The effect of combining vibratory platform and unstable footwear on static balance in active young people

Vibratory platforms (VPs) and unstable footwear (UF) have both shown benefits on balance in some populations. However, there is no evidence about the combined effects of using UF while training on an VP in healthy and physically active young people. We aimed to evaluate the effects of wearing unstable footwear (UF) while training on a whole-body VP on balance in healthy, physically active young people. 23 participants were randomized into groups assigned UF (n = 11) or stable footwear (SF; n = 12). Both groups followed the same training program on an VP with the assigned footwear type twice a week for 12 weeks. The training consisted of performing 8 isometric exercises for progressively longer periods and higher oscillation amplitudes (15-60 s, 1-3 mm), at a fixed vibration frequency (20 Hz). The main outcomes were the antero-posterior and medio-lateral velocities of the center of pressure (COP) recorded using a plantar pressure corridor at baseline, post-treatment and 1-month follow-up. We found a statistically significant difference in the antero-posterior velocity during the monopodal test in the UF group between the different time-points (χ²(2) = 13.282, p = 0.001). Mediolateral COP velocity ranking during the bipodal test was lower for UF than for SF group (U = 19.50, z = - 2.86, p = 0.003) at follow-up. The traditional vibratory platform training does not seem to be effective to improve static balance in physically active young people, however, adding UF provided slightly greater effect.

Effects of diaphragmatic myofascial release on gastroesophageal reflux disease: a preliminary randomized controlled trial

The purpose of this study is to investigate whether implementing a myofascial release (MFR) protocol designed to restore the myofascial properties of the diaphragm has any effect on the symptoms, quality of life, and consumption of proton pump inhibitors (PPI) drugs by patients with non-erosive gastroesophageal reflux disease (GERD). We randomized 30 patients with GERD into a MFR group or a sham group. Changes in symptomatology and quality of life were measured with the Reflux Disease Questionnaire and the Gastrointestinal Quality of Life Index. Need of PPIs was measured as the milligrams of drug intake over the 7 days prior to each assessment. All variables were assessed at baseline, one week and 4 weeks after the end of the treatment. At week 4, patients receiving MFR showed significant improvements in symptomatology (mean difference-1.1; 95% CI: −1.7 to −0.5), gastrointestinal quality of life (mean difference 18.1; 95% CI: 4.8 to 31.5), and PPIs use (mean difference-97 mg; 95% CI: −162 to −32), compared to the sham group. These preliminary findings indicate that the application of the MFR protocol we used in this study decreased the symptoms and PPIs usage and increased the quality of life of patients with non-erosive GERD up to four weeks after the end of the treatment.

Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial

BACKGROUND

Flexion-relaxation response of the lumbar erector spinae has been previously studied after different interventions such as exercise programs or spinal manipulation, in subjects with chronic low back pain. The objective of the study was to investigate the effects of an isolated myofascial release protocol on erector spinae myoelectric activity and lumbar spine kinematics in chronic low back pain.

METHODS

Thirty-six participants, with nonspecific chronic low back pain, were randomized to myofascial release group (n = 18) receiving four sessions of myofascial treatment, each lasting 40 min, and to control group (n = 18) receiving a sham myofascial release. Electromyographic and kinematic variables as well as pain and disability questionnaires were analyzed.

FINDINGS

There was a bilateral reduction of the flexion relaxation ratio in individuals receiving myofascial release and who did not show myoelectric silence at baseline (right difference M = 0.34, 95% CI [0.16, 0.33], p ≤ .05 and left difference M = 0.45, 95% CI [0.16, 0.73], p ≤ .05). There was also a significant reduction in pain in the myofascial release group (difference M = -9.1, 95% CI [-16.3, -1.8], p ≤ .05) and disability (difference M = -5.6, 95% CI [-9.1, -2.1], p ≤ .05), compared with control group. No significant differences between groups were found for the kinematic variables.

INTERPRETATION

The myofascial release protocol contributed to the normalization of the flexion- relaxation response in individuals who did not show myoelectric silence before the intervention, and also showed a significant reduction in pain and disability compared with the sham group.

The effectiveness of a video-supported group-based Otago exercise programme on physical performance in community-dwelling older adults: a preliminary study

OBJECTIVES

To evaluate the short-term effects of a video-supported group-based Otago exercise programme (OEP) on physical performance variables in independent community-dwelling older adults.

DESIGN

Preliminary randomized controlled trial.

SETTING

Local senior centre.

PARTICIPANTS

Fifty-one adults aged 65 and older with no cognitive impairment.

INTERVENTION

Participants were randomly allocated to the intervention group (IG) or to the control group (CG). During 4 months, IG participants performed the exercise routine.

MEASUREMENTS

The primary outcome measure was the Timed 'Up-and-Go' test (TUG). Secondary outcome measurements included functional balance, one-leg balance, lower-limb function and aerobic endurance. All data were collected before and after intervention.

RESULTS

TUG scores showed a significant reduction in the performance time in the IG compared to CG after intervention [IG 7.5 (2.0) vs CG 8.8 (1.9), mean difference -1.3seconds, 95% confidence interval (CI) of the difference -2.3 to -0.1; P=0.03]. Secondary outcomes also showed a significant improvement in the performance of the functional balance [IG 54.9 (2.5) vs CG 51.4 (5.3), mean difference 3.5 points, 95% CI 1.2 to 5.8; P=0.003], one-leg balance [IG 39.1 (21.6) vs CG 15.6 (12.1), mean difference 23.5seconds, 95% CI 13.3 to 33.7; P<0.001] and lower extremity strength [IG 8.7 (3.8) vs CG 10.9 (3.3), mean difference -2.2seconds, 95% CI -4.2 to -0.1; P=0.035] in the IG compared to CG.

CONCLUSION

This study shows that, from a short-term perspective, a video-supported group-based OEP programme can significantly improve the levels of mobility, functional balance, one-leg balance and lower extremity strength in community-dwelling older adults.

TRIAL REGISTRATION

ClincicalTrials.gov ID: NCT02218411.

Effects of three different low-intensity exercise interventions on physical performance, muscle CSA and activities of daily living: a randomized controlled trial

OBJECTIVES

To evaluate the short-term effects of three different resistance training programs, conducted at low intensity, on physical performance, muscle cross-sectional area (CSA) and the capacity to perform daily tasks in older adults living in a geriatric nursing home.

DESIGN

Randomized controlled trial, with a 4-month intervention period.

SETTING

A geriatric nursing home in Valencia, Spain.

PARTICIPANTS

Eighty-nine adults aged 75 to 96 who were independent in their daily activities.

INTERVENTION

After a baseline assessment, the participants were randomly assigned to the control group or one of the three intervention groups: volitional contraction (VC; n=22), neuromuscular electrical stimulation (NMES; n=22), or neuromuscular electrical stimulation superimposed onto voluntary contractions (NMES+; n=22). The intervention focused on knee extension exercises and its intensity was set at 40% of one-repetition maximum (1RM).

MEASUREMENTS

The primary outcome measure was mobility. Secondary outcomes were rectus femoris CSA, balance, aerobic endurance, upper-body strength and the capacity to perform daily tasks. All data were collected at baseline and after the 4-month intervention period.

RESULTS

The two-way ANOVA analysis showed a significant group×time interaction effect for the mobility (P=.022), rectus femoris CSA (P=.001), and the capacity to perform daily tasks (P=.05). The within-group analysis found a more prominent effect in the NMES+ group. Significant improvements were seen in rectus femoris CSA and the capacity to perform daily tasks in all intervention groups. Mobility only improved in the NMES+ group (P=.026).

CONCLUSION

From a short-term perspective, NMES+ exercise training, performed at low intensity, can improve physical performance, muscle CSA, and the capacity to perform daily activities, and to partially mitigate age-related consequences in older adults.

Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial

The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions. The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs (P<.001) and Pain-Impairement beliefs (P<.001), which was strongly correlated with an improvement in clinicians' activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores (P<.01), and their recommendations for activity levels worsened significantly (P<.001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.

Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative to traditional pain treatments. TENS has been studied in the past as a pain reduction modality in colonoscopy with limited success. Reviews and meta-analysis have shown that the inconclusive results of TENS may be due to the lack of randomized controlled trials and the difficulty in defining precise output parameters. The objective of this double-blind randomized placebo-controlled trial was to investigate the pain-relieving effect of a new application of TENS in unsedated screening colonoscopy. Ninety patients undergoing unsedated screening colonoscopy were randomly allocated to one of three groups: a control group (n=30), a group to receive active TENS (n=30), or a group to receive placebo TENS (n=30). A visual analogue scale (VAS) and a five-point Likert scale were used to assess pain 5 min into the procedure and at the end of the procedure. The patient's bloating sensation during colonoscopy and the effect on the duration of the procedure were also evaluated. Throughout the procedure, the active TENS group experienced a VAS pain score reduction ≥50% compared to the placebo TENS group (P<0.001) and the control group (P<0.001). On the five-point Likert scale, there was also a significant reduction in pain score in the active TENS group compared to the placebo TENS and control groups (P=0.009). No significant differences were found between the study groups as to the bloating sensation and the duration of the procedure. We conclude that TENS can be used as a pain relief therapy in unsedated screening colonoscopy.

[Physiotherapy during hemodialysis: results of a progressive resistance-training programme]

During the last decades, aerobic exercise programs have shown beneficial effects on quality of life of End Stage Renal Disease (ESRD) patients, but there is still little evidence on the benefits of resistance training programmes. The aim of this study was to analyze the effects of a short strengthening exercise program for ESRD during hemodialysis on exercise and functional capacity and on quality of life.

METHODS

16 hemodialysis patients were assigned, according to their own election, to exercise (N>or=8) or control group (N>or=8). The experimental group performed a 6-month duration intradialytic exercise program supervised by a physiotherapist, consisting of a battery of isometric and isotonic exercises for the lower limbs. Control group remained sedentary. A graded exercise test (Naughton protocol), functional measurements (<<6 minutes walking test>> 6MWT and 'sit to stand to sit tests' STS-10 and STS-60), and the SF-36, to assess quality of life were measured pre and post intervention in the experimental group, while the control group only completed the SF-36 questionnaire.

RESULTS

Considering the experimental group, both time and METS increased after the intervention, although it was not significant. Meters measured in the 6MWT significantly increased after the intervention (399.57+/-39.56 meters pre-intervention; 471.71+/-70.63 meters post-intervention p<0.01). Both time on the STS-10 (22.52+/-4.77 seconds pre-intervention; 17.71+/-1.79 seconds post-intervention p<0.05) and repetitions on the STS-60 (28.57+/-5.12 repetitions pre-intervention; 31.42+/-2.443 repetitions post-intervention p<0.05) significantly improved after the intervention. After training, the mental component scale of the SF-36 significantly increased in the experimental group compared to baseline (41.74+/-9.25 before; 50.61+/-12.13 after, p<0.05), while the control group showed a significant decrease (48.19 +/- 16.1 before; 33.7+/- 13.8 after, p<0.05). Comparison between groups also showed a significant difference in the mental component scale after the intervention (p<0.05).

CONCLUSION

It is concluded that a strengthening exercise program during hemodialysis improves the functional capacity of ESRD patients (walking and standing from a seat) and improves the mental component of quality of life perceived by dialysis patients.

Response of the flexion-relaxation phenomenon relative to the lumbar motion to load and speed

STUDY DESIGN

Nonrandomized control trial.

OBJECTIVE

To determine if the variations of speed and loading conditions during trunk flexion-extension could influence the times of occurrence and disappearance of the electrical silence of the erector spinae muscles, the degrees of lumbar flexion at those instants, and the relative lumbar motion time.

SUMMARY OF BACKGROUND DATA

It has been suggested that varying either the speed of movement or the load on the trunk during trunk flexion-extension movements may influence the flexion-relaxation phenomenon or the kinesiologic data. However, no study dealt with the simultaneous effect of the speed of movement on the spine rhythm and on the occurrence of the electrical silence of the erector spinae.

METHODS

A total of 22 pain-free volunteers performed a series of trunk flexion-extension movements varying the speed and load. The motion of the lumbar spine ( degrees ) and the integrated electromyography (microV) of erector spinae muscles were simultaneously recorded. Two measures were calculated: the percentage of the maximum lumbar spine flexion at the instants when changes of electrical activity represented the beginning and end of the electrical silence and the relative lumbar spine motion time during trunk flexion and extension movements.

RESULTS

The increase in speed of movement significantly increased the relative lumbar flexion time and significantly reduced the relative lumbar extension time (t = 2.49 and t = 2.25, P < 0.05); furthermore, it significantly delayed the appearance of the electrical silence in the range of flexion (t = 3.52, P < 0.01). There was no significant effect from a change in load.

CONCLUSIONS

The relative spine motion time differed depending on the direction of movement, being longer during trunk flexion and shorter during extension. The increase in speed of movement produced greater differences in the relative time between trunk flexion and extension; furthermore, it delayed the appearance of the electrical silence of the erector spinae muscles in the range of flexion.