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At least 1,495 records · Page 83Linked to original sources
PubMed1999

Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database.

OBJECTIVE: To establish isometric endurance holding times, as well as ratios between torso extensors, flexors, and lateral flexors (stabilizers), for clinical assessment and rehabilitation targets. DESIGN: Simple measurement of endurance times in four tests performed in random order by a healthy cohort. To measure reliability, a subsample also performed the tests again 8 weeks later. SETTING: University laboratory. PARTICIPANTS: Seventy-five young healthy subjects (31 men, 44 women). RESULTS: Women had longer endurance times than men for torso extension, but not for torso flexion or for the "side bridge" exercise, which challenges the lateral flexors (stabilizers). Men could sustain the "side bridge" for 65% of their extensor time and 99% of their flexion time, whereas women could sustain the "side bridge" for only 39% of their extensor time and 79% of their flexion time. The tests proved reliable, with reliability coefficients of >.97 for the repeated tests on 5 consecutive days and again 8 weeks later. CONCLUSION: Healthy young men and women possess different endurance profiles for the spine stabilizing musculature. Given the growing support for quantification of endurance, these data of endurance times and their ratios between extensor, flexor, and lateral flexor groups in healthy normal subjects are useful for patient evaluation and for providing clinical training targets.

Adult↗
PubMed1999

Moderate-intensity exercise training with elements of step aerobics in patients with severe chronic heart failure.

OBJECTIVE: To evaluate whether a specific program of moderate-intensity step aerobics training may be sufficient to improve the exercise tolerance of patients with severe chronic heart failure. PATIENTS: Twenty-six patients (22 men, 4 women; mean +/- SD age, 54 +/- 9yrs) with a history of severe chronic heart failure (left ventricular ejection fraction of 18% +/- 8%). STUDY DESIGN: Prospective, randomized, controlled trial. Patients were randomized into exercise and control groups. All patients underwent a clinical examination and a ramp pattern cycle exercise test before and after the observation period. The exercise group underwent a moderate-intensity (50% of peak oxygen uptake) 12-week training program, progressing to 100 minutes per week of step aerobics and 50 minutes per week of cycling. The control group did not perform a training program. MAIN OUTCOME MEASURES: Peak oxygen uptake, peak workload, percent of predicted power ability. RESULTS: Significant increases in peak oxygen uptake (15 +/- 3.4 to 18.5 +/- 2.9mL/kg/min; p = .001), peak workload (77 +/- 26 to 99 +/- 31 watts; p = .000), and percent of predicted power ability (43% +/- 10% to 56% +/- 13%; p = .000) were observed in the exercise group. No significant changes in baseline parameters occurred in the control group. There were no critical changes in heart rate or blood pressure in either group. CONCLUSION: Moderate-intensity step aerobics training significantly increases peak oxygen uptake and peak workloads in patients with severe chronic heart failure.

Aged↗
PubMed2006

Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch?

The aim of this study was to determine whether an intensive stretch program increases muscle extensibility or subjects' tolerance to an uncomfortable stretch sensation. Twenty healthy able-bodied individuals with limited hamstring muscle extensibility were recruited. A within-subjects design was used whereby one leg of each subject was randomly allocated to the experimental condition and the other leg was allocated to the control condition. The hamstring muscles of each subject's experimental leg were stretched for 20 minutes each weekday for four weeks. Hamstring muscle extensibility (angle of hip flexion corresponding with a standardised torque) and stretch tolerance (angle of hip flexion corresponding with maximal torque tolerated) were assessed on both legs at the beginning and end of the study. The intervention did not increase the extensibility of the hamstring muscles (mean change in hip flexion was -1 degree, 95% CI -4 to 3 degrees) but did increase subjects' tolerance to an uncomfortable stretch sensation (mean change in hip flexion was 8 degrees, 95% CI 5 to 12 degrees). These results highlight the importance of distinguishing between real and apparent increases in muscle extensibility when assessing the effectiveness of stretch, and indicate that whilst a four-week stretch program increases subjects' tolerance to an uncomfortable stretch sensation it does not increase hamstring muscle extensibility.

Adult↗
PubMed2002

Combined physiotherapy and education is efficacious for chronic low back pain.

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

Adult↗
PubMed1999

Is physical activity as effective in reducing risk of cardiovascular disease as estrogen replacement therapy in postmenopausal women?

Coronary heart disease (CHD) is known as a disease of postmenopausal women. While hormone replacement therapy is recommended increasingly to postmenopausal women for the prevention of CHD, the potential impact of non-pharmacologic interventions on cardiovascular disease reduction has been largely unexplored. The purpose of this article is to develop the understanding of the research literature on three risk factors by which estrogen and physical activity, a non-pharmacologic intervention, may confer cardiovascular protection in postmenopausal women. Three risk factors are lipoproteins, systolic pressure, and changes in the vascular endothelial functions. Effects of estrogen and physical activity on these biological factors are compared.

Cardiovascular Diseases↗
PubMed2001

Posterior instability.

Posterior shoulder instability is a pathology that is increasingly seen in athletes. Excessive capsular laxity was originally proposed as the key component. Recent cadaveric and arthroscopic work has identified the importance of glenolabral integrity and glenoid depth in maintaining glenohumeral stability. Arthroscopic techniques to treat posterior instability are emerging. Until recently, reports of arthroscopic reconstruction focused entirely on capsular glenohumeral stability by altering two separate mechanisms: deepening of the glenoid concavity and reducing the capsular joint volume. This is accomplished by shifting the capsule to buttress the glenoid labrum. Thus increasing capsular tension increases the resultant compressive force vector into a deepened glenolabral concavity that, when combined together, enhances glenohumeral stability. In clinical and laboratory settings, we have shown that posteroinferior shoulder instability is associated with both capsular laxity and well-defined pathological lesions of the glenolabral concavity. Our results indicate that arthroscopic posterior capsulolabral repair and augmentation is a useful tool to restore the depth of the glenolabral concavity and to reduce the redundant posteroinferior capsule. This technique is effective in treating posteroinferior instability.

Adult↗
PubMed2001

Monopolar radiofrequency energy for arthroscopic treatment of shoulder instability in the athlete.

Monopolar radiofrequency energy is increasingly being used in the treatment of shoulder instability. Basic science studies and early clinical results have shown that application of thermal energy can result in successful shrinkage of the shoulder capsule. This procedure is useful in treating certain traumatic and recurrent instability conditions of the shoulder especially in the athlete where range of motion is preserved, recovery is faster than with open procedures, and there, is little disruption or alteration of inherent anatomy. The procedure is technically easy to perform, and the complication rate is low. Success, however, depends on proper patient selection, attention to the rehabilitation program, and patient compliance. Long-term follow-up will be necessary to determine if results for this procedure will deteriorate over time, especially in patients with multidirectional instability.

Arthroscopy↗
PubMedDate not supplied

Exercise intolerance in patients with chronic heart failure.

Patients with chronic heart failure (CHF) experience significant morbidity because of dyspnea and fatigue with activities of daily living. Although central hemodynamic abnormalities are the hallmark of this disorder, investigators have not shown a relationship between left ventricular ejection fraction or exercise pulmonary capillary wedge pressure and exercise intolerance in this disorder. Recent studies have focused on the contributions of pulmonary abnormalities and alterations in peripheral vasomotor control and skeletal muscle in exercise intolerance in this disorder. Early anaerobic metabolism occurs in patients with CHF and appears to be caused by a combination of reduced skeletal muscle blood flow and decreased aerobic enzyme content in skeletal muscle. Atrophy in skeletal muscle and alterations in skeletal muscle fiber typing are accompanied by alterations in contractile function in skeletal muscle. These results suggest that exercise intolerance in patients with CHF is multifactorial, and that research efforts must consider central hemodynamic abnormalities, pulmonary abnormalities, and alterations in peripheral blood flow and skeletal muscle biochemistry and histology. The present review will explore current research in this area and develop a model for understanding exercise intolerance in CHF.

Chronic Disease↗
PubMedDate not supplied

Exercise training in heart failure.

Patients with heart failure challenge the clinician with a constellation of difficult clinical, pathophysiologic, and psychologic issues. As a result, until recently, exercise training was not considered a safe and effective treatment strategy to be used in these patients. However, in the past 10 years, data from both randomized and nonrandomized trials showed that regular exercise training in patients with stable Class II and III heart failure can safely improve exercise tolerance, attenuate an overactivated sympathetic nervous system, partially reverse skeletal muscle abnormalities, and enhance health-related quality of life. These outcomes are achievable with a relatively moderate dose of physical activity, such as 30 to 60 minutes of walking or cycling 3 to 5 days per week at an intensity equivalent to 60% to 70% of peak oxygen consumption. Sufficiently powered trials are needed to assess morbidity, mortality, and cost-effectiveness endpoints relative to exercise training in patients with heart failure.

Cardiac Output↗
PubMed1994

Randomised controlled trial of respiratory rehabilitation.

Disability associated with chronic obstructive pulmonary disease has led to the development of rehabilitation programmes that aim to increase exercise tolerance and improve quality of life. Many reports of the benefits of rehabilitation have been from uncontrolled trials and unsupervised programmes. In view of the commitment asked of patients, their families, and health-care professionals, rehabilitation should be justified by a demonstration of sustained improvement over conventional treatment. We undertook a prospective randomised controlled trial of respiratory rehabilitation in 89 subjects (44 men, 45 women) aged 66 (SD 7) years with severe but stable chronic obstructive pulmonary disease who received rehabilitation or conventional community care. The treatment group were rehabilitated as inpatients for 8 weeks and supervised as outpatients for 16 weeks. Primary outcome measures of exercise tolerance and quality of life were made at baseline and repeated at 12, 18, and 24 weeks. The difference between baseline and last follow-up was significant for 6 min walk distance (37.9 m [95% CI 10.8-65.0], p = 0.0067) and submaximal cycle time (4.7 min [2.1-7.3]). There were also significant differences in questionnaire assessment of dyspnoea (p = 0.0061), emotional function (p = 0.0150), mastery (p = 0.0002), and dyspnoea index (p = 0.0053). Improvements in exercise tolerance and quality of life can be achieved and sustained for 6 months in patients undergoing respiratory rehabilitation compared with those receiving conventional care.

Aged↗
PubMed1999

Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial.

BACKGROUND: We investigated the effects of different intensities of arm and leg rehabilitation training on the functional recovery of activities of daily living (ADL), walking ability, and dexterity of the paretic arm, in a single-blind randomised controlled trial. METHODS: Within 14 days after stroke onset, 101 severely disabled patients with a primary middle-cerebral-artery stroke were randomly assigned to: a rehabilitation programme with emphasis on arm training; a rehabilitation programme with emphasis on leg training; or a control programme in which the arm and leg were immobilised with an inflatable pressure splint. Each treatment regimen was applied for 30 min, 5 days a week during the first 20 weeks after stroke. In addition, all patients underwent a basic rehabilitation programme. The main outcome measures were ability in ADL (Barthel index), walking ability (functional ambulation categories), and dexterity of the paretic arm (Action Research arm test) at 6, 12, 20, and 26 weeks. Analyses were by intention to treat. FINDINGS: At week 20, the leg-training group (n=31) had higher scores than the control group (n=37) for ADL ability (median 19 [IQR 16-20] vs 16 [10-19], p<0.05), walking ability (4 [3-5] vs 3 [1-4], p<0.05), and dexterity (2 [0-56] vs 0 [0-2], p<0.01). The arm-training group (n=33) differed significantly from the control group only in dexterity (9 [0-39] vs 0 [0-2], p<0.01). There were no significant differences in these endpoints at 20 weeks between the arm-training and leg-training groups. INTERPRETATION: Greater intensity of leg rehabilitation improves functional recovery and health-related functional status, whereas greater intensity of arm rehabilitation results in small improvements in dexterity, providing further evidence that exercise therapy primarily induces treatment effects on the abilities at which training is specifically aimed.

Activities of Daily Living↗
PubMed2002

Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity.

BACKGROUND: In patients with congestive heart failure (CHF) there is a shift from aerobic type I muscle fibres to less aerobic type II fibres. Exercise training has been shown to have beneficial effects on exercise performance, peripheral pathology and the neurohumoral profile in stable patients with CHF. This study evaluated the effect of a 3 month exercise training program on skeletal muscle characteristics and the correlation of these to cytokines and exercise capacity in CHF patients. METHODS: Skeletal muscle biopsies for enzyme-histochemical analysis were performed in 15 CHF patients in New York Heart Association classes II-III, with a mean ejection fraction of 33+/-5% before and after a 12 week training period. The patients were trained for 30 min, five times a week at 80% of the peak heart rate achieved at baseline ergometer cycle test. Fifteen healthy men were used as controls. Plasma samples were examined by enzyme immunoassays for levels of pro-inflammatory cytokines. RESULTS: (a) At baseline we found muscle atrophy in five of the patients. The percent area of type I fibres (40.7+/-12.0 vs. 56.4+/-11.0%, P<0.05) and the thickness of type IIA (56.10+/-7.8 vs. 71.6+/-11.9 microm, P<0.001) and B-fibres (49.0+/-8.9 vs. 63.9+/-10.6 microm, P<0.001) were reduced, whereas the percent area of type IIA fibres (52.1+/-13.3 vs. 36.4+/-9.9%, P<0.05) was increased in heart failure patients compared to healthy controls. There was a modest correlation between fibre thickness and the level of interleukin 6 (r=-0.657, P=0.008). (b) After exercise training there was a reduction in muscle area examined by light-microscopy, measured as a percentage of field (-2.7, P=0.003) with an concomitant increase in interstitium. This reduction correlated to the increase in the 6-min walk test (r=-0.558, P=0.031). The thickness of type IIB fibres increased (+5.6 microm, P=0.068) and the area of type I fibres decreased (-6.1%, P=0.062). CONCLUSIONS: Patients with CHF have a relatively increased area of type IIA fibres and a relatively decreased area of type I fibres compared to healthy individuals. The thickness of type IIA and type IIB fibres is decreased compared to normal individuals. A modest negative correlation between the level of interleukin 6 and fibre thickness at baseline, suggests that inflammatory cytokines may be involved in the pathogenesis of the CHF related myopathy. A significant correlation between the reduction of muscle area, with increased interstitum, and the increase in the 6-min walk test may indicate that the improvement is due to increased capillary density permitting better flow reserve to exercising muscles.

Aged↗
PubMed2002

Individual assessment of intensity-level for exercise training in patients with coronary artery disease is necessary.

BACKGROUND: Target intensity-level of exercise training in patients with coronary artery disease is adjusted usually by a target heart rate (THR). This THR is aimed to be at or nearby the anaerobic threshold (AT) and is calculated commonly from parameters of regular exercise training, instead of an actual measurement of AT and its related heart rate. Therefore, this study evaluated whether a calculation is reliable. METHODS: In 91 male patients (age 52+/-9 years) exercise capacity was measured after a recent (>4 weeks) coronary event. AT was compared with peak exercise capacity and heart rate at AT was compared with THR, using the Karvonen method. RESULTS: Mean AT (18.2 ml/min/kg, range 9.2-32.2) and mean peak V(O2) (24.5, range 10.9-43.9) were slightly decreased (respectively 0.83 and 0.79 of predicted). When related to peak exercise capacity, AT showed a large inter-individual variation. For example, heart rate at AT ranged from 0.55 to 0.96 of peak heart rate. As a result heart rate at AT varied considerably with THR. The mean THR, although significantly higher, correlated well with mean heart rate at AT (respectively, 109 and 105/min, P<0.01; r=0.86, P<0.001). However, in an important number of patients heart rate at AT was more than 10% below or above THR (respectively, 30 and 7%). CONCLUSION: In individual exercise prescription for cardiac rehabilitation the training level should be determined directly, and not indirectly by calculation from heart rate parameters of exercise testing.

Anaerobic Threshold↗