Morbid obesity is associated with fear of movement and lower quality of life in patients with knee pain-related diagnoses

OBJECTIVE

To compare fear of movement in patients with different body mass index (BMI) values referred for rehabilitative care of the knee and to examine whether this fear contributed to self-reported knee-related function. We hypothesized that fear of movement would be elevated with increasing BMI and that fear would correspond with lower self-report knee-related function and lower quality of life (QOL).

DESIGN

Retrospective cross-sectional study.

SETTING

Outpatient therapy clinic affiliated with a tertiary care hospital.

PATIENTS

Patients with knee pain diagnoses (n = 278) were stratified into 4 BMI groups (in < or =25 kg/m(2) nonobese; 25-29.9 kg/m(2) overweight; 30-39.9 kg/m(2) obese; > or =40 kg/m(2) morbidly obese).

MAIN OUTCOME MEASUREMENTS

The Tampa Scale of Kinesiophobia (TSK; fear of movement), International Knee Documentation (IKDC; knee function), and Short-Form 8 (SF-8; QOL) scores were main outcomes. Pain and straight leg raise test scores also were collected.

METHODS

After review of the medical records, descriptive statistics and nonparametric tests were performed, and TSK, QOL, and SF-8 scores were compared. Hierarchical regression modeling determined the contribution of TSK scores to the variance of IKDC scores.

RESULTS

Pain scores were greatest in the nonobese group and lowest in the morbidly obese group (7.5 +/- 2.6 points vs 4.8 +/- 3.1 points; P < .05). TSK scores in morbidly obese patients were greater than in nonobese patients (27.1 +/- 7.7 points vs 22.0 +/- 6.6 points; P = .002). The SF-8 mental-physical subscores were 27% to 32% lower in the morbidly obese than nonobese patients (both P < .0001). IKDC scores were lower in the morbidly obese than nonobese patients (32.1 +/- 19.2 points vs 50.9 +/- 23.8 points; P = .0001). Pain severity and TSK scores contributed 28.6% and 7.1% to the variance of the IKDC scores (overall R(2) = 68.6).

CONCLUSIONS

Morbid obesity is associated with elevated fear of movement. Pain was the strongest predictor of IKDC scores, and fear of movement enhanced this predictive value of the regression model. Despite lower absolute pain severity in the morbidly obese group, this fear may influence IKDC scores in this population. Morbidly obese patients might benefit from rehabilitation activities that reduce fear of movement to optimize participation in rehabilitation activity.

Obesity and mobility disability in the older adult

Mobility disability is becoming prevalent in the obese older population (> or = 60 years of age). We included a total of 13 cross-sectional and 15 longitudinal studies based on actual physical assessments of mobility in the obese older population in this review. We systematically examined existing evidence of which adiposity estimate best predicted mobility disability. Cross-sectional studies (82-4000 participants) showed poorer lower extremity mobility with increasing obesity severity in both men and women. All longitudinal studies (1-22 years) except for one, reported relationships between adiposity and declining mobility. While different physical tests made interpretation challenging, a consistent finding was that walking, stair climbing and chair rise ability were compromised with obesity, especially if the body mass index (BMI) exceeded 35 kg m(-2). More studies found that obese women were at an increased risk for mobility impairment than men. Existing evidence suggests that BMI and waist circumference are emerging as the more consistent predictors of the onset or worsening of mobility disability. Limited interventional evidence shows that weight loss is related with increased mobility and lower extremity function. Additional longitudinal studies are warranted that address overall body composition fat and muscle mass or change on future disability.

Aquaporin-1-mediated cerebral edema following traumatic brain injury: effects of acidosis and corticosteroid administration

OBJECT

Dysregulation of water homeostasis induces cerebral edema. Edema is a major cause of morbidity and mortality following traumatic brain injury (TBI). Aquaporin-1 (AQP-1), a water channel found in the brain, can function as a transporter for CO2 across the cellular membrane. Additionally, AQP-1's promoter contains a glucocorticoid response element. Thus, AQP-1 may be involved with edema-related brain injury and might be modulated by external conditions such as the pH and the presence of steroids. In this study, the authors investigated the hypotheses that: 1) AQP-1 participates in brain water homeostasis following TBI; 2) secondary injury (for example, acidosis) alters the expression of AQP-1 and exacerbates cerebral edema; and 3) corticosteroids augment brain AQP-1 expression and differentially affect cerebral edema under nonacidotic and acidotic conditions.

METHODS

Anesthetized Sprague-Dawley rats were subjected to moderate to severe TBI (2.5-3.5 atm) or surgery without injury, and they were randomized to receive a 3-mg/kg bolus of intravenous dexamethasone within 10 minutes after injury or surgery, a 3-mg/kg bolus of dexamethasone followed by 1-mg/kg maintenance doses every 8 hours for 24 hours, or saline boluses at similar time intervals. A second group of animals was subjected to respiratory acidosis with target arterial blood pH 6.8-7.2 for 1 hour following the surgery or injury. To evaluate selective blockage of AQP-1, some animals received a single intraperitoneal dose of HgCl2 (0.3-30.0 mmol/L) within 30 minutes of injury or surgery. At 4 or 24 hours postinjury, animals were killed and their brains were harvested for mRNA, protein, or water content analyses.

RESULTS

The authors demonstrated elevated cerebral edema levels at 4 and 24 hours following TBI. Dexamethasone administration within 1 hour of TBI attenuated the cerebral edema under nonacidotic conditions but worsened it under acidotic conditions. Selective blockage of AQP-1 channels with HgCl2 attenuated the edematous effects of corticosteroids and acidosis. Reverse transcriptase polymerase chain reaction and immunohistochemical analyses demonstrated a paucity of AQP-1 in the cerebral cortices of the uninjured animals. In contrast, AQP-1 mRNA and protein levels were higher in the cerebral cortices of animals that sustained a TBI.

CONCLUSIONS

These findings implicate an important, modifiable role for AQP-1 in water homeostasis within the CNS following TBI.

Absence of combined effects of anemia and bilateral surgical status on inpatient rehabilitation outcomes following total knee arthroplasty

PURPOSE

To examine the effects of anemia on inpatient rehabilitation outcomes following unilateral and bilateral total knee arthroplasty (TKA).

METHOD

This was a multicenter, retrospective study from 15 inpatient rehabilitation facilities. Patients (N = 5421) with very low hematocrit (Hct <30%), low Hct (30-36% women, 30-41% men), or normal Hct (>36% women, 41% men) were included. Inpatient rehabilitation occurred following TKA. Functional independence measure (FIM) scores, length of stay (LOS), itemized hospital charges, discharge destination were main outcomes.

RESULTS

LOS was 13% longer and hospital charges were 12.5-18.0% higher in the very low Hct than remaining groups (p = 0.0001). The FIM score and subscores for walking, stair climbing, bathing, transfers, and dressing changes were comparable for all Hct groups for the overall score. Hct <30% did not correspond to worse outcomes in patients with bilateral surgeries compared with unilateral surgeries; total FIM scores improved 47-53% across all Hct groups, regardless of bilateral surgical status. Discharge to home ranged 92.6-94.7% across all Hct groups (p > 0.05).

CONCLUSIONS

Rehabilitation teams can expect comparable functional improvements and discharge to home in anemic and non-anemic patients with either unilateral or bilateral surgeries without hematologic correction in the rehabilitation setting, but might need an additional day to accomplish these outcomes.

Relationship of the dietary phytochemical index to weight gain, oxidative stress and inflammation in overweight young adults

BACKGROUND

Phytochemicals are bioactive nutrients that help reduce disease risk. A high intake of these compounds is important for optimal health and prevention of disease, but quantification of these nutrients in vivo is costly and time consuming. The present examined whether an alternative, simple 'phytochemical index' (PI) ratio calculation (PI = the ratio of the energy from high-nutrient phytochemical-rich foods to overall daily energy consumed [kJ phytochemical rich foods/total kJ consumed]) was related to several precursors of future disease: annual weight gain, adiposity, oxidative stress and inflammation.

METHODS

This was a cross-sectional, quantitative, descriptive study (n = 54, age range 18-30 years). Participants were stratified into normal weight and overweight groups. Three-day dietary records were analysed for food items, food groups, energy and the PI score at repeated time points. Blood plasma samples were analysed by colorimetric or an enzyme-linked immunoabsorbent assay for cholesterol subfractions, glycated haemoglobin, total antioxidant status, lipid hydroperoxides, cytokines (interleukins-1beta and -6) and C-reactive protein).

RESULTS

PI values were higher in the overweight-obese group. Correlation values between the PI score and body mass index, waist circumference, waist-to-hip ratio and plasma oxidative stress were significant. The PI score did not correlate with any cytokine levels. The PI score was a significant contributor to yearly weight gain.

CONCLUSIONS

The PI is inversely related to adiposity and oxidative stress in healthy young adults, and is responsive to body weight changes. This simple, easy to administer index might be useful as a dietary target for appropriate proportion consumption of nutrient-rich foods in weight reduction or management programmes.

Effects of antioxidant supplementation on insulin sensitivity, endothelial adhesion molecules, and oxidative stress in normal-weight and overweight young adults

The objective of the study was to determine whether short-term antioxidant (AOX) supplementation affects insulin sensitivity, endothelial adhesion molecule levels, and oxidative stress in overweight young adults. A randomized, double-blind, controlled study tested the effects of AOXs on measures of insulin sensitivity (homeostasis model assessment [HOMA]) and quantitative insulin sensitivity check index), endothelial adhesion molecules (soluble intercellular adhesion molecule-1, vascular adhesion molecule, and endothelial-leukocyte adhesion molecule-1), adiponectin, and oxidative stress (lipid hydroperoxides) in overweight and normal-weight individuals (N = 48, 18-30 years). Participants received either AOX (vitamin E, 800 IU; vitamin C, 500 mg; beta-carotene, 10 mg) or placebo for 8 weeks. The HOMA values were initially higher in the overweight subjects and were lowered with AOX by week 8 (15% reduction, P = .02). Adiponectin increased in both AOX groups. Soluble intercellular adhesion molecule-1 and endothelial-leukocyte adhesion molecule-1 decreased in overweight AOX-treated groups by 6% and 13%, respectively (P < .05). Plasma lipid hydroperoxides were reduced by 0.31 and 0.70 nmol/mL in the normal-weight and overweight AOX-treated groups, respectively, by week 8 (P < .05). Antioxidant supplementation moderately lowers HOMA and endothelial adhesion molecule levels in overweight young adults. A potential mechanism to explain this finding is the reduction in oxidative stress by AOX. Long-term studies are needed to determine whether AOXs are effective in suppressing diabetes or vascular activation over time.

Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study

OBJECTIVE

This multicenter study examined whether inpatient rehabilitation outcomes following total knee arthroplasty (TKA) were influenced by BMI.

METHODS AND PROCEDURES

This was a retrospective, comparative study conducted using a computerized medical database and medical records derived from TKA patients, at 15 independent rehabilitation hospitals (N = 5,428). Patients were separated into four groups based on BMI: non-obese (BMI < 25 kg/m(2)), overweight (25-29.9 kg/m(2)), moderately obese (30-40 kg/m(2)), severely obese (BMI > or = 40 kg/m(2)). All patients completed an interdisciplinary inpatient rehabilitation program post-TKA. Total and individual functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores, itemized hospital charges, and discharge disposition location, were collected.

RESULTS

The percentage of total FIM change was 7.5% greater by the time of discharge in the non-obese than in the very severely obese (P < 0.05). FIM efficiency was lowest in the severely obese as compared to the remaining groups (3.7 points (pts)/day vs. 4.0-4.3 pts/day; P = 0.044). The change in the motor FIM score from admission to discharge was 6.7-15.6% greater in the non-obese than in the remaining groups (P < 0.05). The changes in cognition FIM, toilet transfer and walking without assistance scores were higher in the non-obese as compared to the severely obese group (P < 0.05). The severely obese group had higher total, physical and occupational therapy and pharmacy charges than the remaining groups (P < 0.05).

DISCUSSION

An excessive BMI does not prevent gains during inpatient rehabilitation; however, these gains are made less efficiently and at a higher cost than those made when the BMI is low.

The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review

There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970-2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.

Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity

PURPOSE

Obesity may be a state of chronic oxidative stress. Oxidative stress may be the mechanism underlying the development of co-morbidities in obesity. This review provides a summary of the available evidence regarding systemic oxidative stress in young, older and clinical obese populations.

METHODS

Medline was searched for all available articles published between 1975 and 2006 that evaluated oxidative stress biomarkers in resting conditions or following various interventions in overweight and obese humans.

RESULTS

Obesity elevates oxidative stress in young, old and clinical populations as shown by elevations in lipid peroxidation (malondialdehyde, hydroperoxides, 4-hydroxynonenal, isoprostanes, conjugated dienes) or protein oxidation (8-hydroxy-deoxyguanosine). Lipid peroxidation is associated with several indices of adiposity and a low systemic antioxidant defence (i.e. antioxidant enzymes, tissue dietary antioxidants, glutathione). Oxidative stress may be exacerbated with acute exercise, advancing age or co-existing clinical conditions and may be corrected by improving antioxidant defences through fat volume reduction via surgery, pharmacological agents, exercise and/or dietary modification.

CONCLUSION

Oxidative stress is related to chronic disease in obesity, but is reversible with one or more interventions described above.

Influence of Admission Hematocrit on Inpatient Rehabilitation Outcomes After Total Knee and Hip Arthroplasty

OBJECTIVE

To examine admission hematocrit (Hct) status on inpatient rehabilitation outcomes after total knee (TKA) and hip arthroplasty (THA).

DESIGN

This study was a retrospective, exploratory analysis. Patients (n = 400) were stratified by admission hematocrit levels: normal (Hct >or=36-41%, World Health Organization criteria for normal Hct in women and men), low (Hct between the operational 30% cutoff and 36-41%), and very low (Hct <30%). Functional Independence Measure (FIM) scores and specific lower-body FIM motor scores, FIM efficiency, length of stay (LOS), and total hospital charges were analyzed.

RESULTS

Regardless of arthroplasty joint, all improved total FIM score, motor FIM score, and specific lower-body activity FIM scores (walking, wheelchair, dressing, transfers, stairs) by discharge (all P < 0.05). LOS was 28.9-31% longer in the TKA-very low Hct and THA-very low Hct groups than in the normal Hct groups (P = 0.026). Total hospital charges were 32.6-45.6% higher in the TKA-very low Hct and THA-very low Hct groups than in the normal Hct groups (P < 0.05). Hct was a significant contributor to the variance of linear regression models for LOS and total charges (P < 0.05).

CONCLUSIONS

Although very low Hct at admission does not impede functional gains, it is related to longer LOS and greater hospital charges. Rehabilitation teams should consider this when preparing plans of care, rehabilitation goals, and plans for discharge.

Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part 2: a potential role for mind-body therapies

Cardiovascular disease (CVD) is the leading cause of death and disability in the industrialized world, and its prevalence is rapidly increasing among developing nations. The increasing global prevalence of CVD reflects in part the concurrent rise in insulin resistance, obesity, dyslipidemia, and other atherogenic changes associated with insulin resistance syndrome (IRS). Evidence suggests that chronic stress and related psychosocial factors also play an important role in the development and progression of IRS-related states and ultimately, in the pathogenesis of CVD. Designed to address these interrelated psychological and physiological components of health, yoga and other traditional mind-body therapies may offer particular promise in both the primary and secondary prevention of CVD. In this article, we review the evidence regarding the potential benefits of specific mind-body modalities for CVD risk reduction and discuss possible mechanisms underlying these observed effects.

Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part I: neurophysiological responses and pathological sequelae

Cardiovascular disease (CVD) is the leading cause of death and disability in the industrialized world, and the prevalence is increasing rapidly among developing nations. The rising prevalence of CVD worldwide may be attributed in large part to specific atherogenic changes in insulin resistance, adiposity, lipid profiles, and other indices of insulin resistance syndrome (IRS), a cluster of metabolic and hemodynamic abnormalities that are strongly predictive of CVD. A growing body of research suggests that chronic psychosocial stress and related factors significantly contribute to the pathogenesis of IRS-related abnormalities, associated insulin-resistant states, and CVD, in part by promoting dysregulation of the sympathoadrenal system and hypothalamic-pituitary-adrenal axis. In this article, we review the literature supporting the relationships between these factors, outline the neurophysiologic responses to chronic stress, and discuss the pathways by which chronic or recurrent psychosocial stress may lead to a destructive cascade of neuroendocrine, metabolic, inflammatory, and neuropsychological changes that fosters the development of IRS and, ultimately, CVD.

Effects of Alpha-Lipoic Acid Supplementation in Peripheral Arterial Disease: A Pilot Study

OBJECTIVE

To examine whether 3 months of lipoic acid (LA) supplementation improved walking tolerance and delayed claudication pain onset in peripheral arterial disease (PAD).

DESIGN

Randomized, double-blind, controlled study.

SETTING

General Clinical Research Center.

SUBJECTS

Twenty-eight (28) participants (15 men, 13 women) with PAD (ankle brachial index range 0.9-0.4, mean age 73.2 +/- 1.6 years).

INTERVENTION

LA (600 mg/day) or placebo for 3 months.

OUTCOME MEASURES

Walking tolerance was assessed by 6-minute walk test distance, 4-meter walk time, initial claudication pain time (ICT) and distance (ICD), and peak claudication pain. Serum was assessed for inflammation (C-reactive protein [CRP]) and oxidative stress (lipid hydroperoxides) as potential mechanisms for changes in walking tolerance.

RESULTS

ICT increased 34.4% and 15%, ICD was reduced by 40.5% and 18%, and peak claudication pain ratings were reduced by 93% and 7% in LA and placebo groups, respectively. Although the improvements in peak pain and ICT achieved significance within the LA group (both p<0.05), the interactions of group by time were not found to be significant (p>0.05). Oxidative stress and CRP measures were not different between groups by month 3 (p>0.05). There were no serious side-effects associated with the LA.

CONCLUSIONS

LA may confer pain relief during exercise. However, longer and larger trials are warranted to determine long-term effects of LA alone or combined with other interventions on PAD symptoms.

Effect of obesity on inpatient rehabilitation outcomes following total knee arthroplasty

OBJECTIVES

To examine obesity effects on outcomes following inpatient rehabilitation in patients following primary total knee arthroplasty or revision total knee arthroplasty.

DESIGN

Retrospective, comparative study.

SETTING

Fifty-bed, university-affiliated rehabilitation hospital.

PATIENTS

Obese (N = 139; body mass index >30 kg/m(2)) and non-obese (N = 146; body mass indexB <30 kg/m(2)) total knee arthroplasty patients. Participants were further stratified based on total knee arthroplasty type, primary and revision for a total of four groups.

INTERVENTION

Interdisciplinary inpatient rehabilitation.

MAIN MEASURES

Range of motion, length of stay, Functional Independence Measure (FIM) scores, FIM efficiency scores, total and daily hospital charges, and discharge disposition location.

RESULTS

Range of motion and FIM scores improved from admission to discharge in both obese and non-obese patients regardless of total knee arthroplasty type. FIM efficiency was lower in revision than primary total knee arthroplasty (2.8 versus 3.6 patients/day; P < 0.005) but not different between obese and non-obese groups. Total hospital charges were lower for the primary than for the revision patients (P < 0.05), but were directly related with body mass index (r = 0.140, P < 0.05). Discharge disposition locations were not different among groups.

CONCLUSION

Rehabilitation teams can expect comparable gains between obese and non-obese patients following total knee arthroplasty, but at a greater expense.

Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty

OBJECTIVE

This study examined whether obesity affected inpatient rehabilitation outcomes after total hip arthroplasty (THA).

RESEARCH METHODS AND PROCEDURES

This was a retrospective, comparative study conducted using a computerized medical database derived from THA patients at a university-affiliated rehabilitation hospital (data from 2002 to 2005). Patients were divided into four brackets based on BMI: non-obese (<25 kg/m(2)), overweight (25 to 29.9 kg/m(2)), moderate obesity (30 to 39.9 kg/m(2)), and severe obesity (> or = 40 kg/m(2)). All patients completed an interdisciplinary inpatient rehabilitation program after THA. Functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores (FIM/LOS), hospital charges, and discharge disposition location were collected.

RESULTS

FIM scores improved from admission to discharge similarly in all groups (25 to 29.5 points). However, FIM efficiency, LOS, and total charges were curvilinearly related with BMI (all p < 0.05). Total hospital charges were highest in the severely obese group compared with the overweight group (p < 0.05). Non-homebound discharge disposition rates were lower in non-obese (13.1%) and severely obese groups (10.5%).

DISCUSSION

Elevated BMI does not prevent FIM gains in THA patients during inpatient rehabilitation. However, BMI is related with FIM efficiency, LOS, and hospital charges in a curvilinear fashion. Severely obese patients can achieve physical improvements but at a lower efficiency and greater cost.

Antioxidant supplementation lowers exercise-induced oxidative stress in young overweight adults

OBJECTIVE

To determine whether antioxidant (AOX) supplementation attenuates post-exercise oxidative stress and contributors to oxidative stress (inflammation, blood lipids) in overweight young adults.

RESEARCH METHODS AND PROCEDURES

This was a randomized, double-blind, controlled study. Overweight (BMI, 33.2 +/- 1.9 kg/m(2)) and comparative normal-weight (BMI, 21.9 +/- 0.5 kg/m(2)) adults 18 to 30 years old (total N = 48) were enrolled. Participants received either daily antioxidant (AOX) treatment (800 IU of vitamin E, 500 mg of vitamin C, 10 mg of beta-carotene) or placebo (PL) for 8 weeks for a total of four groups. All participants completed a standardized 30-minute cycle exercise bout at baseline and 8 weeks. Exercise-induced changes in lipid hydroperoxide (DeltaPEROX), C-reactive protein (DeltaCRP), interleukin-6 (DeltaIL-6), cholesterol subfractions, triglycerides, total AOX status (DeltaTAS), and adiponectin were assessed.

RESULTS

Exercise-induced DeltaPEROX was lower in the overweight-AOX group (0.09 nM/kg per min) compared with PL-treated overweight and normal-weight groups (0.98, 0.53 nM/kg per min) by 8 weeks (p < 0.05). Adiponectin was increased in both overweight and normal-weight AOX groups (22.1% vs. 3.1%; p < 0.05) but reduced in PL groups. DeltaIL-6, Deltatotal cholesterol, and Deltalow-density lipoprotein-cholesterol concentrations during exercise were lower in the AOX-treated groups compared with PL groups (all p < 0.05). After controlling for BMI, the Deltatotal cholesterol, Deltalow-density lipoprotein-cholesterol, Deltaadiponectin, and DeltaTAS explained 59.1% of the variance of the regression model of the DeltaPEROX by 8 weeks (total model R(2) = 0.600; p = 0.015).

DISCUSSION

AOX lowers exercise-induced oxidative stress in overweight adults. Inflammatory and lipid markers may also be attenuated with AOX. Further studies are needed to determine whether AOX may be used in cardiovascular disease prevention in the overweight population.

A Preliminary Examination of the CMS Eligibility Criteria in Total-Joint Arthroplasty

OBJECTIVE

To analyze inpatient rehabilitation outcomes in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA) patients using the 2004 Medicare 75% rule criteria.

DESIGN

This retrospective study compared outcomes in unilateral TKA (UTKA), bilateral TKA (BTKA), and THA after interdisciplinary inpatient rehabilitation (n = 867). Patients were separated into three comparison pairs: 1) UTKA or BTKA, 2) age <85 yrs or > or =85 yrs, and 3) body mass index (BMI) <50 or > or =50 kg/m. Length of stay (LOS), functional independence measure (FIM) scores (total, motor, and cognitive), hospital charges, FIM efficiency, and discharge disposition were analyzed.

RESULTS

BTKA improved total FIM score more than UTKA (43 vs. 38%; P = 0.039). TKA with BMI > or =50 kg/m had similar admission and discharge FIM motor scores compared with BMI <50 kg/m (P > 0.05). TKA patients > or =85 yrs had lower admission FIM scores, longer LOS (11.3 vs. 9.4 days), and 22% higher total charges than TKA patients younger than 85 yrs (P = 0.042). THA patients > or =85 yrs had 6-10% lower total FIM, FIM motor, and FIM cognition scores and were discharged to home less frequently than younger patients (P < 0.05). Total and daily charges were 21-162% higher in THA patients with BMIs > or =50 kg/m than in THA patients with BMIs <50 kg/m (P < 0.045).

CONCLUSION

All patients made functional gains during rehabilitation. However, the most costly and lengthy rehabilitation occurred in TKA patients > or =85 yrs and THA patients with BMI > or =50 kg/m.

Resistance training lowers exercise-induced oxidative stress and homocysteine levels in overweight and obese older adults

OBJECTIVE

To compare exercise-induced oxidative stress and levels of homocysteine and cholesterol in normal-weight and overweight older adults after resistance exercise (RX).

RESEARCH METHODS AND PROCEDURES

This interventional study was conducted at a wellness center. Forty-nine older adults (age range, 60 to 72 years) were stratified by BMI (<25 kg/m(2) normal weight, > or =25 kg/m(2) overweight/obese) and then randomly assigned to either a control non-exercise group or an RX group. The RX group completed a 6-month training program. Exercise-induced lipid hydroperoxides (PEROXs) and thiobarbituric-reactive acid substances, homocysteine, lipoprotein a, cholesterol, and high-density lipoprotein cholesterol were measured before and after the 6-month RX program.

RESULTS

PEROXs and thiobarbituric-reactive acid substances were lower in both the overweight/obese and normal-weight RX-trained groups compared with control groups (p < 0.05). Homocysteine levels were lower in both overweight/obese and normal-weight RX groups compared with control groups (p < 0.05). Lipoprotein a, total cholesterol, and high-density lipoprotein cholesterol were not different in normal-weight and overweight/obese groups before or after RX. The change in muscle strength was correlated with homocysteine at 6 months (r = -0.452, p < 0.05), whereas the change in PEROXs was correlated with the change in body fat (r = -0.329).

DISCUSSION

To our knowledge, these data are the first to show that RX reduces exercise-induced oxidative stress and homocysteine regardless of adiposity, indicating that this protection can be afforded in an older, overweight/obese population as effectively as in healthy older adults. These data suggest that RX may afford some protection against emerging cardiovascular risk factors using a mode of exercise that supports body weight.

Outcomes After Inpatient Rehabilitation of Primary and Revision Total Hip Arthroplasty

OBJECTIVE

To compare the outcomes of patients who have gone to inpatient rehabilitation after primary total hip arthroplasty (THA) and revision THA.

DESIGN

Retrospective, comparative study.

SETTING

Fifty-bed freestanding, university-affiliated rehabilitation hospital.

PARTICIPANTS

Two hundred fifty-five male and female primary THA patients and 147 male and female revision THA patients.

INTERVENTION

Interdisciplinary inpatient rehabilitation.

MAIN OUTCOME MEASURES

Length of stay (LOS), FIM instrument score and FIM motor score components, hospital charges, and discharge disposition location.

RESULTS

FIM scores improved from admission to discharge by 29.7 and 27.9 points for the primary THA and revision THA groups, respectively (P<.05). LOS was shorter for primary THA patients compared with revision THA patients (10.0d vs 11.5d, P<.05). FIM efficiency (DeltaFIM/LOS) was greater for primary THA compared with revision THA (3.4 and 2.7 points/day, P<.05). Total rehabilitation hospital charges were 11,421 US dollars and 13,707 US dollars for the primary and revision THA groups, respectively, with the mechanical and infection revision THAs incurring the greatest charges (14,596 US dollars and 15,386 US dollars, respectively; P<.001). Compared with primary THA, revision THA patients were twice as likely to be discharged to locations other than home.

CONCLUSIONS

FIM score improvement was lower and LOS and hospital charges were greater in revision THA than in primary THA after rehabilitation. Infection revision THA patients gained less functional independence and were discharged home less often than mechanical or pain revision THA patients; finally, infection and mechanical revision THA accrued the highest hospital charges.

Obesity and postexercise oxidative stress in older women

PURPOSE

This study compared lipid peroxidation values in nonobese and obese postmenopausal women before and after acute maximal aerobic exercise (AX).

METHODS

Blood samples were collected in nonobese (22.1 +/- 0.9% body fat) and obese (40.8 +/- 0.9% body fat) women (61-75 yr, N = 34) before and immediately after a maximal graded treadmill test. Lipid hydroperoxides (PEROX), cholesterol, and thiol profiles were measured. Oxygen consumption (V(O2), respiratory exchange ratios (RER), and minute ventilation (VE) values were determined before and during exercise.

RESULTS

PEROX levels were not different between the nonobese and obese groups at baseline (2.4 vs 2.8 nmol.mL(-1), respectively) or post-AX (2.8 vs 3.2 nmol.mL(-1), respectively) (P > 0.05). When expressed as DeltaPEROX (nmol.mL(-1))/DeltaVO(2) (mL.kg(-1).min(-1)), to account for different exercise durations, the obese group had a greater lipid peroxidation response compared with the nonobese group (0.13 vs 0.02 (nmol.mL(-1)).mL(-1).kg(-1).min(-1), respectively; P < 0.05). Regression analysis revealed that when baseline PEROX and body fat values were controlled, age, exercise intensity, and duration were significant contributors to the DeltaPEROX/DeltaV(O2) after AX (R(2) = 0.536 P < 0.05).

CONCLUSION

For a given oxidative challenge (exercise-associated oxygen utilization), older, obese women were at a greater risk for oxidative stress compared with nonobese counterparts.