more extended follow-ups to verify the sustained effect of exercise should be needed for understanding its long-term benefits.

Upper Limb Anaerobic Metabolism Capacity is Reduced in Mild and Moderate COPD Patients

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3′ and 5′ of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r 2 = 0.604, adjusted r 2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3′ and 5′ of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Robustness and Tracking Performance Evaluation of PID Motion Control of 7 DoF Anthropomorphic Exoskeleton Robot Assisted Upper Limb Rehabilitation.

Upper limb dysfunctions (ULD) are common following a stroke. Annually, more than 15 million people suffer a stroke worldwide. We have developed a 7 degrees of freedom (DoF) exoskeleton robot named the smart robotic exoskeleton (SREx) to provide upper limb rehabilitation therapy. The robot is designed for adults and has an extended range of motion compared to our previously designed ETS-MARSE robot. While providing rehabilitation therapy, the exoskeleton robot is always subject to random disturbance. Moreover, these types of robots manage various patients and different degrees of impairment, which are quite impossible to model and incorporate into the robot dynamics. We hypothesize that a model-independent controller, such as a PID controller, is most suitable for maneuvering a therapeutic exoskeleton robot to provide rehabilitation therapy. This research implemented a model-free proportional–integral–derivative (PID) controller to maneuver a complex 7 DoF anthropomorphic exoskeleton robot (i.e., SREx) to provide a wide variety of upper limb exercises to the different subjects. The robustness and trajectory tracking performance of the PID controller was evaluated with experiments. The results show that a PID controller can effectively control a highly nonlinear and complex exoskeleton-type robot.