An isokinetic training program for reducing falls in a community-dwelling older adult: a case report

Comparison of the Therapeutic Effects Between Isokinetic and Isotonic Strength Training in Patients After Total Knee Replacement: A Prospective, Randomized Controlled Trial

Background:

Rebuilding the strength of the quadriceps as soon as possible after total knee replacement (TKR) is important so as to restore gait stability. To date, there are no standard postoperative strength training programs during the early recovery stage after TKR.

Purpose:

To compare the therapeutic effects between isokinetic and isotonic strengthening in patients after TKR.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

From April 2018 to August 2020, 37 patients met the inclusion criteria and were randomly assigned to perform either 4-week isokinetic or isotonic strength training programs. Other components of the rehabilitation program were kept the same between the 2 groups. All cases were evaluated by the Timed Up and Go (TUG) test, peak torque of knee extension and flexion (60 and 120 deg/s), 36-item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Arthritis Index (WOMAC).

Results:

After undergoing a 4-week strength training regimen, significant improvements in the TUG test were noted in both groups; however, the time improvement in the isotonic group did not reach the minimal detectable change. All peak torque measurements improved in the isokinetic group but not in the isotonic group for knee flexion at 60 deg/s. The pain subdomain, physical domain, mental domain, total SF-36 score, and WOMAC index all improved significantly in both groups after training. Both training groups improved significantly in peak torque of knee strength, TUG test, and functional scores, but the differences between isokinetic and isotonic training were not statistically significant.

Conclusion:

The study findings showed that a 4-week strengthening exercise program in the early postoperative stage, involving either isokinetic or isotonic training, resulted in significant improvements in patients undergoing TKR.

Registration:

NCT02938416 (ClinicalTrials.gov identifier).

The Effects of Ankle Position on Torque and Muscle Activity of the Knee Extensor During Maximal Isometric Contraction

CONTEXT

It is very important to empirically determine the optimal ankle position for the quadriceps femoris (QF) strengthening during isometric exercises.

OBJECTIVE

To examine the effect of different ankle positions on torque and electromyography (EMG) activity of QF during maximal isometric contraction.

STUDY DESIGN

Within-subject repeated measures.

SETTING

University laboratory.

PARTICIPANTS

Thirty-six healthy volunteers (15 males and 21 females).

MAIN OUTCOME MEASURES

The isometric strength of the QF was measured at 3 different ankle positions: active dorsiflexion (AD), active plantar flexion (AP), and neutral position (NP). Simultaneously, 3 different ankle positions were assessed for EMG activity of the vastus medialis, vastus lateralis, and rectus femoris muscles during maximal voluntary isometric contraction.

RESULTS

The peak torque per body weight and average peak torque were significantly higher in AD than in AP and NP (P < .01). The vastus medialis and rectus femoris maximal voluntary isometric contraction EMG activity were significantly higher in AD than in AP and NP (P < .01). The vastus lateralis maximal voluntary isometric contraction EMG activity was significantly higher in AD than in AP and NP (P < .01), and was significantly higher in AP than in NP (P < .05).

CONCLUSIONS

These results indicate that the 3 different ankle positions affect the QF torque and EMG activity. In particular, AD position may be more efficient for improving QF strength than AP and NP position. Future studies should prove whether long-term duration QF isometric exercise effects muscle strength and functional performance in different ankle positions.

Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial

[Purpose] The aim of the present study was to determine the effects of Pilates on lower leg strength, postural balance and the health-related quality of life (HRQoL) of older adults. [Subjects and Methods] Thirty-two older adults were randomly allocated either to the experimental group (EG, n = 16; mean age, 63.62 ± 1.02 years), which performed two sessions of Pilates per week for 12 weeks, or to the control group (CG, n = 16; mean age, 64.21 ± 0.80), which performed two sessions of static stretching per week for 12 weeks. The following evaluations were performed before and after the interventions: isokinetic torque of knee extensors and flexors at 300°/s, the Timed Up and Go (TUG) test, the Berg Balance Scale, and the Health Survey assessment (SF-36). [Results] In the intra-group analysis, the EG demonstrated significant improvement in all variables. In the inter-group analysis, the EG demonstrated significant improvement in most variables. [Conclusion] Pilates exercises led to significant improvement in isokinetic torque of the knee extensors and flexors, postural balance and aspects of the health-related quality of life of older adults.

Changes in disability levels among older adults experiencing adverse events in postacute rehabilitation care: a prospective observational study

This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs. A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. The level of disability regarding mobility activities was estimated using the disability qualifiers from the International Classification of Functioning, Disability, and Health. Changes in the levels of disability between admission and discharge were assessed. Baseline-measured covariates were also selected. Regarding all 4 disability levels ("no limitation," "mild," "moderate," "severe," and "complete disability"), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline. The occurrence of fall-related events and the diagnostic group (musculoskeletal system) are specific predictive factors of change in the level of disability. The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012). Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

Effects of Resistance Exercise Using Thera-band on Balance of Elderly Adults: A Randomized Controlled Trial

[Purpose] This study investigated the effects of resistance exercise using Thera-band on balance of elderly adults. [Methods] Subjects (age range, 60–70 years) were randomly assigned to an experimental (n=12) or control group (n=12). The experimental group performed stretching and resistance exercises, and the control group performed stretching exercises only. Before and after the 5-week intervention, the participants’ static and dynamic balance were evaluated using the Berg Balance Scale, the Timed Up & Go Test, and the Tetrax Portable Multiple System (Tetrax Ltd., Ramat Gan, Israel) after 5 weeks. [Results] After the intervention, the values of the Tetrax in the weight distribution index with eyes open and that with eyes closed and the stability test index with eyes open were significantly lower in the resistance exercise group than in the control group, and the pre-test values were was significantly higher than the post-test values. However, there were no significant differences between groups in the values of the Berg Balance Scale, the Timed Up & Go Test, and the Tetrax stability test index with the eyes closed. [Conclusion] The findings of this study indicate that resistance exercise using the Thera-band is possible to improve the static and dynamic balance of elderly adults.