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Official recommendations and actual practice in physiotherapy: managing troubles of physical performance.

This paper explores relations between official written recommendations for physiotherapists and actual practice. It does so by presenting and discussing findings from a conversation analytic study of 74 physiotherapy treatment sessions video-recorded in four English hospitals. Various practices are described by which therapists address troubles of ongoing or recent physical performance by patients during phases of sessions that are occupied with therapists' instructions in treatment activities and patients' physical responses. Divergence between practice and official guidance can be observed, particularly regarding recommendations that therapists always be unambiguous and clear in their communication with patients. Also, there seem to be conflicting demands between maintaining performance of physical treatment activities, whilst also spending time giving patients information and explanation about troubles of performance, and checking their understanding (as is recommended). There are also conflicting demands between individual recommendations. These observations inform a discussion of the wider challenges involved in formulating relevant, appropriate official guidance on communication practice. I argue that the difficulties of auditing actual conduct against official recommendations on interaction should be acknowledged, and that recommendations should be explicitly tentative and broad. Conversation analytic studies can provide resources and understandings to complement and augment such official guidance.

Aged↗

[A physical performance battery assessing low/high extremity functional fitness in older Japanese women].

The aim of this study was to establish a physical performance test battery to assess the wide variation of functional fitness in older Japanese women. The criteria for sampling low/high extremity functional fitness were the amount of physical activities that older women perform on a regular basis and the distance they could move by foot. Seventeen tests related to the activities parallel to daily living (APDL) were completed for 178 women, aged 60 to 91 years. Principal component analysis of the 17 performance tests in the reference group (n = 140) yielded 5 components accounting for 63.5% of the total variance. Fourteen test items were heavily loaded on the 1st principal component, so that 31.4% of the total variance was accounted for by this component. Considering these results as well as test-retest reliability, kurtosis, and skewness of each item, the following four items were selected as a combination of test battery: (X1) repetition of the bicipital flexion/extension, (X2) walking around two cones and sitting on a chair, (X3) moving beans with chopsticks, and (X4) functional reach. Principal component analysis was again applied to these four variables so as to obtain the first principal component score of each person. As a result, the following equation was drawn: the first principal component score = 0.063X1 - 0.055X2 + 0.098X3 + 0.042X4 - 2.65. The scores averaged 0.68 +/- 0.27 for the exercise group (n = 19) (those who played croquet or other similar sports activities consistently twice or more a week); and -0.76 +/- 0.55 for the sedentary group (n = 19) (those who did no exercise and confined their activities to the home). Biserial correlation coefficient as an index of criterion-related validity was 0.67 (P < 0.05) between the scores in the exercise and sedentary groups. These results indicate that a wide range of functional fitness among older Japanese women can be assessed by the four tests.

Aged↗

Haemodynamic changes and physical performance at comparative levels of haemoglobin after long-term treatment with recombinant erythropoietin.

Physical performance and haemodynamic parameters at rest and with exercise were compared in a prospective, cross-over fashion in 12 anaemic haemodialysis patients (Hb 6.4 +/- 0.5, mean +/- SEM) at two levels of haemoglobin (Hb 9 and 12 g/dl) before and after long-term treatment with recombinant human erythropoietin (rHuEpo). Patients were divided into two groups and measurements made prior to treatment, upon reaching, and after 4 months at the first target Hb (9 g/dl group A, 12 g/dl group B), and after 4 months at the alternative target Hb. Tests included an exercise radionuclide ventriculogram, Doppler echocardiogram, and respiratory function exercise test. Compared to pretreatment, there was a significant reduction in resting pulse rate (P < 0.001), and in pulse rate (P < 0.001) and arterial lactate (P < 0.01) concentrations at specified levels of exercise. Work capacity improved 60% (P < 0.001), and left ventricular mass fell by 26% (P < 0.001). Although cardiac output (CO) during and after exercise was reduced (P < 0.05), resting CO, cardiac index, stroke volume and ejection fraction (rest and exercise) were not significantly altered. There appeared little benefit in having the higher target Hb: no significant difference could be found between target levels for almost any measure. In addition, despite marked improvement from pretreatment levels, performance parameters were still below those of non-uraemic age-matched controls. These results demonstrate the beneficial but incomplete effect of rHuEpo on resting and exercise-related factors, and suggest that most improvement is achieved with modest increments in haemoglobin.

Anemia↗

[Effects of preliminary muscular exercise on body temperature, water loss and physical performance].

We investigated the effects of preliminary exercise (muscular warm-up) on body temperature, water loss and physical performance during consecutive sustained exercise. Thirty-one untrained men aged 21 to 30 years old (mean 25.12 +/- 2.92) were subjected to two physical trial tests at 75% Pma. One trial. (T - PE) was performed without preliminary exercise (PE) and the other (T + PE) was preceded by 15 minutes of preliminary exercise performed at 50% Pma. The trials involved pedaling an ergocycle until exhaustion, followed by a 30 minutes period of inactive recovery. The rate of increase of body temperature during the work consecutive to preliminary exercise (T + PE) was lower than that of the work without preliminary exercise (T - PE). The energy output and water loss during T + PE were significantly (P < 0.01) greater than during T - PE. However, the body temperatures at the end of the two tests were identical. The rate of decrease of body temperature, measured after 30 minutes of recovery, was higher for T + PE than T - PE. The duration of work was increased by PE for 25 (80.65%) subjects and decreased for 6 (19.35%). We conclude that preliminary exercise allows better adjustment of thermohydric regulation by moderating the rise in body temperature and increasing water loss during physical work. For most subjects, these adjustments allow improved endurance.

Adaptation, Physiological↗

Psychological factors that influence traumatic injury occurrence and physical performance.

This 9 month prospective study, conducted at the US Army Sergeants Major Academy (USASGMA), examined the association of selected psychological variables (e.g., measures of tension/anxiety, sleep disturbance, Type A behavior pattern) with injury occurrence and physical performance in 126 soldiers. ANOVA and logistic regression analyses revealed significant relationships between: 1) Traumatic injury occurrence and mean tension/anxiety scores, 2) Mean self-reported sleep disturbance scores and traumatic injury occurrence, 3) The Type A behavior pattern (abbreviated Jenkins Activity Survey) and number of sit-ups repetitions completed in 2 minutes, one component of the Army Physical Fitness Test (APFT), 4) The Type A behavior pattern and total score APFT. No significant associations were found for mean tension/anxiety scores and overuse injuries, or Type A behavior pattern and two mile run time or number of push-up repetitions completed in 2 minutes. These data suggest traumatic injury occurrence is influenced by tension/anxiety and disturbances in sleep habits. Additionally, individuals with higher Jenkins Activity scores (characteristic of the Type A behavior pattern) perform better physically.

Adult↗

Assessments of the physical performance of 2 generations of 2 direct digital intraoral sensors.

OBJECTIVE: To evaluate the performance of 4 intraoral direct digital sensors regarding their fundamental physical characteristics. The sensors are made by Schick Technologies Inc (Long Island City, NY) and Gendex Dental Systems (Milan, Italy). STUDY DESIGN: The sensors were exposed by using a Prostyle dental x-ray machine (Planmeca Oy, Helsinki, Finland) operating at 50 kV, 8 mA and various exposure times. Three test phantoms were used: a homogeneous 10-mm thick aluminum block, an aluminum block with a pattern of holes of varying sizes, and a resolving power target. Digital images were transferred as 8 bit TIFF files and analyzed by using a personal computer. RESULTS AND CONCLUSIONS: Some improvements could be observed in the physical performance of the new generation of direct digital radiographic sensors when compared with the earlier generation. Smaller pixels and higher quantum efficiency have improved sensor performance.

Artifacts↗

[Human genetics of physical performance].

Development of human molecular genetics gradually revealed that certain people seem to have congenital capacity in physical performance, and this capacity may correlate with genes. Recently, more and more evidences have shown that genes control some physical characters, such as extreme motion, muscle strength, endurance, ductility, fatigue recovery, and VO2max, ect. The development of spaceflight in China and nation defence urgently require appearance of this study, and its application will help to find physically potential individuals in advance and save large amount of money in the later systematic training.

Exercise↗

Military operations at moderate altitude: effects on physical performance.

The purpose of this study was to examine changes in select anaerobic and aerobic dependent physical performance tasks in U.S. Marines exposured to field operations at moderate altitude. The subjects (N = 16) completed Wingate anaerobic power, submaximal aerobic cycle ergometry, hand grip strength, and push-up tests on three separate occasions. Testing sessions occurred at sea level, at altitude after a 10-day acclimatization period (immediately before field operations), and at altitude immediately after 4.5 days of field operations. Anaerobic power was significantly (p < 0.05) reduced after the field operations at altitude. In contrast, the aerobic cost of doing submaximal exercise was slightly elevated (p < 0.05) after the altitude field operations. No physiologically significant effect was noted for hand grip or push-up results. The findings of this study indicate that field operations at moderate altitude do result in slight, but significant, anaerobic-aerobic performance decrement in U.S. Marines.

Adult↗

Antioxidants and physical performance.

Performance of strenuous physical activity can increase oxygen consumption by 10- to 15-fold over rest to meet energy demands. The resulting elevated oxygen consumption produces an "oxidative stress" that leads to the generation of free radicals and lipid peroxidation. A defense system of free radical scavengers minimizes these dangerous radicals. Indirect measurements of free radicals generated during exercise include assessing products of lipid peroxidation that appear in the blood (e.g., malondialdehyde and conjugated dienes) or expired in the breath (pentane). Changes in antioxidant scavengers and associated enzymes (e.g., glutathione, tocopherol, glutathione peroxidase) also provide clues about demands on the defense system. Physical training has been shown to result in an augmented antioxidant system and a reduction in lipid peroxidation. Supplementation with antioxidants appears to reduce lipid peroxidation but has not been shown to enhance exercise performance. The "weekend athlete" may not have the augmented antioxidant defense system produced through continued training. This may make them more susceptible to oxidative stress. Whether athletes or recreational exercisers should take antioxidant supplements remains controversial. However, it is important that those who exercise regularly or occasionally ingest foods rich in antioxidants.

Antioxidants↗

Physical performance decrements in children with sickle cell anemia.

Prior studies have suggested that cardiorespiratory dysfunction might contribute to the inability of children with sickle cell anemia to exercise competitively with normal children. This article presents a study designed to detect differences in performance of routine physical activities between groups of children having homozygous hemoglobin of sickle cell anemia (HbSS) and those with normal hemoglobin (HbAA). Thirty 10-year-old girls were divided into two equal groups exhibiting no significant differences in height, weight, or body surface area. Each subject performed 20-yd swimming, 40-yd swimming, and 100-yd "potato" foot-racing activities. Results showed significant performance decrements in HbSS compared with HbAA children. Performance decrements on the 20-yd swimming were found to be significantly greater than in either the 40-yd swimming or the 100-yd "potato" races. Assessment of 20-yd swim time as a fraction of 40-yd swim time showed diminished capacity of HbSS children for "burst activity." It is concluded that distance might play a role in the capacity of HbSS children to compete with HbAA children in racing activities such as those encountered in school-based physical education programs. Parents and educators should consider that short distance racing might exaggerate the inability of children with sickle cell anemia to compete with normal children.

Anemia, Sickle Cell↗

Physical performance in individuals with late effects of polio.

The aim of this study was to evaluate physical performance in individuals with late effects of polio; specifically, to evaluate the effects of reduced muscle strength in the lower limbs. Thirty-two individuals seen at the polio clinic at Sahlgrenska University Hospital, Göteborg, Sweden, participated in the study. Each subject performed a bicycle exercise test in which peak oxygen uptake and anaerobic threshold were determined. Muscle strength in the quadriceps and the hamstrings were measured on an isokinetic dynamometer. Reductions in peak workload, peak oxygen uptake and predicted heart rate were seen. The anaerobic threshold was within or slightly lower than normal limits in relation to predicted maximal oxygen uptake, indicating that the cardio-respiratory system was not limiting performance. The muscle testing demonstrated a significantly lower ability to perform muscle actions compared with individuals from a reference group, and strong correlations were found between muscle strength peak VO2 and peak workload, respectively. Adjusted peripheral muscle endurance training might improve the work capacity in those individuals with weak leg muscles and low oxygen uptake, while individuals with relatively good muscle strength would improve their aerobic fitness in a general fitness program.

Adult↗

Gender-related differences in physical performance among seniors.

This study examined gender differences in balance, gait, and muscle performance in seniors and identified gender-specific factors contributing to physical performance. Forty (20 men, 20 women) healthy, community-dwelling seniors (74.5 +/- 5.3 years) participated. Limits of stability, gait speed, lower limb flexor and extensor isokinetic concentric peak torques, self-reported activity level, and balance confidence were measured. No gender differences were detected in gait speed, limits of stability when normalized to height, activity level, or balance confidence (p = .188). Women were weaker than men (p = .007), even after controlling for weight and body-mass index, suggesting that other gender-related factors contribute to strength. Gender accounted for 18-46% of the variance in strength and served as a modifier of the relationship between activity level and strength in some muscle groups. The primary factors relating to gender-specific strength was activity level in men and body weight in women.

Aged↗

Mechanisms of improved physical performance of chronic hemodialysis patients after erythropoietin treatment.

Correction of the anemia that is common among chronic hemodialysis patients by treatment with human recombinant erythropoietin (rHuEPO), even if incomplete, improves physical performance of patients. Oxygen uptake and physical work capacity at maximal work loads and at the anaerobic threshold increase by approximately 20%. Analysis of underlying mechanisms by pulmonary function tests and ergospirometry demonstrate that improved oxygen transport in the blood and its concomitant changes of the anaerobic threshold and heart rate appear to be main causes of improvement. Parameters of respiratory mechanics and gas exchange remain essentially unaltered.

Adult↗

Anemia and decline in physical performance among older persons.

PURPOSE: Anemia is prevalent in old age and is potentially modifiable, but its effects on physical function have not been determined. We examined whether anemia in older persons increases the risk of subsequent decline in physical function, as measured by objective performance-based tests. METHODS: Participants in this 4-year prospective cohort study included 1146 participants, aged 71 years or older, living in Iowa and Washington counties, Iowa. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. An assessment of standing balance, a timed 2.4-m walk, and a timed test of five chair rises were used to assess physical performance; these were combined into a 0 (poor) to 12 (excellent) summary scale. RESULTS: After adjustment for baseline performance score, health status, and demographic characteristics, anemia was associated with greater mean decline in physical performance over 4 years; the adjusted mean decline was 2.3 (95% confidence interval [CI]: 1.7 to 2.8) in subjects with anemia and 1.4 (95% CI: 1.2 to 1.5) in those without anemia (P = 0.003). The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia (cancer, infectious disease, and renal failure), and after adjustment for serum cholesterol, iron, and albumin levels. Persons with borderline anemia, a hemoglobin concentration within 1 g/dL above the WHO criteria, also showed greater mean physical decline (1.8; 95% CI: 1.5 to 2.2) than did those with higher hemoglobin concentrations (P = 0.02). CONCLUSION: This study suggests that anemia in old age is an independent risk factor for decline in physical performance.

Age Distribution↗

A comparative study of the physical performance capacity of rural and urban Burmese women aged 19-24 years.

A comparative study of the physical performance capacity of 32 Burmese women aged 19-24 years of the rural and urban area was conducted. Difference in physique was found between the two groups. Maximal oxygen uptake of the rural group was 39.21 ml/kg/min and that of the urban group was 32.32 ml/kg/min, the difference being significant at 0.1% level. Maximal oxygen pulse and maximal work load were significant only at 2% and 5% levels respectively. Though maximal ventilation in the rural group had a higher mean value it was not significant. These showed a higher cardiorespiratory fitness in the rural group, which was attributable to their high work intensity of 55.13% of the maximal aerobic power. However, a positive training effect of habitual physical activity on muscle strength could not be observed in this study.

Adult↗

Effects of hypoxia, heat, and humidity on physical performance.

The effects of hot, humid environment were compared with the effects of high altitude on the physical performance capacity of Ne-palese residents by measuring oxygen uptakes and heart rates at various work rates. The following groups of men were selected: 66 residents of a hot and humid environment in the Terai at sea level; 24 residents and 16 sojourners at 3,8000 m. The maximal oxygen uptake of the sea-level residents was, on the average, 2.55 1.min-1, at which a maximal heart rate of about 200 beats/min was reached. The sojourners at 3,800 m showed a higher maximal oxygen uptake (2.94 1. min-1) at their maximal heart rate of about 175 beats/min. The residents of 3,800 m achieved a similiar oxygen uptake as the sojourners, but did not show a similar maximal heart rate limitation, suggesting that they were capable of achieving a higher maximal oxygen uptake. This study shows that hot, humid environment at sea level is as much incapacitating as is hypoxia at high altitude.

Adult↗

After-effects of night work on physical performance capacity and sleep quality in relation to age.

The after-effects of night work on physical performance capacity and sleep quality were studied. Ten younger (age < or = 34 years) and eight older (age > 34 years) experienced shift workers were examined. Subjects performed cycle ergometer tests at an exercise intensity requiring 70% of the individual maximal oxygen uptake. Two conditions were studied: a baseline condition, i.e. the last day of a 4 days-off period, and a recovery condition after a period of seven consecutive night shifts, i.e. the second day-off after the night-shift period (32 h after leaving the night-shift period). Sleep quality of the sleep period preceding the test was also measured for both conditions. During the recovery condition the endurance time (i.e. time to exhaustion) was reduced by an average of 20% (-160s, P < 0.05) for the older shift workers only. In both age groups exercise ventilation, heart rate, oxygen uptake, perceived exertion and sleep quality remained unaffected. These findings support the hypothesis that the aging shift worker is faced with increasing complaints, even after the night-shift period. However, to clarify the mechanisms responsible for these after-effects of night work, further extensive studies must be designed.

Adult↗

Physical performance and metabolic changes induced by combined prolonged exercise and different energy intakes in humans.

The purpose of this study was to evaluate the effects on physical performance of three levels of energy intake during a 5-day period of prolonged physical exercise and relative sleep deprivation. A group of 27 male soldiers were randomly assigned to three groups receiving either 1800 kcal.24 h-1 (7560 kJ, LC), 3200 kcal.24 h-1 (13440 kJ, MC) or 4200 kcal.24 h-1 (17,640 kJ, HC). They took part in a 5-day combat course (CC) of heavy and continuous physical activities, with less than 4 h sleep per day. Performance capacity was tested just before and at the end of CC. Maximal oxygen uptake (VO2max) was determined during an exhausting incremental exercise test on a cycle ergometer. Anaerobic performance was measured from the time during which exercise could be maintained at supra maximal loads on a cycle ergometer. After CC, the subjects receiving LC exhibited a 14% decrease in power output at exhaustion in the incremental exercise test [from 325 (SEM 8) to 278 (SEM 9) W, P < 0.001] and a significant decrease in VO2max of 8% [from 3.74 (SEM 0.06) to 3.45 (SEM 0.05) 1.min-1, P < 0.05]. The remaining two experimental groups demonstrated the same mechanical and metabolic performances on days 1 and 5. Anaerobic performance was not influenced by energy intake and the field course. Blood samples were obtained at rest on days 1 and 5. At the end of CC, the data demonstrated a significant decrease in blood glucose concentrated ion (P < 0.01) for LC diet only.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗