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Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome.

BACKGROUND: Longer life expectancy is resulting in increasing numbers of elderly adults with mental retardation. In elderly adults with Down syndrome (DS), the maintenance of muscle strength, endurance, and dynamic balance are important to ensure quality of life and functional independence. The objective of this study was to compare isokinetic leg strength and dynamic balance of aged mentally retarded individuals with DS (n = 16, mean age 63) before and after a treadmill walking program lasting 6 months in comparison with a nonwalking control group (n = 10) with similar physical characteristics. METHODS: Participants in the study undertook leg strength testing on a dynamometer. Parameters measured included peak torque, peak torque % body weight, and average power % body weight. A "timed get-up and go" functional test for dynamic balance was also analyzed and compared prior to and after the treadmill program. RESULTS: Knee extension and flexion isokinetic strength in elderly individuals with DS showed significant improvement after 6 months of treadmill training. Dynamic balance performance was also significantly improved (p <.05). CONCLUSIONS: Aged adults with DS can significantly improve muscle strength and balance by adopting suitable programs of treadmill walking.

Aged↗

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke.

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.

Adult↗

What change in isokinetic knee muscle strength can be detected in men and women with hemiparesis after stroke?

OBJECTIVE: To assess the intra-rater (between occasions) test-retest reliability of isokinetic knee muscle strength measurements in subjects with chronic poststroke hemiparesis and to define limits for the smallest change that indicates real (clinical) improvements for stroke patients. SUBJECTS: Fifty men and women (mean age 58 +/- 6.4 years) 6-46 months post stroke, able to walk at least 300 m with or without a unilateral assistive device. METHODS: Maximal concentric knee extension and flexion contractions at 60 degrees/s and 120 degrees/s, and maximal eccentric knee extension contractions at 60 degrees/s, with the paretic and nonparetic limbs, were performed seven days apart using a Biodex dynamometer. MEASURES: Reliability of the maximum peak torque measurements was evaluated with the intraclass correlation coefficient (ICC(2,1)), the Bland and Altman analyses, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). RESULTS: Test-retest agreements were high (ICC(2,1) 0.89-0.96) with no discernible systematic differences between limbs, angular velocities and modes. The SEM%, representing the smallest change that indicates a real (clinical) improvement for a group of subjects, was relatively small (8-20%). The SRD%, representing the smallest change that indicates a real improvement for a single subject ranged from 26% to 33% for concentric knee extension, from 39% to 55% for concentric knee flexion, and from 22% to 25% for eccentric knee extension. CONCLUSION: Isokinetic knee muscle strength can be reliably measured and used to detect real improvements following an intervention for single subjects as well as for groups of subjects with chronic mild to moderate hemiparesis after stroke.

Aged↗

Maximal oxygen uptake, muscle strength and walking speed in 85-year-old women: effects of increased physical activity.

This study explores the effect of regular training on blood pressure, maximal oxygen uptake, maximal isometric muscle strength, and walking speed in the very old. A total of 55 community-dwelling women, 85-year-old, were enrolled in a training group (N = 22) or a control group (N = 33). These groups were reduced to 19 and 26 subjects, respectively, after the training period. Training was performed once a week over eight months, and consisted of various exercises with particular attention to movements important for everyday activities. Training reduced diastolic blood pressure (p < 0.05), and showed a similar trend for systolic blood pressure. Measurements of maximal oxygen uptake before the start of the training (15 mL min-1 kg-1) revealed a level close to the presumed limit for independent living (13 mL min-1 kg-1). Training improved VO2 max by 18% (p < 0.05), whereas the control group experienced a trend towards a reduction. Maximal isometric muscle strength of both the right and left leg showed a tendency to increase with training, but no significant changes were evident in the trunk flexor and extensor muscles. The training group showed a significant increase of 17% in maximal walking speed after the training period. However, one year later, without training, this improvement was reduced to 8% (p < 0.05). No major changes were observed in the control group for any of these parameters. This study demonstrates a maximal oxygen capacity in very old community-dwelling women close to a threshold level indicating dependency. Furthermore, 8 months of regular training appears to lower blood pressure, and to increase maximal oxygen uptake and maximal walking speed. This suggests that physical reactivation of the very old may reduce the risk for acquiring age-related diseases associated with an elevated blood pressure, and may improve parameters crucial for independence.

Aged↗

Cardiorespiratory fitness and isokinetic muscle strength of elite Asian junior soccer players.

There is a scarcity of descriptive data on the physiological characteristics of elite Asian junior soccer players. The purpose of this study was to evaluate the cardiorespiratory fitness and isokinetic muscle strength of elite junior soccer players in Hong Kong. It was conducted in conjunction with the selection of the Hong Kong team to the 1989 Gothia Cup held in Sweden. Twenty-one top junior soccer players were selected as subjects for the study. The following means (+/- SD) were observed: age 17.3 +/- 1.1 years; height 172.5 +/- 6.2 cm; weight 62.8 +/- 7.0 kg; body fat 5.2 +/- 1.8%; forced vital capacity (FVC) 4.6 +/- 0.6 L; maximum oxygen uptake (VO2max) 58.6 +/- 2.9 ml.kg-1.min-1; anaerobic threshold (AT) 76.7 +/- 10.2% of VO2max; peak isokinetic dominant knee extensor and flexor strengths 3.28 +/- 0.37 Nm.kg-1 and 1.84 +/- 0.24 Nm.kg-1; hamstring to quadriceps peak torque ratio (H/Q) 56 +/- 0.6% measured at 60 degrees s-1. Hong Kong players appeared to have comparable aerobic power, light body weight, poor flexibility and above average isokinetic muscle strength compared to other international junior soccer players. Training programs to improve the contralateral knee muscle imbalance and to increase the fast speed movement capability of the non-dominant knee flexors are recommended.

Adipose Tissue↗

Relation of estrogen receptor-alpha gene polymorphism and hormone replacement therapy to fall risk and muscle strength in early postmenopausal women.

BACKGROUND: Several factors may increase fracture risk, among them reduced bone mineral density (BMD), increased bone resorption, microarchitectural deterioration of bone, increased fall risk, and decreased muscle strength. We have previously reported that PvuII polymorphism of the estrogen receptor-alpha (ER alpha) gene is associated with bone loss rate, fracture risk, and response to hormone replacement therapy (HRT) in early postmenopausal Finnish women. METHOD: We studied the influence of the ER alpha genotype on fall risk and muscle strength in a 5-year randomized HRT trial of 331 early postmenopausal women (subgroup of the population-based OSTPRE study, Kuopio, Finland). A 5-year postal inquiry in May 1994 included questions on falls during the previous 12 months. Grip strength was measured with dynamometer. The ER alpha gene polymorphism was analysed using PCR and PvuII restriction enzyme digestion. RESULTS. In all, 97 out of the 331 women reported falls. Half of those (56%) were slip falls, mostly during the winter season. In the HRT group, the ER alpha genotype was associated with fall risk (P = 0.002, logistic regression). The risk of falls (RR) was higher in women with the PP genotype than in those with the Pp (RR = 5.26, 95% CI 1.98-13.94, P = 0.001) or the pp (RR = 3.84, 95% CI 1.46-10.12, P = 0.007) genotype. When the falls were divided into slip (environment-related) and non-slip (endogenous) falls, the non-slip falls were associated with the genotype (P = 0.004), but the slip falls were not so clearly (P = 0.061). When all falls and non-slip falls were adjusted to the number of chronic health disorders and the variable time-since-menopause, the difference between the genotypes persisted (P = 0.003 and P = 0.010, respectively). In the non-HRT group, the ER alpha genotype was not associated with fall risk. The baseline or the 5-year grip strength values were not influenced by the ER alpha genotype. In conclusion, ER alpha polymorphism is associated with fall risk, especially with non-slip falls, in early postmenopausal Finnish women during the HRT. We have previously reported that, during HRT, women with the P allele have decreased fracture risk and that they may preferentially derive benefit from the positive effect of HRT on BMD. This suggests that the influence of ER alpha polymorphism may depend on the target tissue (bone versus the nervous system). CONCLUSIONS: In these early postmenopausal, non-osteoporotic and relatively healthy women, the increased fall risk associated with the PP genotype was not associated with increased fracture risk, possibly due to improved bone strength during the HRT although falls generally predispose to fractures.

Accidental Falls↗

Effects of resistance training and detraining on muscle strength and blood lipid profiles in postmenopausal women.

OBJECTIVES: To study the effects of eight weeks of supervised, low intensity resistance training (80% of 10 repetition maximum (10RM)) and eight weeks of detraining on muscle strength and blood lipid profiles in healthy, sedentary postmenopausal women. SUBJECTS: Fifteen postmenopausal women, aged 49-62 years, took part in the study. Subjects were assigned to either a control (n = 7) or training (n = 8) group. The training regimen consisted of three sets of eight repetitions of leg press, bench press, knee extension, knee flexion, and lat pull-down, three days a week at 80% of 10RM. Dynamic leg strength, 10RM, and blood lipid profiles (total cholesterol (TC), low and high density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and very low density lipoprotein cholesterol (VLDL-C)) were measured at baseline, after eight weeks of training, and after a further eight weeks of detraining. RESULTS: Eight weeks of resistance training produced significant increases in knee extension (F(1,13) = 12.60; p<0.01), bench press (F(1,13) = 13.79; p<0.01), leg press (F(1,13) = 15.65; p<0.01), and lat pull-down (F(1,13) = 16.60; p<0.005) 10RM strength tests. Although 10RM strength decreased after eight weeks of detraining, the results remained significantly elevated from baseline measures. Eight weeks of training did not result in any significant alterations in blood lipid profiles, body composition, or dynamic isokinetic leg strength. There were no significant differences in any of the variables investigated over the 16 week period in the control group. CONCLUSIONS: These data suggest that a short, low intensity resistance training programme produces substantial improvements in muscle strength. Training of this intensity and duration was not sufficient to produce significant alterations in blood lipid concentrations.

Blood Pressure↗

Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients.

A common complaint among patients with fibrositis syndrome is exhaustion and fatique. It was therefore felt desirable to evaluate the muscle strength of these patients compared with normal subjects. Maximum isometric and isokinetic strength of knee extension was measured in 15 patients and 15 healthy matched subjects, using an isokinetic dynamometer (Cybex II). Maximum isometric strength at various knee extension angles (90 degrees, 60 degrees and 30 degrees degrees) was significantly (p less than 0.001) lower in the fibrositis group than in controls, a reduction of approximately 58-66%. Maximum isokinetic strength at various knee extension velocities (30-240 degrees per second) was also significantly (p less than 0.01) lower in the fibrositis group than in controls, the reduction being approximately 41-51%. In conclusion, isometric and isokinetic muscle strength is found to be lower in patients with fibrositis syndrome than in healthy subjects.

Female↗

Objective measurement of muscle strength in children with spastic diplegia after selective dorsal rhizotomy.

OBJECTIVES: To examine changes in isometric muscle strength at the elbow, knee, and ankle at 6 months and 1 year after selective dorsal rhizotomy (SDR) and to determine if SDR altered the frequency of muscle cocontraction. DESIGN: Prospective outcome study of a consecutive sample. SETTING: Children's hospital. PATIENTS: Ten children with spastic diplegia (7 independent and 3 dependent ambulators who used assistive devices) and 8 age-matched controls. INTERVENTIONS: SDR; physical and occupational therapy; elbow, knee, and ankle measured for flexion and extension strength during three 10-second isometric contractions for each muscle group; and monitored cocontraction measured via muscle electrodes. MAIN OUTCOME MEASURES: Absolute and normalized values of isometric strength; and alterations in the frequency of cocontraction at 6 months and 1 year postoperatively. RESULTS: Children with spastic diplegia showed significantly weaker knee extensors, ankle dorsiflexors, and ankle plantarflexors than age-matched controls. There were no significant differences in strength between the 2 groups in the elbow flexors, elbow extensors, and knee flexors. Isometric strength did not increase or decrease significantly after SDR. Cocontraction during knee extension was normalized after SDR, whereas cocontraction during ankle plantarflexion was unchanged by SDR in the majority of children. CONCLUSION: SDR did not result in a significant decrease in muscle strength in ambulatory children with spastic diplegia. The normalization of the electromyographic patterns at the knee and not the ankle after SDR lends support to the premise that in children with cerebral palsy cocontraction is multifaceted, representing a volitional strategy to enhance control, as well as a disorder of the mechanisms that govern patterns of muscle activity.

Cerebral Palsy↗

A digital test for pelvic muscle strength in older women with urinary incontinence.

A digital test of pelvic muscle strength for evaluation of a pelvic muscle exercise (PME) program was developed with a sample of 338 incontinent women living at home. Factors of perceived pressure, alteration of the vertical plane, and time were combined to form a 7-point scale ranging from 0 to 4. Test-retest for the anteroposterior score was r = .65, p less than .01 with interrater reliability, r = .91, p less than .01. Relationship to other variables and further development of the measure are discussed.

Age Factors↗

Training can improve muscle strength and endurance in 78- to 84-yr-old men.

Nine men, 78-84 yr of age, participated in a dynamometer training program 2-3 times/wk, totaling 25 sessions, using voluntary maximal isometric, concentric, and eccentric right knee-extension actions (30 and 180 degrees/s). Measurements of muscle strength with a Kin-Com dynamometer and simultaneous electromyograms (EMG) were performed of both sides before and after the training period. Muscle biopsies were taken from the right vastus lateralis muscle. The total quadriceps cross-sectional area was measured with computerized tomography. Training led to an increase in maximal torque for concentric (10% at 30 degrees/s) and eccentric (13-19%) actions in the trained leg. The EMG activity increased at maximal eccentric activities. The total cross-sectional quadriceps area of the trained leg increased by 3%, but no changes were recorded in muscle fiber areas in these subjects, who already had large mean fiber areas (5.15 microns 2 x 10(3)). The fatigue index measured from 50 consecutive concentric contractions at 180 degrees/s decreased and the citrate synthase activity increased in all but one subject. The results demonstrate that increased neural activation accompanies an increase in muscle strength at least during eccentric action in already rather active elderly men and that muscle endurance may also be improved with training.

Aged↗

Aminophylline, respiratory muscle strength and exercise tolerance in chronic obstructive airway disease.

Fourteen patients with chronic obstructive airway disease participated in a randomized, double-blind, placebo controlled, cross-over study to assess the effect of acutely administered aminophylline on respiratory muscle strength and exercise tolerance. An increase in the distance walked in 6 min occurred following aminophylline (p less than 0.01). There was no improvement in respiratory muscle strength, assessed by maximal static mouth pressures, and no increase in maximal ventilation or oxygen uptake during a progressive exercise test. The ventilatory response to inhaled CO2 was increased (p less than 0.02), suggesting a central stimulatory effect of aminophylline. The mean increase in walking distance was 5.7%. In most cases, the change was small and unlikely to be of practical benefit.

Aminophylline↗

Association of IGF-I levels with muscle strength and mobility in older women.

The functional consequences of the age-associated decline in IGF-I are unknown. We hypothesized that low IGF-I levels in older women would be associated with poor muscle strength and mobility. We assessed this question in a population representative of the full spectrum of health in the community, obtaining serum IGF-I levels from women aged 70-79 yr, enrolled in the Women's Health and Aging Study I or II. Cross-sectional analyses were performed using 617 women with IGF-I levels drawn within 90 d of measurement of outcomes. After adjustment for age, there was an association between IGF-I and knee extensor strength (P = 0.004), but not anthropometry or other strength measures. We found a positive relationship between IGF-I levels and walking speed for IGF-I levels below 50 microg/liter (P < 0.001), but no relationship above this threshold. A decline in IGF-I level was associated with self-reported difficulty in mobility tasks. All findings were attenuated after multivariate adjustment. In summary, in a study population including frail and healthy older women, low IGF-I levels were associated with poor knee extensor muscle strength, slow walking speed, and self-reported difficulty with mobility tasks. These findings suggest a role for IGF-I in disability as well as a potential target population for interventions to raise IGF-I levels.

Activities of Daily Living↗

Effects of exercise on muscle strength and characteristics in rheumatic diseases and sarcopenia: Protocol for the Care for Muscle (C4M) Study.

OBJECTIVE: Muscle weakness is prevalent in rheumatoid arthritis (RA), osteoarthritis (OA) and sarcopenia (SARC). Endurance exercises may improve mitochondrial function and oxidative capacity, while strength exercises are thought to stimulate myofibrillar protein synthesis. This study aims to compare the effects of strength and endurance exercise and explore the association between muscle characteristics and exercise outcomes in patients with RA, OA and SARC. We hypothesize that responses to endurance and strength exercises in patients with muscle weakness are influenced by intramuscular pathology including muscle morphology, mitochondrial function, and systemic inflammation, based on their disease pathology, potentially requiring personalized training schedules. METHODS: This two-arm, parallel-group exploratory trial will enroll 69 patients (23 RA, 23 OA, 23 SARC), randomized to endurance (n&#x2009;=&#x2009;35) or muscle strength exercises (n&#x2009;=&#x2009;34), using minimization to balance disease type and gender. The 8-week intervention includes two supervised sessions per week using a controlled cable pulley device (Reforter&#x2122;) and fitness equipment, plus one weekly home-based session. The primary outcome is isokinetic muscle strength (peak torque), measured with the Biodex system&#xae;. Secondary outcomes include muscle morphology, mitochondrial function, systemic inflammation and muscle endurance (by Biodex and 6 Minute Walk test). Muscle morphology will be assessed via 3D ultrasound imaging of the vastus lateralis. Mitochondrial function will be analyzed using high-resolution respirometry on muscle biopsies. Systemic inflammation will be measured using multiplex assays or ELISA on serum samples. DISCUSSION: This study will explore differential responses to muscle endurance and muscle strength exercises in patients with RA, OA, and SARC, offering novel insights into the molecular mechanisms of muscle weakness. The findings may help identify potential mechanisms underlying variability in exercise response and provide effect size estimates to guide future confirmatory studies and more targeted exercise interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT06480643 (date of registration28-06-24).

Humans↗

[Evaluation of respiratory muscle strength and thoracic and abdominal amplitudes after a functional reeducation of breathing program for obese individuals].

The purpose of this study was to assess the elements of respiratory mechanics in obese individuals with respect to respiratory muscle strength determined by maximum respiratory pressure (PImax and PEmax) and the amplitude of thoracoabdominal movements at the levels: axillary (AAX), xiphoid (AXf) and abdominal (AAb). Twenty nine patients (43 +/- 13 years) were divided in two groups: Experimental group (E) and Control group (C). All patients were submitted to an initial evaluation and determination of PImax, PEmax, AAx, AXiph and AAb. The E group was submitted to 18 sessions of a Functional Reeducation of Breathing Program that consisted of respiratory orientation, respiratory coordination exercise associated to trunk and limb movements and muscle relaxation two times a week during 9 weeks. Student t-test showed a significant increase in PImax, Axif and Aabd in the experimental group, but when authors compared the two groups, they did not find any statistical difference. The results showed that the Program increased the respiratory muscle strength and the amplitude of abdominal movements in obese patients.

Abdominal Muscles↗

Recovery of muscle strength after late repair of distal biceps brachii tendon.

BACKGROUND AND AIMS: Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated. MATERIALS AND METHODS: Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer. RESULTS: Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work. CONCLUSION: Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.

Adult↗

Estrogen and bone-muscle strength and mass relationships.

The largest voluntary loads on bones come from muscles. To adapt bone strength and mass to them, special strain threshold ranges determine where modeling adds and strengthens bone, and where remodeling conserves or removes it, just as different thermostat settings control the heating and cooling systems in a house. If estrogen lowers the remodeling threshold, two things should occur. First, at puberty in girls, bone mass should begin to increase more than in boys with similar muscle strengths, owing to reduced remodeling-dependent bone losses, while gains from longitudinal bone growth and bone modeling continue normally. That increase in bone mass in girls should plateau when their muscle strength stops increasing, since their stronger bones could then reduce bone strains enough to turn modeling off, but could let remodeling keep conserving existing bone. Second, decreased estrogen secretion [or a related factor(s)], as during menopause, should raise the remodeling threshold and make remodeling begin removing that extra bone. That removal should also tend to plateau after the remaining and weaker bone lets bone strains rise to the higher threshold. Postmenopausal bone loss shows the second effects. Previously unremarked relationships in the data of a 1995 Argentine study showed the first effects. This supports the idea that estrogen can affect human bone strength and mass by lowering the remodeling threshold, and loss of estrogen would raise the threshold and help cause postmenopausal bone loss even if other factors help to do it. The Argentine study also suggested ways to study those things and the roles of muscle strength and other factors in controlling bone strength and mass in children and adult humans. Those factors included, in part, hormones, vitamins, calcium, diet, sex, race, age, medications, cytokines, genetic errors, gene expression patterns, and disease.

Absorptiometry, Photon↗

[Early abductor muscle strength after total hip replacement performed by antero-lateral approach].

Between November 2000 and April 2001 31 patients with unilateral coxarthrosis were assessed in order to determine strength of the hip abductors and hip mobility 2 days prior surgery, 10 and 14 days post surgery. All patients underwent total hip replacement though an antero-lateral approach. It was found that maximal and average muscle strength decreased during the first 2 weeks post-op, with concomitant increase in time needed to achieve full muscle strength and hip mobility.

Adult↗