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PubMed2005

Exercise prescription for a patient 3 months after hip fracture.

BACKGROUND AND PURPOSE: Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. CASE DESCRIPTION: The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. OUTCOME: The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved by 400%; balance confidence increased by 41%; and self-reported ability to perform lower-extremity functional activities increased by 20%. DISCUSSION: The authors believe that some patients can perform comprehensive exercise programs after hip fracture and that properly designed programs can affect patient outcomes beyond observed impairments.

Aged↗
PubMed1999

Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study.

OBJECTIVES: To investigate whether a home exercise programme could safely be performed by patients with stable, inactive polymyositis (PM) and dermatomyositis (DM), regarding disease activity, muscle function, health status and pain. METHODS: Ten patients with reduced muscle function completed the study. A home exercise programme including exercises for strength in the upper and lower limbs, neck and trunk, for mobility in the upper limbs and moderate stretching was developed. The patients exercised for 15 min and took a 15 min walk 5 days a week during a 12 week period. Assessments included clinical evaluation of disease activity, serum creatinine phosphokinase (CPK) levels, magnetic resonance imaging (MRI) of the quadriceps, repeated muscle biopsy of the vastus lateralis, a muscle function index (FI), a walking test and a health status instrument (the SF 36) performed at the start of the study and after 12 weeks. RESULTS: After 12 weeks of exercise, there were no signs of increased disease activity as assessed clinically, by CPK values, MRI or muscle biopsy findings. On an individual basis, all patients improved regarding muscle function according to the FI, in six cases the improvement reached statistical significance (P < 0.05). A significant improvement regarding muscle function in the upper and lower limbs, walking distance and general health status was achieved. CONCLUSIONS: Our results indicate that this home exercise programme can be safely employed in patients with stable, inactive PM and DM, with beneficial effects on muscle function.

Adult↗
PubMed1999

Effect of a static calf-stretching exercise on the resistive torque during passive ankle dorsiflexion in healthy subjects.

STUDY DESIGN: A within-subject experimental design was used with to measure the effect of calf-stretching exercises on the resistive torque during passive ankle dorsiflexion in a group of 20 healthy men (aged 21 to 40). OBJECTIVES: The purpose of this study was to determine if the performance of calf-stretching exercises would produce a decrease in resistive torque during passive ankle dorsiflexion. BACKGROUND: Calf-stretching exercises are widely used in sporting, fitness, and rehabilitation settings yet the effects of stretching on the passive mechanics of the ankle joint are not well understood. METHODS AND MEASURES: A KIN-COM isokinetic dynamometer was used to measure the passive resistive torque of the ankle while the joint complex was moved through return cycles from 10 degrees plantarflexion to 10 degrees dorsiflexion at a constant velocity of 6 degrees/s. Each subject's right or left ankle was randomly assigned to either a control or an experimental condition. The latter underwent a total of 4 static stretches, each lasting 30 seconds. RESULTS: The main findings of the study were that the calf-stretching exercises did not produce a significant reduction in the resistive torque during ankle dorsiflexion, as measured by the peak to peak torque at 10 degrees of ankle dorsiflexion or in the center range of the hysteresis loop at 0 degree dorsiflexion. CONCLUSION: Static calf-stretching exercises of short duration did not reduce the passive resistance of the connective tissue within the surrounding muscle and joint structures in the ankles of healthy young men.

Adult↗
PubMedDate not supplied

The role of passive muscle stiffness in symptoms of exercise-induced muscle damage.

We examined whether passive stiffness of an eccentrically exercising muscle group affects the subsequent symptoms of muscle damage. Passive hamstring muscle stiffness was measured during an instrumented straight-leg-raise stretch in 20 subjects (11 men and 9 women) who were subsequently classified as "stiff" (N = 7), "normal" (N = 6), or "compliant" (N = 7). Passive stiffness was 78% higher in the stiff subjects (36.2 +/- 3.3 N.m.rad(-1)) compared with the compliant subjects (20.3 +/- 1.8 N.m.rad(-1)). Subjects then performed six sets of 10 isokinetic (2.6 rad.s(-1)) submaximal (60% maximal voluntary contraction) eccentric actions of the hamstring muscle group. Symptoms of muscle damage were documented by changes in isometric hamstring muscle strength, pain, muscle tenderness, and creatine kinase activity on the following 3 days. Strength loss, pain, muscle tenderness, and creatine kinase activity were significantly greater in the stiff compared with the compliant subjects on the days after eccentric exercise. Greater symptoms of muscle damage in subjects with stiffer hamstring muscles are consistent with the sarcomere strain theory of muscle damage. The present study provides experimental evidence of an association between flexibility and muscle injury. Muscle stiffness and its clinical correlate, static flexibility, are risk factors for more severe symptoms of muscle damage after eccentric exercise.

Adult↗
PubMed2003

Treatment and prevention of delayed onset muscle soreness.

Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

Malleability of the motor system: a comparative approach.

The various ways in which the power output of muscles can be changed are described. As a result of exercise and growth, force production is increased by an increase in the cross-sectional area of the fibres. This is associated with changes in the rate of synthesis and degradation of muscle proteins which lead to build up of the myofibrils. These then split longitudinally when they reach a critical size. This process is repeated so that the number of myofibrils increases very considerably. Also, during growth, the displacement is increased by increasing the length of the muscles. To do this more sarcomeres are produced in series along the length of the fibres. This is induced by stretch which also encourages fibre growth in girth as well as in length. Yet another way of changing the power output of a muscle is to change the types of muscle fibres (motor units) within the muscle. Fibre type transformation has been fibres (motor units) within the muscle. Fibre type transformation has been shown to occur with cross innervation and stimulation but it does not usually occur with exercise training. It has been possible, however, to change the fibre type proportions in young animals. Also, by combining stretch with stimulation, it has been possible for instance to make the fast glycolytic fibres add on fast oxidative type sarcomeres or even slow oxidation type sarcomeres. Interestingly, fibre transformation also occurs in some species of fish during acclimation to low temperatures in that the specific myofibrillar ATPase activity is increased. This means that the reduction in power output due to decreased temperature is to some extent compensated for by an increase in the intrinsic rate of shortening. EMG studies of fish swimming at different temperatures have shown that the acclimated fish can swim faster and can derive more aerobic sustainable power as a result of this change.

Adaptation, Physiological↗
PubMed1998

The effects of serial stretch loading on stretch work and stretch-shorten cycle performance in the knee musculature.

Training methods to optimize stretch-shorten cycle performance and an active muscle's ability to resist a sudden stretch (stretch work) and the relationship between the two have not been fully explored. The purpose of this study was to examine the effects of an 8-week strengthening program of serial stretch loading on stretch work and stretch-shorten cycle performance in the quadriceps and hamstring muscles. Thirty-one asymptomatic subjects participated in pre- and post-tests of maximum voluntary isometric contractions, stretch work and stretch-shorten cycle trials, and single-leg vertical jumps. The training portion consisted of progressively resisted isotonic single-leg squats. One leg exercised against an isotonic load with serial stretch loading, while the other leg exercised against isotonic load alone. Training resulted in strength gains in both legs indicated by the increase in weight lifted during training, but not by maximum voluntary isometric contractions. Vertical jump height increased in both legs. In the hamstring, stretch work decreased and stretch-shorten cycle performance increased in both legs. In the quadriceps, serial stretch loading intervention resulted in increased stretch-shorten cycle performance and no significant change in stretch work. The correlation between stretch-shorten cycle and stretch work was weak but significant. These findings suggest that the use of serial stretch loading could improve muscular performance and enhance a muscle's potential for dynamic stabilization.

Adult↗
PubMed2004

Muscle weakness in a mouse model of nemaline myopathy can be reversed with exercise and reveals a novel myofiber repair mechanism.

Patients with the inherited muscle disease nemaline myopathy experience prolonged muscle weakness following periods of immobility. We have examined endurance exercise as a means of improving recovery following muscle inactivity in our alpha-tropomyosin(slow)(Met9Arg)-transgenic mouse model of nemaline myopathy. Physical inactivity, mimicked using a hindlimb immobilization protocol, resulted in fiber atrophy and severe muscle weakness. Following immobilization, the nemaline mice (NM) were weaker than WT mice but regained whole-body strength with exercise training. The disuse-induced weakness and the regain of strength with exercise in NM were associated with the respective formation and resolution of nemaline rods, suggesting a role for rods in muscle weakness. Muscles from NM did not show the typical features of muscle repair during chronic stretch-immobilization of the soleus muscle (regeneration occurred with relative lack of centralized nuclei). This indicates that the normal process of regeneration may be altered in nemaline myopathy and may contribute to poor recovery. In conclusion, endurance exercise can alleviate disuse-induced weakness in NM. The altered myofiber repair process in the nemaline mice may be a response to primary myofibrillar damage that occurs in nemaline myopathy and is distinct from the classical repair in muscular dystrophy resulting from plasma membrane defects.

Animals↗
PubMed1994

Stretch reflex responses following mechanical stimulation in power- and endurance-trained athletes.

The basic stretch reflex responses evoked by the mechanical stimuli were investigated among different athletic groups. The tests were performed by a special ankle ergometer, which created dorsiflexion velocities from 25 deg x s-1 to 115 deg x s-1 around the ankle joint. The EMG activity of soleus (SO), gastrocnemius (GA) and tibialis anterior (TA) muscles was recorded with surface electrodes. In all subjects higher angular velocities caused higher stretch reflex responses. The endurance-trained athletes were more sensitive to the used stimuli than the power-trained athletes, because of their shorter latency times (43 +/- 7 ms vs 45 +/- 7 ms, p < 0.001 for the SO muscle and 40 +/- 8 ms vs 43 +/- 6 ms, p < 0.001 for the GA muscle), longer duration of action potentials and shorter recovery times of the monosynaptic reflex. Thus, the neural control of reflex movements in skeletal muscles was dependent on the training background of the subjects. Additionally, the findings may be explained by differences in the motor unit composition as well as by possible differences in the muscle spindle density of the two subject groups.

Action Potentials↗
PubMed1992

Three distinctive activities of human triceps surae muscle during the stance phase in treadmill walking and running.

Activity of human triceps surae muscle (TS) during locomotion was investigated in relation to the muscle shortening and lengthening contractions. Length changes in the TS were presumed from its girth recorded using a mercury-in-silastic gauge wrapped around the muscle belly. The muscle girth during the stance phase resulted in three peaks corresponding to the actions of heel contact, weight support and toe kick. These peak heights were apparently larger than the girth level in the perpendicular standing posture. Three girth increases in running appeared in the process of ankle dorsiflexion. During walking, girth increases on weight support and toe kick were seen in the same phase. The TS through the stance phase is considered to always contract into a shortening state less than the muscle length in the perpendicular standing posture. These muscle activities are probably imposed to resist the muscle stretching. Therefore, it was suggested that the TS contracts eccentrically, with no lengthening contraction.

Adult↗
PubMed2003

A comparison of two stretching protocols on hip range of motion: implications for total daily stretch duration.

It is theorized that the total stretch time in a day is more important than the actual single stretch duration time. The purpose of this study was to compare 2 stretching protocols, keeping total stretching time equivalent. The 2 protocols were a 10-second duration stretch and a 30-second duration stretch. Although the stretch durations differed, the total stretching time over the course of a day was held constant at 2 minutes for both protocols. Participants were randomly assigned a protocol to each of their legs: subjects stretched 1 leg with the 10-second protocol and the opposite leg with the 30-second protocol. The 10-second stretch was repeated 6 times for a total of 1 minute; the 30-second protocol was repeated 2 times for a total of 1 minute. Stretching was performed twice daily (a total of 2 minutes each day) for 6 weeks. All stretching was performed to the hamstring muscles. Hip flexion measurements were recorded at pretest, 3-weeks, and 6-weeks. Subjects demonstrated significant gains in range of motion for hip flexion over the course of 6 weeks, p = 0.000. No differences existed between the 2 protocols. Range of motion gains were equal between the 2 stretching protocols. The common denominator was total stretch time for a day. Regardless of the duration of a single stretch, the key to improvement was the total daily stretch time. These findings are important as they allow clinicians and individuals to customize stretching protocols to meet individual needs.

Adult↗
PubMed2006

Resistance training increases heat shock protein levels in skeletal muscle of young and old rats.

Heat shock proteins (HSP) HSP72, HSC70 and HSP25 protein levels and mRNA levels of HSP72 genes (Hsp72-1, Hsp72-2, Hsp72-3) and HSC70 were examined in tibialis anterior muscles from young and old rats following 4.5 weeks of heavy resistance exercise. Young (3 months) (n=10) and old (30 months) (n=9) rats were subjected to 14 sessions of electrically evoked resistance training using stretch-shortening contractions of the left limb that activated the dorsiflexor muscle group, including the tibialis anterior muscle, while the right side served as the intra-animal control. Muscle wet weight of the left tibialis anterior increased by 15.6% in young animals compared to the untrained right side, while the aged rats demonstrated no significant hypertrophy based on muscle wet weight. There were no differences in mRNA expression between the control and experimental muscles in either the old or the young animals for any of the four genes examined. On the other hand, HSP72 levels as determined by Western blots were significantly (p<0.01) higher (968.8 and 409.1%) in the trained as compared to the contralateral control muscle in young and old animals, respectively. HSP25 expression was increased significantly (p<0.01) by training in muscles of young rats (943.1%) and old rats (420.3%). Moreover, there was no training by age interaction for HSP72, while a significant age and training by age effects were found in muscles for HSP25. There was no change in HSC70 protein expression in response to the training intervention in either age group. SOD-1 enzyme level increased by 66.6% in the trained muscles of the young rats, while this enzyme was 33% lower in trained muscles compared to the untrained control side in old rats. Moreover, a significant (p<0.05) training by age interaction was found for SOD-1 enzyme levels. This study suggests that fast contracting muscles in young and old animals are capable of increasing HSP expression in response to high intensity contractile stress. Furthermore, the data are consistent with the hypothesis that higher levels of oxidative stress in muscles of old animals limit HSP levels and/or function in response to high intensity contractile stress.

Aging↗
PubMed1975

Synergistic tenotomy: effect on chronically denervated slow and fast muscles of rat.

A study was conducted with chronically denervated adult female Wistar rats to test the hypothesis that synergistic tenotomy of denervated skeletal muscles does not just retard atrophy but produces an increase in muscle weight. The animals were categorized in three groups-denervated exercised (DE), denervated tenotomized (DT), and denervated-tenotomized-exercised (DTE). Mechanical stretch was induced in the DE group by forcing the animals to stand on their hind legs to reach for food and water. In the DT group, mechanical stretch was induced by tenotomy of two synergists in the gastrocnemius-plantaris-soleus complex of each leg of the rat so that either the soleus or the plantaris was left as the only plantar-flexor of the ankle joint in each leg. Mechanical stretch was induced in the DTE group by forcing the animals to stand after the tenotomy of synergists at eight weeks postdenervation. All animals in the three experimental groups, and in the sedentary control group (D) were sacrificed at nine weeks postdenervation; the soleus and plantaris muscles were removed and evaluated for MW, DW and percent of hydration. The slow muscle (soleus) increased in muscle mass in DT (53%), DE (26%), and DTE (17%). The fast muscle (plantaris) increased in weight in DE (18%) and in DTE (24%), but showed no significant changes in DT. Study results confirm the hypothesis that synergistic tenotomy stimulates an increase in muscle weight rather than merely retarding atrophy, and that this phenomenon can take place in the absence of neuronal influences. It is suggested that the increase in denervated muscle mass stimulated by muscle elongation is not a true work hypertrophy associated with significant changes in protein concentrations but only an adaptation to a new muscle length. The purpose of the adaptational changes is to optimize the overlap of actomyosin bridges in anticipation of forceful muscle contraction.

Animals↗
PubMed1976

Integrated electromyogram and oxygen uptake during positive and negative work.

1. Integrated electromyogram (e.m.g.) from the vastus lateralis muscles, and steady-state rates of oxygen uptake, were measured simultaneously during the performance of set rates of positive (concentric) and negative (eccentric) work at 50 rev/min on a motorized bicycle ergometer. 2. Similar experiments were also carried out at other pedalling rates and using other leg muscles. 3. The relationships between each of the variables (integrated e.m.g., oxygen consumption) and mean torque on pedals were found to be linear (r greater than 0-98) with a remarkable degree of reproducibility in surface e.m.g. for each subject over several months. 4. The ratio of the e.m.g. slopes at 50 rev/min (positive/negative) was 1-96 +/- 0-12 while the same ratio for the oxygen uptake slopes was 6-34 +/- 0-82. The discrepancy between the ratios suggests that not only is less muscle fibre activity required to maintain the same exerted force during negative work exercise, but there is also a substantial reduction in the oxygen uptake when the fibres are stretched. This was observed for all speeds of pedalling.

Biomechanical Phenomena↗
PubMed2003

Delayed onset muscle soreness : treatment strategies and performance factors.

Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.

Athletic Injuries↗
PubMed2001

Comparison of the exercise pressor reflex between forelimb and hindlimb muscles in cats.

In thirteen cats anesthetized with alpha-chloralose, we compared the cardiovascular and ventilatory responses to both static contraction and tendon stretch of a hindlimb muscle group, the triceps surae, with those to contraction and stretch of a forelimb muscle group, the triceps brachii. Static contraction and stretch of both muscle groups increased mean arterial pressure and heart rate, and the responses were directly proportional to the developed tension. The cardiovascular increases, however, were significantly greater (P < 0.05) when the triceps brachii muscles were contracted or stretched than when the triceps surae muscles were contracted or stretched, even when the tension developed by either maneuver was corrected for muscle weight. Likewise, the ventilatory increases were greater when the triceps brachii muscles were stretched than when the triceps surae muscles were stretched. Contraction of either muscle group did not increase ventilation. Our results suggest that in the anesthetized cat the cardiovascular responses to both static contraction and tendon stretch are greater when arising from forelimb muscles than from hindlimb muscles.

Animals↗