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Physical activity and its relationship to physical performance in patients with end stage knee osteoarthritis.

STUDY DESIGN: Cross-sectional observational design. OBJECTIVES: To compare physical activity levels in men and women with end-stage knee osteoarthritis to those of a comparison group and to examine the relationship between physical activity level and physical performance. BACKGROUND: Osteoarthritis of the knee is associated with significant losses in functional performance and high social costs. Although reductions in physical activity are reported, they have not been quantified or explored. METHODS AND MEASURES: Fifty-nine candidates awaiting total knee arthroplasty (TKAC group) and 79 individuals without osteoarthritis (comparison group) participated. Physical activity was assessed using the Voorrips Questionnaire. Performance measures included fast self-paced walk test, timed up-and-go test, and a timed stair performance measure. A subset of subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and underwent muscular strength and endurance testing. The effects of gender and group were tested using GLM ANOVA. Pearson product moment correlations were used to examine relationships between the variables. RESULTS: All aspects of physical activity were lower (P<.001) in the TKAC group, with a moderate difference in household score (18%) and a large difference in leisure activities (63%). Unlike the comparison group, modest but significant correlations (r = 0.31-0.33, P<.03) were observed between overall physical activity and performance test scores for the TKAC group. Physical activity was not significantly related to pain reported on the WOMAC or during the performance tasks. CONCLUSIONS: The belief that pain limits the physical activity of patients with severe osteoarthritis requires further investigation. The profound differences between a comparison group and patients with end-stage osteoarthritis in physical activity have critical implications for the well-being and effective treatment of this population.

Activities of Daily Living↗

Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee.

BACKGROUND AND PURPOSE: Pain and physical function are core outcome measures for people with osteoarthritis, and self-report questionnaires have been the preferred assessment method. There is evidence suggesting that self-reports of physical function represent what people experience when performing activities rather than their ability to perform activities. The purpose of this study was to examine the factorial validity of performance-specific assessments of pain and function. SUBJECTS: The sample consisted of 177 participants who had osteoarthritis of the hip (n=81) or knee (n=96) and who were awaiting total joint arthroplasty. METHODS: Through a cross-sectional design, participants performed 4 performance activities (self-paced walk test, stair test, Timed "Up & Go" Test, and Six-Minute Walk Test). OUTCOMES: were time or distance (function) and pain ratings obtained immediately after each activity. The authors conceptualized 2 correlated factors, with pain items loading uniquely on 1 factor and functional items loading on the second factor, and uncorrelated error terms. Confirmatory factor analysis was applied. RESULTS: Initial analysis yielded results consistent with the conceptualized model in this study with the exception of a nonzero correlation between the stair pain and function error terms. Dropping the stair test provided results consistent with the conceptualized model. DISCUSSION AND CONCLUSION: Given the limitations of self-report alone as a method of obtaining reasonably distinct assessments of pain and function, the extent to which performance-specific assessments could accomplish this goal was examined in this study. It was found that collectively the walk test, Timed "Up & Go" Test, and Six-Minute Walk Test yielded 2 factors consistent with the health concepts of pain and function. The authors believe that the application of these tests may provide clinicians and clinical researchers with more distinct impressions of pain and function that complement information from self-report measures.

Aged↗

Fenceline contact of beef calves with their dams at weaning reduces the negative effects of separation on behavior and growth rate.

The purpose of this study was to examine the hypothesis that fenceline contact between beef calves and cows at weaning reduces indices of behavioral distress and associated temporary reductions in weight gain. One hundred Angus/Hereford-cross calves were randomly assigned to five treatments for 7 d in each of 3 yr to determine the effect of different weaning techniques on their behavior and subsequent growth. Treatments were 1) fenceline separation from dams on pasture (F-P), 2) total separation from dams on pasture (S-P), 3) total separation from dams in a drylot (corral) preconditioned to hay (S-D-P), 4) total separation from dams in a drylot not preconditioned to hay (S-D-NP), and 5) nonweaned controls on pasture (C-P). At the end of the 7-d postweaning period, all calves were placed on pasture in large groups. Calves were weighed weekly for 10 wk. In the days following weaning, F-P and C-P calves spent more time eating (grazing or eating hay) than S-P and S-D-NP calves (P < 0.05). The S-P calves spent more time walking (pacing) than calves in the other four treatments (P < 0.05), which did not differ. The S-P calves also spent less time lying down than C-P, F-P, and S-D-P calves (P < 0.05); S-P and S-D-NP calves did not differ in lying time. The F-P calves vocalized less than S-P and S-D-NP calves (P < 0.05). In general, treatment differences were greatest during the first 3 d following weaning with d 2 (20 to 30 h after weaning) showing the greatest disparity. The F-P calves spent approximately 60% of their time within 3 m of the fence separating them from their dams during the first 2 d following weaning, whereas F-P cows spent about 40% of their time within 3 m of the fence during this period. Postweaning cumulative body weight gains of the F-P calves were greater than the gains recorded for the calves in the three totally separated treatments (which did not differ). The F-P calves gained 95% more weight than the average calf in the three totally separated treatments in the first 2 wk and were still heavier at 10 wk (21.4 vs 11.0 kg, respectively, at 2 wk and 50.0 vs 38.2 kg, respectively, at 10 wk; P < 0.05). It was concluded that providing fenceline contact between beef calves and cows for 7 d following weaning reduces behavioral indices of distress seen in the totally separated calves. In addition, fenceline contact with dams at weaning minimizes losses in weight gain in the days following separation. Totally separated calves did not compensate for these early losses in weight gain even after 10 wk.

Animals↗

The lower extremity activity profile: a health status instrument for measuring lower extremity disability.

The Lower Extremity Activity Profile (LEAP) is a comprehensive measure of lower extremity function. It measures the client's perception of difficulty and satisfaction with performance in the following areas: self care, mobility, household activities, work, leisure activities, and social activities. The development and initial reliability and validity testing of LEAP was conducted with 32 osteoarthritis clients undergoing total knee replacement. Using a one-group repeated measures design, the LEAP, knee range of motion and self-paced walk measures were administered pre-operatively and 3 months post-operatively. The internal consistency of the LEAP using Cronbach's Alpha was 0.73. All LEAP scores showed significant improvement (p<0.01) between the two administration times demonstrating responsiveness of the measure. Correlations of LEAP with the clinical measures were moderate. LEAP is recommended for use as an outcome measure in similar populations, if used in conjunction with clinical and physical performance measures. Further testing of the LEAP is warranted for use in evaluating outcomes of rehabilitation programs addressing lower extremity musculoskeletal impairment and disability.

Activities of Daily Living↗

Risk factors for benign breast biopsies: a nested case-control study in the Alberta breast screening program.

A nested case-control study was conducted to identify risk factors for benign breast biopsies in 382 cases (women with a benign biopsy result) and 399 controls (women who had not undergone a biopsy) who were sampled from the Alberta breast cancer screening program. The breast biopsy specimens of the cases were reviewed by a panel of pathologists, and percent fibroglandular tissue density was assessed. The multivariable odds ratios for the risk of open benign breast biopsy associated with current cigarette smoking was 2.04 (95% CI 1.32-3.13), for ever regular smoking was 1.61 (1.20-2.16), and for passive smoking was 1.41 (0.99-2.02). A risk reduction was found for ever alcohol consumption (0.61 [0.44-0.85]). Some risk reductions were found when the highest and the lowest quintiles of total aerobic recreational activity were compared (0.71 [0.42-1.20]), stair climbing (0.61 [0.37-1.01]) and walking pace (0.13 [0.02-0.741). Lifestyle risk factors may be implicated in the continuum between detection of an abnormality on a screening mammogram and a breast biopsy specimen. By considering these risk factors, breast screening programs may be better able to identify those women who require a breast biopsy and reduce the number of benign breast biopsies.

Aged↗

Sleep and performance--recent trends.

Sleep and sleep deprivation are intimately related to performance. Sleep management of people working in different sectors of the society like multi shift workers, nurses, doctors, students in professional schools and the armed forces has a great bearing on performance, health and safety of the subject population. The detrimental effects of sleep deprivation on psychological performance are indicated as increased lapsing, cognitive slowing, memory impairment, decrease in vigilance and sustained attention and shift in optimum response capability. Its effects on physical performance are manifested as decline in ability to perform maximal exercise, self-selected walking pace and increase in perceived exertion. Sleep deprivation appears to have no effect in respect of muscle contractile properties and maximum anaerobic power. At high altitude (HA), there is a reduction in NREM sleep with frequent awakening due to hypoxia as a physiological adaptive measure to prevent accentuation of hypoxemia due to sleep-hypoventilation. Total sleep deprivation for 48 hours at high altitude can affect the acclimatization status, thermoregulation efficiency and cognitive functions. The concept of 'sleepiness' has also been studied, as it is an emerging concept for better understanding of the effects of sleep deprivation and its effects on performance. A special mention of sustained operations in the armed forces has been made keeping in mind its uniqueness in challenging the normal sleep-work schedule and its deployment in extreme environment and operational condition. This article reviews in detail the functions of sleep, its requirement and the effects of sleep deprivation on human performance.

Circadian Rhythm↗

Creatine supplementation and anterior compartment pressure during exercise in the heat in dehydrated men.

CONTEXT: Theoretically, the risk of compartment syndrome is increased during creatine monohydrate (CrM) supplementation because of intracellular fluid retention in muscle cells and the overall increased size of the muscle tissue. Whether this change in intracellular fluid is associated with an increase in anterior compartment pressure in the lower leg when subjects are under thermal stress is unknown. OBJECTIVE: To assess the influence of CrM on the resting and postexercise anterior compartment pressure of the lower leg in mildly to moderately dehydrated males exercising in the heat. DESIGN: Double-blind, randomized, crossover design. SETTING: Human Performance Laboratory. PATIENTS OR OTHER PARTICIPANTS: Eleven well-trained, non- heat-acclimated, healthy males (age = 22 +/- 2 years, height = 181.1 +/- 7 cm, mass = 78.4 +/- 4.2 kg, V(O2)max = 50.5 +/- 3.4 mL.kg(-1).min(-1)). INTERVENTION(S): Subjects were supplemented with 21.6 g/d of CrM or placebo for 7 days. On day 7, they performed 2 hours of submaximal exercise, alternating 30 minutes of walking with 30 minutes of cycling in the heat, resulting in approximately 2% dehydration. This was followed by an 80-minute heat tolerance test (temperature = 33.5 +/- 0.5 degrees C, humidity = 41.0 +/- 12%), which included 12 repetitions of a 3-minute walk (pace = 4.0 +/- 0.1 miles/h, intensity = 37.1 +/- 6.1% V(O2)max) alternating with a 1-minute, high-intensity run (pace = 11.8 +/- 0.4 miles/h, intensity = 115.0 +/- 5.6% V(O2)max), resulting in an additional 2% decrease in body weight. MAIN OUTCOME MEASURES: Before supplementation and on day 7 of supplementation, anterior compartment pressure was measured at rest, after dehydration, and at 1, 3, 5, 10, 15, and 60 minutes after the heat tolerance test. Analysis of variance with repeated measures was calculated to compare differences within the trials and time points and to identify any interaction between trial and time. RESULTS: The CrM intake was associated with an increase in body weight (P < .05). A moderate effect size was noted for compartment pressures between the trials for the differences between predehydration and postdehydration (eta2 = 0.414). This effect diminished substantially by 3 minutes after the heat tolerance test. Compared with the placebo trial, the change in anterior compartment pressure from rest to dehydration was greater, as was the change from rest to 1 minute after the heat tolerance test (P < .05) during the CrM trial. CONCLUSIONS: A 7-day loading dose of CrM increased anterior compartment pressures after dehydration and immediately after the heat tolerance tests, but the changes did not induce symptoms and the pressure changes were transient.

Journal Article↗

The effects of verapamil and propranolol on quality of life in hypertension.

Quality of life was evaluated in a four-month randomised double-blind trial of verapamil compared with propranolol in the treatment of hypertension in 94 patients in the UK. Scores on a health status index, measuring activity and perceived health, increased in verapamil patients compared to a decrease in propranolol patients (P = 0.01). Measures of psychiatric morbidity also tended to improve with verapamil and deteriorate with propranolol. Propranolol patients reported more symptoms overall compared with verapamil (P less than 0.05). The prevalence of certain symptoms--headaches, weak limbs and slower walking pace, increased significantly with propranolol compared with verapamil, but constipation was more common in verapamil patients (P less than 0.05). After four months, diastolic blood pressure averaged 86.2 mmHg with verapamil and 90.3 mmHg with propranolol (P = 0.02). However, this difference in final blood pressure did not explain the more favourable quality of life scores with verapamil, and the data suggest that health-related well-being is higher with this drug.

Adult↗

The 100 m walk: a simple and reproducible exercise test.

In a modification of conventional walking tests in respiratory disease patients were asked to walk successive 50 m lengths of a corridor and the time taken over the third 100 m was taken as the walking pace. This pace was highly correlated (r = 0.994) with the 12-minute distance and was highly reproducible (r = 0.98).

Adult↗

Environmental effects on the life of bone-plate-type surgical implants.

Assuming satisfactory fixation of metallic bone-plates and no subsequent accidental high impact loading, the major cause of implant failure during the lifetime of the patient will be that of corrosion fatigue. The mechanisms of corrosion fatigue are various and component life depends on a large number of interacting variables. These variables are noted and the particular importance of changing pH in a saline environment for implants is discussed. It is known, for example, that very low pH of body fluids results from shock and/or locally in the crevice between implant and bone. Some in vitro test results for stainless steel type 316, titanium 130, and titanium alloy 318, at a "walking pace" of 1.7 Hz, simulating normal and extreme conditions possibly met in practice, are reported. Further, since it is commonplace for some bone-plates to be drilled for fitting, the combined effect of this procedure and a changing local environment has been investigated. The life of stainless steel 316 was not affected by the hole drilling, but its use as an implant material is questionable because of poor resistance to corrosion fatigues at "lower-than-normal" pH. A small reduction in the life of titanium 130 resulted from the hole drilling operation. However, this material was generally superior to stainless steel at low pH. Titanium 318 showed by far the best resistance to corrosion fatigue but its performance was drastically reduced by hole drilling. Some early failures were also noted as the result of fretting with T318. Good implant design, and cautious modifications when fitting, is required here for the realization of the full potential of T318.

Alloys↗

Activity recording of radio-tagged animals.

A system for automatic activity recording of free-living animals instrumented for radio tracking is described. Technical details are given on a recorder, based on a frictionless transducer assuring extreme accuracy (Gould Brush 220 and 222). Activity separation from chart roll diagrams is possible for inactivity (resting, lying, etc.) and some activity performances like moving while foraging on a restricted area, steady movements of a walking pace, and rapid movements (running and jumping). Distinction between different activities could be done with an accuracy of less than 1 min. Examples from recorded data of an instrumented free-living roe deer and a mountain hare at the Grimsö Research Area are shown. For both species daily activity pattern is more or less related to sunrise and sunset, when activity reaches its highest value. Except for the roe deer in winter, day activity is lower than during night. The mean length of active periods in roe deer is fairly equal between winter and summer while mean length of inactive periods is significantly extended in winter. This could be explained by the digestive processes in relation to food quality.

Animal Population Groups↗

Drag and sprint performance of wheelchair basketball players.

The purpose of this study was to measure the wheelchair drag and maximal sprint performance abilities of wheelchair basketball players and to make comparisons between male and female players. A group of nine male and eight female wheelchair basketball players attending a national training camp consented to serve as subjects. Each subject completed six coast-down trials at speeds from a walking pace (1 to 1.5 m/s) to maximal for determining wheelchair drag and then performed four maximal sprint trials from a stationary start over the length (35 m) of the gymnasium floor. A portable computer that recorded the time to the nearest 0.001 second of each half revolution of a rear wheel was attached to the wheelchair of each subject. The drag force during the coast-down trials and the power output during the sprint trials were determined from the recorded data. Differences between the genders in a number of subject and trial variables were evaluated by t-tests using the 0.05 level of significance. There were no significant differences between the means of the male and female groups in age (27 vs. 28 yrs), wheelchair mass (12.0 vs. 11.61 kg), or regression predicted drag forces at speeds of 2 m/s (5.3 vs. 5.5 N) and 5 m/s (16.7 vs. 13.5 N). The male subjects were significantly heavier (78.3 vs. 59.1 kg) and had a higher tire pressure (123 vs. 94 psi). In the sprint trial results, the males exhibited a significantly higher maximal speed (4.75 vs. 4.08 m/s), higher peak acceleration (1.32 vs. 1.03 m/s/s), and a higher peak power output (530 vs. 264 w).

Acceleration↗

Reliability and validity of the measurement of position sense in women with osteoarthritis of the knee.

OBJECTIVE: We examined the test-retest reliability and the construct validity of the measurement of knee position sense for describing the functional weightbearing performance of women with osteoarthritis (OA) of the knee. METHODS: For the purpose of this study, position sense was defined as the error occurring when subjects attempted to reproduce a criterion angle in standing with visual cues eliminated. Five such tests were recorded photographically on 3 different occasions. On each occasion the 10 subjects also completed a self-paced walking test over a 13 m indoor walkway. RESULTS: The photographic measurements were reproducible (r = 0.90) and there was no change in positioning accuracy across sessions. There was a significant (p < 0.05) inverse correlation of 0.70 between the standard deviation of the mean individual measurements of position sense (precision of the test) and those of walking speed. CONCLUSION: Our study demonstrates good measurement reliability and a comparable mean angular error with repeated tests. It also suggests the amplitude of the variability of this error is a strong determinant of an individual OA patient's functional performance in walking.

Aged↗

Physical training program for rehabilitating extremely obese patients.

Performance records of 22 extremely obese adult patients undergoing physical rehabilitation in a multi-disciplinary program were used to devise three progressive training protocols to which patients can be individually assigned. These protocols include "fastest pace" walking and jogging and are designed to rehabilitate patients to a two-mile continuous walk within three, five or seven weeks. Specific definition of progressions in distance/work session units are given and criteria for assigning patients to each protocol are discussed. The program allows time for psychological as well as physiological adaptation and improves the rehabilitative process by eliminating much of the variability and regression previously attributed to patient manipulation.

Adolescent↗

Haemodynamic effects of dual-chamber pacing versus ventricular pacing during a walk test in patients with depressed or normal left ventricular function.

PURPOSE: Dual-chamber rate-modulated pacing provides haemodynamic benefits compared with ventricular pacing at rest, but it is unclear whether this also holds true during physical exercise in patients with heart failure. This study assessed the haemodynamic response to a walk test during dual-chamber pacing and ventricular pacing in patients with depressed or normal left ventricular (LV) function. METHODS: Twelve patients with an LV ejection fraction <50% and 11 patients with an LV ejection fraction >or=50% underwent two randomised 6-min walk tests under dual-chamber rate-modulated pacing and ventricular pacing at a fixed rate of 70 beats/min. All patients had a dual-chamber pacemaker implanted for complete heart block. LV function was monitored by a radionuclide ambulatory system. RESULTS: In patients with depressed LV function, the change from dual-chamber pacing to ventricular pacing induced a decrease in end-systolic volume at the peak of the walk test (P<0.05), with no difference in end-diastolic volume. As a consequence, higher increases in LV ejection fraction (P<0.0001) and stroke volume (P<0.01) were observed during ventricular pacing. No difference in cardiac output was found between the two pacing modes. In patients with normal LV function, the change from dual-chamber pacing to ventricular pacing induced a significant decrease in cardiac output (P<0.005 at rest and P<0.05 at the peak of the walk test). CONCLUSION: Compared with dual-chamber rate-modulated pacing, ventricular pacing improves cardiac function and does not affect cardiac output during physical activity in patients with depressed LV function, whereas it impairs cardiac output in those with normal function.

Aged↗

Treadmill versus shuttle walk tests of walking ability in intermittent claudication.

PURPOSE: To compare treadmill and shuttle walk tests for assessing functional capacity in patients with intermittent claudication, with respect to test-retest reliability, cardiovascular responses, and patient preferences. METHODS: Patients with stable intermittent claudication (N = 55, ages 52-85 yr, median age 68 yr) were recruited from the Sheffield Vascular Institute at the Northern General Hospital, Sheffield, UK. Each patient performed an incremental shuttle walk test, a constant-pace shuttle walk test, and a standardized treadmill test (3.2 km x h(-1), 12% gradient), each on three occasions. The incremental shuttle walk began at 3 km x h(-1) and increased by 0.5 km x h(-1) every minute, whereas the constant-pace shuttle walk was performed at the fixed pace of 4 km x h(-1). Claudication distance (CD), maximum walking distance (MWD), heart rate (HR), and blood pressure were assessed in each testing session. The patients also completed a test preference questionnaire. RESULTS: CD and MWD for both shuttle walks were greater than the corresponding walking distances achieved in the treadmill test (P < 0.001). Average coefficients of variation for repeated incremental shuttle walk, constant-pace shuttle walk, and treadmill tests were 15.9%, 21.1%, and 18.7%, respectively, for MWD, corresponding to average intraclass correlation coefficients of 0.87, 0.82, and 0.87. Treadmill walking evoked greater increases in HR and blood pressure (P < 0.001), and fewer patients expressed a preference for it (24 vs 43% for shuttle walking). CONCLUSION: These findings indicated that shuttle walk testing exhibits similar test-retest reliability as treadmill testing, but that it evoked a lower level of cardiovascular stress and is preferred to treadmill testing by a large proportion of patients.

Aged↗

Executive function correlates with walking speed in older persons: the InCHIANTI study.

OBJECTIVES: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: Nine hundred twenty-six persons aged 65 and older, without dementia, stroke, parkinsonism, visual impairment, or current treatment with neuroleptics, enrolled in a large epidemiological study. MEASUREMENTS: Trail Making Test (TMT) parts A and B and two performance-based measures of lower extremity function that require different executive/attentional-demanding skills: walking speed on a 4-m course at usual pace and walking speed on a 7-m obstacle course at fast pace. A difference score (Delta TMT), obtained by subtracting time to perform part A from time to perform part B of the TMT, was used as an indicator of executive function. Based on Delta TMT, subjects were divided into poor performance, intermediate performance, and good performance. RESULTS: After adjustment, no association between Delta TMT and 4-m course usual-pace walking speed was found. Participants with poor Delta TMT and with intermediate Delta TMT performance were more likely to be in the lowest tertile for 7-m obstacle course walking speed. CONCLUSION: In nondemented older persons, executive function is independently associated with tasks of lower extremity function that require high attentional demand.

Aged↗