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Biomedical subjects

G W Gleim

Publications and source records attributed to G W Gleim.

At least 37 records · Page 2Linked to original sources
PubMed1998

Preoperative indicators of motion loss and weakness following anterior cruciate ligament reconstruction.

Loss of motion and knee extension weakness are recognized as significant complications following anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine 1) what degree of preoperative motion loss represents a risk for postoperative motion problems and 2) if preoperative weakness (deficit > or = 20%) affects return of strength following surgery. Measurements of range of motion and strength were made on 102 patients (56 men, 46 women; age = 31 +/- 1 years) within 2 weeks prior to ACL reconstruction (preop) and repeated 6 months following surgery (postop). Thirteen of 40 patients (33%) lacking > or = 5 degrees preop, eight of 20 patients (40%) lacking 1-4 degrees preop, and three of 42 (7%) patients with full extension preop had > or = 5 degrees loss 6 months postop (p < 0.001). Thirty-two of 39 (82%) patients with normal strength preop had weakness 6 months postop. Forty of 51 (78%) patients with preop knee extension weakness still had weakness 6 months postop. Preop strength was not a good predictor of residual weakness following ACL reconstruction. The magnitude of the preop extension loss appears not to be a risk factor. It is the presence or absence of full extension equal to the contralateral leg that identifies risk for postop problems regaining extension.

Adult↗
PubMed1997

Flexibility and its effects on sports injury and performance.

Flexibility measures can be static [end of ROM (range of motion)], dynamic-passive (stiffness/compliance) or dynamic-active (muscle contracted, stiffness/compliance). Dynamic measures of flexibility are less dependent on patient discomfort and are more objective. Acute and chronic changes in flexibility are likely to occur with stretching exercises, but it is difficult to distinguish between changes in stretch tolerance as opposed to changes in muscle stiffness. How flexibility is measured impacts these findings. There is no scientifically based prescription for flexibility training and no conclusive statements can be made about the relationship of flexibility to athletic injury. The literature reports opposing findings from different samples, frequently does not distinguish between strain, sprain and overuse injury, and rarely uses the proper denominator of exposure. There is basic scientific evidence to suggest that active warm-up may be protective against muscle strain injury but clinical research is equivocal on this point. Typically, specific flexibility patterns are associated with specific sports and even positions within sports. The relationship of flexibility to athletic performance is likely to be sport-dependent. Decreased flexibility has been associated with increased in-line running and walking economy. Increased stiffness may be associated with increased isometric and concentric force generation, and muscle energy storage may be best manifested by closely matching muscle stiffness to the frequency of movement in stretch-shorten type contractions.

Athletic Injuries↗
PubMed1996

Fluid balance and renal response following dehydrating exercise in well-trained men and women.

We examined the recovery of plasma volume, plasma osmolality, renal water and sodium handling and fluid-regulating hormones to dehydrating exercise in well-trained women and compared them to men. Ten male and eight female athletes cycled at anaerobic threshold at an ambient temperature of 32 degrees C until dehydration by 3% of their body mass (mb). After exercise, they drank water equal to 1% mb and rested for 240 min. Plasma renin activity (PRA), serum aldosterone [ALDO]s, plasma arginine vasopressin [AVP]pl, norepinephrine concentrations and plasma osmolality (Osmpl) were determined at baseline, end of exercise, 30, 60, 120 and 240 min postexercise. Urine was collected at baseline, end of exercise, 60, 120 and 240 min postexercise. Renal free water and sodium handling were assessed. The recovery of OSMpl and plasma volume occurred within the first 60 min of recovery and at similar rates between the groups. However, women had lower PRA at the end of exercise (P = 0.05), an earlier recovery of [ALDO]s, and a slower [AVP]pl recovery. Overall fluid balance was similar between the men and women, as were the early recovery of renal free water clearance (CH2O). During the last 120 min of recovery CH2O was more negative (greater water reabsorption) and fractional sodium excretion was increased in the women compared to the men. Despite small differences in sodium and water reabsorption following dehydration, it appears from other study that recovery from dehydrating exercise in well-trained men and women is remarkably similar.

Adult↗
PubMed1996

Comparison of five body-composition methods in peritoneal dialysis patients.

Body-composition assessment is an important method of evaluating nutritional status in peritoneal dialysis patients. Because body-composition measurement estimates have not been fully validated in this population, we assessed five body-composition methods in 30 well-dialyzed peritoneal dialysis patients. The techniques studied included bioelectrical impedance analysis, dual-energy X-ray absorptiometry, total-body potassium counting, and anthropometry by two techniques. The dialysis patients were matched for age, race, sex, height, weight, and body mass index with 29 healthy control subjects in our laboratory database. By 5 x 2 x 2 analysis of variance, significant differences were found between results by modality (P < 0.0001) as well as by sex, with women having an increased percentage of fat (P < 0.0001). However, there was no significant intermethod difference by condition (peritoneal dialysis or control). That is, although significantly different percentage fat values were found between the body-composition techniques, this variability was independent of whether the measurement was made on control or peritoneal dialysis patients. Despite the differences between modalities, all techniques were found to correlate significantly with each other (P < 0.01 or better for men and P < 0.001 or better for women). Our experience shows that these routine techniques for measuring body composition can be readily applied to stable peritoneal dialysis patients.

Absorptiometry, Photon↗
PubMed1996

Regulation of glucose turnover and hormonal responses during electrical cycling in tetraplegic humans.

To examine the importance of blood-borne vs. neural mechanisms for hormonal responses and substrate mobilization during exercise, six spinal cord-injured tetraplegic (C5-T1) males (mean age: 35 yr, range: 24-55 yr) were recruited to perform involuntary, electrically induced cycling [functional electrical stimulation (FES)] to fatigue for 24.6 +/- 2.3 min (mean and SE), and heart rate rose from 67 +/- 7 (rest) to 107 +/- 5 (exercise) beats/min. Voluntary arm cranking in tetraplegics (ARM) and voluntary leg cycling in six matched, long-term immobilized (2-12 mo) males (Vol) served as control experiments. In FES, peripheral glucose uptake increased [12.4 +/- 1.1 (rest) to 19.5 +/- 4.3 (exercise) mumol.min-1.kg-1; P < 0.05], whereas hepatic glucose production did not change from basal values [12.4 +/- 1.4 (rest) vs. 13.0 +/- 3.4 (exercise) mumol.min-1.kg-1]. Accordingly, plasma glucose decreased [from 5.4 +/- 0.3 (rest) to 4.7 +/- 0.3 (exercise) mmol/l; P < 0.05]. Plasma glucose did not change in response to ARM or Vol. Plasma free fatty acids and beta-hydroxybutyrate decreased only in FES experiments (P < 0.05). During FES, increases in growth hormone (GH) and epinephrine and decreases in insulin concentrations were abolished. Although subnormal throughout the exercise period, norepinephrine concentrations increased during FES, and responses of heart rate, adrenocorticotropic hormone, beta-endorphin, renin, lactate, and potassium were marked. In conclusion, during exercise, activity in motor centers and afferent muscle nerves is important for normal responses of GH, catecholamines, insulin, glucose production, and lipolysis. Humoral feedback and spinal or simple autonomic nervous reflex mechanisms are not sufficient. However, such mechanisms are involved in redundant control of heart rate and neuroendocrine activity in exercise.

Adult↗
PubMed1995

Effects of blood donation on exercise performance in competitive cyclists.

This study evaluated 10 male cyclists before and after phlebotomy to determine the effect of donation of 1 U of blood on exercise performance. Each subject underwent maximal exercise testing with oxygen consumption measurement at baseline, 2 hours after phlebotomy, 2 days after phlebotomy, and 7 days after phlebotomy. Maximal performance was decreased for at least 1 week. Submaximal performance was unaffected by blood donation.

Bicycling↗
PubMed1995

Death from Crohn's disease. Lessons from a personal experience.

We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term "virulent" Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25-46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.

Adolescent↗
PubMed1995

Viscoelastic response to repeated static stretching in the human hamstring muscle.

The purpose of this study was (1) to evaluate the reproducibility of a new method of measuring passive resistance to stretch in the human hamstring muscle group, in vivo, using a test re-test protocol and 2) to examine the effect of repeated stretches. Passive resistance offered by the hamstring muscle group during knee extension was measured in 10 subjects as knee flexion moment (Nm) using a KinCom dynamometer. The knee was passively extended at 5 deg/s to the final position where it remained stationary for 90 s (static phase). EMG of the hamstring muscle was also measured. The test re-test protocol included 2 tests (tests 1 and 2) administered 1 h apart. On a separate occasion 5 consecutive static stretches were administered (stretches 1-5) separted by 30 s. Stretch 6 was administered one hour after stretch 5. In the static phase passive resistance did not differ between test 1 and test 2. Resistance declined in both tests 1 and 2, whereas EMG activity remained unchanged. The decline in resistance was significant up to 45 s. For the repeated stretches there was an effect of time (90 s) and stretch (1-5) with a significant interaction i.e., resistance diminished with stretches, and the 90-s decline was less as more stretches were performed. Passive resistance in stretch 6 was lower than in stretch 1. The present study has demonstrated a reliable method for studying resistance to stretch of the human hamstring muscle group. A viscoelastic response of the human hamstring muscle was shown. With 5 repeated stretches, resistance to stretch diminished and each stretch exibited a viscoelastic response, albeit less with each subsequent stretch. The effect of 5 repeated stretches was significant 1 h later.

Adult↗
PubMed1994

Effect of anterior cruciate ligament deficiency on economy of walking and jogging.

The metabolic cost of walking and jogging following injury to the anterior cruciate ligament is unknown. Economy of motion refers to the oxygen consumption for a submaximal work rate. The purpose of this study was to compare the economy of walking and jogging of an anterior cruciate ligament-deficient population with that of a control population without orthopaedic abnormalities. Steady-state oxygen consumption was measured in 30 patients and 98 controls while they were on a treadmill at various speeds. Deficiency of the anterior cruciate ligament was diagnosed arthroscopically. The patients also were tested for isokinetic knee extension-flexion strength, hip flexion, and abduction and adduction strength and underwent arthrometric measurement of anterior tibial displacement. The patients had a statistically significant increase in oxygen consumption when jogging at 160.9 m/min (p = 0.007); however, there was no significant effect of anterior cruciate ligament deficiency on economy at the other speeds tested. The patients had significant deficits in strength of all muscle groups tested. Steady-state oxygen consumption at 160.9 m/min tended to be inversely related to the deficit of strength of knee flexion (r = -0.44, p = 0.07). Arthrometric measurements and chronicity of injury were unrelated to steady-state oxygen consumption. These data indicate that anterior cruciate ligament deficiency increases oxygen consumption during jogging. In long-distance running, this decreased economy translates into significant additional caloric requirements, which may result in earlier fatigue.

Adult↗
PubMed1994

Effect of athletic training on heart rate variability.

The time and frequency domain components of heart rate variability have been used to assess prognosis in patients with different types of heart disease. However, the effect of habitual exercise, which influences baseline parasympathetic tone, on heart rate variability has not been fully evaluated. To determine the effect of chronic exercise on heart rate variability, we studied 12 athletes and 18 control subjects. Time domain and frequency domain analysis was performed on 15-minute resting heart rate acquisitions. Athletes had evidence of increased vagal activity in the time domain compared with control subjects (eg, increased standard deviation of R-R intervals) but showed evidence of decreased power in variables reflecting vagal activity in the frequency domain (eg, total power and high-frequency power). Of note, there was good correlation between time and frequency domain variables, which reflected parasympathetic tone in the control group that was not seen in athletes. These data suggest that frequency domain analysis of heart rate variability may not be an accurate indicator of cardiac vagal tone in chronically trained endurance athletes and activity level may have to be considered when using heart rate variability to carry out prognostic stratification in patients with heart disease.

Adult↗
PubMed1994

Systemic effects of ingesting varying amounts of a commercial carbohydrate beverage postexercise.

OBJECTIVE: Although the role of postexercise carbohydrate intake in the replenishment of muscle glycogen is well established, large amounts of carbohydrate may affect other systems which are recovering from exercise as well. METHODS: We varied the timing and amount of a commercial glucose polymer/fructose (CHO) beverage ingested postexercise in 2 groups of 8 normotensive men following 1 hour of cycling exercise. In Study A the subjects ingested 1 L of a 200 g CHO solution or 1 L of water (W) immediately postexercise. The participants in Study B consumed 1 L of a 1.5 g/kg CHO solution, or W, immediately and 2 hours postexercise. RESULTS: Recovery systolic blood pressure was elevated after 200 g CHO as compared to water, but not after 1.5 g/kg CHO. Diastolic blood pressure was decreased, while heart rate, insulin and glucose increased following both doses of CHO. Despite the potassium (K) content of the beverages, serum K decreased in Study A and B, while a trend was noted following CHO for decreased urinary K excretion at 2 hours and for increased sodium excretion at 4 hours in Study B. Post CHO aldosterone declined more rapidly than after W, and urine volumes were decreased compared to W in both studies 2 hours after CHO. CONCLUSIONS: We speculate that hyperinsulinemia contributed to the rapid decline in K and aldosterone by creating a flux of K to the intracellular space. It appears that CHO ingestion postexercise results in systemic effects that are related to the amount and timing of CHO consumed.

Adult↗
PubMed1994

Shoulder weakness in professional baseball pitchers.

The purposes of this study were to: 1) compare shoulder range of motion and strength in professional baseball pitchers (N = 47) compared with age-matched controls (N = 16), and 2) examine the relationship of injury history to strength and range of motion. Based on injury history pitchers were categorized as: 1) none (N = 26), 2) injury requiring conservative intervention (N = 9), or 3) injury requiring surgical intervention (N = 12). Range of motion was measured for internal rotation (IROM) and external rotation (EROM). Eccentric strength was measured by hand-held dynamometer for internal rotation (IR), external rotation (ER), abduction (ABD), and supraspinatus muscle (SUP) strength. Injury history had no effect on strength and range of motion. Dominant EROM was greater in pitchers, P < 0.0001, and controls, P < 0.05, with pitchers having greater EROM motion bilaterally, P < 0.0001. Pitchers were weaker in SUP on the dominant vs nondominant side, P < 0.0001, and on the dominant side for weight adjusted ER, ABD, P < 0.01, and SUP, P < 0.0001, compared with controls. In conclusion, dominance and pitching resulted in soft tissue adaptation. Pitchers displayed weakness in three of four tests by comparison with controls, suggesting that the demands of pitching are insufficient to produce eccentric strength gains and may in fact lead to weakness. Dominant-side SUP weakness in pitchers may reflect subclinical pathology or chronic fatigue.

Analysis of Variance↗
PubMed1993

Exercise is not an effective weight loss modality in women.

The excess caloric expenditure which results from physical activity should lead to weight loss if caloric expenditure at other times remains constant. Unfortunately, while there is good evidence for such an effect in men, there is little if any evidence for a similar effect in women. Weight loss with exercise does not readily occur in women unless accompanied by caloric restriction. Further, the role of exercise in maintaining resting metabolic rate while dieting has only marginal support. Potential reasons for the ineffectiveness of exercise in inducing weight loss in women include smaller body size and lower aerobic capacity, under-reporting of caloric intake, differences in body fat distribution and sensitivity to catecholamines, a different gonadal hormone milieu, and energy conservation resulting from evolutionary pressures. Nevertheless, regular exercise in women has many beneficial effects on lipids, glucose homeostasis and bone metabolism even if weight loss does not occur.

Adipose Tissue↗
PubMed1993

The effect of stabilization on isokinetic knee extension and flexion torque production.

The purpose of this study was to examine the effect of four methods of stabilization on maximal reciprocal isokinetic knee extension and flexion. Left knee extension/flexion was tested at 60 degrees /s in 20 subjects. Warm-up consisted of five submaximal and one maximal effort followed by three maximal efforts in each of four randomized stabilization conditions: 1) Hands and back stabilization; the trunk was strapped to the back rest and the hands grasped the seat. 2) Back stabilization; the trunk was strapped to the back rest and the hands were folded across the chest. 3) Hand stabilization; the hands grasped the seat and the back rest was removed. 4) No stabilization; the hands were folded across the chest and the back rest was removed. One-way repeated measures ANOVA showed a significant effect of stabilization for knee extension (F(3,57)=17.44, p=.0001) and knee flexion (F(3,57)= 5.37, p=.002). Paired, two-tailed student's t-tests with Bonferroni correction showed that, in knee extension, no stabilization was significantly less than all others, p<.001. In addition, back stabilization was less than hands and back stabilization, p<.005. In knee flexion, no stabilization was significantly less than all others, p<.01. In conclusion, the method of trunk stabilization significantly affected maximal reciprocal isokinetic knee extension/flexion strength measurements. Maximal knee extension/flexion torque production was achieved when the trunk was strapped to the back support and when the hands grasped the seat.

Journal Article↗
PubMed1993

Determining peritoneal dialysis prescriptions by employing a patient-specific protocol.

OBJECTIVE: To develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance. DESIGN: Prospective study of peritoneal dialysis patients followed for 6 months. SETTING: A primary care teaching hospital in New York. PATIENTS: Twenty-six patients beginning peritoneal dialysis entered and completed the study. INTERVENTION: By employing each patient's measured peritoneal equilibration test (PET) and a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour D/Pcreat was used for continuous cycling peritoneal dialysis (CCPD) and the 4-hour D/Pcreat was used for patients on continuous ambulatory peritoneal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clearance daily. MAIN OUTCOME MEASURES: Patients were followed for 6 months to assess the ability of this approach of maintaining acceptable levels of blood urea nitrogen, creatinine, albumin, and hematocrit over the 6-month period of observation. RESULTS: Our study of 26 patients revealed that only 6 patients (23%) could be treated with the standard prescription of 8 L/day on CAPD. The remaining 77% of our patients required 9-13 L/day for CAPD and 12-21 L/day for CCPD. All patients were free of uremic symptoms and demonstrated acceptable biochemical parameters over a 3-6 month period of observation. CONCLUSIONS: A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.

Adult↗