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Bone mass and muscle strength in young female soccer players.

In this cross-sectional study, bone mass and muscle strength of the thigh were investigated in 51 female soccer players, age 16.3 +/- 0. 3 years, who had been playing soccer for 8.1 +/- 2.1 years and were at the time of the study in soccer training for 5.0 +/- 1.7 hours/week. They were compared with 41 nonactive females, age 16.2 +/- 1.3 years. The groups were matched according to age, weight, and height. Areal bone mineral density (BMD) was measured of the total body, head, lumbar spine, femoral neck, Ward's triangle, and the greater trochanter using dual energy X-ray absorptiometry (DXA). Isokinetic muscle strength of the quadriceps and hamstrings muscles was measured using an isokinetic dynamometer. Compared with the nonactives, the soccer players had significantly higher BMD of the total body (2.7%), lumbar spine (6.1%), the dominant and nondominant hip (all sites). The largest differences were found in the greater trochanter on both sides (dominant, 16.5%, nondominant, 14.8%). The soccer players had significantly higher concentric and eccentric peak torque of the thigh muscles. In the soccer group, there was only a positive association between thigh muscle strength and BMD of the adjacent hip, and in the nonactive group there were several positive associations between muscle strength and BMD. However, when adjusting for the variation in weight and height all these associations became nonsignificant. Using multiple linear regression, the type of activity (soccer player, nonactive) independently predicted BMD of all dominant hip sites (beta = 0.32-0.48, P < 0.01). No other variable was found to independently predict BMD of any site. In the younger subjects (</=16 years) only BMD of the greater trochanter was significantly higher in the soccer players. In the older subjects (>16 years) the soccer players had significantly higher BMD in all measured sites except for the nonweight-bearing head. The differences in muscle strength between soccer players and nonactives were already seen in the young age group. In conclusion, girls who train and play soccer in adolescence have a higher bone mass in the hip and lumbar spine, and a higher muscle strength of the thigh compared with nonactive controls, indicating a site-specific skeletal response of weight-bearing and impact-loadng acting on the skeleton. The differences in bone mass were already apparent in early adolescence, but became more pronounced in late adolescence, probably explained by a longer exposure to soccer training with time. Our results also indicate that muscle strength in itself might not be of decisive importance for bone mass in the hip of adolescent females.

Absorptiometry, Photon↗

Internal consistency of dynamometer measurements in healthy subjects and stroke patients.

Measurements of strength from six muscle groups described in two previously completed reports were analyzed further using Cronbach alpha. The coefficients were greater than .948 for a small sample of stroke patients and a larger sample of healthy individuals. This finding shows in diverse samples that the measures possess internal consistency and are measuring the same underlying construct.

Aged↗

Computer-assisted hand-held dynamometer: low-cost instrument for muscle function assessment in rehabilitation medicine.

In rehabilitation medicine, muscle function is assessed during the physical examination of the patient. Although a simple hand-held instrument improves the assessment of static strength, it is rarely used in clinical practice, where dynamic measurements are preferred. A computer-assisted hand-held dynamometer (CAHNDY) has been developed that enables the clinician to measure dynamic muscle function in a standardised manner, using simple (i.e. portable and low-cost) apparatus. The CAHNDY comprises a force transducer and a movement transducer interfaced to a personal computer. In the study dynamic measurement protocols are used, based on a biomechanical analysis of daily activities. In this way, iso-functional profiles can be established, describing the kinematics of muscle function in its functional context. Using the iso-functional profiles as a basis for standardisation, the double feedback algorithm of the CAHNDY assists the tester in meeting this standard, during maximal muscle function testing. In a multi-centre trial, the CAHNDY is evaluated by physical therapists for knee extensor and flexor function. The CAHNDY enables iso-functional dynamic muscle function testing, although application is limited by the maximal strength of the tester. It is concluded that the CAHNDY is suitable for use in rehabilitation medicine.

Ambulatory Care↗

[(Neuro)muscular changes in the knee stabilizing muscles after rupture of the anterior cruciate ligament].

Recent data indicate that the function of the knee joint may be the result of a complex synergy between bones, ligaments, muscles and proprioceptive receptors in these structures. Therefore, it was the aim of this study to investigate if muscular changes could be found more than 5 years following ACL-injury and if there are therapy-dependent differences. 35 patients with ACL-reconstruction and 25 conservatively treated patients were studied. The thigh circumference was measured and in 5 randomly selected patients of each group additionally MRI cross-sections of both limbs were made. Using an isokinetic dynamometer and an EMG device the relation of strength, electrical activity and muscle size were analyzed. Only minimal differences in thigh circumference as well as in muscular cross sections were found between the uninjured and injured limb of both groups; however, the isokinetic torque and iEMG values showed significant differences. It may be assumed that the major reason for these results is a modified muscle fiber utilization in the ACL-injured limb, caused by a changed joint receptor afferent inflow or a compensation of the central nervous system to primary alterations of the muscle fibers.

Adult↗

Hand grip--a simple test for morbidity after fracture of the neck of femur.

Seventy-six female patients, having sustained a fracture of the neck of femur, were assessed preoperatively by measuring their muscle strength in the form of grip using a hand-held dynamometer and by measuring serum albumin. A grip strength of less than 15 kg was found to be a reliable predictor of subsequent postoperative complications in female patients over the age of 80. Serum albumin had no predictive value. There was no significant difference in complication rates between different surgeons.

Aged↗

Test-retest reliability of glenohumeral internal and external rotator strength.

OBJECTIVE: To establish test-retest reliability for a strength testing protocol of the glenohumeral internal and external rotator muscles using a KinCom (Chattanooga Group, Hixson, TN) isokinetic dynamometer. DESIGN: Prospective test-retest reliability study. SETTING: Rehabilitation research laboratory. PARTICIPANTS: Fourteen volunteers between the ages of 27 and 35 years participated in the study. Subjects had no history of traumatic shoulder injury and no overuse-based shoulder pain interfering with activity within the last 6 months. Nine of the 14 subjects were not participating in more than 6 hours weekly of arm-based sporting activities, while the remaining five subjects were involved in swim training at workout volumes of no greater than 3000 m per week. INTERVENTION: Subjects performed three test sessions of four maximal repetitions each of concentric and eccentric shoulder internal and external rotation bilaterally in a standardized sitting position. An average of 5.9 days occurred between consecutive test sessions (range, 2-21 days). MAIN OUTCOME MEASURES: Average torque data were collected for concentric and eccentric internal and external rotation tests bilaterally. Intraclass correlation coefficients were calculated to compare the data across sessions. Pearson product moment correlation coefficients were calculated to assess reliability between sessions. RESULTS: High test-retest reliability, ranging from 0.82 to 0.97, was demonstrated for all tests. CONCLUSIONS: The results indicate that a reliable test protocol has been determined for shoulder internal and external rotation strength testing on the KinCom isokinetic dynamometer.

Adult↗

Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry.

BACKGROUND: The lower limb muscle strength is an important determinant of physical function in older people. However, measurement in clinical and epidemiological settings has been limited because of the requirement for large-scale equipment. A protocol using a novel, versatile hand-held dynamometer (HHD) has been developed to measure the quadriceps strength in a supine position. OBJECTIVE: The objective of this study was to assess the validity of this new methodology for measuring the lower limb muscle strength compared to the gold standard Biodex dynamometer. METHODS: The supine quadriceps strength was measured twice with each of the Biodex and the HHD in 20 men and women, aged 61-81 years, on their non-dominant leg. The agreement between the peak torques obtained by Biodex and HHD was analyzed. RESULTS: The mean peak Biodex and HHD results were 83.4 +/- (SD) 28.0 Nm and 68.9 +/- 19.6 Nm, respectively. The HHD undermeasured the quadriceps strength by an average of 14.5 Nm (95% CI 8.5, 20.6) compared to the Biodex, and this effect was most marked in the strongest participants. Nevertheless, there was a good correlation between the measures (r = 0.91, p < 0.0001). Classification of individuals into tertiles of muscle strength showed good agreement between the two methods (Kappa = 0.69, p < 0.0001). CONCLUSIONS: Our findings suggest that the HHD using a supine positioning offers a feasible, inexpensive, and portable test of quadriceps muscle strength for use in healthy older people. It underestimates the absolute quadriceps strength compared to the Biodex particularly in stronger people, but is a useful tool for ranking muscle strength of older people in epidemiological studies. It may also be of value for quick and objective assessment of physical function in the clinical setting.

Age Factors↗

Plantar flexor strength testing using the cybex isokinetic dynamometer.

Twenty male subjects and twenty female subjects in each of three age categories, 6 to 8 years, 14 to 16 years, and 23 to 28 years, were tested on the Cybex Isokinetic Dynamometer to obtain normative strength values for the ankle plantar flexor muscle group. Values were established for both isokinetic and isometric contractions at two speeds. The results indicate that age and weight are the significant variables in determining strength scores.

Adolescent↗

The interrelationship between physical exercise, muscle strength and body adiposity in a healthy elderly population.

OBJECTIVE: To determine the relationship between habitual physical exercise and body adiposity in a healthy elderly population. RESEARCH DESIGN AND METHODS: Physical exercise was measured by a questionnaire previously adapted for use with the healthy elderly. The level of exercise was converted into calories expended over the previous 14 days and was divided into tertiles. Body adiposity was measured at six sites by anthropometry, and overall percent body fat was measured by bioelectric impedence. PARTICIPANTS AND SETTING: Two hundred and thirteen healthy ambulatory subjects over the age of 60 (116 females and 97 males) were recruited from a large retirement community in Southern Arizona. The mean age of the subjects was 70.0 years. RESULTS: Percent body fat was similar in men with different levels of physical activity (27.9% for lowest tertile of activity, 28.1% for middle tertile of activity, and 28.5% for highest tertile of activity). The corresponding values of percent fat in women was 38.0%, 36.0%, and 37%, respectively. There was a statistically significant increase in muscle strength measured in five muscle groups with a hand-held dynamometer with increasing levels of activity. CONCLUSIONS: These data indicate that level of physical exercise, over the range of 0 to 1,528 Kcal/day, does not predict body adiposity in the healthy elderly population. To decrease body fat without a change in dietary habits would require a more intensive exercise regimen than currently being undertaken by most healthy elderly people.

Aged↗

Predictive leg strength values in immediately prepubescent and postpubescent athletes.

Sixty healthy, athletic children were treated on a Cybex II Dynamometer to obtain values for the relative strengths of the major muscle groups of the lower extremity. Prepubescent and postpubescent boys and girls were tested. Of the anthropometric parameters measured, lean body weight correlated best with maximal torque force development. In prepubescent children, the mean maximal quadriceps torque force, measured in foot-pounds at 60 deg/sec, is equal to 70% of the lean body weight. In postpubescent subjects, the mean peak quadriceps torque equalled 80% of the lean body weight in girls and 90% of the lean body weight in boys. Correlations can be established between the maximal torque force generated by the quadriceps and the strength of the hamstrings, ankle dorsiflexors, and plantar flexors. The values obtained are useful in planning training and rehabilitation programs and in determining when an injured young athlete can safely return to his or her sport.

Adolescent↗

The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis.

OBJECTIVE: To study the effect of physical exercise shortly after an acute episode of dermato/polymyositis (DM/PM). DESIGN: Pilot study of a descriptive nature. SETTING: Rehabilitation unit of a large general hospital. SUBJECTS: Ten patients 2-3 weeks after an acute phase of DM/PM (early recovery group) and 11 patients in the inactive stage of DM/PM for at least three months (chronic stage group). INTERVENTIONS: Isotonic muscle training consisted of several series of different repeated movements at 65-70% of individual maximal repetition limit. Special training was applied for the respiratory muscles. Relaxing baths, mud packs and massages were also applied. OUTCOME MEASURES: Dynamometer and spirometer were used for measuring the changes in muscle strength and respiratory function. Disability tests were done before and after therapy. RESULTS: No disease relapses or decreases in muscle function were seen. In the early recovery group, the average muscle strength improvement was 17 +/- 31 % (p > 0.05) in the proximal muscles and 37 +/- 23% (p < 0.05) in the distal muscles, while the vital capacity also increased by 17 +/- 21% (p < 0.05). In the chronic stage group the average improvement in muscle strength was 46 +/- 34% (p < 0.05) in the proximal muscles and 37 +/- 29% (p < 0.05) in the distal muscles. By the end of the therapy both groups showed improvements in disability tests (p < 0.05). CONCLUSIONS: Physical training started 2-3 weeks following an acute exacerbation of the disease seems to be useful and safe. Some improvement in muscle strength and respiratory function can be obtained, muscle atrophy due to inactivity may be partially prevented and the level of disability can be decreased.

Acute Disease↗

Standing balance, lower extremity muscle strength, and walking performance of patients referred for physical therapy.

The purposes of this study of 30 patients referred to physical therapy were to describe the reliability of two measures of impairment and a measure of gait performance and to examine the relationships between the impairment and gait measures. The impairments measured were standing balance and muscle strength of the lower extremities, the former with a seven-level ordinal scale and the latter with a hand-held dynamometer. Gait performance was measured using the seven-category scale of the Functional Independence Measure. Interday reliability was acceptable for all three measures, standing balance (weighted Kappa = .95), muscle strength (intraclass correlation coefficients = .871 to .951), and gait (weighted Kappa = .915). A Spearman correlation of .860 was found between balance and gait measures. The correlations between the strengths of various muscle groups and gait were lower (.138 to .581). Multiple regression identified none of the strength scores as offering additional independent explanation of gait performance. Balance, as scored, appears to be a reliable and valid measure worth broader application among hospitalized patients.

Adult↗

Distribution of muscle weakness of central and peripheral origin.

According to the established clinical tradition about the distribution of weakness, the ratios of flexor/extensor strength of patients with upper motor neuron lesions are expected to be relatively high for the elbow and wrist and low for the knee. To assess the diagnostic value of these patterns of weakness, muscle strength of 70 patients with limb weakness of central or peripheral origin was measured with a hand held dynamometer. The ratios of flexor/extensor strength at the knee, elbow, and wrist did not differ significantly between patients with central or peripheral origin of muscle weakness. The examination of tendon jerks proved to be of more value as a localising feature. The traditional notion about the distribution of weakness in upper motor neuron lesions may be explained by an intrinsically greater strength in antigravity muscles, together with the effects of hypertonia.

Adult↗

Skeletal muscle endurance is reduced in chronically energy deficient adults.

Fifty eight adult males (well nourished; WN = 25, underweight; UW = 13, chronically energy deficient; CED = 20), aged 18 to 30 yr underwent an assessment of skeletal muscle function using a load cell based handgrip dynamometer coupled to a polygraph. WN subjects had higher handgrip strengths than either the UW or CED subjects (P < 0.05), though not when corrected for forearm muscle area or forearm volume. CED subjects fatigued faster than WN subjects during sustained maximal isometric contraction (P < 0.05) as well as during prolonged isotonic exercise (P < 0.05). During the latter, the onset of fatigue in the CED subjects was also faster than that in their anthropometrically similar UW controls. These data are consonant with reports of decreased productivity in undernourished adults during real life tasks.

Adolescent↗

Relationship of skeletal muscle mass, muscle strength and bone mineral density in adults with cystic fibrosis.

Few studies have investigated peripheral muscle strength and quality in patients with cystic fibrosis (CF). The present study tested the isometric and isokinetic strength of the quadriceps and hamstrings using an isokinetic dynamometer and a strength-testing chair in 25 CF adults and 25 controls. Total body and leg muscle mass were determined by dual-energy X-ray absorptiometry, and bone mineral density (BMD) was also measured. Both muscle strength and muscle mass (total body and leg) were decreased in the CF group. In both groups there was a highly significant relationship between quadriceps strength and leg muscle mass (CF, r=0.7, P=0.0002; controls, r=0.6, P=0.0013). When strength was normalized for muscle size, there was no significant difference between the two groups. Total body and leg BMD were significantly reduced in CF subjects compared with controls. However, when corrected for height, the differences disappeared. There was a significant relationship found between leg muscle mass and leg BMD. We conclude that CF adults are significantly weaker than controls. This is due to lower muscle mass, and not to a reduced force-generating capacity of the muscle, implying that there is no decrease in the quality of CF muscle. BMD is also reduced in CF subjects, and this appears to be related to shorter stature in this group.

Absorptiometry, Photon↗

Use and misuse of the tape-measure as a means of assessing muscle strength and power.

The tape-measure is frequently used by the medical profession to assess muscle function following injury. It is assumed that increasing limb girth is reflected by increasing muscle power and strength; but this assumption is empirical and may not in practice be justified. The relationship between thigh circumference and muscle strength and power, measured as the torque produced on an isokinetic dynamometer, was assessed in 64 subjects--24 non-injured sportsmen and 40 injured sportsmen. The correlation between the torque produced at the knee by the knee extensors and flexors and the thigh circumference at three levels was not significant in either group. Comparison of the injured with the non-injured limb also failed to show any correlation. By contrast, in eight subjects, repeated measurements over a six to eight month period showed a significant relationship between change in thigh circumference and change in quadriceps power. It is concluded that a single measurement of circumference at the same point in both thighs of a subject with unilateral injury should not be used as an assessment of muscle function. Serial measurements, however, at the 4 and 10 cm levels may be of value as an index of quadriceps power. Reasons for this are discussed.

Adolescent↗

The measurement of muscle strength in patients with peripheral neuromuscular disorders.

The variability of voluntary isometric strength measurements has been assessed in normal subjects and patients with peripheral neuromuscular disorders. Knee extensor strength was measured in a muscle testing chair 13 times over 5 months in each of six normal subjects: coefficients of variation (CV) ranged from 4.5 to 14.0% (mean 8.5%) for individual legs in different subjects. Paired measurements of the strength of several clinically weak muscle groups were made 1-4 days apart in 20 patients using both a handheld dynamometer and the muscle chair technique: the test/retest correlation was high (r = 0.97, p less than 0.001). Visual biofeedback did not affect the strength recorded in most cases. Each of five patients had the strength of six or seven clinically weak muscle groups measured by five examiners within a 24 hour period: the CV for the five examiners ranged from 3.6-27.3% (mean 12.8%). A single examiner measuring the same groups on five occasions in three patients obtained a mean CV of 8.9%. Sources of variation are analysed and it is concluded that, with certain precautions, voluntary strength measurements offer a simple, reliable and acceptable method for monitoring change in patients.

Adolescent↗

Bone mass in female cross-country skiers: relationship between muscle strength and different BMD sites.

In this cross-sectional study, bone mass and muscle strength of the thigh were investigated in 16 Caucasian female cross-country skiers, age 16.2 +/- 0.3 years, that had been ski-training for 6.4 +/- 1.8 years (range 3-9 years) and were now training for 6.3 +/- 2.4 hours/week (range 3-12 hours). They were compared with 16 nonactive females, age 16.4 +/- 0.7 years. The groups were matched according to age, weight, height, and pubertal status. Areal bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, in the total body, head, both total humerus and humerus diaphyses, spine, and in the right femoral neck, greater trochanter, femoral diaphysis, distal femur, proximal tibia, and tibia diaphysis. Bone mineral apparent density (BMAD) was also calculated for the femoral neck and humerus diaphyses. Isokinetic muscle strength of the quadricep and hamstring muscles was measured in an isokinetic dynamometer. Compared with the controls, the cross-country skiing group had significantly higher BMD in the right whole humerus (6.9%), left whole humerus (9.2%), left humerus diaphysis (8.1%), femoral neck (8.9%), greater trochanter (9.3%), femur diaphysis (7.6%), and BMAD of the femoral neck (+19.4%). In the nonactive group there were significant side-to-side differences in BMD of the whole humeri, humerus diaphyses, and BMAD of the humerus diaphyses (3.1%, 5.4%, and 8.8% higher in the right arm, respectively). No such differences were found in the cross-country skiing group. Lean body mass was significantly higher in the cross-country skiers (21.7%), and fat mass (-25.5%) and body fat percent (-28.0%) were significantly lower compared with the nonactive group. There were, however, no significant differences in concentric peak torque of the thigh muscles between the two groups. Stepwise regression analyses revealed that BMI was the best predictor of several sites in the nonactive group. In the cross-country group, on the other hand, muscle strength was a strong predictor of BMD, both at adjacent and more distant BMD sites. In conclusion, it seems that this type of endurance training is associated with a site-specific higher bone mass that may be associated with the type and magnitude of loading during off-season and during the main sports activity, cross-country skiing.

Absorptiometry, Photon↗