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PubMed2005

[Obesity and osteoporosis].

Atherosclerosis is a chronic inflammatory disease associated with an elevation of inflammatory markers such as CRP -- a robust predictor of cardiovascular events. Inflammation also plays a pivotal role in the pathogenesis of osteoporosis. IL-6 proved to be the most important predictor of bone loss in the proximal femur. Adipocyte-produced inflammatory cytokines are the pathogenetic link between obesity and its metabolic consequences. The different components of the metabolic syndrome are at the same time well-established risk factors for osteoporosis. Physical training, weight loss, and a Mediterranean-style diet all have a proven cytokine-lowering effect. Contrary to muscle mass, adipose tissue if at all contributes only marginally to the preservation of bone. As a consequence, increasing lean body mass while reducing fat mass seems to be the most effective way to prevent both atherosclerosis and osteoporosis.

Arteriosclerosis↗
PubMed2000

Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees.

We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0 degrees to at least 135 degrees) was found in 436 knees (98%), and mild losses of extension (-5 degrees) were found in 7 knees. Twenty-three knees (5%) required interventions; 9 had extension casts, 9 had gentle manipulations under anesthesia, 3 had arthroscopic debridements, and 2 had continuous epidural anesthetic and inpatient therapy. All of these 23 knees regained full motion. The 7 patients with mild losses of extension had refused treatment intervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% reoperation rate for knee motion limitations, demonstrated the effectiveness of our program.

Adolescent↗
PubMed2003

Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy.

Treatment of urinary stress incontinence (USI) by intravaginal electrical stimulation (IES) and pelvic floor physiotherapy represents an alternative to other therapies. The purpose of this work was to evaluate the effectiveness of this treatment inpatients with urinary incontinence. From January 1998 to May 2000, 30 women (mean age 54 years) were studied. All patients had USI and 70% urge incontinence; average follow-up was 7 months. Selection criteria were based on clinical history, objective evaluation of perineal musculature by perineometry, and urodynamics. The treatment protocol consisted of three sessions of IES per week for 14 weeks using INNOVA equipment. Physiotherapy was initiated in the fifth week of IES. A significant decrease in the number of micturitions and urgency was observed after treatment ( P<0.01). The pad test showed a reduction in urinary leakage from 13.9 to 5.9 g after treatment ( P<0.01). Objective evaluation of perineal muscle strength showed a significant improvement in all patients after treatment ( P<0.01). A positive correlation was observed between maximum flow rate (Qmax) and all three variables: urethral pressure profile at rest and on straining (stop test), and abdominal leak-point pressure (ALPP). A positive correlation was also observed between ALPP and the stop test. Over 100 different surgical and conservative treatments have been tried to manage USI. The majority of these procedures reveal that despite progress already made in this area, there is no ideal treatment. Satisfactory results can be achieved with this method, especially with patients who are reluctant to undergo surgery because of personal or clinical problems.

Electric Stimulation Therapy↗
PubMed2005

Learning outcomes of a group behavioral modification program to prevent urinary incontinence.

This study describes acquisition of knowledge and motor skill in bladder training (BT) and pelvic floor muscle training (PFMT) and adherence following a behavioral modification program (BMP). Essentially continent (0-5 episodes in past year) community-dwelling older women (n = 359) were randomized to treatment (n = 164), a 2-h group education session supplemented by one brief individualized session of approximately 10 min, or control (n = 195), no instruction, and followed for 12 months. Knowledge, motor skill, and adherence to the BMP were documented. Changes in pelvic muscle function and voiding interval were used to validate self-reported adherence. Following group instruction, mean BT and PFMT knowledge was 90 and 86%, respectively; 68% demonstrated correct PFMT technique without additional instruction, 29% required brief instruction, and 3% were unable to learn PFMT technique. Adherence ranged from 63 to 82% for PFMT and 58 to 67% for BT. Group instruction supplemented with brief individual instruction as needed is an effective teaching method for BT and PFMT.

Aged↗
PubMed2001

Urge incontinence and detrusor instability.

Detrusor instability is a syndrome of urinary frequency, urgency and urge incontinence which can be demonstrated using urodynamic studies to document uninhibited bladder contractions. Idiopathic cases account for 90% and 10% are related to neurologic disorders. Several different treatment modalities are available, including bladder training/drill, electrical stimulation, medical and surgical therapies.

Diagnosis, Differential↗
PubMed2005

Home-based resistance training improves femoral bone mineral density in women on hormone therapy.

This study tested whether moderate resistance training would improve femoral bone mineral density (BMD) in long-term users of hormone therapy with low BMD. The study was a 2-year randomized, controlled, trial (RCT) of moderate resistance training of either the lower extremity or the upper extremity. Eighty-five women participated in a 6-month observation period. The setting was center-based and home-based training. The participants were 189 women aged 59-78 years, with total femur T-scores from -0.8 to -2.8 and on hormone therapy (HT) for a minimum of 2 years (mean 11.8 years); 153 completed the trial. Lower extremity training used weight belts (mean 7.8 kg) in step-ups and chair rises; upper extremity training used elastic bands and dumbbells. Measurements were BMD and body composition [dual-energy X-ray absorptiometry (DXA)], bone turnover markers. Total femoral BMD showed a downward trend during the observation period: 0.35%+/-0.18% (P=0.14). The response to training was similar in the upper and lower groups in the primary outcomes. At 2 years, total femoral BMD increased 1.5% (95% CI 0.8%-2.2%) in the lower group and 1.8% (95% CI 1.1%-2.5%) in the upper group. Trochanter BMD increased 2.4% (95% CI 1.3%-3.5%) in the lower group and 2.5% (95% CI 1.4%-3.6%) in the upper group (for both analyses time effect P<0.001). At 1 year, a bone resorption marker (C-telopeptide) decreased 9% (P=0.04). Bone formation markers, bone-specific alkaline phosphatase, decreased 5% (P<0.001), and N-terminal type I procollagen peptide decreased 7% (P=0.01). Body composition (percent lean and percent body fat) was maintained in both groups. We concluded that long-term moderate resistance training reversed bone loss, decreased bone turnover, increased femur BMD, and maintained body composition. The similarity of response in upper and lower groups supports a systemic response rather than a site-specific response to moderate resistance training.

Aged↗
PubMed2004

Transfer of resistance training to enhance rapid coordinated force production by older adults.

The purpose of this study was to examine the capacity of resistance training to enhance the rapid and coordinated production of force by older people. Thirty adults (> or =60 years) completed a visually guided aiming task that required the generation of isometric torque in 2 df about the elbow prior to and following a 4-week training period. Groups of six participants were allocated to two progressive (40-100% maximal voluntary contraction (MVC)) resistance-training (PRT) groups, to two constant low-load (10% MVC) training groups (CLO) and to one no-training control group. Training movements required the generation of either combined flexion and supination (FLESUP), or combined extension and supination (EXTSUP). In response to training, target acquisition times in the aiming task decreased for all groups; however, both the nature of the training load and the training movement influenced the pattern and magnitude of improvements (EXTSUP_CLO: 36%, FLESUP_PRT 26%, EXTSUP_PRT 22%, FLESUP_CLO 20%, CONTROL 15%). For one group that trained with progressively increasing loads, there arose a subsequent decrease in performance in one condition of the transfer task. For each group, these adaptations were accompanied by systematic changes in the coordination of muscles about the elbow joint, particularly the biceps brachii.

Adaptation, Physiological↗
PubMed2005

Sympathetic skin responses in reflex sympathetic dystrophy.

This study was performed to determine the utility of sympathetic skin response (SSR) in evaluating the sympathetic function and to follow up the effects of sympathetic blockade in reflex sympathetic dystrophy (RSD). Thirty patients having RSD with upper extremity involvement were randomly divided into two groups. Besides medical therapy and exercise, physical therapy agents were applied to both the groups. In addition to this treatment protocol, stellar ganglion blockade was done by diadynamic current in Group II. The normal sides of the patients were used for the control group. SSRs were measured in all the patients before and after the therapy. The amplitude was found to be increased and the latency was found to be decreased in the affected side in both the groups before the therapy. After the therapy, the amplitude was decreased and latency was increased in both the groups. But, the differences in amplitude (P = 0.001) and latency (P = 0.002) before and after the therapy were significantly higher in Group II. (Before the treatment, SSRs were significantly different between the normal and the affected sides in both the groups. The observed change in SSRs after the treatment was higher in Group II.) It was concluded that, SSR can be a useful and noninvasive method in diagnosing the sympathetic dysfunction in RSD and can be used for evaluating the response to sympathetic blockade and other treatment modalities.

Adult↗
PubMed2006

Hysterical paralysis.

Hysterical paralysis is an uncommon type of conversion disorder. It can be difficult to diagnose. In cases in which symptoms are difficult to explain neuroanatomically or are functionally inconsistent, hysteria should enter into the differential diagnosis. We report a case of hysterical paralysis that had rapid improvement using physical therapy and antidepressant therapy.

Adult↗
PubMed2005

[The concept of frailty--from phenomenology to therapeutic approaches].

Frailty--the weakness of many (oldest) old persons--induces a lot of human sorrow with functional disabilities as well as health-economic costs. Sarcopenia (loss of muscle mass) is also a form of frailty and a co-factor of two of the "geriatric Is"--immobility and instability. Pathophysiologically, both phenomena show signs of an inflammatory state. Physical activity and a healthy diet can partially reverse these health problems. Therefore, therapeutic strategies emerge to treat these frequent and clinically relevant phenomena.

Aged↗
PubMed2003

Long-term effects of a maintenance program after supervised or self-monitored training programs in patients with COPD.

The evaluation of a 13-month maintenance program (MP) for 39 severe COPD patients with FEV(1)%pred 44(7)% who, as result of two different 8-week leg exercise training (LET) programs, one supervised at the hospital (group S; n = 20) and the other self-monitored (SM; n = 19), had achieved different levels of exercise tolerance. After LET, patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group [ O(2)max 1.43(0.30) l. min(-1)] vs l.25(0.27) l. min(-1) and endurance-time 16(4) min vs 12 (5) min, respectively). During the MP patients were advised to walk vigorously at least 4 km/day, 4 times/wk. After the MP, while endurance time remained higher than at baseline, it had decreased ( p < 0.01) immediately after LET in both groups and no differences were evident between groups (11(4) min and 10(4), respectively). In contrast, Chronic Respiratory Diseases Questionnaire scores, which had improved significantly after LET in both groups, remained high. Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET. SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance, though "quality of life" can be maintained.

Exercise Therapy↗
PubMed2002

Training improves muscle oxidative capacity and oxygenation recovery kinetics in patients with chronic obstructive pulmonary disease.

We studied 21 patients with chronic obstructive pulmonary disease aged [mean (SD)] 63 (10) years, with a mean forced expiratory volume in 1 s of 40 (6)% and a peak oxygen uptake of 67 (11)% of predicted values. Patients trained for 6 weeks on a cycle ergometer at high work-rates (WR). Near-infrared spectroscopy was used to obtain the time-constant of the deoxygenation recovery signal (tauHbO(2)) during three constant WR exercise tests, one below and two above the lactic acidosis threshold (theta(L)). Glycolytic and oxidative enzymes and lactate concentrations were assessed in muscle biopsies. The tauHbO(2) decreased significantly in all three constant WR tests: -18 (24)s, -20 (23) s and -13 (22) s, respectively. Endurance time increased in the higher WR tests, by 5.7 (4.8) min and 3.6 (2.7) min, respectively. The activity of citrate-synthase (CS) and creatine-kinase changed significantly from 20 (10) to 30 (13) micro mol x min(-1) x g(-1)and from 3.825 (950) to 3.402 (526) micro mol x min(-1) x g(-1), respectively. Training also improved significantly the mean response time of the on-transient of oxygen uptake (tau'VO(2)) of the below-theta(L) test. We found significant correlations between changes in CS and changes in tauHbO(2), tau'VO(2) and endurance time. We conclude that leg training accelerates the speed of re-oxygenation of the vastus lateralis muscle after exercise. This improvement is correlated to changes in the oxidative enzymes.

Adaptation, Physiological↗
PubMed2003

The effect of previous weight training and concurrent weight training on endurance for functional electrical stimulation cycle ergometry.

Forty-five paraplegic subjects participated in three series of experiments to examine the interrelationships between previous weight training, concurrent weight training and muscle strength and endurance during cycle ergometry elicited by functional electrical stimulation (FES). When subjects only underwent isokinetic weight training (series 1) three times per week on the quadriceps, hamstring and gluteus maximus groups for 12 weeks, strength increased linearly with time for all three muscle groups from an initial average of 17 N to 269 N at the end of training, a 15-fold increase. In the second series of experiments, different groups of subjects either underwent no strength training prior to cycle ergometry or underwent strength training of these same three muscle groups for 2 weeks, four weeks, or 6 weeks prior to cycle ergometry. Any strength training was effective in increasing endurance for cycle ergometry. However, the rate of increase in endurance during cycle ergometry with no prior strength training was only 5 min per week, whereas the rate of increase in cycle endurance during ergometry was 14.6, 25.0, and 33.3 min per week increase in endurance after strength training for 2.4 and 6 weeks, respectively. When weight training was accomplished during FES cycle ergometry (concurrently) in a third series of experiments, there was an additional increase in endurance during cycling if strength training was concurrently accomplished. With no weight training, endurance increased 23 min per week, whereas with concurrent weight training at three times per week, endurance increased during cycling by 41.6 min per week. The results of these experiments seem to show a clear advantage of weight training concurrently and before FES cycle ergometry. Results are given as mean (SD).

Adult↗
PubMed2004

Oxygen uptake kinetics and maximal aerobic power are unaffected by inspiratory muscle training in healthy subjects where time to exhaustion is extended.

The aim of this study was to determine whether 4 weeks of inspiratory muscle training (IMT) would be accompanied by alteration in cardiopulmonary fitness as assessed through moderate intensity oxygen uptake (V(.)O(2)) kinetics and maximal aerobic power (V(.)O(2max)). Eighteen healthy males agreed to participate in the study [training group (Tra) n=10, control group (Con) n=8]. Measurements of spirometry and maximal static inspiratory mouth pressure ( PI(max)) were taken pre- and post-training in addition to: (1) an incremental test to volitional exhaustion, (2) three square-wave transitions from walking to running at a moderate intensity (80% ventilatory threshold) and (3) a maximal aerobic constant-load running test to volitional fatigue for the determination of time to exhaustion ( T(lim)). Training was performed using an inspiratory muscle trainer (Powerbreathe). There were no significant differences in spirometry either between the two groups or when comparing the post- to pre-training results within each group. Mean PI(max) increased significantly in Tra ( P<0.01) and showed a trend for improvement ( P<0.08) in Con. Post-training T(lim) was significantly extended in both Tra [232.4 (22.8) s and 242.8 (20.1) s] ( P<0.01) and Con [224.5 (19.6) and 233.5 (12.7) s] ( P<0.05). Post-training T(lim) was significantly extended in Tra compared to Con ( P<0.05). In conclusion, the most plausible explanation for the stability in V(.)O(2) kinetics and V(.)O(2max) following IMT is that it is due to insufficient whole-body stress to elicit either central or peripheral cardiopulmonary adaptation. The extension of post-training T(lim) suggests that IMT might be useful as a stratagem for producing greater volumes of endurance work at high ventilatory loads, which in turn could improve cardiopulmonary fitness.

Adaptation, Physiological↗
PubMed2005

High versus low training frequency in cardiac rehabilitation using a systems model of training.

No study has reported the long term effects of cardiac rehabilitation, concerning the duration of beneficial effects of training program. The present study analyzed the influence of training session frequency on long-term beneficial effects in patients with coronary artery disease (CAD) undergoing phase 2 cardiac rehabilitation. Four patients with CAD completed 20 training sessions. Two patients were assigned to low training frequency (LTF) and two to high training frequency (HTF): three and five sessions per week(-1), respectively. The method was based on the systems model of training and required training quantification and the assessment of real exercise tolerance. Convolution of training quantity with real exercise tolerance provided the model exercise tolerance for every patient. The model parameters, the magnitude factor (k), and the time constant of decay (tau), were fitted from real and model exercise tolerances by the least squares method. LTF and HTF resulted in similar increases in exercise tolerance (12-14%). A model with one-component (fitness) allowed fitting exercise tolerance in all patients with r (2) = 0.77, 0.79, 0.84, and 0.91, respectively (p < 0.05). The addition of a second component did not improve the fit in any patient (p > 0.05). The k value was about twice as high with LTF (0.13 and 0.16 AU) than with HTF (0.05 AU for the two patients), whereas the tau value was about twice as low with LTF (37 and 41 days) than with HTF (72 and 89 days). The long term beneficial effects estimated by 4tau, were twice as long with HTF (288 and 356 days) than with LTF (148 and 164 days). We concluded that exercise tolerance was similarly increased with HTF and LTF but HTF training induced beneficial effects which were sustained twice as long.

Adaptation, Physiological↗
PubMed2001

Treatment of low back pain: myths and facts.

QUESTION: Which are the most effective treatments for acute and chronic low back pain? METHODS: Systematic reviews were conducted including identification and selection of relevant trials, assessment of the methodological quality, data extraction (study populations, interventions, and outcomes), and data analysis. RESULTS: acute low back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants relieve pain more than placebo; advice to stay active speeds up recovery and reduces chronic disability; bed rest and specific back exercises are not effective. RESULTS: chronic low back pain. Exercise therapy, back schools, behavioral therapy, and multidisciplinary programs are effective. CONCLUSIONS: Scientific evidence shows that an active approach to low back pain patients is effective.

Acute Disease↗