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Tseng SY, Lai CL, Ko CP, Chang YK, Fan HC, Wang CH. The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1650. [PMID: 36674404 PMCID: PMC9861224 DOI: 10.3390/ijerph20021650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 05/22/2023]
Abstract
Whole-body vibration (WBV) is a novel exercise training measure that promotes the muscle strength, flexibility, and balance abilities of elderly groups. The feasibility and applicability of 20-30 min (lowering a heat pack at 73 °C by wrapping it in multiple layers of towels to 40-43 °C before it touched the skin) thermotherapy are increasingly being demonstrated by applications and clinical trials. Studies show that it increases the flexibility of macules and ligament. However, no studies have examined the interactions between the pre-exercise and post-exercise application of heat therapy (duration a training course). Therefore, this study investigates the effects of WBV and heat therapy on the muscle strength, flexibility, and balance abilities of elderly groups. Eighty middle-age and elderly participants with no regular exercise habits were enrolled in this study. They were randomly assigned to a WBV group, a WBV plus heat therapy group, a heat therapy alone group, and a control group. The WBV groups underwent 5-min, fixed-amplitude (4 mm), thrice-weekly WBV training sessions for 3 consecutive months on a WBV training machine. Participants' balance was measured using the limits of stability (LOS) test on a balance system. The pretest and posttest knee extensor and flexor strength were tested using an isokinetic lower extremity dynamometer. Pretest and posttest flexibility changes were measured using the sit-and-reach test. Significantly larger pretest and posttest differences in flexibility and muscle strength were observed in the WBV and WBV plus heat therapy groups. The addition of heat therapy to WBV resulted in the largest flexibility improvements.
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Affiliation(s)
- Shiuan-Yu Tseng
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu 30401, Taiwan
| | - Chung-Liang Lai
- Department of Occupational Therapy, Asia University, Taichung 41354, Taiwan
- Department of Physical Medicine and Rehabilitation, Puzi Hospital, Ministry of Health and Welfare, Chiayi 61347, Taiwan
| | - Chung-Po Ko
- Department of Neurosurgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yu-Kang Chang
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
- Nursing and Management, Jenteh Junior College of Medicine, Miaoli 35664, Taiwan
| | - Hueng-Chuen Fan
- Nursing and Management, Jenteh Junior College of Medicine, Miaoli 35664, Taiwan
- Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
| | - Chun-Hou Wang
- Department of Physical Therapy, Chung Shan Medical University, Taichung 40201, Taiwan
- Physical Therapy Room, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Abdelbasset WK, Abdelhalim NM. Assessing the effects of 6 weeks of intermittent aerobic exercise on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study. Burns 2020; 46:1193-1200. [DOI: 10.1016/j.burns.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 12/30/2022]
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Zouboulis CC, Makrantonaki E, Nikolakis G. When the skin is in the center of interest: An aging issue. Clin Dermatol 2019; 37:296-305. [PMID: 31345316 DOI: 10.1016/j.clindermatol.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The skin represents the first bearer of marks of time as well as an easily accessible model for the assessment and determination of the involved molecular mechanisms. The deterioration of important skin functions due to intrinsic and extrinsic aging leads to clinical manifestations, which mirror several internal age-associated diseases, such as neurodegenerative, cardiovascular, skeletal, and endocrine/metabolic skin diseases. Current molecular data indicate that skin aging, especially intrinsic aging, mirrors age-related deficiencies in the entire human body. These data and the development of new biologic technologies highlight the importance of the skin in aging research and should enable future interdisciplinary projects on internal diseases, which could barely have been performed until recently due mainly to the lack of respective tissue.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.
| | - Eugenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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Makrantonaki E, Jiang D, Hossini AM, Nikolakis G, Wlaschek M, Scharffetter-Kochanek K, Zouboulis CC. Diabetes mellitus and the skin. Rev Endocr Metab Disord 2016; 17:269-282. [PMID: 27432328 DOI: 10.1007/s11154-016-9373-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
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Affiliation(s)
- E Makrantonaki
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany.
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany.
| | - D Jiang
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - A M Hossini
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - M Wlaschek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - K Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - C C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
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Abstract
Painful neuropathy, like the other complications of diabetes, is a growing healthcare concern. Unfortunately, current treatments are of variable efficacy and do not target underlying pathogenic mechanisms, in part because these mechanisms are not well defined. Rat and mouse models of type 1 diabetes are frequently used to study diabetic neuropathy, with rats in particular being consistently reported to show allodynia and hyperalgesia. Models of type 2 diabetes are being used with increasing frequency, but the current literature on the progression of indices of neuropathic pain is variable and relatively few therapeutics have yet been developed in these models. While evidence for spontaneous pain in rodent models is sparse, measures of evoked mechanical, thermal and chemical pain can provide insight into the pathogenesis of the condition. The stocking and glove distribution of pain tantalizingly suggests that the generator site of neuropathic pain is found within the peripheral nervous system. However, emerging evidence demonstrates that amplification in the spinal cord, via spinal disinhibition and neuroinflammation, and also in the brain, via enhanced thalamic activity or decreased cortical inhibition, likely contribute to the pathogenesis of painful diabetic neuropathy. Several potential therapeutic strategies have emerged from preclinical studies, including prophylactic treatments that intervene against underlying mechanisms of disease, treatments that prevent gains of nociceptive function, treatments that suppress enhancements of nociceptive function, and treatments that impede normal nociceptive mechanisms. Ongoing challenges include unraveling the complexity of underlying pathogenic mechanisms, addressing the potential disconnect between the perceived location of pain and the actual pain generator and amplifier sites, and finding ways to identify which mechanisms operate in specific patients to allow rational and individualized choice of targeted therapies.
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Affiliation(s)
- Corinne A Lee-Kubli
- Graduate School of Biomedical Sciences, Sanford-Burnham Institute for Molecular Medicine, La Jolla, CA, USA; Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Nigel A Calcutt
- Department of Pathology, University of California San Diego, La Jolla, CA, USA.
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Armstrong MJ, Sigal RJ. Physical activity clinical practice guidelines: what's new in 2013? Can J Diabetes 2015; 37:363-6. [PMID: 24321715 DOI: 10.1016/j.jcjd.2013.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/16/2013] [Accepted: 07/24/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Marni J Armstrong
- Department of Cardiovascular and Respiratory Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Greyling A, Schreuder THA, Landman T, Draijer R, Verheggen RJHM, Hopman MTE, Thijssen DHJ. Elevation in blood flow and shear rate prevents hyperglycemia-induced endothelial dysfunction in healthy subjects and those with type 2 diabetes. J Appl Physiol (1985) 2015; 118:579-85. [PMID: 25593286 DOI: 10.1152/japplphysiol.00936.2014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hyperglycemia, commonly present after a meal, causes transient impairment in endothelial function. We examined whether increases in blood flow (BF) protect against the hyperglycemia-mediated decrease in endothelial function in healthy subjects and patients with type 2 diabetes mellitus (T2DM). Ten healthy subjects and 10 age- and sex-matched patients with T2DM underwent simultaneous bilateral assessment of brachial artery endothelial function by means of flow-mediated dilation (FMD) using high-resolution echo-Doppler. FMD was examined before and 60, 120, and 150 min after a 75-g oral glucose challenge. We unilaterally manipulated BF by heating one arm between minute 30 and minute 60. Oral glucose administration caused a statistically significant, transient increase in blood glucose in both groups (P < 0.001). Forearm skin temperature, brachial artery BF, and shear rate significantly increased in the heated arm (P < 0.001), and to a greater extent compared with the nonheated arm in both groups (interaction effect P < 0.001). The glucose load caused a transient decrease in FMD% (P < 0.05), whereas heating significantly prevented the decline (interaction effect P < 0.01). Also, when correcting for changes in diameter and shear rate, we found that the hyperglycemia-induced decrease in FMD can be prevented by local heating (P < 0.05). These effects on FMD were observed in both groups. Our data indicate that nonmetabolically driven elevation in BF and shear rate can similarly prevent the hyperglycemia-induced decline in conduit artery endothelial function in healthy volunteers and in patients with type 2 diabetes. Additional research is warranted to confirm that other interventions that increase BF and shear rate equally protect the endothelium when challenged by hyperglycemia.
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Affiliation(s)
- Arno Greyling
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; Unilever R&D Vlaardingen, The Netherlands; and
| | - Tim H A Schreuder
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs Landman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Sigal RJ, Armstrong MJ, Colby P, Kenny GP, Plotnikoff RC, Reichert SM, Riddell MC. Activité physique et diabète. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Petrofsky JS, Laymon M, Lee H. Effect of heat and cold on tendon flexibility and force to flex the human knee. Med Sci Monit 2013; 19:661-7. [PMID: 23933600 PMCID: PMC3747018 DOI: 10.12659/msm.889145] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is commonly believed in medicine that using heat will increase the distensability and flexibility of soft tissue. If true, increased flexibility would be a positive factor to reduce injuries in sports. However, cold should have the opposite effect and is often used to treat sports injuries. This study was accomplished to quantify the effect of heat and cold on the force needed to flex the knee and laxness of the anterior and posterior cruciate ligaments. MATERIAL AND METHODS The present study examined 20 male and female subjects to determine if heat would increase extensibility of the anterior and posterior cruciate ligaments of the knee and reduce the force needed to flex the knee. Cold exposure was examined to see if it would have the opposite effect. There were 4 experiments in the series: The first was a room temperature series; the second was a series where cold was applied with an ice pack for 20 minutes; in the third, hydrocollator heat packs were applied for 20 minutes; and in the fourth, ThermaCare heat wraps were applied for 4 hours on the quadriceps and knee. Tendon extensibility was measured with a KT2000. The force for flexing the knee was measured by passive movement being applied (CPM) to the knee through 30° and the force required to move the leg was measured. RESULTS The results show that the anterior and posterior cruciate ligament flexibility increased and the force needed to move the knee decreased with heat by about 25% compared to cold application. CONCLUSIONS Heat is beneficial in increasing muscle and ligament flexibility and may help reduce athletic injuries, but cold treatment may have the opposite effect.
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Sigal RJ, Armstrong MJ, Colby P, Kenny GP, Plotnikoff RC, Reichert SM, Riddell MC. Physical activity and diabetes. Can J Diabetes 2013; 37 Suppl 1:S40-4. [PMID: 24070962 DOI: 10.1016/j.jcjd.2013.01.018] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yim J, Petrofsky J, Berk L, Daher N, Lohman E. Differences in endothelial function between Korean-Asians and Caucasians. Med Sci Monit 2012; 18:CR337-43. [PMID: 22648248 PMCID: PMC3560726 DOI: 10.12659/msm.882902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The vascular endothelium plays an integral role in maintaining vascular homeostasis, including the regulation of blood flow, vascular tone, and platelet aggregation. The aim of this study was to see if there were any differences in endothelial function between Koreans and Caucasians. Material/Methods This was accomplished by 2 measures of endothelial function – the response to local heat and the response to vascular occlusion. Ten Caucasian and 10 Korean male and female subjects participated (<35 years old). Endothelial function was assessed by the skin blood flow response to local heat using a thermode for 6 minutes at 3 temperatures (38°C, 40°C and 42°C) and by vascular occlusion for 4 minutes followed by release and measurement of skin blood flow for 2 minutes. Results When applying 6 minutes of local heat at 3 different temperatures (38°C, 40°C, and 42°C), the skin blood flows were significantly higher for all temperatures in Caucasians as compared with Koreans, with peak blood flow of 223±48.1, 413.7±132.1, and 517.4±135.8 flux in Caucasians and 126.4±41.3, 251±77.9, and 398±97.2 flux in Koreans, respectively (p=0.001). Results of this study support the idea that the skin blood flow response to occlusion was significantly higher in Caucasians (peak 411.9±88.9 flux) than Koreans (peak 332.4±75.8 flux) (p=0.016). Conclusions These findings suggest that Koreans may have lower endothelial function than Caucasians, which may be explained, in part, by genetic variations between the 2 ethnic groups.
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Affiliation(s)
- Jongeun Yim
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA 92350, USA
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12
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Petrofsky JS, Berk L, Alshammari F, Lee H, Hamdan A, Yim JE, Kodawala Y, Patel D, Nevgi B, Shetye G, Moniz H, Chen WT, Alshaharani M, Pathak K, Neupane S, Somanaboina K, Shenoy S, Cho S, Dave B, Desai R, Malthane S, Al-Nakhli H. The interrelationship between air temperature and humidity as applied locally to the skin: the resultant response on skin temperature and blood flow with age differences. Med Sci Monit 2012; 18:CR201-8. [PMID: 22460091 PMCID: PMC3560817 DOI: 10.12659/msm.882619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most studies of the skin and how it responds to local heat have been conducted with either water, thermodes, or dry heat packs. Very little has been accomplished to look at the interaction between air humidity and temperature on skin temperature and blood flow. With variable air temperatures and humidity's around the world, this, in many ways, is a more realistic assessment of environmental impact than previous water bath studies. MATERIAL/METHODS Eight young and 8 older subjects were examined in an extensive series of experiments where on different days, air temperature was 38, 40, or 42°C. and at each temperature, humidity was either 0%, 25%, 50%, 75%, or 100% humidity. Over a 20 minute period of exposure, the response of the skin in terms of its temperature and blood flow was assessed. RESULTS For both younger and older subjects, for air temperatures of 38 and 40°C., the humidity of the air had no effect on the blood flow response of the skin, while skin temperature at the highest humidity was elevated slightly. However, for air temperatures of 42°C., at 100% humidity, there was a significant elevation in skin blood flow and skin temperature above the other four air humidity's (p<0.05). In older subjects, the blood flow response was less and the skin temperature was much higher than younger individuals for air at 42°C. and 100% humidity (p<0.05). CONCLUSIONS Thus, in older subjects, warm humid air caused a greater rise in skin temperature with less protective effect of blood flow to protect the skin from overheating than is found in younger subjects.
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Affiliation(s)
- Jerrold S Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350, USA.
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The influence of autonomic dysfunction associated with aging and type 2 diabetes on daily life activities. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:657103. [PMID: 22566994 PMCID: PMC3332074 DOI: 10.1155/2012/657103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/28/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes (T2D) and ageing have well documented effects on every organ in the body. In T2D the autonomic nervous system is impaired due to damage to neurons, sensory receptors, synapses and the blood vessels. This paper will concentrate on how autonomic impairment alters normal daily activities. Impairments include the response of the blood vessels to heat, sweating, heat transfer, whole body heating, orthostatic intolerance, balance, and gait. Because diabetes is more prevalent in older individuals, the effects of ageing will be examined. Beginning with endothelial dysfunction, blood vessels have impairment in their ability to vasodilate. With this and synaptic damage, the autonomic nervous system cannot compensate for effectors such as pressure on and heating of the skin. This and reduced ability of the heart to respond to stress, reduces autonomic orthostatic compensation. Diminished sweating causes the skin and core temperature to be high during whole body heating. Impaired orthostatic tolerance, impaired vision and vestibular sensing, causes poor balance and impaired gait. Overall, people with T2D must be made aware and counseled relative to the potential consequence of these impairments.
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Al-Nakhli HH, Petrofsky JS, Laymon MS, Arai D, Holland K, Berk LS. The use of thermal infrared imaging to assess the efficacy of a therapeutic exercise program in individuals with diabetes. Diabetes Technol Ther 2012; 14:159-67. [PMID: 22011006 DOI: 10.1089/dia.2011.0187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Exercise is of great value for individuals with diabetes in helping to control their hemoglobin A1c levels and in increasing their insulin sensitivity. Delayed-onset muscle soreness (DOMS) is a common problem in healthy individuals and in people who have diabetes. People with diabetes are also faced with metabolic and endothelial impairments, which could make DOMS even worse. But because they usually have neuropathies, they may not feel this soreness appropriately, leading to premature return to exercise and causing further injuries. RESEARCH DESIGN One hundred eighteen subjects participated in this study and were divided into four groups. Two groups (healthy and diabetes) performed a series of abdominal exercises, and the other two groups (healthy and diabetes) performed a series of arm exercises to induce DOMS. Skin temperature above the muscle was assessed using a thermal infrared camera, and perceived soreness of the exercised muscle was assessed using a 100-mm visual analog scale. Serum myoglobin concentrations were also measured. RESULTS There was a significant increase in skin temperature 24 h post-exercise for all four exercise groups (P<0.05), where the combined average increase in skin temperature for all four groups was approximately 0.65°C from baseline. Also, 24 h post-exercise, all four groups were significantly sorer than they were at baseline (P<0.05). Serum myoglobin levels were also significantly higher on day 3 compared with day 1 (P<0.05). CONCLUSION Infrared thermal imaging may be a valuable technique of seeing which muscles are sore hours or even days after the exercise is over. Thus, thermal imaging would be an efficient and painless way of looking at DOMS in both healthy individuals and individuals who have diabetes, even if they are facing neurological problems.
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Petrofsky J, Berk L, Alshammari F, Lee H, Hamdan A, Yim JE, Patel D, Kodawala Y, Shetye G, Chen WT, Moniz H, Pathak K, Somanaboina K, Desai R, Dave B, Malthane S, Alshaharani M, Neupane S, Shenoy S, Nevgi B, Cho S, Al-Nakhli H. The effect of moist air on skin blood flow and temperature in subjects with and without diabetes. Diabetes Technol Ther 2012; 14:105-16. [PMID: 22017463 DOI: 10.1089/dia.2011.0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat. METHODS Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed. RESULTS For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P>0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P<0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings. CONCLUSION These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California 92350, USA.
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Petrofsky J. A method of measuring the interaction between skin temperature and humidity on skin vascular endothelial function in people with diabetes. J Med Eng Technol 2011; 35:330-7. [PMID: 21736497 DOI: 10.3109/03091902.2011.592237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND A core defect in people with Type 2 Diabetes is endothelial dysfunction. This defect permeates all organ systems in the body including the ability of the skin to protect itself from thermal injuries by an appropriate increase in skin circulation. Most studies on the local response to heating have been done with dry heat sources. Recent data show that endothelial function is improved in people with diabetes with moist heat. Little is known about 'how' moist heat must be or the mechanisms on why moist heat triggers a better blood flow response than dry heat. METHODS In the present investigation, a device was developed to provide variable temperature air and variable humidity as an aid to study the dynamics of the skin circulatory response to heat in people with diabetes. The device consisted of a water bath used to heat air and an air dryer and air bubbler to generate dry and moist air, respectively, at a fixed temperature. The air could then be mixed and the temperature stabilized to produce a variable temperature and humidity air source to expose the skin to in people with diabetes. RESULTS The device was validated at different air temperatures and humidities and tested on four subjects to assess operation. The air flows, temperatures and humilities were stable with less than a 5% coefficient of variation. CONCLUSIONS Testing on humans showed that there appeared to be a linear relationship between air humidity and blood flow at a given air temperature exposed to the skin.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA.
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Petrofsky J, Batt J, Bollinger JN, Jensen MC, Maru EH, Al-Nakhli HH. Comparison of different heat modalities for treating delayed-onset muscle soreness in people with diabetes. Diabetes Technol Ther 2011; 13:645-55. [PMID: 21457064 DOI: 10.1089/dia.2011.0002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Delayed-onset muscle soreness (DOMS) is a serious problem for people who do not exercise on a regular basis. Although the best preventive measure for diabetes and for maintaining a low hemoglobin A1c is exercise, muscle soreness is common in people with diabetes. For people with diabetes, DOMS is rarely reported in exercise studies. RESEARCH DESIGN One hundred twenty subjects participated in three groups (young, older, and type 2 diabetes) and were examined to evaluate the soreness in the abdominal muscles after a matched exercise bout using a p90x exercise video (Beachbody LLC, Los Angeles, CA) for core fitness. Next, three heating modalities were assessed on how well they could reduce muscle soreness: ThermaCare(®) (Pfizer Consumer Healthcare, Richmond, VA) heat wraps, hydrocollator heat wraps, and a chemical moist heat wrap. RESULTS The results showed that people with diabetes were significantly sorer than age-matched controls (P < 0.05). On a 100-mm VAS (100 mm = sorest), the average soreness for the people with diabetes was 73.3 ± 16.2 mm, for the older group was 56.1 ± 15.1 mm, and for the younger group was 41.5 ± 9.3 mm; these differences were significant (analysis of variance, P < 0.05). The greatest reduction in soreness after applying the modalities was using moist heat, both immediately after the modality and up to 2 days after the exercise. Right after the modality, moist heat reduced pain by 52.3% in the older subjects compared with 30.5% in the subjects with diabetes and 33.3% in the younger subjects. Skin blood flow in the abdominal area before exercise was greatest in the younger subjects and lower in the subjects with diabetes after heat application. Skin temperature at rest and after exercise was greatest in the diabetes group. CONCLUSIONS Muscle soreness following exercise was greatest in people with diabetes, and the best modality of the three studied to reduce this type of soreness was chemical moist heat.
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Petrofsky JS. The effect of type-2-diabetes-related vascular endothelial dysfunction on skin physiology and activities of daily living. J Diabetes Sci Technol 2011; 5:657-67. [PMID: 21722580 PMCID: PMC3192631 DOI: 10.1177/193229681100500319] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A common factor contributing to organ damage in type 2 diabetes mellitus (T2DM) is impaired tissue blood flow caused by damage to vascular endothelial cells (VECs). Damage can occur even before the clinical diagnosis of diabetes. It can be caused by both a high average blood glucose concentration and/or large daily spikes in blood glucose. While much of the present literature focuses on the damage to VECs and organs from these large glucose excursions, this review will focus on the consequence of this damage, that is, how endothelial cell damage in diabetes affects normal daily activities (e.g., exercise, reaction to typical stimuli) and various treatment modalities (e.g.. contrast baths and electrical stimulation therapy). It is important to understand the effects of VEC damage such as poor skin blood flow, compromised thermoregulation, and altered response to skin pressure in designing diabetes technologies as simple as heating pads and as complex as continuous glucose monitors. At the simplest level, people with diabetes have poor circulation to the skin and other organs. In the skin, even the blood flow response to locally applied pressure, such as during standing, is different than for people who do not have T2DM. Simple weight bearing on the foot can occlude the skin circulation. This makes the skin more susceptible to damage. In addition, endothelial damage has far-reaching effects on the whole body during normal activities of daily living, including an impaired response to local heat, such as hot packs and contrast baths, and higher body temperatures during whole body heating due to impaired blood flow and a reduced ability to sweat. Finally, because of multiple organ damage, people with T2DM have poor balance and gait and impaired exercise performance.
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Affiliation(s)
- Jerrold Scott Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA.
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Petrofsky J, Paluso D, Anderson D, Swan K, Alshammari F, Katrak V, Murugesan V, Hudlikar AN, Chindam T, Trivedi M, Lee H, Goraksh N, Yim JE. The ability of different areas of the skin to absorb heat from a locally applied heat source: the impact of diabetes. Diabetes Technol Ther 2011; 13:365-72. [PMID: 21291332 DOI: 10.1089/dia.2010.0161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND When heat is applied to the skin, heat is conducted away because of the latent heat transfer properties of the skin and an increase in skin circulation, but little attention has been paid to the heat transfer properties of skin in different areas of the body and in people with diabetes. research design: Thirty subjects in the age range of 20-75 years had a thermode (44°C) applied to the skin of their arm, leg, foot, and back for 6 min to assess the heat transfer characteristics of skin in these four areas of the body. Skin blood flow and skin temperature were monitored over the 6-min period. RESULTS For the younger subjects, blood flow was not statistically different in response to heat in three areas of the body, starting at less than 200 flux measured by a laser Doppler imager and ending at approximately 1,200 flux after heat exposure. The foot had higher resting blood flow and higher blood flow in response to heat. Temperature and the rate of rise of temperature were also not different in any of the areas. The heat added to raise temperature, however, varied by body region. The arm required the least, whereas the leg and foot required the most. For the older group and subjects with diabetes, the heat required for any region of the body was much less to achieve the same increase in skin temperature, and blood flows were also much less; the subjects with diabetes showed the least blood flow and required the fewest calories to heat the skin. Whereas the foot required the greatest number of calories to heat the tissue in younger and older subjects, in subjects with diabetes, the foot took proportionally fewer calories. CONCLUSION Thus, specific areas of the body are damaged more by diabetes than other areas.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, California, USA.
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