Role of physical therapy in the management of common low back pain.
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Acupuncture Therapy↗
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Exercise reduces fatigue in chronic fatigued Hodgkins disease survivors--results from a pilot study.
The aims of this pilot study were to compare aerobic capacity in non-fatigued and fatigued Hodgkin's disease survivors (HDS) and to assess the feasibility of an exercise-programme and its effects upon fatigue, physical functioning and aerobic capacity in chronic fatigued HDS. 53 HDS (85%) of originally 62 survivors treated at the Trondheim University Hospital in the period 1987-1997 completed a questionnaire including the Fatigue Questionnaire (FQ). 18 subjects were identified with chronic fatigue. 15 non-fatigued HDS matched for gender and age were drawn as controls. Both groups were invited to medical examination and exercise tests. All 15 fifteen non-fatigued HDS showed up to the medical examination. 12 of the 18 patients with chronic fatigue completed the tests and nine agreed to enter a home-based exercise intervention. Outcome measures were aerobic capacity, fatigue and physical functioning. No significant difference in aerobic capacity was found between the chronic fatigued HDS and the controls. Fatigue, physical functioning and maximal aerobic capacity were significantly improved after the intervention. Aerobic exercise had a positive effect upon chronic fatigue in HDS. However, the study is a pilot study and needs confirmation in a larger group of subjects. The intervention was well accepted, and the majority of the patients adhered to the programme.
Adult↗
Rehabilitation of peripheral nerve injuries.
Traumatic injuries to peripheral nerves pose complex challenges to both military and civilian physicians. Treatment of nerve injuries must consider all aspects of the inherent disability. Pain control is of paramount importance. Little will be accomplished until pain is brought down to tolerable levels. Rehabilitation needs to be instituted as first-line treatment. Focus must be first placed on protection of the affected area from complications stemming from disuse and immobility and then on enhancement of strength, flexibility, sensory discrimination, and dexterity. Early intervention sets the stage for optimal physiologic and functional recovery.
Anti-Inflammatory Agents, Non-Steroidal↗
Improved ventilation and decreased sympathetic stress in chronic heart failure patients following local endurance training with leg muscles.
BACKGROUND: Two-legged knee extensor training activates only about half the muscle mass used in traditional cycle ergometer training. With such an exercise model it is possible to achieve a substantial local training effect in spite of a restricted circulatory capacity. The present study sought to investigate the systemic effects of such local training on ventilation and neurohumoral activity in patients with moderate heart failure. METHODS AND RESULTS: Thirteen male patients with chronic heart failure (age 56 +/- 3 years, EF 28 +/- 3%) performed two-legged knee extensor exercises (about 4 kg of working muscle) for 15 minutes 3 times a week during 8 weeks at 65-75% of peak VO2 of a two-legged kick and were compared to a non-training control group (n = 7, age 62 +/- 3, EF 27 +/- 3%). Before and after the training period VO2, VCO2 and the minute ventilation (1/min) were determined at rest and at submaximal and maximal workloads. Also measured before and after training were two-legged knee extensor peak exercise capacity (W), strength (Nm), a 6-minute walking test (m), quadriceps femoris citrate synthase activity, plasma catecholamines, vasoactive amines and blood lactate during submaximal knee extension exercise, and perceived health-related quality of life. After training, VO2 and VCO2 were reduced at submaximal exercise by 20-30% (P < .01) but were unchanged at peak exercise. With training, the two-legged knee extensor peak exercise capacity increased by 38% (P < .01). The 6-minute walking gait velocity increased by 12% (P < .01) and skeletal muscle citrate synthase activity by 28% (P < .01). Training improved the quality of life (P < .01). After training, VO2 (P < .001), VCO2 (P < .001) and minute ventilation (P < .001) were reduced at the workload corresponding to the maximal workload before training. The ratio minute ventilation/VO2 was reduced (P < .05) after training at the before-training maximal workload. No change was observed in the control group with regard to two-legged peak exercise capacity or peak VO2. Plasma NPY was reduced both at rest and at submaximal exercise by 35% (P < .01), whereas noradrenaline was reduced only during exercise (P < .05). CONCLUSIONS: Local muscle training is effective in stable chronic heart failure and can improve, in addition to exercise capacity and quality of life, the ventilatory response, and decrease the sympathetic stress.
Adult↗
Exercise training in heart failure: an intervention whose time has come.
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Exercise Therapy↗
Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and quality of life in both women and men with chronic heart failure.
BACKGROUND: Data of training effects in chronic heart failure patients are based on findings in men. The purpose of this study was to compare the effects of skeletal muscle endurance training between men and women with chronic heart failure. METHODS AND RESULTS: Twelve consecutive men (mean [+/- SD] age 58 +/- 9 years, left ventricular ejection fraction 29 +/- 9%) and 12 women (60 +/- 10 years, left ventricular ejection fraction 28 +/- 7%) with moderate, chronic heart failure stratified according to age and inclusion criteria were investigated at baseline and after 8 weeks of knee extensor endurance training. The activity of skeletal muscle citrate synthase and resting heart rate were similar in men and women at baseline and with training improved (P < .0001) similarly in both genders. Peak work rate (P < .0001), peak oxygen uptake (P < .001) and muscle strength (P < .05) at baseline were higher in men than in women. Training improved peak work rate (P < .0001) and muscle strength (P < .0001) similarly in both genders, while improvement in peak oxygen uptake was better in women (P < .001). The distance ambulated during 6 minutes was similar in both genders at baseline and increased after training more in men (P < .004). The overall and physical Sickness Impact Profile indicated similarly reduced health-related quality of life in men and women, while worse psychosocial quality of life was observed in men (P < .05). Both genders improved after exercise training in the overall, physical, and psychosocial Sickness Impact Profile (P < .01). CONCLUSIONS: Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and the health-related quality of life in women as well as in men with moderate, chronic heart failure.
Aged↗
The effect of physical training on skeletal muscle in patients with chronic heart failure.
BACKGROUND: The improvement of exercise capacity in patients with chronic heart failure (CHF) by physical training has been connected with reversal of the abnormalities in muscle fiber distribution and with the reduced activity of the enzymes of oxidative metabolism in skeletal muscle. However, the change in fiber type distribution induced by training is controversial and in previous studies the activities of the rate-limiting enzymes of the metabolic pathways have not been measured. AIMS: To examine the effect of dynamic training on percentage distribution of muscle fibers, on activities of the rate-limiting enzymes of the metabolic pathways and on electrophysiology in skeletal muscle. METHODS: A total of 27 patients with stable CHF (NYHA class II-III) were randomized to a training (N=12) or a control (N=15) group. The training group exercised on a bicycle ergometer for 30 min three times a week for 3 months using a load corresponding to 50-60% of their peak oxygen consumption. This was followed by a 3-month training period at home according to personal instructions. The control group did not change its physical activities. We studied muscle histology and measured the activities of the rate-limiting enzymes of anaerobic glycolysis (phosphofructokinase, PFK), glycogenolysis (phosphorylase), citric acid cycle (alpha-ketoglurate dehydrogenase, KGDH) and fatty acid oxidation (carnitinepalmitoyl transferase I and II, CPT I and II) from biopsies of the vastus lateralis muscle at baseline and after 3 and 6 months. Muscle strength and strength endurance with surface EMG and macro EMG of the right knee extensors were also determined. RESULTS: Exercise capacity, particularly submaximal, improved in the training group. The activity of PFK rose significantly but that of the other enzymes did not when compared with the change in the controls. Training had no effect on the percentage distribution of slow-twitch and fast-twitch muscle fibers or on capillary density around these fibers in skeletal muscle. Maximum voluntary force, strength endurance and the function of motor units remained unaffected. CONCLUSIONS: Dynamic training results in improved exercise endurance in CHF. In skeletal muscle, the capacity of anaerobic glycolysis is increased but that of the citric acid cycle and fatty acid oxidation is not. Furthermore, the improvement in exercise endurance seems to be independent of changes in the percentage distribution of muscle fibers, capillarity or electrophysiological factors.
Electromyography↗
Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study.
BACKGROUND: Sympathetic activity is a significant predictor of a poor prognosis in heart failure. Beta-blockers have been shown to improve the prognosis of patients with heart failure. AIM: This pilot study examined the tolerability and efficacy of the new beta-blocker nebivolol on left ventricular function in patients with chronic heart failure. METHODS AND RESULTS: Twelve patients with an ejection fraction of 13-39% were included in this double blind, placebo-controlled randomized trial of nebivolol administered in addition to standard therapy. Exercise time, heart rate, left ventricular function and tolerability were examined at baseline and after 3 months of orally administered nebivolol (2.5 and 5 mg, n = 6) or placebo (n = 6). Nebivolol was well tolerated and the NYHA class improved in four patients. Heart rate decreased while the maximal exercise duration and performance remained stable. Left ventricular function increased (ejection fraction 31.5 +/- 10.11 to 42.0 +/- 10.99%, P < or = 0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5 +/- 9.40 to 50.2 +/- 9.43 mm (P < or = 0.02). CONCLUSION: These data indicate that nebivolol might improve cardiac function in patients with reduced left ventricular function.
Administration, Oral↗
Hydrotherapy--a new approach to improve function in the older patient with chronic heart failure.
AIMS: Hydrotherapy, i.e. exercise in warm water, as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure (CHF) due to the increased venous return caused by the hydrostatic pressure. However, hydrotherapy has advantages compared to conventional training. We studied the applicability of an exercise programme in a temperature-controlled swimming pool, with specific reference to exercise capacity, muscle function, quality of life and safety. METHODS AND RESULTS: Twenty-five patients with CHF (NYHA II-III, age 72.1+/-6.1) were randomised into either 8 weeks of hydrotherapy (n=15), or into a control group (n=10). The training program was well tolerated with no adverse events. Patients in the hydrotherapy group improved their maximal exercise capacity (+6.5 vs.-5.9 W, P=0.001), isometric endurance in knee extension (+4 vs.-9 s, P=0.01) together with an improvement in the performance of heel-lift (+4 vs. -3 n.o., P=<0.01), shoulder abduction (+12 vs. -8 s, P=0.01) and shoulder flexion (+6 vs. +4, P=0.01) in comparison to patients in the control group. CONCLUSION: Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF. This new approach broadens the variety of training regimes for older patients with CHF.
Aged↗
Effects of resistive breathing on exercise capacity and diaphragm function in patients with ischaemic heart disease.
BACKGROUND: Muscle weakness has been suggested to result from the deconditioning that accompanies decreased activity levels in chronic cardiopulmonary diseases. The benefits of standard exercise programmes on exercise capacity and muscular strength in disease and health are well documented and exercise capacity is a significant predictor of survival in patients with chronic heart failure (CHF). Selective respiratory muscle training has been shown to improve exercise tolerance in CHF and such observations have been cited to support the suggestion that respiratory muscle weakness contributes to a reduced exercise capacity (despite biopsies showing the metabolic profile of a well trained muscle). AIMS: This study aimed to determine the effects of selective inspiratory muscle training on patients with chronic coronary artery disease to establish if an improved exercise capacity can be obtained in patients that are not limited in their daily activities. METHODS: Nine male patients performed three exercise tests (with respiratory and diaphragm function assessed before the third test) then undertook a 4-week programme of inspiratory muscle training. Exercise tolerance, respiratory and diaphragmatic function were re-assessed after training. RESULTS: Exercise capacity improved from 812+/-42 to 864+/-49 s, P<0.05, and velocity of diaphragm shortening increased (during quiet breathing from 12.8+/-1.6 to 19.4+/-1.1 mm s(-1), P<0.005, and sniffing from 71.9+/-9.4 to 110.0+/-12.3 mm s(-1), P<0.005). In addition, five from nine patients were stopped by breathlessness before training; whereas only one patient was stopped by breathlessness after training. CONCLUSION: The major findings in this study were that a non-intensive 4-week training programme of resistive breathing in patients with chronic coronary artery disease led to an increase in exercise capacity and a decrease in dyspnoea when assessed by symptom limited exercise testing. These changes were associated with significant increases in the velocity of diaphragmatic excursions during quiet breathing and sniffing. Patients that exhibited small diaphragmatic excursions during quiet breathing were most likely to improve their exercise capacity after the training programme. However, the inspiratory muscle-training programme was not associated with any significant changes in respiratory mechanics when peak flow rate, forced expiratory volume and forced vital capacity were measured. The resistive breathing programme used here resulted in a significant increase in the velocity of diaphragm movement during quiet breathing and sniffing. In other skeletal muscles, speed of contraction can be determined by the relative proportion of fibre types and muscle length (Jones, Round, Skeletal Muscle in Health and Disease. Manchester: University Press, 1990). The intensity of the training programme used here, however, is unlikely to significantly alter muscle morphology or biochemistry. Short-term training studies have shown that there can be increases in strength and velocity of shortening that do not relate to changes in muscle biochemistry or morphology. These changes are attributed to the neural adaptations that occur early in training (Northridge et al., Br. Heart J. 1990; 64: 313-316). Independent of the mechanisms involved, this small, uncontrolled study suggests that inspiratory muscle training may improve exercise capacity, diaphragm function and symptoms of breathlessness in patients with chronic coronary artery disease even in the absence of heart failure.
Aged↗
Effect of an exercise programme for elderly patients with heart failure.
AIMS: Benefit from exercise training programmes for patients with chronic heart failure has been demonstrated in relatively young (mean age 60 years) and predominantly male subjects. This study was undertaken to assess the effect of an exercise programme for older subjects more representative of the general heart failure population. METHODS AND RESULTS: Twenty-two patients with chronic heart failure of mean age 81+/-4 years were recruited into the study. Twenty-five percent were female and 31% were in chronic atrial fibrillation. A crossover study design was employed. The programme consisted of once weekly exercise sessions tailored to the abilities of elderly subjects and lasted for 12 weeks. Fifteen subjects completed the exercise component and nine the control component. The programme resulted in a 20% relative increase in 6-min walk test distance (ANCOVA: P<0.012). There was no improvement in quality of life as measured by the Living With Heart Failure Questionnaire, but the majority of subjects reported subjective improvement in wellbeing. CONCLUSION: Elderly patients with chronic heart failure can benefit from an appropriately designed exercise programme and should not be excluded from future large scale trials.
Aged↗
Validity and reliability of a physical activity recall instrument among overweight and non-overweight men and women.
This study examined the validity and reliability of survey items measuring one-week recall of physical activity (PA) and examined differences by weight status. A sub-aim of the study was to objectively assess the intensity of activity that most closely matches self-report. A questionnaire was administered to adults twice, three days apart. It was again administered after subjects wore a MTI/CSA accelerometer for seven days (n = 118). Several metabolic equivalent (MET) thresholds were applied to the accelerometer data. Agreement between test and re-test estimates of sufficient physical activity for health benefits (150 min/week) was high (% agreement > 90%). Correlations (rho) between total reported PA (mins/day) and accelerometer data were 0.29 (p < 0.05) among men and 0.25 (p < 0.05) among women. Among men, self-reported duration of moderate PA (3-5.9 METS) and accelerometer data were significantly correlated (rho = 0.40, p < 0.01), with no differences by weight status. Among women, a significant relationship was found only for those who were not overweight (rho = 0.52, p < 0.001). A significant correlation between self-reported duration of vigorous PA (6+ METS) and accelerometer data was only found for overweight men (rho = 0.40, p < 0.05). When lower MET thresholds were applied to the accelerometer data, women's reported duration of moderate-intensity PA was most strongly correlated with moderate PA (accelerometer) defined as 2.0-5.9 METS (rho = 0.39, p < 0.01). The recall instrument provides a consistent measure of physical activity and validation coefficients were similar to those obtained for other physical activity recall questionnaires. However, the ability to measure PA by self-report may vary by weight status.
Adult↗
[Changes in exercise tolerance, health related quality of life, and peripheral muscle characteristics of chronic obstructive pulmonary disease patients after 6 weeks' training].
OBJECTIVE: This study was designed to assess changes in skeletal muscle characteristics after 6 weeks' high-intensity physical training of patients with moderate to severe chronic obstructive pulmonary disease (COPD) and to determine how the changes were related to improvements in exercise tolerance and health related quality of life (HRQL). PATIENTS AND METHODS: Ten patients with a mean (SD) age of 60 (10) years and a forced expiratory volume in 1 second of 32% (9%) were enrolled. The effect of training on the 6-minute walk test, HRQL questionnaires, and skeletal muscles was examined for the 8 patients who completed the program. The structural and chemical characteristics of skeletal muscles before and after training were studied in vastus lateralis muscle biopsies. RESULTS: Training significantly modified the 6-minute walk test (P<.01), HRQL (P<.05), and citrate synthetase activity (P<.05). Changes in distances walked during the 6-minute walk test were significantly related to changes in the mean area of fibers (r=0.81). CONCLUSIONS: The results of this study indicate that 6 weeks of high-intensity physical training of COPD patients produces moderate changes in skeletal muscles which could partly explain improvements observed in exercise tolerance after respiratory rehabilitation.
Aged↗
[How much strength is needed for fitness?].
In order to tolerate the exertion in fitness exercise in the long term a sufficiently strong trunk musculature should be aimed at. In order to stabilize and balance the trunk and the pelvis there should be an optimal interaction of the muscles of the abdomen, the lateral trunk, the back and the flexors and extensors of the hip. If that balance is disrupted, muscular imbalance and a weakening or shortening of the muscles involved can occur. That imbalance leads to inadequate and excessive strain of the functional system of spine and pelvis. The functional anatomy of the trunk is described with clinical references in order to elucidate this context. A program of strength and stretching exercises for the trunk is presented suited to the needs of those practicing fitness exercise.
Exercise Therapy↗
[Conservative treatment of shoulder disorders].
The extreme complexity of the shoulder joint results from the coordinated activity of five different articulations and the supporting soft-tissue girdle. Any perturbation of this system has deleterious biomechanical consequences to the shoulder muscular girdle integrity and will eventually lead to pain and functional limitations. A functional diagnosis of the lesion will always be a prerequisite for a targeted conservative therapy. Treating pain is often the basis of the treatment, but it should rapidly be implemented with a broad range of physiotherapeutic techniques and manual therapy as well when appropriate. The guidelines for therapy include an active stabilisation program in case of joint instability and passive mobilisation whenever functional limitations are present. This paper deals with the different problem-oriented interdisciplinary therapeutic modalities used in frequent shoulder problems.
Acute Disease↗
Influence of immersion on respiratory requirements during 30-min cycling exercise.
Immersion is considered to facilitate exercise-based rehabilitation. However, the drag effect of moving limbs in water, likely to increase the respiratory requirements at exercise, is not mentioned in many reports. The energetic and ventilatory requirements of 30 min steady state cycling exercise performed by healthy male subjects in air and during immersion up to the xiphoid in 33 degrees C water were compared. In the first experimental series nine subjects exercised at the same 60% maximal oxygen consumption (V'O2,max) in air and water. In the two ambient conditions, ventilatory variables had similar values, but the ergometric setting had to be reduced during water immersion so that the workload rated only 69+/-20 W (mean+/-SD) in water versus 121+/-32 W (p<0.001) in air. In the second experimental series, the same ergometric work load (122 W) was achieved by nine subjects with an average V'O2 of 2,210+/-300 mL x min(-1) in air versus 2,868+/-268 mL x min(-1) in water (p<0.001). Resting water immersion caused a marked trend for decreasing vital capacity (p=0.06), but no modification of other ventilatory variables. During exercise at similar V'O2, the average values of minute ventilation (V'E), tidal volume (VT), respiratory frequency (fR), tidal inspiratory time (VT/tI) were not different between water and air. However, at similar ergometric workload, V'E, VT, fR, VT/tI and plasma lactate levels were significantly higher in water than in air. Such consequences of the drag effect of water upon limb movements have not been reported in previous studies relying on shorter exercise bouts. Thus, maintaining steady exercise levels in water either led to a decrease in the workload or required a 25% higher oxygen consumption than in air. These findings may be relevant to the prescription of water immersion rehabilitation programmes.
Adult↗
Electrical impulses recharge spinal cord injury research.
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Animals↗
Neurogenic bladder: conservative methods of treatment.
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Electric Stimulation↗