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PubMed1998

Epithelial rests colocalize with cementoblasts forming acellular cementum but not with cementoblasts forming cellular cementum.

Epithelial rests of Malassez and cementoblasts were examined in the rat molars during the early stages of root formation using an antilaminin antibody and/or peanut agglutinin (PNA), and an antiosteocalcin (OC) antibody, respectively. The roots of the first molars were used for study. The antilaminin antibody stained the basement membrane surrounding the epithelial root sheath and epithelial rests. The basement membrane of the epithelial root sheath was continuous, but that of the epithelial rests was discontinuous. The cells of epithelial rests and epithelial root sheath were positive for PNA. The structural characteristics of the epithelial rests were seen in the sections stained doubly with PNA and the antilaminin antibody. The cells of epithelial rests were fibroblast-like and formed a fine mesh in 2-week-old rats. In 3-week-old rats, the epithelial rests were also present at the coronal half of root surface, showing typical cell cords, but were not present at the apical part of the root surface where the cellular cementum covered the root dentin. At the root apex of 3-week-old rats, the cells of epithelial rests forming fine meshes were seen near the epithelial root sheath. The anti-OC antibody stained cementoblasts lining acellular and cellular cementum. The sections doubly stained with the anti-OC and the antilaminin antibodies or PNA further revealed the close relation between epithelial rests and cementoblasts. The OC-positive cells lining acellular cementum or dentin were localized very close to the epithelial rests. In contrast, the OC-positive cells lining cellular cementum did not show close association with the epithelial cells, except the cells located most apically where the basement membrane of the epithelial root sheath is disrupted and the initial cellular cementum begins to be formed. The present results suggest that the epithelial rests and/or the discontinuous basement membrane of them may have a role for the acellular cementum formation at least in the early stage of root formation.

Animals↗
PubMed1988

Etiology of carbon dioxide retention at rest and during exercise in chronic airflow obstruction.

The purpose of this project was to better define factors that influence the resting PaCO2 and the change in the PaCO2 from rest to exercise in patients with moderate to severe chronic airflow obstruction. Pulmonary function testing, symptom-limited exercise tests using arterial catheter lines, and resting ventilatory and mouth occlusion pressure responses to hypercapnia and hypoxia were obtained in 19 patients (mean FEV1 = 1.07 +/- .50 L). The resting PaCO2 was closely related to the resting hypercapnic response. The highest correlation coefficient was between the PaCO2 and the ventilation at PCO2 = 60 obtained from the resting hypercapnic response (r = -0.74, p less than 0.001). A higher PaCO2 also tended to occur in patients with a lower FEV1 and a lower PaO2. The resting PaCO2 was not correlated significantly with the VT or the VD/VT. The change in the PaCO2 from rest to exercise was not significantly related to any measure of resting hypercapnic or hypoxic response, but rather was most dependent on the ventilatory response to exercise (delta VE/delta VCO2). Patients with a lower FEV1 or smaller decreases in the PaO2 with exercise tended to have larger increases in PaCO2 with exercise. The delta VE/delta VCO2 was higher in those with a high FEV1, a low resting PaCO2, and a low resting SaO2.

Carbon Dioxide↗
PubMed1986

Contribution of the receptor and basolateral membranes to the resting potential of a frog taste cell.

Contributions of the receptor and basolateral membranes to the resting potential in bullfrog taste cells were studied by replacing the superficial and interstitial fluids of the tongue by various salines. When the interstitial K+ concentration ([K+]0) was increased to 100 mM, the resting potential decreased by 45%. A similar increase in superficial [K+]0 decreased the resting potential by 15%. A simultaneous increase in both superficial and interstitial [K+]0 to 100 mM decreased the resting potential by 60%. Total removal of Na+ from either the superficial or interstitial fluid increased the resting potential by 40%. Ouabain (10(-4) M) in the interstitial fluid decreased the resting potential by 30%, while the drug in the superficial fluid had no effect. Amiloride (10(-3) M) in the superficial fluid hyperpolarized the cells to 145%, while the drug in the interstitial fluid caused no change in the resting potential. Ca2+-free superficial saline reduced the resting potential to 75%. Interstitial Ca2+ did not affect the resting potential. Total removal of either superficial Cl- or interstitial Cl- did not change the resting potential. These results suggest: 1) Na+ and K+ move across the receptor and basolateral membranes of the taste cell down their electrochemical gradients, 2) Na+ is extruded from the taste cell by the Na-K pump which exists only in the basolateral membrane, 3) the resting potential of a frog taste cell consists of the diffusion potentials of Na+ and K+ across the receptor and basolateral membranes, and the potential resulting from the activity of the electrogenic Na-K pump in the basolateral membrane.

Amiloride↗
PubMed2004

Automatic quantification of myocardial perfusion stress-rest change: a new measure of ischemia.

UNLABELLED: In myocardial perfusion SPECT (MPS), ischemia is typically quantified as the difference between stress and rest defect sizes obtained by separate comparisons with stress and rest normal limits. Such an approach is not optimal because images are not compared directly with each other and a complex set of stress and rest normal limits is required. METHODS: We developed a fully automatic technique to quantify stress-rest change. We applied it to 204 patients whose SPECT images were acquired using a same-day dual-isotope (99m)Tc/(201)Tl protocol and on whom coronary angiography had been performed. A 10-parameter registration of rest and stress images was performed by an iterative search of best translational, rotational, scaling, and optimal stress-rest count normalization parameters. Identical stress-rest 3-dimensional left ventricle (LV) contours were automatically derived from stress images. Integrated deficit counts (normalized rest-stress) within the LV volume were derived from registered image pairs. A global measure of ischemia (ISCH) was calculated as the ratio of the total deficit stress LV counts to the total rest LV counts. RESULTS: Registration and derivation of quantitative measures were fully automatic. The average processing time was <40 s on a 2-GHz processor. When compared for prediction of stenosis, the area under the receiver operating characteristic curve (0.88 +/- 0.03) was significantly better for ISCH than that obtained by existing quantitative approaches, which use reference databases (0.80-0.82 +/- 0.03). The normalized stress-rest change could be visualized and localized directly on raw patient images using overlay display. CONCLUSION: Automatic stress-rest MPS image registration allows a direct estimation of ischemia from SPECT that does not require comparisons with normal limits.

Adenosine↗
PubMedDate not supplied

Resting metabolic rate variability as influenced by mouthpiece and noseclip practice procedures.

Mouthpiece and noseclip introduction affect resting physiologic function (i.e., hyperventilation, anxiety), which can influence a resting metabolic rate measurement. It also is obvious that practice is required to minimize this influence when such apparatuses are used. However, the type of practice that best minimizes this influence has not been established. To determine the effect of acute and longer term practice on measurement variability of resting metabolic rate, 27 healthy, premenopausal women were randomly assigned to one of three groups: (1) a practice group, involving three 10-minute practice sessions 1 day to 1 week before resting metabolic rate was measured (n = 9); (2) an acclimation group, in which each subject acclimated to the mouthpiece and noseclip for 5 minutes before the resting metabolic rate measurement (n = 8); and (3) a control group (no practice) (n = 10). Resting metabolic rate was measured three times for each subject via a 5-minute oxygen uptake in the early morning (5:00 to 8:30 am) after a 25-minute supine rest. Resting metabolic rate measurements (kJ/day) and intraindividual variance estimates, adjusted for age and weight, were calculated to determine which practice group had the lowest resting metabolic rate measurement and the lowest variability around each individual's repeated resting metabolic rate measures. Of the three averaged resting metabolic rate measures, significantly lower 24-hour energy expenditures were found with the practice (5647 kJ) and acclimation (5550 kJ) groups when compared with those of the control group (6077 kJ) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2003

Rest: a qualitative exploration of the phenomenon.

The founders of occupational therapy perceived rest as one of the performance areas of the profession. They believed that an optimal balance between work, play and rest was crucial in obtaining maximal function and health. However, few occupational therapy theorists or researchers have explored the phenomenon. The authors explored the phenomenon of rest as reported in the literature and through a qualitative study. The results of the literature review showed that rest is differentiated from sleep; rest is equated with interrupting physical and mental activity resulting in a relaxed state. Rest can be achieved by listening to music, hypnosis, reading, walking and sitting quietly. In this exploratory study, seven individuals working at Tel Aviv University were interviewed regarding their definitions of rest. The results indicated that rest was defined as an activity that was personal, quiet and effortless, experienced alone or with friends, and helped in doing daily activities. It is concluded that there is a need for occupational therapists to explore further the phenomenon of rest as it relates to occupational performance, ergonomics and health maintenance. Examining the concept of rest is a challenge that involves returning to the theoretical origins of the profession.

Humans↗
PubMed1977

Cardiorespiratory responses to exercise after bed rest in men and women.

The purpose of this study was to compare cardiorespiratory responses of men and women to submaximal and maximal workloads before and after bed rest (BR). Fifteen male college students (19-23 yr) and 8 female nurses (23-34 yr) underwent 14 d and 17 d, respectively of bed rest. The maximal work capacity test was performed in the supine position on a bicycle ergometer just before and immediately after bed rest. The women's maximal O2 uptake (maximal VO2) was 41% lower (P<0.05) than the men's before bed rest and 42% lower (P<0.05) after bed rest. During bed rest the women's maximal VO2 decreased from 2.06 to 1.86 liter/min (-9.7%, P<0.05), and that of the men decreased from 3.52 to 3.20 liter/min (-9.1%, P<0.05). Compared with pre-BR values, after bed rest the maximal ventilatory volume was essentially unchanged in the men (+1.8%) and women (+ 2.3%), but maximal heart rate was elevated from 185 to 193 b/min (+ 4.3%, P<0.05) in the men and from 181 to 187 b/min (3.3%, P<0.05) in the women. Submaximal VO2 was unchanged after bed rest in the men but was significantly reduced in the women; the women's Hct and RBC levels were lower (P<0.05) than comparable male data. Mean corpuscular volume was unchanged in both groups pre- and post-bed rest. It is concluded that the proportional deterioration in maximal VO2 following prolonged bed rest was essentially the same in young men and women.

Adult↗
PubMed2006

Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins.

Supine weight-bearing exercise within lower body negative pressure (LBNP) alleviates some of the skeletal deconditioning induced by simulated weightlessness in men. We examined this potential beneficial effect in women. Because dietary acid load affected the degree of bone resorption in men during bed rest, we also investigated this variable in women. Subjects were 7 pairs of female identical twins assigned at random to 2 groups, sedentary bed rest (control) or bed rest with supine treadmill exercise within LBNP. Dietary intake was controlled and monitored. Urinary calcium and markers of bone resorption were measured before bed rest and on bed rest days 5/6, 12/13, 19/20, and 26/27. Bone mineral content was assessed by dual-energy X-ray absorptiometry before and after bed rest. Data were analyzed by repeated-measures two-way analysis of variance. Pearson correlation coefficients were used to define the relationships between diet and markers of bone metabolism and to estimate heritability of markers. During bed rest, all markers of bone resorption and urinary calcium and phosphorus increased (P<0.001); parathyroid hormone (P=0.06), bone-specific alkaline phosphatase (P=0.06), and 1,25-dihydroxyvitamin D (P=0.09) tended to decrease. LBNP exercise tended to mitigate bone density loss. The ratio of dietary animal protein to potassium was positively correlated with urinary calcium excretion for all weeks of bed rest in the control group, but only during weeks 1 and 3 in the exercise group. Pre-bed rest data suggested that many markers of bone metabolism have strong genetic determinants. Treadmill exercise within LBNP had less of a protective effect on bone resorption during bed rest in women than previously published results had shown for its effect in men, but the same trends were observed for both sexes. Dietary acid load of these female subjects was significantly correlated with calcium excretion but not with other bone resorption markers.

Alkaline Phosphatase↗
PubMed2005

Effects of rest-duration, time-of-day and their interaction on periodic leg movements while awake in restless legs syndrome.

BACKGROUND AND PURPOSE: The diagnostic criteria for restless legs syndrome (RLS) indicate that both time-of-day and rest effects induce or aggravate symptoms. Periodic limb movements while awake (PLMW) provide an objective motor sign of RLS that can be measured during an awake suggested immobilization test (SIT). This study uses the SIT at different times of the day and analyzes time-of-day and duration-of-rest effects and their interaction on the PLMW. PATIENTS AND METHODS: Twenty-eight RLS patients who were not on medications had SIT tests at 10 pm, 8 am and 4 pm on two consecutive days. PLMW for each 20-min period were analyzed for time-of-day and rest effects and their interaction. PLMW increase from the first to last 20-min SIT period assessed the rest-effects. RESULTS: Significant effects were found for rest, time-of-day and rest-time-of-day interaction. The rest-effect increased most from morning to afternoon while total PLMW increased more from afternoon to night. Males compared to females had significantly more PLMW and a larger rest-effect change with time-of-day. CONCLUSIONS: Rest and time-of-day effects and their interaction all increase RLS symptoms. PLMW increase with rest may provide a sensitive measure of symptom severity.

Age Factors↗
PubMed2003

Resting behaviors of captive bottlenose dolphins (Tursiops truncatus).

In order to specify the resting behaviors in captive bottlenose dolphin, we quantitatively analyzed behavior of 16 dolphins in three aquariums in Japan. We observed their behaviors in the low-activity time (0 a.m.-3 a.m.), assuming that the resting behaviors would be most prominent and abundant at this time. We analyzed these behaviors based on the data of their diurnal activity rhythm that we have clarified by measuring swimming speed and breath frequency. The behavior patterns characteristic to the low-activity time could be categorized into the following three types: "bottom-rest" characterized by long immobile stay on the tank bottom, "surface-rest" characterized by long immobile stay at the water surface, and "swim-rest" characterized by slow circle-swim near the bottom along a fixed trajectory. During these behaviors, breath frequency was significantly lower than the daily mean and at least one eye tended to be closed. These three behaviors accounted for 86.6% of the total observation time in the low-activity time. The resting behaviors were often observed even in the high-activity time (0 p.m.-4 p.m.); these three behaviors accounted for 38.5% of the total observation time in the high-activity time. In swim-rest, frequency of sound emission was significantly lower than that of other behaviors with high-speed swimming, and both eyes or one eye, especially the eye facing the inner side of the swimming circle tended to be closed. The eye condition and the periodical change of circle-swim direction or position-exchange observed during swim-rest suggest a relation between this behavior and unihemispheric sleep. The change in the resting behavior observed in the dolphins under nervous situations suggests that the dolphins flexibly change the type and the quantity of the resting behaviors according to the situation.

Activity Cycles↗
PubMedDate not supplied

Combined analysis of resting regional wall thickening and stress perfusion with electrocardiographic-gated technetium 99m-labeled sestamibi single-photon emission computed tomography: prediction of stress defect reversibility.

BACKGROUND: The high photon flux and stable distribution of the myocardial perfusion agent 99mTc-labeled sestamibi allow the perfusion data to be acquired in an electrocardiographic (ECG)-gated mode, such that information on resting regional wall thickening may be obtained simultaneously with stress perfusion data. The objective of this study was to assess whether visual analysis of resting regional wall thickening provided by ECG-gated acquisition of 99mTc-labeled sestamibi stress perfusion images correlates with and predicts the reversibility of stress-induced perfusion defects, potentially obviating the need for rest imaging. METHODS AND RESULTS: Fifty-nine patients referred for myocardial perfusion imaging were studied with rest and stress single-photon emission computed tomographic (SPECT) sestamibi imaging, and the stress perfusion data were acquired in an ECG-gated mode. Visual analysis of the presence and reversibility of stress perfusion defects on standard imaging was correlated with the wall thickening data from the poststress gated SPECT images. Quantitative circumferential profile analysis of the short-axis images was performed to assess the influence of relative stress perfusion defect severity on the correlation between wall thickening and defect reversibility. Among the 72 segments with stress-induced perfusion defects and visually apparent wall thickening on ECG-gated SPECT images, 69 were reversible on rest imaging (positive predictive value of 96% for wall thickening to predict stress defect reversibility). Of the 35 segments with stress-induced defects and no apparent wall thickening on ECG-gated SPECT images, however, 14 (40%) demonstrated significant stress defect reversibility on rest imaging. This result represents a negative predictive value of only 60% for the lack of apparent wall thickening to predict correctly an irreversible stress defect. Among the segments with reversible stress perfusion defects and visually apparent wall thickening, relative stress sestamibi activity was higher (51% +/- 10% [percentage of peak]) than in segments with reversible stress defects and no visually apparent wall thickening (39% +/- 4% of peak activity [p < 0.0001]). CONCLUSIONS: Visual evidence of wall thickening by poststress ECG-gated SPECT sestamibi imaging in the territory of a stress-induced perfusion defect correlates highly with stress defect reversibility on rest imaging and may obviate the need to perform rest imaging, thereby potentially reducing the time and cost involved in myocardial perfusion imaging. The absence of visually apparent wall thickening, however, underestimates the prevalence of stress defect reversibility on rest imaging; in such instances, rest imaging must be performed to differentiate ischemia from infarction in the territory of a stress perfusion defect.

Adult↗
PubMedDate not supplied

Comparison of left ventricular function at rest and post-stress in patients with myocardial infarction: Evaluation with gated SPECT.

BACKGROUND: Quantitative electrocardiogram-gated single photon emission computed tomography (SPECT) myocardial imaging (QGS) is a means of providing functional information about the left ventricle and myocardial perfusion. However, the functional information derived 30 minutes post-stress may be different from the left ventricular (LV) function determined at rest. This study determined whether LV function post-stress would be different from LV function at rest in patients with an earlier myocardial infarction. METHODS AND RESULTS: LV perfusion and ejection fraction (LVEF), were determined by means of both the rest and post-stress acquisition in 58 patients with an earlier myocardial infarction and in 23 patients with a low likelihood of coronary artery disease by using technetium-99m tetrofosmin and the QGS program. The interobserver and intraobserver variability of LVEF was excellent, within a margin of 2%. No significant differences in LVEF were observed between post-stress and rest in the 23 patients with a low likelihood of disease (DeltaLVEF, 0.04% +/- 3.2%, P = not significant). Conversely, the patients with an earlier myocardial infarction showed a significantly lower LVEF post-stress, compared with that at rest (DeltaLVEF, -1.9% +/- 4.2%, P =.002). In 33 patients (57%), the LVEF post-stress was 2% or more lower than the LVEF at rest. Furthermore, reversible ischemia, which was present in 16 patients (28%), did not interact with the DeltaLVEF post-stress, compared with the DeltaLVEF at rest (P = not significant). Parameters such as the stress modality (adenosine stress or exercise), the number of stenosed vessels, or the perfusion defect severity score did not influence the DeltaLVEF post-stress, compared with the DeltaLVEF at rest. CONCLUSIONS: In patients with an earlier myocardial infarction, LV function post-stress may not represent the true resting LV function. Consequently, this result justifies the stratification of patients before starting the gated SPECT study. In patients with an earlier myocardial infarction, the gated acquisition should be performed during the rest study.

Adenosine↗
PubMed2005

The effects of work-rest duration on intermittent exercise and subsequent performance.

This study examined the effects of different work - rest durations during 40 min intermittent treadmill exercise and subsequent running performance. Eight males (mean +/- s: age 24.3 +/- 2.0 years, body mass 79.4 +/- 7.0 kg, height 1.77 +/- 0.05 m) undertook intermittent exercise involving repeated sprints at 120% of the speed at which maximal oxygen uptake (nu-VO2max) was attained with passive recovery between each one. The work - rest ratio was constant at 1:1.5 with trials involving short (6:9 s), medium (12:18 s) or long (24:36 s) work - rest durations. Each trial was followed by a performance run to volitional exhaustion at 150% nu-VO2max. After 40 min, mean exercise intensity was greater during the long (68.4 +/- 9.3%) than the short work - rest trial (54.9 +/- 8.1% VO2max; P < 0.05). Blood lactate concentration at 10 min was higher in the long and medium than in the short work - rest trial (6.1 +/- 0.8, 5.2 +/- 0.9, 4.5 +/- 1.3 mmol x l(-1), respectively; P < 0.05). The respiratory exchange ratio was consistently higher during the long than during the medium and short work - rest trials (P < 0.05). Plasma glucose concentration was higher in the long and medium than in the short work - rest trial after 40 min of exercise (5.6 +/- 0.1, 6.6 +/- 0.2 and 5.3 +/- 0.5 mmol x l(-1), respectively; P < 0.05). No differences were observed between trials for performance time (72.7 +/- 14.9, 63.2 +/- 13.2, 57.6 +/- 13.5 s for the short, medium and long work - rest trial, respectively; P = 0.17), although a relationship between performance time and 40 min plasma glucose was observed (P < 0.05). The results show that 40 min of intermittent exercise involving long and medium work - rest durations elicits greater physiological strain and carbohydrate utilization than the same amount of intermittent exercise undertaken with a short work-rest duration.

Adult↗
PubMed1994

Maintenance of euglycemia is impaired in gluconeogenesis-inhibited iron-deficient rats at rest and during exercise.

To evaluate the hypothesis that mild iron deficiency increases dependence upon gluconeogenesis, control and mildly iron-deficient (Hb = 80 +/- 2 g/L) rats were injected with mercaptopicolinic acid (MPA), a known inhibitor of gluconeogenesis, or with injection vehicle (sham) and studied at rest or after 30 min of treadmill running (13.4 m/min, 0% grade). Liver glycogen concentration was lower in resting iron-deficient rats than in resting control rats, but iron deficiency did not influence arterial substrates or hormones in sham-treated rats. Glucose and insulin concentrations were less in resting control and iron-deficient MPA-treated rats than in sham-treated animals. However, arterial lactate was greater in resting iron-deficient MPA-treated rats than control MPA-treated animals, and glucagon and epinephrine were greater in resting iron-deficient MPA-treated rats than in iron-deficient sham-treated animals, indicating that gluconeogenesis is more important to maintenance of euglycemia in resting iron-deficient animals than in controls. Moderate exercise stimulated glucose metabolism in iron-deficient rats, as evidenced by the lower arterial glucose and higher arterial lactate when compared with resting iron-deficient rats. However, MPA treatment did not clearly establish differences between iron-deficient and control rats after exercise. Therefore, changes in substrate and hormone concentrations in resting iron-deficient MPA-treated rats indicate that dependence on gluconeogenesis for maintenance of euglycemia is greater at rest with dietary iron deficiency. Furthermore, consistent with previously published results for severely iron-deficient rats, results from the present investigation indicate that dependence on glucose metabolism is greater during moderate exercise in mildly iron-deficient rats.

Animals↗
PubMed2003

The influence of resting periods on friction in the artificial hip.

Insufficient tribologic performance of total joint components is a major cause of prostheses failure. Wear has been studied intensively using testing machines that apply continuous motions. Human locomotion, however, is not well represented by continuous motions alone. Singular events and resting periods are a substantial part of daily activities. Resting does influence adhesion in the artificial joint with possible effects on friction, wear, and loosening. The current study evaluated the effects of resting on the frictional properties of hip prosthesis components. The activity measurements of 32 patients with artificial hip replacements were analyzed for resting durations of the hip. A pin-on-ball screening device was used to determine friction after characteristic resting periods and during continuous oscillating motion. All common articulation pairings were investigated. Prolonged and frequent resting periods of the hip were found for the patients. Initial friction increased with increasing resting duration for all tested materials (between 41% and 191%). The metal-on-metal articulations showed the highest friction level (0.098 for sliding) and the highest increase (191%) in friction with resting duration (0.285 after resting periods of 60 seconds). A high static frictional moment after resting periods might present a risk for aseptic implant loosening. Therefore, large head diameters of metal-on-metal joints should be used with caution, especially when additional unfavorable risk factors such as obesity, weak bone-implant interface, or high activity level are present.

Aged↗
PubMed2003

Voice rest after microlaryngoscopy: current opinion and practice.

OBJECTIVE: Although voice rest is often recommended after excision of benign mucosal vocal fold lesions, no standard of care exists regarding the use, duration, or extent of vocal restrictions. This prospective study is intended to explore current opinions and practices of otolaryngologists regarding the use of complete and relative voice rest. STUDY DESIGN AND METHODS: A 16-item survey was mailed to all active U.S. members of the American Academy of Otolaryngology-Head and Neck Surgery (n = 7,321) regarding use of complete and relative voice rest after surgical excision of vocal fold nodules, polyps, and cysts. Treatment preference questions used a Likert 5-point scale with end anchors of 1 equaling "never" and 5 equaling "always". RESULTS: The response rate was 16.5% (1,208 respondents). Differences by lesion type were not statistically significant, suggesting that surgeons consider the mucosal disruption resulting from the surgery to be similar across lesions. Approximately 51.4% (620) favored complete voice rest. Approximately 62.3% (753) favored relative voice rest. Approximately 18% (213) of the respondents who "always" recommend complete rest also "always" recommend relative rest. The most common duration for both types of rest is 7 days. CONCLUSIONS: There is a clear preference for the use of voice rest, but the specific type (complete or relative) is controversial, and a notable percentage of respondents (15%) do not favor any type of voice rest. It is likely that the lack of uniformity of opinions and practices reflects the absence of empirical data. Prospective clinical trials are needed to guide clinical standards of care.

Attitude of Health Personnel↗
PubMed1997

Classics from the spine literature revisited: a randomized trial of 2 versus 7 days of recommended bed rest for acute low back pain.

STUDY DESIGN: Review of a trial of bed rest for patients with acute low back pain. OBJECTIVES: To assess the validity and results of the study, and their applicability to and influence on current clinical practice and recommendations. SUMMARY OF BACKGROUND DATA: Although bed rest has been a cornerstone of treatment for acute low back pain, historically this recommendation was largely based on "expert opinion." In 1986, Deyo et al. published a randomized study of 2 versus 7 days of recommended bed rest for acute low back pain. Despite results from this and other studies, current clinical practice and treatment recommendations continue to overemphasize bed rest. METHODS: The study was reviewed using structured criteria adopted from the medical literature that focus on the validity of the study design, the results of the treatment, and the relevance of the findings to clinical practice. RESULTS: Two hundred and three patients were randomized to 2 versus 7 days of recommended bed rest. Groups were similar at baseline evaluation. Outcomes assessed at 3 and 12 weeks were similar between groups, except that patients receiving a recommendation for 2 days of bed rest had significantly fewer days of work absence than those recommended 7 days. Limitations of the study included poor compliance with recommended bed rest, especially in the 7-day group, a marginal sample size without information on relevant confidence intervals, and patient characteristics that may have affected the generalizability of these findings to others with acute low back pain. CONCLUSIONS: Despite limitations, this study provided strong evidence that less bed rest was associated with similar outcomes for acute low back pain along with quicker return to work. Results from this and other studies support a shift away from bed rest as a primary recommendation in the initial management of low back pain. In spite of this, bed rest recommendations for episodes of low back pain remain common. Additional efforts are needed to change clinical practice.

Absenteeism↗
PubMed1995

Post-rest potentiation and its decay after inotropic interventions in isolated rat heart muscle.

The effects of various inotropic interventions on post-rest potentiation and its decay were investigated in isolated cardiac muscle. The inotropic interventions studied were: reduced extracellular Na+ and elevated extracellular Ca2+ concentration; exposure to ouabain, monensin, isoprenaline, phenylephrine and cirazoline. Force of contraction (stimulation frequency 2 Hz) was measured isometrically in left atria and right ventricular strips of rat hearts. Maximum post-rest potentiation was reached after 10 sec. of rest and amounted to 245 +/- 26% of pre-rest control in ventricle and 192 +/- 15% in atria. Ca(2+)-recirculation fraction was calculated from the decay of post-rest potentiation after resumption of regular stimulation, it was 0.77 +/- 0.01 in 11 control ventricular strips. High concentrations of caffeine (3 mmol/l) completely abolished post-rest potentiation in both tissues. The development of post-rest potentiation was accelerated in the presence of most of the inotropic agents. However, with the exception of ouabain and only in atrial muscle, none of the inotropic interventions produced higher post-rest contraction amplitudes than during controls. In rat heart muscle, the inotropic interventions studied are not any more effective in augmenting force of contraction than prolonged stimulation intervals. This suggests that (1) the distribution of Ca2+ into the sarcoplasmic reticulum is at a maximum during post-rest potentiation; (2) modifications of signal transduction pathways cannot further increase post-rest potentiation; and therefore that (3) shifts in Ca2+ distribution act as a limiting factor.

Animals↗