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Da Silva F, Chorin F, Michel É, Jaafar A, Guérin O, Zory R. Age-related effects on absolute and relative isokinetic knee extensor strength in community-dwelling older men and women at a French geriatric day hospital. Eur Geriatr Med 2024:10.1007/s41999-024-01008-8. [PMID: 38990505 DOI: 10.1007/s41999-024-01008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Isokinetic knee extensor strength is poorly evaluated in geriatric day hospitals (GDHs), despite its potential functional significance compared to grip strength. This study aimed to investigate age-related effects on absolute and relative isokinetic knee extensor peak torque (KEPT) data in community-dwelling older GDH patients. METHODS A total of 472 French GDH patients (179 men and 293 women, aged 75-94 years) participated in this study. Absolute and relative KEPT were measured at six distinct angular velocities between 0.52 and 3.14 rad/s. In addition, comfortable gait speed and grip strength were assessed. Participants were stratified by sex and age using 5-year intervals. One-way ANOVAs were used to examine age-related effects on KEPT values. Multiple linear regression models were employed to investigate the associations between gait speed and both mean KEPT values and grip strength, with separate models conducted on absolute and relative values. RESULTS The recruited GDH patients presented lower absolute and relative KEPT values in comparison with established reference values for healthy community-dwelling older individuals, with men being consistently stronger than women. Notably, there was a significant decline in both absolute and relative KEPT values beyond the age of 85 for both sexes. Importantly, the multiple linear regression analyses conducted revealed a significant positive relationship between gait speed and mean KEPT values, surpassing the association with grip strength. CONCLUSIONS These findings underscore the clinical importance of assessing isokinetic knee extensor strength in community-dwelling older GDH patients, particularly for tailoring personalized physical activity interventions.
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Affiliation(s)
- Flavio Da Silva
- Laboratoire Motricité Humaine Expertise Sport Sant (UPR 6312), Université Côte d'Azur, École Universitaire de Recherche HEALTHY: Ecosystèmes Des Sciences de La Santé, Campus STAPS - Sciences du Sport, 261, Boulevard du Mercantour, Nice Cedex 03, 06205, Nice, France.
- Centre Hospitalier Universitaire de Nice, Nice, France.
- University of Nîmes, APSY-V, Nîmes Cedex 1, 30021, Nîmes, France.
| | - Frédéric Chorin
- Laboratoire Motricité Humaine Expertise Sport Sant (UPR 6312), Université Côte d'Azur, École Universitaire de Recherche HEALTHY: Ecosystèmes Des Sciences de La Santé, Campus STAPS - Sciences du Sport, 261, Boulevard du Mercantour, Nice Cedex 03, 06205, Nice, France
- Centre Hospitalier Universitaire de Nice, Nice, France
| | - Émeline Michel
- Laboratoire Motricité Humaine Expertise Sport Sant (UPR 6312), Université Côte d'Azur, École Universitaire de Recherche HEALTHY: Ecosystèmes Des Sciences de La Santé, Campus STAPS - Sciences du Sport, 261, Boulevard du Mercantour, Nice Cedex 03, 06205, Nice, France
- Centre Hospitalier Universitaire de Nice, Nice, France
| | - Amyn Jaafar
- Centre Hospitalier Universitaire de Nice, Nice, France
| | - Olivier Guérin
- UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Université Côte d'Azur, CNRS, Faculté de Médecine, Nice, France
| | - Raphael Zory
- Laboratoire Motricité Humaine Expertise Sport Sant (UPR 6312), Université Côte d'Azur, École Universitaire de Recherche HEALTHY: Ecosystèmes Des Sciences de La Santé, Campus STAPS - Sciences du Sport, 261, Boulevard du Mercantour, Nice Cedex 03, 06205, Nice, France
- Centre Hospitalier Universitaire de Nice, Nice, France
- Institut Universitaire de France, Paris, France
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Medina LAR, Oliveira MF, Santos RDCLD, Souza ASD, Mazzuco A, Sperandio PCDA, Alencar MCND, Arbex FF, Neder JA, Medeiros WM. Heart failure worsens leg muscle strength and endurance in coexistence patients with COPD and heart failure reduced ejection fraction. Acta Cardiol 2024; 79:454-463. [PMID: 38420970 DOI: 10.1080/00015385.2024.2319955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Exercise intolerance and dyspnoea are clinical symptoms in both heart failure (HF) reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD), which are suggested to be associated with musculoskeletal dysfunction. We tested the hypothesis that HFrEF + COPD patients would present lower muscle strength and greater fatigue compared to compared to the COPD group. METHODS We included 25 patients with HFrEF + COPD (100% male, age 67.8 ± 6.9) and 25 patients with COPD alone (100% male, age 66.1 ± 9.1). In both groups, COPD severity was determined as moderate-to-severe according to the GOLD classification (FEV1/FVC < 0.7 and predicted post-bronchodilator FEV1 between 30%-80%). Knee flexor-extensor muscle performance (torque, work, power and fatigue) were measured by isokinetic dynamometry in age and sex-matched patients with HFrEF + COPD and COPD alone; Functional capacity was assessed by the cardiopulmonary exercise test, the 6-min walk test (6MWT) and the four-minute step test. RESULTS The COPD group exhibited reduced lung function compared to the HFrEF + COPD group, as evidenced by lower FEV1/FVC (58.0 ± 4.0 vs. 65.5 ± 13.9; p < 0.0001, respectively) and FEV1 (51.3 ± 17.0 vs. 62.5 ± 17.4; p = 0.026, respectively) values. Regarding musculoskeletal function, the HFrEF + COPD group showed a knee flexor muscles impairment, however this fact was not observed in the knee extensors muscles. Power peak of the knee flexor corrected by muscle mass was significantly correlated with the 6MWT (r = 0.40; p < 0.05), number of steps (r = 0.30; p < 0.05) and work ratepeak (r = 0.40; p < 0.05) in the HFrEF + COPD and COPD groups. CONCLUSION The presence of HFrEF in patients with COPD worsens muscular weakness when compared to isolated COPD.
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Affiliation(s)
- Luiz Antônio Rodrigues Medina
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Mayron F Oliveira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- VO2 Care Research Group, Physiotherapy Unit, Vila Nova Star Hospital, São Paulo, SP, Brazil
- Exercise Physiology and Integrated Cardiopulmonary Research Group - EPIC group, Exercise Science, Lyon College, Batesville, AR, USA
| | - Rita de Cassia Lima Dos Santos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Aline Soares de Souza
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Adriana Mazzuco
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Priscila Cristina de Abreu Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Maria Clara Noman de Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Flávio Ferlin Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Wladimir Musetti Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
- Department of Rehabilitation and Functional Capacity, School of Physiotherapy, Ibirapuera University (UNIB), São Paulo, SP, Brazil
- Department of Education and Research, HEART - Institute of Cardiology, São Paulo, SP, Brazil
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Zhang Y, Chen K, Liu K, Wang Q, Ma Y, Pang B, Huang L, Ma Y. New prediction equations for knee isokinetic strength in young and middle-aged non-athletes. BMC Public Health 2023; 23:2558. [PMID: 38129858 PMCID: PMC10734189 DOI: 10.1186/s12889-023-17478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to develop alternative prediction equations to predict isokinetic muscle strength at 60°/s based on anthropometric characteristics, including body mass, height, age, and sex for young and middle-aged non-athlete populations. METHODS Three hundred and thirty-two healthy non-athletic participants (174 females, 158 males) between 20 and 59 years underwent a 60°/s isokinetic knee joint concentric contraction test. Forty people were randomly selected for retesting to assess the reliability of the isokinetic instrument. Multivariate linear regression was used to establish extension peak torque (EPT) and flexion peak torque (FPT) prediction equations. Sixty extra participants were used individually to validate the prediction equations, and Bland Altman plots were constructed to assess the agreement of predicted values with actual measurements. RESULTS The result demonstrated that the instrument we used has excellent reliability. The multivariable linear regression model showed that body mass, age, and sex were significant predictors of PT (EPT: Adjusted R2 = 0.804, p < 0.001; FPT: Adjusted R2 = 0.705, p < 0.001). Furthermore, the equations we established had higher prediction accuracy than those of Gross et al. and Harbo et al. CONCLUSION: The equations developed in this study provided relatively low bias, thus providing a more suitable reference value for the knee isokinetic strength of young and middle-aged non-athletes.
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Affiliation(s)
- Ye Zhang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Kang Chen
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Kun Liu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Qingliang Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yuhui Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bo Pang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Lihua Huang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Jacinto M, Matos R, Gomes B, Caseiro A, Antunes R, Monteiro D, Ferreira JP, Campos MJ. Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2688. [PMID: 37830725 PMCID: PMC10572461 DOI: 10.3390/healthcare11192688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
The average life expectancy of individuals with intellectual and developmental disabilities (IDDs) is increasing. However, living more years does not mean living better, leading to the need for research on comorbidities associated with the aging process. Associated with this process are the physical characteristics most prevalent in an individual with IDD: low levels of all physical capacities, the accumulation of central fat, hyperglycemia, dyslipidemia, and hypertension, variables considered to be some of the main risk factors of the onset of metabolic and cardiovascular diseases, and variables that can negatively impact quality of life (QoL). Therefore, the aim of this study is to evaluate a sample of 21 institutionalized adults with IDD (42.81 ± 10.99 years old) in terms of their anthropometric characteristics, body composition, general health status, functional capacity, neuromuscular capacity, and dementia/cognitive function, and the possible associations with QoL. All assessments were performed in the laboratory of the Faculty of Sport Sciences and Physical Education-University of Coimbra. Participants, in the present study, have low levels of physical fitness and high metabolic and cardiovascular markets, which need to be improved. On the other hand, functional and neuromuscular ability seems to be associated with QoL (p ≤ 0.05). This study highlights the role of primary and secondary care providers in diagnosis, prevention, and supporting individuals with IDDs to promote QoL.
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Affiliation(s)
- Miguel Jacinto
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal; (B.G.); (A.C.); (J.P.F.); (M.J.C.)
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.M.); (R.A.); (D.M.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Rui Matos
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.M.); (R.A.); (D.M.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Beatriz Gomes
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal; (B.G.); (A.C.); (J.P.F.); (M.J.C.)
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
| | - André Caseiro
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal; (B.G.); (A.C.); (J.P.F.); (M.J.C.)
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
| | - Raul Antunes
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.M.); (R.A.); (D.M.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Diogo Monteiro
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.M.); (R.A.); (D.M.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Portugal Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - José Pedro Ferreira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal; (B.G.); (A.C.); (J.P.F.); (M.J.C.)
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
| | - Maria João Campos
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal; (B.G.); (A.C.); (J.P.F.); (M.J.C.)
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
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de Oliveira Saraiva NA, de Oliveira Farias I, Dos Santos BM, Xavier RS, Lopes AJ. Reference value for the 6-min walking distance in women with systemic sclerosis considering the impact of muscle strength. Clin Biomech (Bristol, Avon) 2023; 109:106094. [PMID: 37725867 DOI: 10.1016/j.clinbiomech.2023.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Early triage, the search for new therapies, and closer monitoring of patients with systemic sclerosis before their lung function irreversibly deteriorates are urgent concerns. Because it is an independent predictor of systemic sclerosis-related mortality, the 6-min walk test is a potentially useful tool to evaluate outcomes, along with pulmonary function and computed tomography. This study aimed to establish a reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease that takes into account the effects of muscle and lung function. METHODS This was a cross-sectional study in which 69 women with systemic sclerosis underwent the 6-min walk test, Health Assessment Questionnaire-Disability Index, pulmonary function, handgrip strength test, and quadriceps strength test. FINDINGS The mean 6-min walking distance was 447 ± 78 m, and 43.5% of the participants did not reach 80% of their predicted value. 6-min walking distance correlated positively with quadriceps strength (r = 0.418, P = 0.0004), forced vital capacity (r = 0.306, P = 0.011), pulmonary diffusion (r = 0.360, P = 0.002), maximum inspiratory pressure (r = 0.268, P = 0.029), and maximum expiratory pressure (r = 0.288, P = 0.019) and negatively with age (r = -0.378, P = 0.001), body mass index (r = -0.248, P = 0.039), and Health Assessment Questionnaire-Disability Index (r = -0.438, P = 0.0001). In the multiple linear regression analysis, quadriceps strength, body mass index, pulmonary diffusion, age, and maximum expiratory pressure explained 72% of the 6-min walking distance variability. INTERPRETATION Muscle function and, to a lesser extent, lung function are key contributors in determining the reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease.
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Affiliation(s)
| | | | | | - Rosemere Saldanha Xavier
- Local Development Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Local Development Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.
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Tanguay S, Saey D, Marklund S, Nyberg A, Gephine S, Frykholm E, De Brandt J, Burtin C, Maltais F. Reference equations for quadriceps strength, endurance and power: a multicentre study. ERJ Open Res 2023; 9:00313-2023. [PMID: 37650093 PMCID: PMC10463037 DOI: 10.1183/23120541.00313-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction The lack of reference values of lower-limb muscle function hinders the clinical recommendations of its measurement in patients with COPD. Therefore, this study aimed to develop reference equations to predict reference values for quadriceps strength, endurance and power and evaluate their construct validity in patients with COPD. Methods Quadriceps strength, endurance and power were assessed in 158 healthy individuals and 87 patients with COPD. In addition, patients with COPD performed a 6-min walk test (6MWT) and a 1-min sit-to-stand test (1STS). Multiple linear regressions were performed to develop reference equations. The proportion of patients with COPD with reduced quadriceps function was determined, and correlations between quadriceps strength, endurance and power expressed in percentage of predicted values and 6MWT and 1STS performance were used to document the construct validity of the reference equation. Results Except for quadriceps isometric endurance, the proposed reference equations explained 50-70% of the variance of the quadriceps properties in healthy individuals. All quadriceps properties were systematically reduced in a large proportion of patients with COPD compared to healthy individuals. Correlation coefficients between quadriceps properties expressed in percentage of predicted values and 6MWT and 1STS performance ranged between 0.28 and 0.49 (all p<0.05). Conclusion In healthy individuals, age, sex, height and body mass index explained 50-70% of the variance of quadriceps strength, endurance and power. When expressed in percentage of predicted values, these quadriceps properties correlated with 6MWT and 1STS performance, suggesting construct validity of the reference values in patients with COPD.
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Affiliation(s)
- Sophie Tanguay
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
| | - Sarah Marklund
- Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå, Sweden
| | - Andre Nyberg
- Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå, Sweden
| | - Sarah Gephine
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 – URePSSS – Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Erik Frykholm
- Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå, Sweden
| | - Jana De Brandt
- Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå, Sweden
- Hasselt University, Faculty of Rehabilitation Sciences, REVAL – Rehabilitation Research Center, BIOMED Biomedical Research Institute, Diepenbeek, Belgium
| | - Chris Burtin
- Hasselt University, Faculty of Rehabilitation Sciences, REVAL – Rehabilitation Research Center, BIOMED Biomedical Research Institute, Diepenbeek, Belgium
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
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Dean JM, Murton AJ, Glover SQ, Gutierrez I, Andersen CR, Herndon DN, Lee JO, Suman OE. Use of Isokinetic Dynamometry To Assess Muscle Function In Burned Patients Is A Reliable Tool To Assist Progressive Resistance Exercise Prescription. J Burn Care Res 2023; 44:546-550. [PMID: 30649359 PMCID: PMC10152992 DOI: 10.1093/jbcr/irz003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 11/14/2022]
Abstract
Isokinetic dynamometry is used during exercise testing and rehabilitation to obtain a quantitative strength measurement on which progressive strength training programs can be based. This study assesses the test-retest reliability of isokinetic leg function in the knee flexors and extensors at 150°/s in children and young adults with severe burns to be used for rehabilitation exercise program prescription. In 39 severely burned patients (49 ± 14% total body surface area burn [TBSA], mean ± SD; 34 ± 21% TBSA 3rd degree; 14 ± 5 years, 153.3 ± 16.5 cm height; 53.8 ± 17.9 kg) knee flexion/extension isokinetic dynamometry at 150°/s was performed on each patient's dominant leg in two sessions. The patient was acquainted with the test and performed 1 set of 10 repetitions at 150°/s. A second session of 1 set of 10 repetitions at 150°/ was performed within 24 h of the first. Muscle function outcomes were knee flexion/extension peak torque, average peak torque, and average power. One-sample paired t tests were performed for all muscle function outcomes; intraclass correlation coefficients and r2 values with session two as a function of session one were calculated. Sessions did not differ significantly in knee extension or flexion for any muscle function outcome or the hamstrings to quadriceps ratio. All intraclass correlation coefficients were >0.89 and r2 > 0.79. Test-retest isokinetic dynamometry functional measurements in the knee flexors and extensors at 150°/s are reliable in the burn population and may aid resistance rehabilitation program prescriptions.
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Affiliation(s)
- Julianna M Dean
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Department of Surgery, Shriners Hospitals for Children, Galveston, TX
| | - Andrew J Murton
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
| | - Shauna Q Glover
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
| | - Ileana Gutierrez
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
| | - Clark R Andersen
- Office of Biostatistics, The University of Texas Medical BranchGalveston, TX
| | - David N Herndon
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
| | - Jong O Lee
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
| | - Oscar E Suman
- Department of Surgery, The University of Texas Medical BranchGalveston, TX
- Division of Rehabilitation Sciences, The University of Texas Medical BranchGalveston, TX
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Schindler IFS, Pontes SS, Bertoni MB, Junior GF, Júnior BR, de Jesus FL, Neto MG. A Systematic Review of Isokinetic Muscle Strength in a Healthy Population With Special Reference to Age and Gender. Sports Health 2023; 15:328-332. [PMID: 36645122 PMCID: PMC10170235 DOI: 10.1177/19417381221146258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Despite increasing use of reference values in isokinetic measurements and increasing importance, there is no systematic review of the reference values for lower and upper limb isokinetic muscle strength. OBJECTIVE A systematic review to analyze studies on the reference values and protocols for the measurement for upper and lower limb isokinetic muscle strength in an untrained and noninjured healthy population. DATA SOURCES MEDLINE, Scopus, Scielo, and CINAHL (from the earliest date available to June 2020). STUDY SELECTION Studies that measured a set of reference values for isokinetic muscle strength. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Two reviewers selected studies independently. Data related to participants characteristics, outcomes of interest, isokinetic parameters, reference values for isokinetic muscle strength, and quality of evidence assessment were systematically reviewed independently by 2 authors. RESULTS A total of 31 studies met the study criteria. The included studies were used to synthesize the isokinetic muscle strength data according to age-group and sex. We extracted 1845 normative data related to isokinetic strength. Of these, 1181 items referred to lower limbs and 664 items to upper limbs. CONCLUSION In general, agonist muscle groups are stronger than antagonist muscles, and the men tend to obtain higher strength values than women. The angular velocity varied from 10 to 300 deg/s. The reference values identified can be useful for professionals to obtain during the isokinetic evaluation of the diagnostic parameters of muscle deficiency.
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Affiliation(s)
- Ingara Fernanda S.R. Schindler
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Postgraduate Program in Medicine and Health,
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
| | - Sarah S. Pontes
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Postgraduate Program in Medicine and Health,
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
| | - Mariana B.M. Bertoni
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Graduate Program in Interactive Processes of
Organs and Systems, University of Bahia, Bahia, Brazil
| | - Grimaldo F. Junior
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Graduate Program in Interactive Processes of
Organs and Systems, University of Bahia, Bahia, Brazil
| | - Balbino R.N. Júnior
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Postgraduate Program in Medicine and Health,
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
| | - Fábio L.A. de Jesus
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Postgraduate Program in Medicine and Health,
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
| | - Mansueto G. Neto
- Physiotherapy Research Group, Federal
University of Bahia, Bahia, Brazil
- Postgraduate Program in Medicine and Health,
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
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Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes. Clin J Sport Med 2023; 33:33-44. [PMID: 36111996 DOI: 10.1097/jsm.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN Mixed-methods, cross-sectional survey. SETTING Online. PATIENTS OR PARTICIPANTS In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.
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Mayer C, Rühlemann A, Busch A, Jäger M. Measures of Knee Capability in Handball Players Differ by Age: A Cross Sectional Study. Sports Med Int Open 2022; 6:E60-E68. [PMID: 36575730 PMCID: PMC9790767 DOI: 10.1055/a-1926-0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022] Open
Abstract
The return to sport after knee injury is challenging. This is burdensome for sports with a high incidence of injuries, such as team handball. Various tests guide decision making, but often the athlete's preinjury performance of these measures remains unknown. Moreover, objective return-to-sport criteria of a matching population are missing. The purpose of this study was to evaluate objective measures of knee capability in handball depending on players' age. Two hundred sixty-one handball players performed a functional test battery designed to evaluate knee capability after an anterior cruciate ligament injury: two- and one-legged stability analysis, jumps, speed tests, and agility assessments. For age-specific evaluation, athletes were divided into three age groups (16-19; 20-29;≥30 years). Male players showed differences in two and one-legged jumping height (p<0.02) as well as power per body weight (p<0.01) between age groups. Young female players reached better results in two-and one-legged stability. Besides the quick feet test, results of females did not differ between age groups. Functional knee stability in healthy handball players is partly influenced by age, and females show better results in stability and male athletes in power measurements. This aspect should be considered for return to sports testing and underlines the importance of performance measures in athletic testing.
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Affiliation(s)
- Constantin Mayer
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Correspondence Dr. Constantin
Mayer St Marien-Hospital Mülheim an der
RuhrOrthopedics and
TraumatologyKaiserstrasse
5045468
MülheimGermany+49
208 305 2202
| | - Alina Rühlemann
- Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
| | - Andre Busch
- Orthopedics and Traumatology, katholische Kliniken Philippusstift
Essen, Essen, Germany
| | - Marcus Jäger
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
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Imamura M, Shinzato GT, Sugawara AT, Uchiyama SST, Matheus D, Simis M, Ayres DVM, dos Santos ACA, Assone T, Ramos VD, Fregni F, Battistella LR. The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis. Front Med (Lausanne) 2022; 9:1029140. [DOI: 10.3389/fmed.2022.1029140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
BackgroundKnee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain.ObjectiveTo report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort.MethodsThis is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and functional electrical stimulation according to individual needs. The baseline was compred with the treatment results with a paired t-test.ResultsThe study sample is composed of 96 participants, mostly females (n = 81, 84.38%), with bilateral osteoarthritis (n = 91, 94.79%), and a mean age of 68.89 (SD 9.73) years. Functional improvement was observed in TUG (p = 0.019), 6-mwt (p = 0.033), right knee flexion strength (p < 0.0001), WOMAC rigidity and difficulty domains (p < 0.0001). Pain was reduced from baseline as measured by WOMAC pain domain (p < 0.0001), VAS for both knees (p < 0.0001), and SF-36 pain domain (p < 0.0001). Pressure pain threshold was modified above the patella (p = 0.005 and p = 0.002 for right and left knees, respectively), at the patellar tendons (p = 0.015 and p = 0.010 for right and left patellar tendons, respectively), left S2 dermatome (p = 0.017), and L1-L2 (p = 0.008).ConclusionsThe IMREA comprehensive rehabilitation program improved functioning and reduced disabling pain in elderly people with knee OA. We highlight the relevance and discuss the implementation of our intervention protocol. Although this is an open cohort study, it is important to note the significant improvement with this clinical protocol.
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12
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Moraes IG, Brito CP, Francisco DDS, Faria LM, Luders C, de Brito CMM, Yamaguti WP. Efficacy of neuromuscular electrical stimulation with combined low and high frequencies on body composition, peripheral muscle function and exercise tolerance in patients with chronic kidney disease undergoing haemodialysis: a protocol for a randomised, double-blind clinical trial. BMJ Open 2022; 12:e062062. [PMID: 36351736 PMCID: PMC9664278 DOI: 10.1136/bmjopen-2022-062062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) as an adjunctive strategy to increase isolated muscular strength or endurance has been widely investigated in patients with chronic kidney disease (CKD) undergoing haemodialysis (HD). However, the efficacy of combined low and high frequencies, to improve both muscular strength and endurance, is unknown. This trial aims to evaluate the efficacy of this combined NMES strategy in this population. METHODS AND ANALYSIS This is a randomised controlled trial with blinded assessments and analysis. A total of 56 patients with CKD undergoing HD will be recruited and randomised to an NMES protocol. The evaluations will be performed on three different days at baseline and after 24 sessions of follow-up. Assessments will include the background, insulin-like growth factor, lactate measurement, malnutrition and inflammation score evaluation, an electrical bioimpedance examination, global muscular evaluation by means of the Medical Research Council scale, handgrip strength evaluation, muscular isokinetic evaluation of lower limbs, 6 min step test performance and quality of life (QoL) questionnaire with emphasis on physical function. The patients will be allocated in one of the following four groups: 1) combined low and high frequencies; 2) low frequency; 3) high frequency; and 4) sham stimulation with minimal intensity to generate only sensory perception (with no visible contraction). In all groups, the intensity throughout the session will be the highest tolerated by patient (except for control group). The primary endpoint is the change of peripheral muscle function (muscular strength and endurance). The secondary endpoints will be the changes of body composition; muscle trophism; exercise tolerance; QoL; and nutritional, inflammatory, and metabolic markers. The findings of this study are expected to provide valuable knowledge on how to optimise the NMES intervention, with improvements in both muscle strength and endurance. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee on Research with Humans of Hospital Sírio-Libanês (approval no. 24337707). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03779126.
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Affiliation(s)
| | | | | | | | - Claudio Luders
- Haemodialysis Centre, Hospital Sírio-Libanês, São Paulo, Brazil
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13
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Gao Y, Huang H, Ni C, Feng Y, Yu J, Huang Y, Luo L, Jiang Y, Wang A. Comparison of Five Expressions of Handgrip Strength for Predicting Cardiovascular Disease Risk Factors in Chinese Middle-Aged Community Residents. Front Public Health 2022; 10:903036. [PMID: 35769791 PMCID: PMC9234447 DOI: 10.3389/fpubh.2022.903036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the predictive performance of five handgrip strengths for cardiovascular disease (CVD) risk factors. Methods A total of 804 Chinese middle-aged community residents' health medical examinations were collected. The absolute handgrip strength was denoted as HGS. HGS/body weight (HGS/BW), HGS/body mass index (HGS/BMI), HGS/lean body mass (HGS/LBM), and HGS/muscle mass (HGS/MM) represented relative handgrip strength (RHGS). To assess predictive performance, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were constructed. Results HGS was not associated with most CVD risk biomarkers; however, RHGS showed a negative correlation trend after controlling for covariates (sex, age, smoking, and exercise). HGS/BMI and HGS/BW had better AUCs for predicting CVD risk factors than HGS/LBM or HGS/MM. HGS/BMI and HGS/BW can successfully predict all CVD risk factors in men with AUCs 0.55–0.65; similarly, women may effectively predict arteriosclerosis, hyperglycemia, hyperuricemia, and metabolic syndrome with AUCs 0.59–0.64, all p < 0.05. The optimal HGS/BW cut-off points for identifying different CVD risk factors were 0.59–0.61 in men and 0.41–0.45 in women, while the HGS/BMI were 1.75–1.79 in men and 1.11–1.15 in women. Conclusions Almost all CVD risk biomarkers and CVD risk factors were unrelated to HGS. There is, however, a significant inverse relationship between RHGS and CVD risk factors. HGS/BMI or HGS/BW should be recommended to be the best choice for predicting the risk of CVD risk factors in five expressions of handgrip strength. We also acquired the recommended optimal cut-off points of HGS/BMI and HGS/BW for predicting CVD risk factors.
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Affiliation(s)
- Yanan Gao
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Huiming Huang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
- *Correspondence: Huiming Huang
| | - Chunxia Ni
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Yong Feng
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Junwu Yu
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Yutong Huang
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Lijun Luo
- Ningbo College of Health Sciences, Ningbo, China
- Ningbo Puyuan Sports Rehabilitation Clinic, Ningbo, China
| | - Yongbao Jiang
- Affiliated Hospital of Ningbo University, Ningbo, China
| | - Aiwen Wang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, China
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Tengman E, Schelin L, Häger CK. Angle-specific torque profiles of concentric and eccentric thigh muscle strength 20 years after anterior cruciate ligament injury. Sports Biomech 2022:1-17. [PMID: 35373714 DOI: 10.1080/14763141.2022.2054856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Thigh muscle weakness prevails following anterior cruciate ligament (ACL) injury, as usually evaluated by peak concentric quadriceps strength. Assessment throughout the range of motion (ROM), and for antagonists may provide more comprehensive information. We evaluated angle-specific torque profiles and ratios of isokinetic thigh muscle strength in 70 individuals 23 ± 2 years post-ACL injury (44males, 46.9 ± 5.4 years); 33 treated with ACL-reconstruction (ACL-R), and 37 treated only with physiotherapy (ACL-PT), and 33 controls. Quadriceps and hamstrings torques for concentric/eccentric contractions (90°/s) and ratios between hamstrings/quadriceps strength (HQ) were compared between and within groups using inferential functional data methods. The injured ACL-R leg had lower concentric and eccentric quadriceps strength compared to non-injured leg throughout the ROM, and lower concentric (interval 70-79°) and eccentric (64-67°) quadriceps strength compared to controls. The injured ACL-PT leg showed lower eccentric quadriceps strength (53-77°) than non-injured leg and lower concentric (41-79°) and eccentric (52-81°) quadriceps and eccentric hamstrings (30-77°) strength than controls. There were no group differences for HQ-ratios. The injured ACL-R leg had higher HQ-ratio (34-37°) than non-injured leg. Angle-specific torque profiles revealed strength deficits, masked if using only peak values, and seem valuable for ACL-injury rehabilitation.
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Affiliation(s)
- E Tengman
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
| | - L Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - C K Häger
- Department of Community Medicine and Rehabilitation, Section for Physiotherapy, Umeå University, Umeå, Sweden
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Horobeanu C, Pullinger SA, Paulus J, Savoia C, Wong FY, Seurot A, Croisier JL, Forthomme B. Sex differences in shoulder performance fatiguability are affected by arm position, dominance and muscle group. BMC Musculoskelet Disord 2022; 23:299. [PMID: 35351091 PMCID: PMC8962062 DOI: 10.1186/s12891-022-05232-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background Injury prevalence data, muscle strength, and fatiguability differ between males and females. In addition, arm spatial orientation affects muscle activation and strength of the shoulder muscles. Nevertheless, little research has been conducted in relation to the shoulder rotator muscles comparing men and women. Therefore, the main aim of of this study was to perform a comparative investigation between two arm spatial orientations (45° and 90° of abduction in the frontal plane) during a fatigue assessment of the internal rotator (IR) and external rotator (ER) shoulder muscles. Secondly, the interaction between sex and dominance with muscular performance was assessed. Methods Forty healthy sedentary participants, 20 males and 20 females took part in this study. Participants performed a fatigue resistance protocol consisting of 30 consecutive maximal concentric contractions of the IR and ER shoulder muscles in a supine position at a speed of 180°/s. The upper limb was abducted to an angle of 45° or 90° in the frontal plane and each participant was tested on the dominant and nom-dominant side, counterbalanced in order of administration. Performance measures of Induced Fatigue (IF; %), Cumulated Performance (C.Perf; J) and Best Repetition (BR; J) were calculated and used for analysis. IF represents the % difference between the amount of work done over the last 3 and first 3 repetitions, BR represents the largest amount of work done during a single contraction, and C.Perf represents the total amount of work done during all repetitions. Results Muscle group was the only factor to display significant variation when not considering other factors, with higher values for C.Perf (mean difference = 353.59 J, P < 0.0005), BR (mean difference = 14.21 J, P < 0.0005) and IF (mean difference = 3.65%, P = 0.0046). There was a significant difference between both angles, with higher values observed at 90° compared to 45° of abduction for C.Perf by ~ 7.5% (mean difference = 75 to 152 J) and ~ 10.8% (mean difference = 5.1 to 9.4 J) for BR in the ER, in males and females respectively (P < 0.0005). The dominant arm was significantly stronger than the non-dominant arm for C.Perf by 11.7% (mean difference = 111.58 J) for males and by 18% (mean difference = 82.77 J) for females in the ER at 45° abduction. At 90° abduction, only females were stronger in the dominant arm by 18.8% (mean difference = 88.17 J). Values for BR ranged from 9.2 to 21.8% depending on the abduction angle and sex of the athlete (mean difference = 2.44 – 4.85 J). Males were significantly stronger than females by 48.8 to 50.7% for values of C.Perf and BR in both the IR and ER (P < 0.0005). There was a significant difference between the ER and IR muscles, with significantly higher values observed for the IR in C.Perf (mean difference = 331.74 J) by 30.0% and in BR (mean difference = 13.31 J) by 26.64%. Discussion Differences in shoulder performance fatiguability between sexes are affected by arm position, arm dominance and muscle groups. In agreement with the literature, performance values in males were approximately 50% higher than in females. However, the amount of IF was no different between both sexes. Based on findings in literature, it could be suggested that this is due to differences between males and females in motor control and/or coordination strategies during repetitive tasks. In addition, we also observed the IR muscles to be significantly stronger than the ER muscles. It has long been established in literature that these observations are due to the muscle-size differences between both muscle groups, where the IR muscles can produce a larger amount of force due to the larger cross-sectional area. Results of our study found similar ER:IR ratios compared to previous reports. Conclusion Therefore, these findings are useful for clinicians when monitoring rehabilitation programs in sedentary individuals following shoulder injuries.
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Santos CAF, Amirato GR, Jacinto AF, Pedrosa AV, Caldo-Silva A, Sampaio AR, Pimenta N, Santos JMB, Pochini A, Bachi ALL. Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women. Healthcare (Basel) 2022; 10:healthcare10020323. [PMID: 35206937 PMCID: PMC8872295 DOI: 10.3390/healthcare10020323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Abstract
Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers’ physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.
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Affiliation(s)
- Carlos A. F. Santos
- Discipline of Geriatrics and Gerontology, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04020-050, Brazil;
- Postgraduate Program in Health Science Applied to Sports and Physical Activity, Paulista School of Medicine (EPM), Sao Paulo 04022-001, Brazil;
- Correspondence:
| | - Gislene R. Amirato
- Mane Garrincha Sports Education Center, Sports Department of the Municipality of Sao Paulo (SEME), Sao Paulo 04039-034, Brazil;
| | - Alessandro F. Jacinto
- Discipline of Geriatrics and Gerontology, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04039-002, Brazil
| | - Ana V. Pedrosa
- Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Science and Physical Education, (FCDEF-UC), University of Coimbra, 3040-248 Coimbra, Portugal; (A.V.P.); (A.C.-S.)
| | - Adriana Caldo-Silva
- Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Science and Physical Education, (FCDEF-UC), University of Coimbra, 3040-248 Coimbra, Portugal; (A.V.P.); (A.C.-S.)
| | - António R. Sampaio
- N2i, Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (A.R.S.); (N.P.)
| | - Nuno Pimenta
- N2i, Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (A.R.S.); (N.P.)
| | - Juliana M. B. Santos
- Post-Graduation Program in Science of Human Movement and Rehabilitation, Federal University of Sao Paulo (UNIFESP), Santos 11015-020, Brazil;
| | - Alberto Pochini
- Postgraduate Program in Health Science Applied to Sports and Physical Activity, Paulista School of Medicine (EPM), Sao Paulo 04022-001, Brazil;
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), Sao Paulo 04829-300, Brazil;
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Zhu H, Nesler C, Divekar N, Peddinti V, Gregg RD. Design Principles for Compact, Backdrivable Actuation in Partial-Assist Powered Knee Orthoses. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2021; 26:3104-3115. [PMID: 34916771 PMCID: PMC8670722 DOI: 10.1109/tmech.2021.3053226] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper presents the design and validation of a backdrivable powered knee orthosis for partial assistance of lower-limb musculature, which aims to facilitate daily activities in individuals with musculoskeletal disorders. The actuator design is guided by design principles that prioritize backdrivability, output torque, and compactness. First, we show that increasing the motor diameter while reducing the gear ratio for a fixed output torque ultimately reduces the reflected inertia (and thus backdrive torque). We also identify a tradeoff with actuator torque density that can be addressed by improving the motor's thermal environment, motivating our design of a custom Brushless DC motor with encapsulated windings. Finally, by designing a 7:1 planetary gearset directly into the stator, the actuator has a high package factor that reduces size and weight. Benchtop tests verify that the custom actuator can produce at least 23.9 Nm peak torque and 12.78 Nm continuous torque, yet has less than 2.68 Nm backdrive torque during walking conditions. Able-bodied human subjects experiments (N=3) demonstrate reduced quadriceps activation with bilateral orthosis assistance during lifting-lowering, sit-to-stand, and stair climbing. The minimal transmission also produces negligible acoustic noise.
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Affiliation(s)
- Hanqi Zhu
- Department of Electrical and Computer Engineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Christopher Nesler
- Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nikhil Divekar
- Robotics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vamsi Peddinti
- Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert D Gregg
- Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Robotics, University of Michigan, Ann Arbor, MI 48109, USA
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Patellofemoral kinematics in patellofemoral pain syndrome: The influence of demographic factors. J Biomech 2021; 130:110819. [PMID: 34749164 DOI: 10.1016/j.jbiomech.2021.110819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022]
Abstract
Due to the multifactorial nature of patellofemoral pain, it is often difficult to identify an individual patient's exact cause of pain. Understanding how demographic variability influences these various factors will support improved consensus in regards to the etiology of PF pain. Thus, in this retrospective study, we tested the hypothesis that sex, height, weight, body mass index (BMI), and age influence the determination of between-groups differences in PF kinematics. We included 41 skeletally mature patients with patellofemoral pain and 79 healthy controls. Three-dimensional patellofemoral kinematics were quantified from dynamic magnet resonance images. We ran multiple regression analyses to determine the influence of demographic covariates (age, sex, height, weight, and BMI) on patellofemoral kinematics. Patellar shift was significantly influenced by weight (p = 0.009) and BMI (p = 0.009). Patellar flexion was influenced by height (p = 0.020) and weight (p = 0.040). Patellar tilt and superior displacement were not influence by demographic variables. Age and sex did not influence kinematics. This study supports the hypothesis that demographic parameters influence PF kinematics. The fact that weight, a modifiable measure, influences both patellar shift and flexion has strong implications for future research and clinical interventions. Clinically, weight loss may have a dual benefit of reducing joint stress and maltracking in patients who are overweight and experiencing patellofemoral pain. The influence of key demographics on patellofemoral kinematics, reinforces the clear need to control for population characteristics in future studies. As such, going forward, improved demographic matching between control and patient cohorts or more advanced statistical techniques that compensate for confounding variables are necessary.
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Gonze BDB, Ostolin TLVDP, Barbosa ACB, Matheus AC, Sperandio EF, Gagliardi ARDT, Arantes RL, Romiti M, Dourado VZ. Dynamic physiological responses in obese and non-obese adults submitted to cardiopulmonary exercise test. PLoS One 2021; 16:e0255724. [PMID: 34370766 PMCID: PMC8351979 DOI: 10.1371/journal.pone.0255724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Obese individuals have reduced performance in cardiopulmonary exercise testing (CPET), mainly considering peak values of variables such as oxygen uptake ([Formula: see text]), carbon dioxide production ([Formula: see text]), tidal volume (Vt), minute ventilation ([Formula: see text]) and heart rate (HR). The CPET interpretation and prognostic value can be improved through submaximal ratios analysis of key variables like [Formula: see text], [Formula: see text], [Formula: see text] [Formula: see text] and oxygen uptake efficiency slope (OUES). The obesity influence on these responses has not yet been investigated. Our purpose was to evaluate the influence of adulthood obesity on maximal and submaximal physiological responses during CPET, emphasizing the analysis of submaximal dynamic variables. METHODS We analyzed 1,594 CPETs of adults (755 obese participants, Body Mass Index ≥ 30 kg/m2) and compared the obtained variables among non-obese (normal weight and overweight) and obese groups (obesity classes I, II and III) through multivariate covariance analyses. RESULT Obesity influenced the majority of evaluated maximal and submaximal responses with worsened CPET performance. Cardiovascular, metabolic and gas exchange variables were the most influenced by obesity. Other maximal and submaximal responses were altered only in morbidly obese. Only a few cardiovascular and ventilatory variables presented inconsistent results. Additionally, Vtmax, [Formula: see text], Vt/Inspiratory Capacity, Vt/Forced Vital Capacity, Lowest [Formula: see text], [Formula: see text], and the y-intercepts of [Formula: see text] did not significantly differ regardless of obesity. CONCLUSION Obesity expressively influences the majority of CPET variables. However, the prognostic values of the main ventilatory efficiency responses remain unchanged. These dynamic responses are not dependent on maximum effort and may be useful in detecting incipient ventilatory disorder. Our results present great practical applicability in identifying exercise limitation, regardless of overweight and obesity.
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Affiliation(s)
- Bárbara de Barros Gonze
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
| | | | | | - Agatha Caveda Matheus
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
- Angiocorpore Institute of Cardiovascular Medicine, Santos, São Paulo, Brazil
| | - Evandro Fornias Sperandio
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
- Angiocorpore Institute of Cardiovascular Medicine, Santos, São Paulo, Brazil
| | | | | | - Marcello Romiti
- Angiocorpore Institute of Cardiovascular Medicine, Santos, São Paulo, Brazil
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
- Lown Scholars Program–Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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20
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Harper J, O'Donnell E, Sorouri Khorashad B, McDermott H, Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med 2021; 55:865-872. [PMID: 33648944 PMCID: PMC8311086 DOI: 10.1136/bjsports-2020-103106] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
Objectives We systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT). Design Systematic review. Data sources Four databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020. Eligibility criteria for selecting studies Eligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English. Results Twenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy. Conclusion In transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.
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Affiliation(s)
- Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Hilary McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gemma L Witcomb
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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21
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Ostolin TLVDP, Gonze BDB, de Oliveira Vieira W, de Oliveira ALS, Nascimento MB, Arantes RL, Romiti M, Sperandio EF, Dourado VZ. Association between the handgrip strength and the isokinetic muscle function of the elbow and the knee in asymptomatic adults. SAGE Open Med 2021; 9:2050312121993294. [PMID: 33717484 PMCID: PMC7924002 DOI: 10.1177/2050312121993294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background: The handgrip strength is a practical, valid, reliable, low-cost tool that presents strong correlations with several health conditions. However, handgrip strength may be inaccurate to prospectively predict the variability of muscular function since the decrease in muscular strength over the years varies according to a muscular group or between upper and lower limbs. Our hypothesis is that the handgrip strength cannot explain the variance of muscle function prospectively. Purpose: The aim of this study was to evaluate the cross-sectional and prospective association between handgrip strength and isokinetic muscle function of the knee and elbow in 780 asymptomatic adults. Methods: In a sample of 780 adults, we obtained handgrip strength and elbow and knee muscle function (for both flexion and extension at 60°/s and 300°/s) using, respectively, a hydraulic dynamometer and an isokinetic dynamometer. In a cross-sectional analysis, we analyzed the data obtained from baseline assessment. Then, we calculated the absolute change as a result of the variation data between the baseline and the 1-year follow-up assessment of each participant. The correlations were analyzed using Pearson or Spearman coefficients. We used multivariate models to investigate the association between handgrip strength and isokinetic muscle function. Results and Discussion: The cross-sectional correlations were significantly moderate-to-strong (r = 0.41–0.71, p < 0.01), but became weak-to-moderate (r = 0.26–0.34, p < 0.01) prospectively. In the cross-sectional analysis, the handgrip strength was selected as a strong predictor for isokinetic variables (∆R2 = 0.171–0.583, p < 0.05) as expected. Although handgrip strength was also selected as a significant predictor in prospective analysis, it explained only a little variance in isokinetic muscle function of the knee (∆R2 = 0.7–0.117, p < 0.05). Regarding the predictive models for the elbow, handgrip strength was not selected prospectively. Conclusion: The 1-year absolute change of the handgrip strength cannot explain the variance of the isokinetic muscle function. Thus, specific measures are required for assessing muscle function in epidemiological studies.
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Affiliation(s)
| | - Bárbara de Barros Gonze
- Laboratory of Epidemiology and Human Movement, Federal University of São Paulo, Santos, Brazil
| | | | | | | | | | - Marcello Romiti
- Institute of Cardiovascular Medicine Angiocorpore, Santos, Brazil
| | - Evandro Fornias Sperandio
- Laboratory of Epidemiology and Human Movement, Federal University of São Paulo, Santos, Brazil.,Institute of Cardiovascular Medicine Angiocorpore, Santos, Brazil
| | - Victor Zuniga Dourado
- Laboratory of Epidemiology and Human Movement, Federal University of São Paulo, Santos, Brazil
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22
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Brito CP, Moraes IG, Luders C, de Brito CMM, Yamaguti WP. Relationship of phase angle and peak torque of knee extensors with the performance in six-minute step test in haemodialysis patients. BMC Nephrol 2021; 22:56. [PMID: 33557771 PMCID: PMC7869460 DOI: 10.1186/s12882-021-02256-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Chronic kidney disease is a systemic disease affecting not only renal function, but also endocrine, cardiovascular, and skeletal muscle systems, with broad impact on functionality. Therefore, the assessment of body composition, peripheral muscle function, and exercise tolerance is also of great importance in this population. In addition, the development of reliable strategies that use feasible tools in clinical practice is of great importance in the functional diagnosis, clinical management and prescription of physical activity. OBJECTIVE To assess the relationship between phase angle and peak torque of knee extensors with the performance in six-minute step test of patients with chronic kidney disease undergoing haemodialysis. METHODS Observational and cross-sectional study at Haemodialysis Centre of Sírio-Libanês Hospital. The evaluations took place 3 days before the haemodialysis sessions. On the first day, patients underwent anthropometric evaluation and biochemical tests (lactate, urea, creatinine, albumin, ferritin and growth factor similar to insulin type 1 [IGF1]). On the second day, performed electrical bioimpedance and exercise tolerance assessed using the six-minute step test. On the last day, the evaluation of knee extensor muscles strength using isokinetic dynamometry was performed. RESULTS Eighteen subjects were included, with a mean age of 62.3 ± 17.6 years. A positive linear correlation was observed between the phase angle, derived from the electrical bioimpedance, and the performance in six-minute step test in these patients. It was also possible to observe a linear correlation between phase angle and IGF1, handgrip strength, peak torque of knee extensors and quality of life questionnaire. The peak torque of knee extensors also presented a linear correlation with IGF1, the performance in six-minute step test and mal-nutrition and inflammation score. CONCLUSION Phase angle and peak torque of knee extensors were correlated with the performance in six-minute step test. Therefore, the phase angle seems to be an important marker of reduced peripheral muscle function and exercise tolerance in haemodialysis patients.
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Affiliation(s)
- Camila Porto Brito
- Hospital Sírio-Libanês, Rehabilitation Centre, Dona Adma Jafet Street, 91 - Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Igor Gutierrez Moraes
- Hospital Sírio-Libanês, Rehabilitation Centre, Dona Adma Jafet Street, 91 - Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Cláudio Luders
- Hospital Sírio-Libanês, Haemodialysis Centre, Dona Adma Jafet, 91 - Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Christina May Moran de Brito
- Hospital Sírio-Libanês, Rehabilitation Centre, Dona Adma Jafet Street, 91 - Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Wellington Pereira Yamaguti
- Hospital Sírio-Libanês, Rehabilitation Centre, Dona Adma Jafet Street, 91 - Bela Vista, São Paulo, SP, 01308-050, Brazil.
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23
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Hilton EN, Lundberg TR. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports Med 2021; 51:199-214. [PMID: 33289906 PMCID: PMC7846503 DOI: 10.1007/s40279-020-01389-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10-50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.
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Affiliation(s)
- Emma N Hilton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tommy R Lundberg
- Department of Laboratory Medicine/ANA Futura, Division of Clinical Physiology, Karolinska Institutet, Alfred Nobles Allé 8B, Huddinge, 141 52, Stockholm, Sweden.
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
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24
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Araújo de Castro L, Morita AA, Sepúlveda-Loyola W, da Silva RA, Pitta F, Krueger E, Probst VS. Are there differences in muscular activation to maintain balance between individuals with chronic obstructive pulmonary disease and controls? Respir Med 2020; 173:106016. [PMID: 33190741 DOI: 10.1016/j.rmed.2020.106016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The mechanisms underlying impaired balance in chronic obstructive pulmonary disease (COPD) are poorly understood, which makes it difficult to choose the best therapeutic approaches. Therefore, this study aimed to investigate patterns of muscular activation to maintain balance and its determinants in this population. METHODS Thirty-three subjects with COPD and 33 controls were assessed by a force platform in four tasks: standing with eyes opened (FHEO) and closed (FHEC); standing on unstable surface (SUS) and one-legged stance (OLS). Electromyographic activity of lower limb, trunk and neck muscles was concomitantly recorded. To asses functional balance, Brief-balance evaluation systems and timed up & go (TUG) tests were applied. Lung function, exercise capacity and muscle force were also assessed. RESULTS Subjects with COPD presented worse balance and higher scalene activation than controls in OLS (mean difference 23.0 [95%CI 1.7-44.3] %Δ μVRMS; P = 0.034), besides presenting also higher activation of gluteus medius during FHEC task (mean difference 1.5 [95%CI 0.2-2.8] %Δ μVRMS; P = 0.023) and taking longer to complete the TUG (mean difference 0.6 [95%CI 0.1-1.2] seconds; P = 0.042). Exercise capacity and peripheral muscle force were determinants of functional balance (r2 = 0.505), whereas age (OR = 1.24; 95%CI 1.02-1.52) and total lung capacity (OR = 2.42; 95%CI 1.05-5.56) were determinants of static balance. CONCLUSION Individuals with COPD have worse static and functional balance in comparison with controls, besides presenting higher activation of scalene and gluteus medius during static balance tasks. Exercise capacity and peripheral muscle force emerged as determinants of functional balance, whereas age and lung hyperinflation contributed to poor static balance.
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Affiliation(s)
- Larissa Araújo de Castro
- Center of Research and Post-Graduation in Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil; Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Andrea Akemi Morita
- Center of Research and Post-Graduation in Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil; Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Walter Sepúlveda-Loyola
- Center of Research and Post-Graduation in Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil; Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil
| | - Rubens Alexandre da Silva
- Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil; Département des Sciences de la Santé, Programme de Physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Centre intersectoriel en santé durable, Lab BioNR et Cupht - UQAC, Saguenay, Québec, Canada
| | - Fabio Pitta
- Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Eddy Krueger
- Center of Research and Post-Graduation in Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil; Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil
| | - Vanessa Suziane Probst
- Center of Research and Post-Graduation in Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil; Masters and Doctoral Program in Rehabilitation Sciences, Physiotherapy Department, Universidade Estadual de Londrina (UEL), Universidade Norte do Paraná (UNOPAR), Londrina, Brazil.
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25
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Steffl M, Stastny P. Isokinetic testing of muscle strength of older individuals with sarcopenia or frailty: A systematic review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Pereira JC, Neri SGR, Vainshelboim B, Gadelha AB, Bottaro M, de Oliveira RJ, Lima RM. Normative Values of Knee Extensor Isokinetic Strength for Older Women and Implications for Physical Function. J Geriatr Phys Ther 2020; 42:E25-E31. [PMID: 29794885 DOI: 10.1519/jpt.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Lower-limb strength is required for everyday activities and thus its evaluation has been especially emphasized in older adults. Isokinetic testing is a criterion standard method to assess muscle strength; however, lack of reference values limits its usefulness in geriatric evaluation and rehabilitation. The aim of this study was to develop reference values of knee extensor isokinetic strength for older women. As a secondary aim, functional tests were performed for clinical significance validation. METHODS A total of 453 older women aged 60 to 84 years participated in this study. Knee extensor isokinetic strength was measured using the Biodex System dynamometer at 60° per second. The Timed Up and Go test and the 5 times Sit-to-Stand test were used for functional performance evaluation. Participants were categorized into age groups of 5 years range. The 20th, 40th, 60th, and 80th percentiles were used for stratification purposes. RESULTS AND DISCUSSION As expected, mean strength values significantly decreased with advancing age groups. Isokinetic percentile groups are presented according to age. Individuals in the lower percentile strata showed significantly reduced performance in both the Timed Up and Go and 5 times Sit-to-Stand tests (P < .05). CONCLUSION This study provides normative values of isokinetic knee extensor strength in older women. The association between lower isokinetic knee extensor strength strata and reduced functional capacity supports the potential application of these reference values in clinical and research settings. Future studies should ascertain these findings in different female populations.
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Affiliation(s)
- Juscelia Cristina Pereira
- Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil.,Federal Institute of Triângulo Mineiro, Campus Paracatu, Paracatu, Minas Gerais, Brazil
| | | | - Baruch Vainshelboim
- Master of Cancer Care Program, School of Health Sciences, Saint Francis University, Loretto, Pennsylvania
| | - André Bonadias Gadelha
- Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Martim Bottaro
- Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Ricardo M Lima
- Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
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Bourbeau J, De Sousa Sena R, Taivassalo T, Richard R, Jensen D, Baril J, Rocha Vieira DS, Perrault H. Eccentric versus conventional cycle training to improve muscle strength in advanced COPD: A randomized clinical trial. Respir Physiol Neurobiol 2020; 276:103414. [DOI: 10.1016/j.resp.2020.103414] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 01/21/2023]
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28
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Cavedon V, Milanese C, Zancanaro C. Are body circumferences able to predict strength, muscle mass and bone characteristics in obesity? A preliminary study in women. Int J Med Sci 2020; 17:881-891. [PMID: 32308541 PMCID: PMC7163357 DOI: 10.7150/ijms.41713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 12/25/2022] Open
Abstract
Measurement of body circumferences (BCs) is widely used as an anthropometric tool to assess body composition and health risk in obese individuals. In this preliminary work we evaluated the association of several BCs with Dual-energy X-ray Absorptiometry (DXA)-measured lean mass as well as leg press test scores with an aim at exploring the potential of BCs as predictor of body composition and muscle strength. A total of 34 female participants aged 47.3±7.6 y who were obese (BMI, 30.4-43.7 kg/m2) were recruited. The upper arm (relaxed), wrist, chest, waist, hip, thigh, and calf circumferences were measured. The skinfold-corrected muscle (including bone) circumferences at the arm, thigh, and calf site were also calculated. Lean mass components were measured by DXA with a Hologic QDR Explorer scanner according to the manufacturer's procedures. Lower limbs strength was assessed with the 1-Repetition Maximum leg press. Bivariate association between variables was assessed with the Spearman's correlation coefficient after the Benjamini and Hochberg False Discovery Rate procedure. Predictive equations were developed using stepwise multiple regression analysis. Several statistically significant correlations (Benjamini and Hochberg corrected P [Pc] < 0.05) were present between BCs and DXA-measured body composition variables, and leg press test scores with special regard to the chest, arm, waist, and hip circumferences. Multiple regression analysis yielded statistically significant predictive models (Pc < 0.05 for all; adjusted R2 ranging 0.123 - 0.504; standard error of the estimate ranging 4.0% - 11% of the mean measured value) for all body composition as well as leg press outcomes. The current findings show that BCs represent a simple, suitable anthropometric measurement with a potential to predict several lean mass components as well as lower limbs strength in obese females. The proposed predictors need to be validated in a larger sample of participants and in obese males.
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Affiliation(s)
| | | | - Carlo Zancanaro
- Laboratory of Anthropometry and Body Composition, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Cattagni T, Gremeaux V, Lepers R. The Physiological Characteristics of an 83-Year-Old Champion Female Master Runner. Int J Sports Physiol Perform 2020; 15:444-448. [PMID: 31605522 DOI: 10.1123/ijspp.2018-0879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the cardiorespiratory, muscular, and skeletal characteristics of an 83-year-old champion female master athlete (called DL in this study) who had set multiple world running records in the 80-to-84-year-old age group. METHODS Measures of maximal oxygen uptake, maximal heart rate, maximal isometric torque for knee extensor muscles, thigh and triceps surae muscle volumes, and bone mineral density (BMD) of the proximal femur region were evaluated. Based on previously published equations, physiological age was determined for maximal oxygen uptake, maximal heart rate, and maximal isometric torque. Muscle volumes for the dominant leg were compared with previously published sex- and age-matched data using z scores. For BMD, T score and z score were calculated. RESULTS DL had the highest maximal oxygen uptake (42.3 mL·min-1·kg-1) ever observed for a female older than 80 years of age, which gave her a remarkable physiological age (27 y). By contrast, she had a physiological age closer to her biological age for maximal isometric torque (90 y) and maximal heart rate (74 y). The z scores for thigh (0.4) and triceps surae (1.1) muscle volumes revealed that DL's leg muscles were affected almost as much as her sex- and age-matched peers. The T score (-1.7) for BMD showed that DL had osteopenia but no osteoporosis, and the z score (0.7) showed that DL's BMD was similar to that of females of the same age. CONCLUSION This single case study shows that the remarkable cardiorespiratory fitness coupled with intensive endurance training observed in a female master athlete was not associated with specific preservation of her muscular and skeletal characteristics.
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30
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de Castro LA, Felcar JM, de Carvalho DR, Vidotto LS, da Silva RA, Pitta F, Probst VS. Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. Physiotherapy 2020; 107:58-65. [PMID: 32026836 DOI: 10.1016/j.physio.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/07/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG {nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted} compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P<0.001). CONCLUSION Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER clinicalTrials.gov NCT01691131.
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Affiliation(s)
- Larissa A de Castro
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Londrina State University, Londrina, Brazil
| | - Josiane M Felcar
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Londrina State University, Londrina, Brazil
| | - Débora R de Carvalho
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Londrina State University, Londrina, Brazil
| | - Laís S Vidotto
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil
| | - Rubens A da Silva
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil
| | - Fabio Pitta
- Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, Londrina State University, Londrina, Brazil
| | - Vanessa S Probst
- Research Centre in Health Sciences, University of North Parana, Londrina, Brazil; Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil; Masters and Doctoral Programme in Rehabilitation Sciences, Physiotherapy Department, Londrina State University, Londrina, Brazil; University of North Parana, Londrina, Brazil.
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Ostolin TLVDP, Gonze BDB, Jesus MOD, Arantes RL, Sperandio EF, Dourado VZ. Effects of obesity on postural balance and occurrence of falls in asymptomatic adults. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Previous studies suggested that body weight is a strong predictor for postural balance. High body mass index (BMI) presented an association with increased postural sway. However, it seems controversial since studies reported no difference between obese and control group regarding the position of the center of pressure in static postural balance (PB). Also, there is a lack of investigations about the impact of obesity on PB, free of the confound effect of cardiometabolic risk. Objective: The aim of this study was to evaluate the effects of obesity in static PB and occurrence of falls in asymptomatic adults and older adults over 40 years old. Method: The PB of 624 subjects divided into quartiles for BMI, waist-to-hip ratio, waist-to-height and fat body mass as percentage (%FBM) was assessed with and without vision using a force platform. An MANOVA was used to determine if there were differences between quartiles and a logistic regression analysis adjusted for confounders variables were applied to determine the obesity role in the occurrence of falls. Results: We found weak to moderate bivariate correlations between obesity and static PB, which became non-significant after adjustment. We found significant differences between first and fourth quartiles, especially using %FBM. Obesity was not related to the occurrence of falls since the odds ratio values became non-significant for all the indices of obesity after adjustment. Conclusion: Obesity presents little influence on maintaining static PB and seems not to determine the occurrence of falls among subjects over 40 years old.
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Affiliation(s)
| | | | | | - Rodolfo Leite Arantes
- Universidade Federal de São Paulo, Brazil; Instituto de Medicina Cardiovascular Angiocorpore, Brazil
| | - Evandro Fornias Sperandio
- Universidade Federal de São Paulo, Brazil; Instituto de Medicina Cardiovascular Angiocorpore, Brazil
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Bouchnak MM, Ostolin TLVDP, Sperandio EF, Vieira WDO, Dourado VZ. Association between electromyographic localized muscle fatigue of the rectus femoris and static postural balance in physically active adult men. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2020. [DOI: 10.1590/1980-0037.2020v22e66062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Although the determinant impact of exercise-induced muscle fatigue prior to postural balance assessment has been widely described, recent evidence suggests that hyperventilation and sensorimotor losses, rather than muscle fatigue, are responsible for the changes observed in postural balance. However, the association between localized muscle fatigue (LMF), induced by isokinetic dynamometer protocol test and assessed through surface electromyography, and postural balance in adults is poorly understood. We aimed to evaluate the association between the LMF of the rectus femoris and static postural balance in 51 adult men (43±14.8 years; 26.9±5 kg/m2). We obtained physical activity level and postural balance, respectively, through a triaxial accelerometry and a force platform. The quadriceps femoris strength and endurance were obtained using an isokinetic dynamometer and surface electromyography simultaneously. The association between the isokinetic and electromyographic LMF and static postural balance was investigated using linear regression models adjusted for age, body mass index, and isokinetic quadriceps strength and LMF. The correlations between postural balance variables and isokinetic muscle strength and LMF were weak-to-moderate. After multivariate analyses, we observed that electromyographic LMF were a predictor of postural balance, mainly of the mean amplitude and COP area and velocity in the mediolateral direction, regardless of isokinetic variables. Therefore, LMF plays a determinant role in the postural balance of physically active adult men. Fatigue indices are significant predictors of postural balance, regardless of previous fatigue induction.
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Ness KK, Plana JC, Joshi VM, Luepker RV, Durand JB, Green DM, Partin RE, Santucci AK, Howell RM, Srivastava DK, Hudson MM, Robison LL, Armstrong GT. Exercise Intolerance, Mortality, and Organ System Impairment in Adult Survivors of Childhood Cancer. J Clin Oncol 2019; 38:29-42. [PMID: 31622133 DOI: 10.1200/jco.19.01661] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Exercise intolerance, associated with heart failure and death in general populations, is not well studied in survivors of childhood cancer. We examined prevalence of exercise intolerance in survivors exposed or not to cardiotoxic therapy, and associations among organ system function, exercise intolerance, and mortality. METHODS Participants consisted of 1,041 people who had survived cancer ≥ 10 years (and had or did not have exposure to anthracyclines and/or chest-directed radiation) and 285 control subjects. Exercise intolerance was defined as peak oxygen uptake < 85% predicted from maximal cardiopulmonary exercise testing; organ functions were ascertained with imaging or clinical testing. Multivariable regression of the data was performed to compare exercise capacity between survivors exposed or unexposed to cardiotoxic therapy and control subjects, and to evaluate associations between treatment and organ function, and organ function and exercise intolerance. Propensity score methods in time-to-event analyses evaluated associations between exercise intolerance and mortality. RESULTS Survivors (mean age ± standard deviation [SD], 35.6 ± 8.8 years) had lower mean (± SD) peak oxygen uptake (exposed: 25.74 ± 8.36 mL/kg/min; unexposed: 26.82 ± 8.36 mL/kg/min) than did control subjects (32.69 ± 7.75 mL/kg/min; P for all < .001). Exercise intolerance was present in 63.8% (95% CI, 62.0% to 65.8%) of exposed survivors, 55.7% (95% CI, 53.2% to 58.2%) of unexposed survivors, and 26.3% (95% CI, 24.0% to 28.3%) of control subjects, and was associated with mortality (hazard ratio, 3.9; 95% CI, 1.09 to 14.14). Global longitudinal strain (odds ratio [OR], 1.71; 95% CI, 1.11 to 2.63), chronotropic incompetence (OR, 3.58; 95% CI, 1.75 to 7.31); forced expiratory volume in 1 second < 80% (OR, 2.59; 95% CI, 1.65 to 4.09), and 1 SD decrease in quadriceps strength (OR, 1.49; 95% CI, 1.23 to 1.82) were associated with exercise intolerance. Ejection fraction < 53% was not associated with exercise intolerance. CONCLUSION Exercise intolerance is prevalent among childhood cancer survivors and associated with all-cause mortality. Treatment-related cardiac (detected by global longitudinal strain), autonomic, pulmonary, and muscular impairments increased risk. Survivors with impairments may require referral to trained specialists to learn to accommodate specific deficits when engaging in exercise.
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Affiliation(s)
| | | | - Vijaya M Joshi
- University of Tennessee Health Science Center, Memphis, TN
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Pereira JC, Neri SGR, Vainshelboim B, Gadelha AB, Bottaro M, Lima RM. A reference equation for normal standards for knee extensor isokinetic strength in Brazilian older women. Aging Clin Exp Res 2019; 31:1531-1537. [PMID: 30515723 DOI: 10.1007/s40520-018-1084-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Knee extensor strength assessment has been especially emphasized in older people, but lack of reference values limits its usefulness in geriatric evaluation. AIMS The aim of this study was to develop a reference equation for knee extensor isokinetic strength standards in older women. METHODS Knee extensor isokinetic tests at 60°/s were performed in 390 Brazilian older women aged 60-84 years (67.38 ± 5.56 years) and in a separate validation sample of 110 women (67.94 ± 6.13 years). A regression equation for peak torque (PT) was derived and compared to commonly used formulas: the equations of Neder and Gross. Age, weight and height were the only significant predictors (multiple R = 0.55; R2 = 0.30; p < 0.001). The proposed equation was examined in the independent sample. Percent from predicted values was calculated and Bland-Altman plots were constructed. RESULTS Both the Neder and Gross equations significantly underestimated predicted PT values (both p < 0.001); mean bias were 6.79 and 6.75, respectively. The proposed equation [PT = 39.72 - (1.24 × age) + (0.44 × weight) + (69.70 × height)] was matched with the independent sample, with a percent predicted isokinetic strength of approximately 95%, a mean bias approximately 40% lower 4.23 than the other equations, and stable across all age groups. CONCLUSIONS Available equations for knee extensor isokinetic strength are not adequate for older women. The equation developed in the present study provided considerably lower average error and thus with more suitable reference values.
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Affiliation(s)
- Juscélia Cristina Pereira
- Faculdade de Educação Física, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, CEP 70910-970, Brazil.
- Federal Institute of Triângulo Mineiro, Campus Paracatu, Paracatu, MG, Brazil.
| | - Silvia Gonçalves Ricci Neri
- Faculdade de Educação Física, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, CEP 70910-970, Brazil
| | - Baruch Vainshelboim
- Master of Cancer Care Program, School of Health Sciences, Saint Francis University, Loretto, PA, USA
| | - André Bonadias Gadelha
- Faculdade de Educação Física, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, CEP 70910-970, Brazil
| | - Martim Bottaro
- Faculdade de Educação Física, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, CEP 70910-970, Brazil
| | - Ricardo M Lima
- Faculdade de Educação Física, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, CEP 70910-970, Brazil
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Zhu H, Nesler C, Divekar N, Ahmad MT, Gregg RD. Design and Validation of a Partial-Assist Knee Orthosis with Compact, Backdrivable Actuation. IEEE Int Conf Rehabil Robot 2019; 2019:917-924. [PMID: 31374747 DOI: 10.1109/icorr.2019.8779479] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents the mechatronic design and initial validation of a partial-assist knee orthosis for individuals with musculoskeletal disorders, e.g., knee osteoarthritis and lower back pain. This orthosis utilizes a quasi-direct drive actuator with a low-ratio transmission (7:1) to greatly reduce the reflected inertia for high backdrivability. To provide meaningful assistance, a custom Brushless DC (BLDC) motor is designed with encapsulated windings to improve the motor's thermal environment and thus its continuous torque output. The 2.69 kg orthosis is constructed from all custom-made components with a high package factor for lighter weight and a more compact size. The combination of compactness, backdrivability, and torque output enables the orthosis to provide partial assistance without obstructing the natural movement of the user. Several benchtop tests verify the actuator's capabilities, and a human subject experiment demonstrates reduced quadriceps muscle activation when assisted during a repetitive lifting and lowering task.
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Abstract
PURPOSE To describe balance for 12 mo in people with chronic obstructive pulmonary disease (COPD). METHODS Individuals with COPD completed the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BEST), and the Activities-Specific Balance Confidence (ABC) scale before pulmonary rehabilitation (PR), post-PR and at 3, 6, and 12 mo. If an acute exacerbation of COPD (AECOPD) occurred, balance measures were repeated after 7 d and 1 mo. Descriptive data are displayed for balance measures at 5 time-points (pre-PR, post-PR, 3 mo, 6 mo, and 12 mo) in those without exacerbations. The outcome score at 7 d and 1 mo post-AECOPD was compared with the assessment closest to the AECOPD. RESULTS A total of 42 patients were recruited and 32 patients (17 male; mean age ± standard deviation = 68.5 ± 9.9 yr; FEV1 % predicted =38 ± 15%) completed balance measures post-PR. Seventeen, 11, and 6 patients, who did not exacerbate, completed balance measures at 3, 6, and 12 mo, respectively, with no overall change in balance measures over time. Of 32 patients, 15 experienced an AECOPD and of these, 8 and 11 completed measures at 7 d and 1 mo, respectively. Balance declined from baseline to 7 d (BBS, P = .010; BEST, P = .002) and to 1 mo post-AECOPD (BBS, P = .035). Balance recovered from 7 d to 1 mo post-AECOPD but did not return to baseline levels (BBS, P = .045; BEST, P = .006). There were no changes in balance confidence post-AECOPD. CONCLUSIONS Balance remained stable over 12 mo after completion of PR in those who remained exacerbation-free. The impact of an AECOPD on measures of balance persisted after 1 mo.
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Trevino MA, Sterczala AJ, Miller JD, Wray ME, Dimmick HL, Ciccone AB, Weir JP, Gallagher PM, Fry AC, Herda TJ. Sex-related differences in muscle size explained by amplitudes of higher-threshold motor unit action potentials and muscle fibre typing. Acta Physiol (Oxf) 2019; 225:e13151. [PMID: 29908102 DOI: 10.1111/apha.13151] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/11/2022]
Abstract
AIM To investigate the relationships between motor unit action potential amplitudes (MUAPAMP ), muscle cross-sectional area (mCSA) and composition (mEI), per cent myosin heavy chain (%MHC) areas and sex in the vastus lateralis (VL). METHODS Ten males and 10 females performed a submaximal isometric trapezoid muscle action that included a linearly increasing, steady torque at 40% maximal voluntary contraction, and linearly decreasing segments. Surface electromyographic decomposition techniques were utilized to determine MUAPAMPS in relation to recruitment thresholds (RT). Ultrasound images were taken to quantify muscle mCSA and mEI. Muscle biopsies were collected to calculate %MHC areas. Y-intercepts and slopes were calculated for the MUAPAMP vs RT relationships for each subject. Independent-samples t tests and ANOVA models examined sex-related differences in mCSA, mEI, slopes and y-intercepts for the MUAPAMP vs RT relationships and %MHC areas. Correlations were performed among type IIA and total type II %MHC area, mCSA and the slopes and y-intercepts for the MUAPAMP vs RT relationships. RESULTS Males exhibited greater slopes for the MUAPAMP vs RT relationships (P = .003), mCSA (P < .001) and type IIA %MHC (P = .011), whereas females had greater type I %MHC area (P = .010) and mEI (P = .024). The mCSA, type IIA and total II %MHC area variables were correlated (P < .001-.015, r = .596-.836) with the slopes from the MUAPAMP vs RT relationships. CONCLUSION Sex-related differences in mCSA and MUAPAMPS of the higher-threshold MUs were likely the result of larger muscle fibres expressing type II characteristics for males.
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Affiliation(s)
- M. A. Trevino
- Biodynamics and Human Performance Center Department of Health Sciences Georgia Southern University Savannah GA USA
| | - A. J. Sterczala
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - J. D. Miller
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - M. E. Wray
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - H. L. Dimmick
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - A. B. Ciccone
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - J. P. Weir
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - P. M. Gallagher
- Applied Physiology Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - A. C. Fry
- Applied Physiology Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
| | - T. J. Herda
- Neuromechanics Laboratory Department of Health, Sport and Exercise Sciences University of Kansas Lawrence KS USA
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Oliveira AEPD, Ostolin TLVDP, Vieira WDO, Arantes RL, Gagliardi ARDT, Sperandio EF, Dourado VZ. The association between physical activity, sedentary behavior and the occurrence of falls in asymptomatic adults over 40 years old. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Sedentary behavior (SB) has been described as an independent risk factor for health, regardless of the recommended amount of moderate-to-vigorous physical activity (MVPA). However, SB and MVPA as predictors of falls have been poorly investigated. Objective: To compare the associations between SB and MVPA and the occurrence of falls in middle-aged and older adults. Method: The participants wore a triaxial accelerometer over the dominant hip for seven days to measure SB and MVPA. The occurrence of falls and cardiovascular risk factors were assessed by self-report. Isokinetic peak torque (PT) of knee extension, peak oxygen uptake (V’O2) in a ramp treadmill protocol, and lean (LBM) body mass and body fat (BFM) (bioelectrical impedance) were also assessed. The critical roles of SB and MVPA on the occurrence of falls were compared by multiple logistic regression adjusted for age, sex, cardiovascular risk factors, LBM, peak V’O2, and PT of knee extension. Results: 379 participants were evaluated, aged 40-80 years. Forty-eight participants reported at least one fall in the previous 12 months (14.5%). Fallers presented lower SB and higher MVPA. They were predominantly women and older adults with lower physical fitness. After multivariate analysis, MVPA, but not SB, was selected as an independent predictor of falls, increasing the odds ratio of having a fall (1.184, 95% confidence interval, 1.016 - 1.378). Conclusion: Episodes of falls in predominantly middle-aged and women subjects were associated with a higher amount of MVPA, not the opposite, indicating an adverse effect of MVPA in these subjects.
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Kemmler W, von Stengel S, Schoene D, Kohl M. Changes of Maximum Leg Strength Indices During Adulthood a Cross-Sectional Study With Non-athletic Men Aged 19-91. Front Physiol 2018; 9:1524. [PMID: 30443219 PMCID: PMC6223067 DOI: 10.3389/fphys.2018.01524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022] Open
Abstract
Age-related loss of muscle mass and function, also called sarcopenia, was recently added to the ICD-10 as an independent condition. However, declines in muscle mass and function are inevitable during the adulthood aging process. Concerning muscle strength as a crucial aspect of muscle function, maximum knee extension strength might be the most important physical parameter for independent living in the community. In this study, we aimed to determine the age-related decline in maximum isokinetic knee extension (MIES) and flexion strength (MIFS) in adult men. The primary study hypothesis was that there is a slight gradual decrease of MIES up to ≈age 60 years with a significant acceleration of decline after this "changepoint." We used a closed kinetic chain system (leg-press), which is seen as providing functionally more relevant results on maximum strength, to determine changes in maximum isokinetic hip/leg extensor (MIES) and flexor strength (MIFS) during adulthood in men. Apart from average annual changes, we aimed to identify whether the decline in maximum lower extremity strength is linear. MIES and MIFS data determined by an isokinetic leg-press of 362 non-athletic, healthy, and community-dwelling men 19-91 years old were included in the analysis. A changepoint analysis was conducted based on a multiple regression analysis adjusted for selected co-variables that might confound the proper relationship between age and maximum strength. In summary, maximum isokinetic leg-strength decline during adulthood averaged around 0.8-1.0% p.a.; however, the reduction was far from linear. MIES demonstrated a non-significant reduction of 5.2 N/p.a. (≈0.15% p.a.) up to the estimated breakpoint of 52.0 years and an accelerated loss of 44.0 N/p.a. (≈1.3% p.a.; p < 0.001). In parallel, the decline in MIFS (10.0 N/p.a.; ≈0.5% p.a.) prior to the breakpoint at age 59.0 years was significantly more pronounced. Nevertheless, we observed a further marked accelerated loss of MIFS (25.0 N/p.a.; ≈1.3% p.a.) in men ≥60 years. Apart from the "normative value" and closed kinetic chain aspect of this study, the practical application of our results suggests that sarcopenia prophylaxis in men should be started in the 5th decade in order to address the accelerated muscle decline of advanced age.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Faculty of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
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Risberg MA, Steffen K, Nilstad A, Myklebust G, Kristianslund E, Moltubakk MM, Krosshaug T. Normative Quadriceps and Hamstring Muscle Strength Values for Female, Healthy, Elite Handball and Football Players. J Strength Cond Res 2018; 32:2314-2323. [PMID: 29794892 PMCID: PMC6092090 DOI: 10.1519/jsc.0000000000002579] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Risberg, MA, Steffen, K, Nilstad, A, Myklebust, G, Kristianslund, E, Moltubakk, MM, and Krosshaug, T. Normative quadriceps and hamstring muscle strength values for female, healthy, elite handball and football players. J Strength Cond Res 32(8): 2314–2323, 2018—This study presents normative values for isokinetic knee extension and flexion muscle strength tests in 350 elite, female, handball (n = 150) and football (n = 200) players. Isokinetic concentric muscle strength tests at 60°·sec−1 were recorded bilaterally using a dynamometer. Peak torque (in Newton meter [N·m]), body mass normalized peak torque (N·m·kg−1), and hamstring to quadriceps ratio (H:Q ratio) for dominant and nondominant legs were recorded. The female elite players were 20.9 ± 4.0 years, started playing at the elite level at the age of 18.2 ± 2.7 years, with a mean of 9.7 ± 2.2 hours of weekly in-season training. Handball players demonstrated greater quadriceps muscle strength compared with football players (11.0%) (p < 0.001), also when normalized to body mass (4.1%) (p = 0.012), but not for weight-adjusted hamstring muscle strength. The H:Q ratio was higher on the dominant compared with the nondominant leg for handball players only (p = 0.012).The H:Q ratio was significantly lower for handball players (0.58) compared with football players (0.60) (p < 0.02). These normative values for isokinetic knee extension and flexion torques of healthy, elite, female handball and football players can be used to set rehabilitation goals for muscle strength after injury and enable comparison with uninjured legs. Significantly greater quadriceps muscle strength was found for handball players compared with football players, also when normalized to body mass.
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Affiliation(s)
| | | | | | | | | | - Marie M Moltubakk
- Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Gea J, Sancho-Muñoz A, Chalela R. Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations. J Thorac Dis 2018; 10:S1332-S1354. [PMID: 29928517 PMCID: PMC5989104 DOI: 10.21037/jtd.2018.02.66] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022]
Abstract
Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.
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Affiliation(s)
- Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Antoni Sancho-Muñoz
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
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42
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Mitchell CJ, D'Souza RF, Schierding W, Zeng N, Ramzan F, O'Sullivan JM, Poppitt SD, Cameron-Smith D. Identification of human skeletal muscle miRNA related to strength by high-throughput sequencing. Physiol Genomics 2018; 50:416-424. [PMID: 29602299 DOI: 10.1152/physiolgenomics.00112.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The loss of muscle size, strength, and quality with aging is a major determinant of morbidity and mortality in the elderly. The regulatory pathways that impact the muscle phenotype include the translational regulation maintained by microRNAs (miRNA). Yet the miRNAs that are expressed in human skeletal muscle and relationship to muscle size, strength, and quality are unknown. Using next-generation sequencing, we selected the 50 most abundantly expressed miRNAs and then analyzed them in vastus lateralis muscle, obtained by biopsy from middle-aged males ( n = 48; 50.0 ± 4.3 yr). Isokinetic strength testing and midthigh computed tomography was undertaken for muscle phenotype analysis. Muscle attenuation was measured by computerized tomography and is inversely proportional to myofiber lipid content. miR-486-5p accounted for 21% of total miR sequence reads, with miR-10b-5p, miR-133a-3p, and miR-22-3p accounting for a further 15, 12, and 10%, respectively. Isokinetic knee extension strength and muscle cross-sectional area were positively correlated with miR-100-5p, miR-99b-5p, and miR-191-5p expression. Muscle attenuation was negatively correlated to let-7f-5p, miR-30d-5p, and miR-125b-5p expression. In silico analysis implicates miRNAs related to strength and muscle size in the regulation of mammalian target of rapamycin, while miRNAs related to muscle attenuation may have potential roles regulating the transforming growth factor-β/SMAD3 pathway.
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Affiliation(s)
| | | | | | - Nina Zeng
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Farha Ramzan
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | | | - Sally D Poppitt
- School of Biological Sciences, University of Auckland , Auckland , New Zealand.,Riddet Institute , Palmerston North , New Zealand
| | - David Cameron-Smith
- Liggins Institute, University of Auckland , Auckland , New Zealand.,Food & Bio-based Products Group, AgResearch, Palmerston North , New Zealand.,Riddet Institute , Palmerston North , New Zealand
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43
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Trethewey R, Esliger D, Petherick E, Evans R, Greening N, James B, Kingsnorth A, Morgan M, Orme M, Sherar L, Singh S, Toms N, Steiner M. Influence of muscle mass in the assessment of lower limb strength in COPD: validation of the prediction equation. Thorax 2017; 73:587-589. [PMID: 28866643 DOI: 10.1136/thoraxjnl-2016-209870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/03/2022]
Abstract
Absence of established reference values limits application of quadriceps maximal voluntary contraction (QMVC) measurement. The impact of muscle mass inclusion in predictions is unclear. Prediction equations encompassing gender, age and size with (FFM+) and without (FFM-), derived in healthy adults (n=175), are presented and compared in two COPD cohorts recruited from primary care (COPD-PC, n=112) and a complex care COPD clinic (COPD-CC, n=189). Explained variance was comparable between the prediction models (R2: FFM+: 0.59, FFM-: 0.60) as were per cent predictions in COPD-PC (88.8%, 88.3%). However, fat-free mass inclusion reduced the prevalence of weakness in COPD, particularly in COPD-CC where 11.9% fewer were deemed weak.
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Affiliation(s)
- Ruth Trethewey
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Dale Esliger
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.,NIHR Leicester Biomedical Research Centre - Lifestyle, Leicester, UK
| | - Emily Petherick
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Rachael Evans
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.,Respiratory Medicine, Glenfield Hospital, Leicester, UK.,Centre for Exercise and Rehabilitation Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Neil Greening
- Respiratory Medicine, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Benjamin James
- NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Andrew Kingsnorth
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Mike Morgan
- Respiratory Medicine, Glenfield Hospital, Leicester, UK
| | - Mark Orme
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Lauren Sherar
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Sally Singh
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.,Centre for Exercise and Rehabilitation Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicole Toms
- Respiratory Medicine, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Michael Steiner
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.,Centre for Exercise and Rehabilitation Services, University Hospitals of Leicester NHS Trust, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
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44
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Hunnicutt JL, Gregory CM. Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals. Top Stroke Rehabil 2017; 24:463-471. [PMID: 28251861 DOI: 10.1080/10749357.2017.1292720] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production. OBJECTIVES To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults. METHODS Scientific literature was searched up to April 2016 to identify studies that included lower extremity muscle size and strength measures in individuals with chronic stroke. Lower extremity muscle size and strength data from healthy controls were sought for comparison. Relative differences were calculated between paretic, nonparetic, and control limbs. RESULTS Fifteen studies with 375 participants (61% male; age = 62 ± 5 years; time since stroke = 60 ± 42 months) were included. The paretic limb exhibited deficits of ~13% in thigh muscle size, ~5% in lower leg muscle size, and ~8% in lean leg mass compared to the nonparetic limb. Paretic plantarflexor and knee extensor strength were 52 and 36% lower, respectively, compared to the nonparetic limb. When compared to age-matched control data, both paretic and nonparetic limbs showed deficits in muscle size and strength. CONCLUSIONS Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction. Understanding these muscular changes is necessary for designing appropriate exercise interventions aimed at restoring muscle function.
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Affiliation(s)
- Jennifer L Hunnicutt
- a Health Sciences and Research , Medical University of South Carolina , Charleston , SC , USA
| | - Chris M Gregory
- a Health Sciences and Research , Medical University of South Carolina , Charleston , SC , USA
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45
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Lauria VT, Sperandio EF, de Sousa TLW, de Oliveira Vieira W, Romiti M, de Toledo Gagliardi AR, Arantes RL, Dourado VZ. Evaluation of dose-response relationship between smoking load and cardiopulmonary fitness in adult smokers: A cross-sectional study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:79-84. [PMID: 28153628 DOI: 10.1016/j.rppnen.2016.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/17/2016] [Accepted: 11/22/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the dose-response relationship between smoking load and cardiopulmonary fitness, as measured with cardiopulmonary exercise testing (CPET), in adult smokers free of respiratory diseases. METHODS After a complete clinical evaluation and spirometry, 95 adult smokers (35 men and 60 women) underwent CPET on a treadmill. RESULTS The physiological responses during CPET showed lower cardiorespiratory fitness levels, regardless of smoking load, with a peak [Formula: see text] lower than 100% of the expected value and a lower maximum heart rate. We observed a significant moderate negative correlation between smoking load and peak [Formula: see text] . The smoking load also presented a significant negative correlation with maximum heart rate(r=-0.36; p<0.05), lactate threshold(r=-0.45; p<0.05), and peak ventilation(r=-0.43; p<0.05). However, a dose-response relationship between smoking load quartiles and cardiopulmonary fitness was not found comparing quartiles of smoking loads after adjustment for age, sex and cardiovascular risk. CONCLUSION There appears to be no dose-response relationship between SL and cardiopulmonary fitness in adult smokers with preserved pulmonary function, after adjusting the analysis for age and cardiovascular risk. Our results suggest that smoking cessation might be useful as the primary strategy to prevent cardiopulmonary fitness decline in smokers, regardless of smoking load. Thus, even a very low dose of tobacco use must be avoided in preventive strategies focusing on becoming people more physically active and fit.
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Affiliation(s)
- V T Lauria
- Laboratory of Epidemiology and Human Movement (EPIMOV), Federal University of São Paulo, Santos, Brazil.
| | - E F Sperandio
- Laboratory of Epidemiology and Human Movement (EPIMOV), Federal University of São Paulo, Santos, Brazil
| | - T L W de Sousa
- Laboratory of Epidemiology and Human Movement (EPIMOV), Federal University of São Paulo, Santos, Brazil
| | - W de Oliveira Vieira
- Laboratory of Epidemiology and Human Movement (EPIMOV), Federal University of São Paulo, Santos, Brazil
| | - M Romiti
- Angiocorpore Institute of Cardiovascular Medicine, Santos, Brazil
| | | | - R L Arantes
- Angiocorpore Institute of Cardiovascular Medicine, Santos, Brazil
| | - V Z Dourado
- Laboratory of Epidemiology and Human Movement (EPIMOV), Federal University of São Paulo, Santos, Brazil
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46
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Gea J, Casadevall C, Pascual S, Orozco-Levi M, Barreiro E. Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction. J Thorac Dis 2016; 8:3379-3400. [PMID: 28066619 DOI: 10.21037/jtd.2016.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Carme Casadevall
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Sergi Pascual
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Mauricio Orozco-Levi
- Department of Respiratory, Cardiovascular Foundation from Colombia Floridablanca, Santander, Colombia, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Esther Barreiro
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
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47
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Bokshan SL, Han AL, DePasse JM, Eltorai AEM, Marcaccio SE, Palumbo MA, Daniels AH. Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery. Orthopedics 2016; 39:e1159-e1164. [PMID: 27536954 DOI: 10.3928/01477447-20160811-02] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/13/2016] [Indexed: 02/03/2023]
Abstract
Sarcopenia is the loss of muscle mass associated with aging and advanced disease. This study retrospectively examined patients older than 55 years (N=46) who underwent thoracolumbar spine surgery between 2003 and 2015. Each patient's comorbidity burden was determined using the Charlson Comorbidity Index, and the Mirza Surgical Invasiveness Index was used to measure procedural complexity. Sarcopenia was diagnosed by measuring the total cross-sectional area of the psoas muscle at the L4 vertebrae using perioperative computed tomography scans. Of the 46 patients assessed, 16 were in the lowest third for L4 total psoas area (sarcopenic). Average follow-up time was 5.2 years (range, 6 days to 12.7 years). The cohort of patients with sarcopenia was significantly older than the cohort without sarcopenia (mean age, 76.4 vs 69.9 years; P=.01) but did not have a significantly different mean Charlson Comorbidity Index (3.3 vs 2.0; P=.32) or mean Mirza Surgical Invasiveness Index (7.1 vs 7.0; P=.49). Patients with sarcopenia had a hospital length of stay 1.7-fold longer than those without sarcopenia (8.1 vs 4.7 days; P=.02) and a 3-fold increase in postoperative in-hospital complications (1.2 vs 0.4; P=.02), and they were more likely to require discharge to a rehabilitation or nursing facility (81.2% vs 43.3%; P=.006). Patients with sarcopenia had a significantly lower cumulative survival (log rank=0.007). All 4 deaths occurred among patients with sarcopenia. Patients with sarcopenia have a significantly increased risk of in-hospital complications, longer length of stay, increased rates of discharge to rehabilitation facilities, and increased mortality following thoracolumbar spinal surgery, making sarcopenia a useful perioperative risk stratification tool. [Orthopedics. 2016; 39(6):e1159-e1164.].
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48
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Lopes AJ, Ferreira AS, Walchan EM, Soares MS, Bunn PS, Guimarães FS. Explanatory models of muscle performance in acromegaly patients evaluated by knee isokinetic dynamometry: Implications for rehabilitation. Hum Mov Sci 2016; 49:160-9. [DOI: 10.1016/j.humov.2016.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/21/2022]
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49
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Muff G, Dufour S, Meyer A, Severac F, Favret F, Geny B, Lecocq J, Isner-Horobeti ME. Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer. J Phys Ther Sci 2016; 28:2445-2451. [PMID: 27799667 PMCID: PMC5080149 DOI: 10.1589/jpts.28.2445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/23/2016] [Indexed: 01/01/2023] Open
Abstract
[Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48-0.86) to 0.87 (95% CI, 0.75-0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2-4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from -0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.
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Affiliation(s)
- Guillaume Muff
- Department of Physical Medicine and Rehabilitation, University Institute of Rehabilitation Clemenceau, Strasbourg University, France; Federation of Translational Medicine (FMTS), Strasbourg University, France
| | - Stéphane Dufour
- Federation of Translational Medicine (FMTS), Strasbourg University, France; Faculty of Sports Sciences, Strasbourg University, France
| | - Alain Meyer
- Institute of Physiology, Faculty of Medicine and University Hospital, Strasbourg University, France; Federation of Translational Medicine (FMTS), Strasbourg University, France
| | - François Severac
- Federation of Translational Medicine (FMTS), Strasbourg University, France
| | - Fabrice Favret
- Federation of Translational Medicine (FMTS), Strasbourg University, France; Faculty of Sports Sciences, Strasbourg University, France
| | - Bernard Geny
- Institute of Physiology, Faculty of Medicine and University Hospital, Strasbourg University, France; Federation of Translational Medicine (FMTS), Strasbourg University, France
| | - Jehan Lecocq
- Department of Physical Medicine and Rehabilitation, University Institute of Rehabilitation Clemenceau, Strasbourg University, France; Federation of Translational Medicine (FMTS), Strasbourg University, France
| | - Marie-Eve Isner-Horobeti
- Department of Physical Medicine and Rehabilitation, University Institute of Rehabilitation Clemenceau, Strasbourg University, France; Federation of Translational Medicine (FMTS), Strasbourg University, France
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50
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Senden PJ, Sabelis LWE, Zonderland ML, van de Kolk R, Meiss L, de Vries WR, Bol E, Mosterd WL. Determinants of maximal exercise performance in chronic heart failure. ACTA ACUST UNITED AC 2016; 11:41-7. [PMID: 15167205 DOI: 10.1097/01.hjr.0000116825.84388.eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is characterized by symptoms like fatigue, dyspnoea and limited exercise performance. It has been postulated that maximal exercise performance (Wmax) is predominantly limited by skeletal muscle function and less by heart function. AIM To study the interrelation between most relevant muscle and anthropometrical variables and Wmax in CHF patients in order to develop a model that describes the impact of these variables for maximal exercise performance. DESIGN In 77 patients with CHF Wmax was assessed by incremental cycle ergometry until exhaustion (20 Watt/3 min). Peak torque (strength) and total work (endurance) for the quadriceps and hamstrings were assessed by isokinetic dynamometry. Isometric strength was measured by hand dynamometry. Relevant muscle areas were calculated by computerized tomography scan. RESULTS Significant correlations between Wmax and isokinetic muscle parameters (peak torque and total work) ranged from 0.41-0.65 (P<0.01). Other significant relationships (P<0.01) with Wmax were obtained for age (r=-0.22), gender (r=0.45), fat free mass (FFM) (r=0.51), quadriceps muscle area (r=0.73), hamstrings muscle area (r=0.50), upper leg muscle function (i.e., a combination of muscle strength and muscle endurance) (r=0.71) and isometric strength (r=0.63). Multiple regression analysis showed that upper leg muscle function and quadriceps muscle area could predict 57% of the variance in Wmax. CONCLUSION Muscle strength and muscle endurance, combined with quadriceps muscle area are the main predictors of maximal exercise performance in patients with CHF.
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Affiliation(s)
- Peter J Senden
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands.
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