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PubMed2002

Field evaluation of energy expenditure in women using Tritrac accelerometers.

PURPOSE: To investigate the use of Tritrac accelerometers to measure energy expenditure (EE) of various activities for women in the field setting, as compared with portable indirect calorimetry. METHODS: Twenty women (age 20-29) performed a choreographed routine of six activities (walking, jogging, stair climbing, walking on an incline, stationary cycling, and arm ergometry) while wearing a Tritrac-R3D accelerometer (Hemokinetics Inc., Madison WI) and the Cosmed K4b(2) portable metabolic cart (Cosmed, Rome, Italy). RESULTS: Comparing the mean error scores (K4b(2) - Tritrac), the Tritrac overestimated the EE (kcal x min(-1)) of walking (-1.45) and jogging (-1.75), whereas underestimating the EE of stair climbing (2.76), stationary cycling (2.75), and arm ergometry (1.20). Walking on an incline showed the lowest mean error score (-0.11). Intraclass correlations were moderate for walking (r = 0.568, < 0.05), jogging (r = 0.666, < 0.05), and stairs (r = 0.503, < 0.05) but for the other activities ranged from r = 0.290 ( > 0.05) to r = 0.480 ( < 0.05). The raw data from the Tritrac was applied to a previously developed nonlinear model to adjust the Tritrac scores to the standard of whole-room indirect calorimetry. This resulted in statistically significant improvements in the agreement between the adjusted Tritrac value and the K4b for walking, jogging, and walking on an incline ( < 0.05). CONCLUSION: When compared with portable indirect calorimetry, the Tritrac overestimates the EE of walking and jogging, whereas underestimating that of stair climbing, stationary cycling, and arm ergometry. This limits the use of such a technique to measure EE in the field. The main issues appear to be the type and intensity of the activity and the need for movement in order for the Tritrac to register EE. Activity specific linear regression equations are proposed as a tool to improve the measurement of EE using the Tritrac in the field.

Acceleration↗

PubMed2006

Modelling and evaluation of surgical performance using hidden Markov models.

Minimally invasive surgery has become very widespread in the last ten years. Since surgeons experience difficulties in learning and mastering minimally invasive techniques, the development of training methods is of great importance. While the introduction of virtual reality-based simulators has introduced a new paradigm in surgical training, skill evaluation methods are far from being objective. This paper proposes a method for defining a model of surgical expertise and an objective metric to evaluate performance in laparoscopic surgery. Our approach is based on the processing of kinematic data describing movements of surgical instruments. We use hidden Markov model theory to define an expert model that describes expert surgical gesture. The model is trained on kinematic data related to exercises performed on a surgical simulator by experienced surgeons. Subsequently, we use this expert model as a reference model in the definition of an objective metric to evaluate performance of surgeons with different abilities. Preliminary results show that, using different topologies for the expert model, the method can be efficiently used both for the discrimination between experienced and novice surgeons, and for the quantitative assessment of surgical ability.

Computer Simulation↗

PubMed1988

Wheelchair racing: effects of rim diameter and speed on physiology and technique.

Effects of different hand rim diameters in wheelchair racing were studied with respect to physiological and technique parameters at five speed levels (N = 8 wheelchair sportsmen). In each of five subsequent 15-min exercise tests on a treadmill, a different sized hand rim was mounted to the rear wheels (0.3, 0.35, 0.38, 0.47, 0.56 m). In each test, speed increased with 0.83 m.s-1 every 3 min, starting at 0.83 m.s-1 and ranging up to 4.17 m.s-1 (slope: 0.5 degrees). Cardiorespiratory responses (ventilation, oxygen cost, heart rate, respiratory exchange ratio, mechanical efficiency) and timing data (cycle time, push time, recovery time, push angle, and work per cycle) were obtained every 3rd min, together with the movement pattern of trunk and arm segments. Clear effects of rim diameter and speed were seen for the physiological parameters (P less than 0.05). In physiological terms, D5 appeared the least beneficial, followed by D4. Moreover, increasing rim diameter had a significant effect on movement pattern of the upper arm in the sagittal as well the frontal plane of motion. However, no timing effects were seen with changing rim diameter. On the other hand, timing parameters varied markedly with speed, whereas the segmental excursions of the upper limb did not show a "speed-effect". In general, small hand rims show lower cardiorespiratory responses. This may be related to the decreased segmental excursions of the upper limb and the lower linear hand velocity. Together with a low rolling and air drag, heart rate, and oxygen cost, these are important prerequisites in racing events.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Differences in performance between trained and untrained subjects during a 30-s sprint test in a wheelchair ergometer.

To compare physiological responses and propulsion technique of able bodied subjects with no prior experience of wheelchairs (AB) and wheelchair dependent subjects (WD), ten AB and nine WD performed a 30-s sprint test in a wheelchair ergometer. The WD had spinal cord injuries with a lesion at T8 or lower. The WD and AB did not show significantly different physiological responses. The power values averaged for the right wheel over the 30 s of the test were 50.2 (SD 14.7) W and 48.0 (SD 4.4) W for WD and AB, respectively. No significant differences in torque application could be discerned, although WD subjects seemed to have a more flattened torque curve with a smaller negative deflection at the beginning of the push. The WD applied a significantly higher horizontal propulsive force to the handrims but did not apply force more effectively. The percentages of effective force to total propulsive force were 61 (SD 16)% for WD and 57 (SD 4)% for AB. With regard to the kinematic parameters, AB followed the handrims significantly longer than WD (end angle AB 65 degrees, WD 44 degrees), started the push phase with their arms more in retroflexion and flexed their trunks further forward. The AB did however show a movement pattern comparable to that of wheelchair athletes measured in a comparable experiment. It could not be decided conclusively that inexperience in wheelchair propulsion led to a less effective propulsion technique. Despite the selection of WD with respect to lesion level, interindividual differences in terms of level of training may have been responsible for the absence of significant results.

Adolescent↗

PubMed2001

Identification of higher brain centres that may encode the cardiorespiratory response to exercise in humans.

1. Positron emission tomography (PET) was used to identify the neuroanatomical correlates underlying 'central command' during imagination of exercise under hypnosis, in order to uncouple central command from peripheral feedback. 2. Three cognitive conditions were used: condition I, imagination of freewheeling downhill on a bicycle (no change in heart rate, HR, or ventilation, V(I)): condition II, imagination of exercise, cycling uphill (increased HR by 12 % and V(I) by 30 % of the actual exercise response): condition III, volitionally driven hyperventilation to match that achieved in condition II (no change in HR). 3. Subtraction methodology created contrast A (II minus I) highlighting cerebral areas involved in the imagination of exercise and contrast B (III minus I) highlighting areas activated in the direct volitional control of breathing (n = 4 for both; 8 scans per subject). End-tidal P(CO(2)) (P(ET,CO(2))) was held constant throughout PET scanning. 4. In contrast A, significant activations were seen in the right dorso-lateral prefrontal cortex, supplementary motor areas (SMA), the right premotor area (PMA), superolateral sensorimotor areas, thalamus, and bilaterally in the cerebellum. In contrast B, significant activations were present in the SMA and in lateral sensorimotor cortical areas. The SMA/PMA, dorso-lateral prefrontal cortex and the cerebellum are concerned with volitional/motor control, including that of the respiratory muscles. 5. The neuroanatomical areas activated suggest that a significant component of the respiratory response to 'exercise', in the absence of both movement feedback and an increase in CO(2) production, can be generated by what appears to be a behavioural response.

Adult↗

PubMed1983

How to use bilateral motions in facilitation techniques.

Influence of contralateral finger motions on ipsilateral finger extension was analyzed in order to explore optimal condition of bilateral motions as a facilitation technique, measuring motor times (MTs) of finger extensor muscles in four conditions; homonymous or non-homonymous as for muscle coupling and simultaneous or successive as for timing of motion-initiation. Compared to unilateral motion, MTs shortened only in bilateral motion with preceding sustained contractions of the contralateral homonymous muscle.

Electromyography↗

PubMed1997

A study of functional spinal motion in women after instrumentation and fusion for deformity or trauma.

STUDY DESIGN: Photographs were used to measure the residual spine motion in 71 women who had undergone spine fusion and instrumentation for spinal deformity or trauma. OBJECTIVES: To accurately define the ability of the patient to flex, extend, and bend to the right and left, thus providing the surgeon some accurate information rather than speculation regarding spinal motion. METHODS: The 71 patients had undergone spine fusion with instrumentation for scoliosis, kyphosis, or spine trauma. The average age of the patient at surgery was 22 years, ranging from 11 years to 62 years. The average time since surgery was 6 years, ranging from 1 year to 32 years. Each patient had six views photographed: flexion, extension, right and left side bending from the front, and right and left side bending from the back. Each photograph was measured independently by two research assistants. A total of 852 photographs were analyzed. RESULTS: The average degree of right side bending was 22 degrees, that of left side bending was 23 degrees, that of flexion was 111 degrees, and that of extension was 30 degrees. For the 59 patients who underwent fusion of seven levels or more and who were fused down to T12, L1, L2, L3, or L4, there was no correlation of the range of motion with the lowermost level of fusion, except in patients with fusion to L4 who had significantly less motion. Flexion was primarily a function of hamstring tightness and was best in those who exercised regularly (aerobics, gymnastics, ballet), regardless of the number of levels fused or the lowermost level of fusion. CONCLUSION: Typical spine fusions for deformity produce a moderate loss of functional motion, except in patients who undergo fusion to L4 who lose much more. The technique of analysis was found to be highly accurate and reproducible.

Adolescent↗

PubMed1986

Aminophylline and interstitial adenosine during sustained exercise hyperemia.

We tested the hypothesis that an increase in interstitial fluid (ISF) adenosine concentration contributes to vasodilation of high oxidative skeletal muscle during sustained free-flow exercise. Canine calf muscles were stimulated at 3 Hz for 10 min before and after the infusion of the adenosine receptor antagonist aminophylline (10 mg/kg). The vasodilation that occurred during aminophylline infusion was allowed to decay before the postaminophylline exercise period was begun. This dose of aminophylline shifted the response to infused adenosine 20-fold during rest and reduced the response to a standard dose by 90% during exercise. Aminophylline had no significant effect on blood flow or on O2 consumption at rest or during exercise. Adenosine release (venous minus arterial plasma concentration times plasma flow) increased during 3-Hz exercise both before and after aminophylline infusion, but venous plasma adenosine concentration did not increase in either case. We developed a mathematical model of adenosine movement between ISF and plasma to help us judge whether to use adenosine release or venous concentration as an index of ISF adenosine and decided that venous concentration should be used. We conclude that aminophylline has no effect on sustained 3-Hz exercise hyperemia because under these conditions ISF adenosine concentration does not increase.

Adenosine↗

PubMed1989

The Washington Regimen: rehabilitation of the hand following flexor tendon injuries.

This article describes the use of the "Washington Regimen" of early controlled motion in the rehabilitation of flexor tendon injuries of the hand. This regimen is derived from a combination of Kleinert's controlled active extension with rubber-hand passive flexion, Duran's controlled passive techniques, and the modification of the Kleinert orthosis that uses a palmar pulley system. Based on results of clinical investigations, this regimen of early controlled motion appears effective in inhibiting peritendinous scarring, joint contractures, and other complications that commonly occur secondary to flexor tendon repairs. A six-week staged regimen of postoperative rehabilitation is presented. Splint design, exercise regimen, and rationale for treatment are reviewed.

Biomechanical Phenomena↗

PubMed1985

Guidelines for rehabilitation of sports injuries.

Rehabilitation involves a functional progression through a systematic program of physical reconditioning involving the re-establishment of intact articulations and muscles, pain-free joints and muscles, joint flexibility, muscular strength, muscular endurance, muscular speed, integrated and coordinated movement (skill patterns), and cardiovascular endurance. Specific demands must be imposed upon the body to bring about redevelopment of each phase. A proper diagnosis prior to beginning, and constant monitoring of the patient's progress during, rehabilitation are necessary so that the demands of the therapeutic regimen can be adjusted according to the patient's progress. The DAPRE technique objectifies isotonic and loaded isometric strength development and therefore stimulates greater strength gains during rehabilitation than other techniques do.

Athletic Injuries↗

PubMed2001

Brain microdialysis in exercise research.

During the last 5 to 10 years, the microdialysis technique has been used to explore neurotransmitter release during exercise. Microdialysis can collect virtually any substance from the brains of freely moving animals with a limited amount of tissue trauma. It allows the measurement of local neurotransmitter release in combination with ongoing behavioural changes such as exercise. Several groups examined the effect of treadmill running on extracellular neurotransmitter levels. Microdialysis probes were implanted in different brain areas to monitor diverse aspects of locomotion (striatum, hippocampus, nucleus accumbens, frontal cortex, spinal cord), food reward (hypothalamus, hippocampus, cerebral cortex), thermoregulation (hypothalamus). Some studies combined microdialysis with running on a treadmill to evaluate motor deficit and improvement following dopaminergic grafts in 6-hydroxydopamine lesioned rats, or combined proton nuclear magnetic resonance spectroscopy and cortical microdialysis to observe intra- plus extracellular brain glucose variations. This method allows us to understand neurotransmitter systems underlying normal physiological function and behaviour. Because of the growing interest in exercise and brain functioning, it should be possible to investigate increasingly subtle behavioural and physiological changes within the central nervous system. There is now compelling evidence that regular physical activity is associated with significant physiological, psychological and social benefits in the general population. In contrast with our knowledge about the peripheral adaptations to exercise, studies relating exercise to brain neurotransmitter levels are scarce. It is of interest to examine the effect of short and long term exercise on neurotransmitter release, since movement initiation and control of locomotion have been shown to be related to striatal neurotransmitter function, and one of the possible therapeutic modalities in movement, and mental disorders is exercise therapy. Until very recently most experimental studies on brain chemistry were conducted with postmortem tissue. However, in part because of shortcomings with postmortem methods, and in part because of the desire to be able to directly relate neurochemistry to behaviour, there has been considerable interest in the development of 'in vivo' neurochemical methods. Because total tissue levels may easily mask small but important neurochemical changes related to activity, it is important to sample directly in the extracellular compartment of nervous tissue in living animals. Since the chemical interplay between cells occurs in the extracellular fluid, there was a need to access this compartment in the intact brain of living and freely moving animals. Estimation of the transmitter content in this compartment is believed to be directly related to the concentration at the site where these compounds are functionally released: in the synaptic cleft. As measurements in the synapse are not yet possible, in vivo measurements in the extracellular fluid appear to provide the most directly relevant information currently available. This article provides an overview of the in vivo microdialysis technique as a method for measuring in the extracellular space, and its application in exercise science. Although this technique has been used in different tissues such as brain, adipose tissue, spinal cord and muscle, in animals as well as humans, we will focus on the use of this in vivo method in brain tissue. Recently two excellent reviews on the application of microdialysis in human experiments especially in subcutaneous tissue have been published, and we refer the interested reader to these articles.

Animals↗

PubMed1995

A modified internal rotation stretching technique for overhand and throwing athletes.

Strength, stretching, and rehabilitation methods for the shoulder have been previously described and have been universally applied; nevertheless, many throwing athletes continue to develop overuse injuries. The pitching process tends to increase external rotation and limit internal rotation of the shoulder joint. Our technique involves a modified stretching method of the posterior shoulder musculature. The athlete lies prone with the elbow flexed 90 degrees. With the shoulder abducted 90 degrees, in neutral flexion/extension, and 90 degrees or more of internal rotation, the scapula protrudes posteriorly. By depressing the inferior angle of the scapula toward the thoracic wall, the infraspinatus muscle and posterior joint capsule are effectively isolated and stretched. Manual stabilization of the scapula onto the chest wall transfers the internal rotation movements to the glenohumeral joint, as opposed to sharing the movement with the scapulothoracic articulation. This method improves the efficacy of the internal rotation stretching exercise for the glenohumeral joint. Such an addition to traditional stretching methods may increase the efficiency of the least effective component. We conclude that this modification to traditional programs should be an integral part of the training and rehabilitation program of any athlete requiring near maximal performance of the shoulder.

Athletic Injuries↗

PubMed1985

The relationship between subcutaneous tissue pressures and intramuscular pressures in normal and edematous legs.

The interstitial hydrostatic pressure is affecting fluid movements at microvascular level. A disturbance in the Starling equilibrium results in edema formation. The effect of venous outflow and lymphatic obstructions in human, on the interstitial fluid pressures subcutaneously and intramuscularly and the possible interaction between veins and lymphatics was studied. Utilizing a slit-catheter technique, subcutaneous tissue and intramuscular pressures were measured bilaterally in 10 patients with venous outflow obstruction and in 10 patients with lymphatic obstruction. In lymphatic obstruction the subcutaneous tissue pressure was significantly elevated as well as the intramuscular pressure, while in venous obstruction the subcutaneous tissue pressure was normal. The intramuscular pressure was significantly elevated during exercise reaching 60 mm Hg or more, combined with severe pain. Pain did not occur in patients with lymphatic obstruction. This study suggests that in lymphatic obstruction there is also an involvement of either deep lymphatics, venous dysfunction or a combination of both. Intramuscular pressures do not reach the critical level for pain during exercise. In venous obstruction mainly the intramuscular compartment is involved and interstitial pressure reaches values well above 60 mm Hg during exercise, at which level pain occurs, possibly due to tension of painreceptors in the muscle fascias.

Adult↗

PubMed1995

Applied physiology of triathlon.

The triathlon is a 3-event endurance sport in which athletes compete sequentially in swimming, cycling and running. The primary determinant of success is the ability to sustain a high rate of energy expenditure for prolonged periods of time. Exercise training-induced physiological adaptations in virtually all systems of the body allow the athlete to accomplish this. Aerobic capacity (measured as maximal oxygen uptake, VO2max), economy of motion (submaximal VO2) and fractional utilisation of maximal capacity (%VO2max) reflect the integrated responses of these physiological adaptations. Numerous studies have reported relatively high mean VO2max values for various groups of triathletes that are comparable to those reported for athletes in single-event endurance sports and clearly above those reported for untrained individuals. In shorter distance triathlons and in studies using recreational (rather than elite) triathletes, VO2max is related to performance in the corresponding event of the triathlon (e.g. tethered swimming VO2max with swim time). In longer events and with more elite triathletes, VO2max correlates less well with performance. The physiological adaptations that correspond to and facilitate improved VO2max occur centrally in the cardiovascular system, centred on increased maximal cardiac output, and peripherally in the metabolic systems, centred around increased arterio-venous O2 (a-v O2) difference. While a high VO2max in individuals is clearly of importance to triathlon performance, energy output must be sustained for long periods of time, making economy of motion also very important. Studies suggests that competitive swimmers have better swimming economy than triathletes. However, since many triathletes have previously been competitive swimmers this finding is questionable. The finding suggests that triathletes from nonswimming backgrounds would benefit from improving swimming technique rather than concentrating training workouts solely on distance. In cycling and running, comparison studies have not been done. Economy of motion in swimming, cycling and running have all been found to be correlated with comparable event performance. Training to improve swimming economy can be done without prior exercise, but training to improve swimming economy can be done without prior exercise, but training to improve cycling and running economy should take the multimode nature of a triathlon into consideration. That is, swimming should precede cycling economy training, and cycling should precede running economy training. Cardiovascular, metabolic and neuromuscular adaptations are the main physiological correlates of improved movement economy. Since exercise-induced stress on most physiological systems is based on relative, rather than absolute, exercise intensity, training and racing intensities are frequently quantified as a percentage of maximal capacity of %VO2max.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗

PubMed1992

Neuromuscular stimulation in spinal cord injury. II: Prevention of secondary complications.

The spinal cord injured patient has been the focus of clinical and research efforts to restore functional movement and to obtain therapeutic benefits by electric stimulation of upper motor neuron paralyzed muscles. This review article treats developments in this field from 1983 to 1990. Efforts have been directed to restoring ventilatory and bladder function, and to preventing secondary complications. Electric stimulation for improving ventilatory function has had reasonable success, and systems are commercially available. Electric stimulation for improving bladder function remains in the research stage in the US, although it has had some clinical success reported in Europe. Electric stimulation techniques to prevent or treat secondary complications have been applied to pressure ulcers, deep-venous thrombosis, contractures, spasticity, deconditioning due to lack of exercise, and muscle atrophy. Therapeutic electric stimulation techniques are largely research techniques. Much additional work remains to be done to solve the difficult problems associated with applying this technology in the treatment of patients with spinal cord injury.

Contracture↗

PubMed1986

Neuromuscular electrical stimulation of the muscles surrounding the shoulder.

Neuromuscular electrical stimulation (NMES) can be used to augment range-of-motion, strengthening, and facilitation treatment programs of the muscles surrounding the shoulder. The purposes of this article are 1) to describe the uses of NMES around the shoulder joint as developed through our clinical use and 2) to detail the effects of an NMES program on chronic shoulder subluxation as determined by a clinical study. Because of the complexities of this multiarticular joint, NMES is most useful in the initial phase of the ROM, and stimulated contractions are compromised, relatively, as the humerus moves above the 90-degree horizontal plane. The use of NMES to provide scapular stabilization often entails unwanted alteration of the pressures on the spinal column, occasionally making the treatment program unusable. Electrical stimulation to prevent or correct shoulder subluxation, especially in the neurologically involved patient, provides the therapist with a powerful new treatment technique. In a group of stroke patients, shoulder subluxation was reduced significantly (p less than .05) at the completion of a six-week NMES program. Some of the problems, and possible solutions, unique to the development of electrical stimulation programs for the shoulder muscles are discussed.

Adult↗

PubMed2006

Effect of exercise-induced fatigue on position sense of the knee in the elderly.

Previously, data on the effects of muscle fatigue on joint position sense (JPS) have been provided. However, to our knowledge, no studies have been conducted so far to assess the effects of local muscle fatigue on elderly proprioception. Thus, the purpose of the present study was to determine the effects of local muscle fatigue on knee JPS in old-age-subjects. Sixteen male volunteers (mean age +/- SD: 69.81 +/- 3.92 years) participated in this study. Each subject completed all of the data collection in one morning session; JPS measures were obtained prior to and immediately after the fatigue protocol. JPS was evaluated by the technique of open-kinetic chain and active knee positioning, and was reported using absolute, relative and variable angular errors. The fatigue protocol applied to the lower extremity consisted of 30 maximum concentric repetitions of the knee extensors and flexors muscles on an isokinetic dynamometer at an angular velocity of 120 s(-1) (2.09 rad s(-1)). The results showed that peak torque of knee extensor and flexor muscles was significantly decreased from rest to post exercise-induced fatigue. After local load to the knee muscles, a significant increase of absolute angular error was observed (2.56 degrees ). The relative error showed the directional bias in the extension movement. However, the reliability and accuracy of estimating knee angles as showed by the variable error is similar at both times. It can be concluded that exercise-induced local muscle fatigue alters knee JPS in old age adults.

Aged↗

PubMed2007

Changes in shoulder muscle size and activity following treatment for breast cancer.

BACKGROUND: Morbidity of the shoulder after breast cancer is a well-known phenomenon. MRI studies have shown muscle morbidity in cervical cancer and prostate cancer. In breast cancer clinical observations and patient reports include muscle morbidity in a number of muscles acting at the shoulder. Several of these muscles lie in the field of surgery and radiotherapy. Timed interaction between muscles that stabilise the shoulder and those acting as prime movers is essential to achieve a smooth scapulohumeral rthythm during functional elevation of the arm. METHOD: CROSS-SECTIONAL STUDY: Seventy-four women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). EMG activity of four muscles was recorded during scaption on the affected and unaffected side. Muscle cross sectional area and signal intensity was determined from MRI scans. The association between EMG and covariates was determined using multiple linear regression techniques. RESULTS: Three of the 4 muscles on the affected side demonstrated significantly less EMG activity, particularly when lowering the arm. Upper trapezius demonstrated the greatest loss in activity. Decreased activity in both upper trapezius and rhomboid were significantly associated with an increase in SPADI score and increased time since surgery. Pectoralis major and minor were significantly smaller on the affected side. CONCLUSION: Muscles affected in the long term are the muscles associated with pain and disability yet are not in the direct field of surgery or radiotherapy. Primary muscle shortening and secondary loss of muscle activity may be producing a movement disorder similar to the 'Dropped Shoulder Syndrome'. Exercise programmes should aim not only for range of movement but also for posture correction and education of potential long-term effects.

Aged↗