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PubMed2004

Role of a mixed type, moderate intensity exercise programme after peripheral blood stem cell transplantation.

OBJECTIVES: To evaluate the effect of peripheral blood stem cell transplantation on functional capacity, and to determine the role of a mixed type, moderate intensity exercise programme in the recovery of patients after intensive cancer treatment. METHODS: Peak aerobic capacity and muscular strength (upper body, lower body, and handgrip strength) measures were assessed before (PI) and after (PII) transplant and after a 12 week intervention period (PIII). After PII, 12 patients aged 16-64 years were allotted in equal numbers to a control group or exercise intervention group. RESULTS: Mean peak aerobic capacity and muscular strength were reduced after the transplant, with significant (p<0.05) decreases for upper body strength. No change was found in aerobic capacity and muscular strength between PII and PIII for the control group. In contrast, participation in the exercise programme led to significant improvements in peak aerobic capacity (p<0.05) and upper and lower body strength (p<0.01). In addition, values recorded after the three month intervention period were significantly higher than before treatment for peak aerobic capacity (litres/min (p<0.05) and ml/kg/min (p<0.01)) and lower body strength (p<0.01). CONCLUSION: Intensive treatment for cancer can adversely affect aerobic capacity and muscular strength. A mixed type, moderate intensity exercise programme can help patients to regain fitness and strength within three months. No exercise can exacerbate physical losses resulting from treatment.

Adolescent↗

PubMed2005

Testosterone, dehydroepiandrosterone, and physical performance in older men: results from the Massachusetts Male Aging Study.

OBJECTIVE: This manuscript examines the relationships of total testosterone (T), bioavailable T, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS) to measures of physical performance in a large, population-based, random sample of men. METHODS: In the most recent wave of the Massachusetts Male Aging Study, measures of strength and physical performance [seven-item physical performance test (PPT), timed chair stand test, and grip strength] were made in 684 men, aged 55-85 yr. Complete hormone data were also obtained. Initial graphical exploration of performance outcomes as a function of hormone levels showed linear increases in physical performance up to certain threshold hormone concentrations, beyond which the associations were diminished. Regression models were used to estimate threshold locations and standardized regression coefficients quantifying the association between hormones and strength. RESULTS: All hormones exhibited significant age-adjusted positive association with PPT score below, but not necessarily above, the thresholds. DHEA was positively associated with chair stand score below, but was not above the threshold. None of the hormones studied was significantly associated with grip strength. CONCLUSION: Up to certain critical concentrations, elevated levels of TT, total T, bioavailable T, DHEA, and DHEA sulfate are associated with increased physical performance, as indicated by the PPT. However, levels beyond those critical concentrations, as might be achieved through exogenous supplementation, do not appear to confer any additional benefit. In general, hormone concentrations do not appear to be meaningfully associated with grip strength or chair stand scores.

Adult↗

PubMed1994

Long-term results following proximal row carpectomy.

The functional outcome, patient satisfaction, and x-ray film status for 23 wrists were examined an average of 6 years following proximal row carpectomy. Surgery was performed for Kienbock's disease, scapholunate dissociation with periscaphoid arthritis, and scaphoid nonunion not suitable for bone grafting. Twenty patients were satisfied with functional performance and pain relief. Wrist flexion-extension arc averaged 74 degrees, or 61%, of the opposite wrist at a later examination. Grip strength, corrected dor dominance, averaged 79% of the opposite side, reflecting an average improvement of 15 kg force. Radiocarpal arthritis developed in three wrists, but only one required arthrodesis for pain relief. The majority of patients experienced satisfactory pain relief, functional wrist motion, and effective grip strength following proximal row carpectomy. The results did not decline at an average of 6 years after surgery.

Adolescent↗

PubMed2001

Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance.

Because a certain percentage of patients with positive ulnar variance experience incomplete pain relief after triangular fibrocartilage complex (TFCC) debridement alone, we prospectively evaluated the feasibility and efficacy of combining arthroscopic TFCC debridement with arthroscopic wafer resection in such wrists as part of the same surgical procedure. We enrolled 12 patients between July 1998 and July 2000 and performed both subjective and objective assessment at follow-up with a minimum of 6 months and an average of 14 months. Seven posttraumatic and 5 degenerative tears were identified. Preoperative ulnar variance with a pronated grip x-ray averaged 2 mm and ranged between 1 and 4 mm. At final review 8 patients experienced complete pain relief and 4 experienced only minimal symptoms. The ulnocarpal stress test failed to elicit pain in any wrist. Nine patients were very satisfied, and 3 were satisfied. Grip strength improved 8 kg (36%). This procedure should be considered in the treatment of ulnar wrist pain when TFCC tears and positive ulnar variance coexist.

Arthroscopy↗

PubMed2004

Manual strength testing in 14 upper limb muscles: a study of inter-rater reliability.

BACKGROUND: Manual muscle testing has been termed a "lost art" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles. PATIENTS AND METHODS: The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classified 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specific for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classified as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by kappa-statistics. In addition, the odds ratio for the relation to symptoms of the definition in agreement of strength was calculated. RESULTS: The median kappa-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was significantly associated with the presence of symptoms. INTERPRETATION: This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.

Adult↗

PubMedDate not supplied

Patterns and determinants of muscle strength change with aging in older men.

Decreased muscle strength with aging is associated with functional disability in older adults. However, few studies have longitudinally evaluated the rate of muscle strength loss and the risk factors for the loss in older men. This study examined the patterns and determinants of muscle strength change with aging in a healthy older male population. The study participants were 321 men (age range 51-84 yrs) recruited from population-based listings in the Pittsburgh region, USA. Grip strength was measured at baseline and after an average of 7-years of follow-up. The amount of longitudinal rate of grip strength loss was 2.8% per year (a total of 20% decline during 7-year follow-up). Although all age groups experienced a decline in strength during follow-up, the rate of loss accelerated with age. After adjusting for baseline measurement, grip strength loss ranged from 2.0% decline per year for men aged < 60 years to 3.4% decline per year for men aged 70 years or older (p < .0001). Multivariate analyses revealed that besides older age, other risk factors also contributed to the loss of muscle strength in older men, including back pain, use of calcium channel blockers, caffeine intake, and height and weight loss.

Age Factors↗

PubMed1999

Creatine supplementation differentially affects maximal isometric strength and time to fatigue in large and small muscle groups.

Ten physically active, untrained, college-aged males (26.4 +/- 5. 8 years old) received creatine (CR, 5 g creatine monohydrate + 3 g dextrose) and placebo (PLA, 7 g dextrose) supplementation four times per day for 5 days in a double-blind, randomized, balanced, crossover design. Performance was assessed during maximal and three repeated submaximal bouts of isometric knee extension and handgrip exercise. CR supplementation significantly increased (p <.05) maximal isometric strength during knee extension but not during handgrip exercise. CR supplementation increased time to fatigue during each of the three bouts of submaximal knee extension and handgrip exercise when compared to the PLA trials. These findings suggest that CR supplementation can increase maximal strength and time to fatigue during isometric exercise. However, the improvements in maximal isometric strength following CR supplementation appear to be restricted to movements performed with a large muscle mass.

Adult↗

PubMed1994

Effects of strength training on neuromuscular function and disease activity in patients with recent-onset inflammatory arthritis.

Thirty-nine consecutive patients with recent-onset rheumatoid or psoriatic arthritis were randomly allotted for six months period either to the experimental progressive dynamic strength training group (EG, 10 women and 11 men; 41 +/- 10 yrs), or to the control group (CG, 10 women and 8 men; 45 +/- 11 yrs) who just maintained their habitual physical activities. All patients received antirheumatic medication throughout the experimental period. During the study period significant improvements took place in the EG in maximal muscle strength of all examined muscle groups (31.5% for the knee extensors, p < 0.001; 14.8% and 10.7% for the trunk flexors and extensors, p < 0.01; 27.8% and 20.4% for grip strength, p < 0.001) as well as in erytrocyte sedimentation rate (p < 0.05). Ritchie's articular index (RI) (p < 0.001) and HAQ (p < 0.01). In the CG only the decrease in RI was statistically significant (p < 0.05). Erosive changes in joints increased only slightly and less in the EG than in the CG. The present results suggest that dynamic strength training in early arthritis increases the neuromuscular performance without detrimental effects on disease activity or joint damage.

Activities of Daily Living↗

PubMed2005

Life raft entry from water: effect of strength, tallness, and weight burden in men and women.

BACKGROUND: The recurring failure of survivors of accidental water immersion to self-board a life raft prompted us to quantify the requisite physical attributes for successful self-boarding for predictive purposes. METHODS: There were 24 men and 24 women (18 to 52 yr) who attempted to self-board an inflated double-tube life raft using ladder, ramp, and over-the-side (OTS) entry methods while wearing a lifejacket in warm, calm water. The OTS method was also tested under weight-bearing conditions to determine the subject's 'reserve' capacity (i.e., maximum additional load capacity). RESULTS: Out of the 24 men, 22 successfully boarded the life raft, as did 17 out of the 24 women, using all methods of entry, and their reserve capacities ranged from 2 to 23% of body mass. Men reported lower efforts of exertion and were faster than women when using the ladder or boarding OTS without weights. There were no gender differences in these measures for the ramp and weighted OTS methods of entry. Strength and tallness were positive attributes for boarding the life raft using the ladder and OTS methods of entry, but not when using the ramp, which was the easiest and fastest entry method to execute. CONCLUSIONS: Men were more successful in boarding the life raft OTS (approximately 90%) compared with women (approximately 70%), but the difference was less pronounced for the ladder and ramp entry methods. The subjects' limited reserve capacities suggest that heavy layers of wet clothing and/or loss of muscle strength can easily compromise an individual's ability to self-board a life raft.

Accidents, Aviation↗

PubMed1999

Complications and outcome in open carpal tunnel release. A 6-year follow-up in 92 patients.

In this retrospective study, 92 patients (83% attendance rate) were examined 6 years after open carpal tunnel release. A questionnaire was answered by the patient and a physical examination was made by an independent observer. Five complications were found, of which 4 were early postoperative problems and one was a major complication with long-term disability. In one third of the patients numerous complaints were noted even after six years. Recurrences were found in 9 cases. No lacerations of nerves, tendons or vessels were seen and no patient developed reflex sympathetic dystrophy. The overall subjective outcome showed that 91% of the patients were free of symptoms or improved. The grip strength at follow-up was reduced, if the symptoms had been present for more than 12 months, as compared to less than 12 months, (p = 0.009) and when associated, unspecific brachialgia had been present (p = 0.02). No differences were found in conjunction with the operating surgeon being either an orthopaedic resident or a specialist in hand surgery. In conclusion, open carpal tunnel release had a subjectively favourable outcome, but due to complications and postoperative complaints, further investigations into alternative techniques seem necessary.

Adult↗

PubMed2002

Grip strength after carpal tunnel release: role of the transverse caxpal ligament.

Weakness after carpal tunnel release is common. Potential factors are transverse carpal ligament (TCL) division, incision or pillar pain, swelling, and flexor tenosynovitis. In the study reported here, we examined the effect of TCL division on reactive grip-strength changes. A minimally invasive technique was used with local anesthesia and sedation for TCL release in 41 hands. Total grip strength and individual-digit grip strength were measured using a computerized dynamometer. These measurements were taken preoperatively; immediately after TCL division; and 1, 3, and 5 weeks postoperatively. There was no significant difference between total grip strength measured preoperatively and strength measured immediately after TCL division, but the difference between these values and strength measured 1 week postoperatively was significant. Preoperatively, index fingers contributed 25.3% of total grip strength; long fingers, 31.3%; ring fingers, 27.0%; and small fingers, 16.4%. These contributions were approximately the same after TCL division.

Adult↗

PubMed2006

Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss--a population-based approach.

INTRODUCTION: Weight loss significantly increases postmenopausal bone loss, but the effects of muscle strength change on weight-loss-associated bone loss remain unclear. The study population, 587 peri- and postmenopausal women, was a random sample of the original Osteoporosis Risk Factor and Prevention Study (OSTPRE) study cohort (n=14,220) in Kuopio, Finland. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual x-ray absorptiometry, and grip strength was measured with a pneumatic squeeze dynamometer at baseline in 1989-1991 and at the 10-year follow-up in 1999-2001. METHODS: Women were divided into three groups according to change in age-grouped grip-strength quartile in both of the measurements: "decreased" (n=133), "maintained" (n=300), and "improved" (n=154). In addition, the study sample was divided into two groups according to weight change during the follow-up: weight losers (n=156) and weight gainers (n=431). RESULTS: There were no differences in the change status of grip (muscle) strength between the weight loss and weight gain groups (p>0.500, Pearson chi-square test). Women losing weight during the follow-up and within the improved grip-strength-change group had a significantly lower bone loss rate compared with those in the maintained and decreased grip-strength-change groups (p<0.01 in comparison to the decreased group). This was in contrast to women who gained weight during the follow-up (not significant between any grip-strength-change groups). Furthermore, women who lost body weight and were in the improved grip-strength-change group had a bone loss rate comparable with that of the women who gained body weight (not significant). This was in contrast to the maintained (p<0.05 between weight losers versus gainers in LS) and decreased grip-strength-change groups (p<0.01 weight losers versus gainers in LS and FN). CONCLUSION: The present study suggests that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss. Accordingly, exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.

Absorptiometry, Photon↗

PubMed1996

Midcarpal arthrodesis.

This retrospective review of midcarpal arthrodesis was undertaken between July 1985 and March 1990. Fourteen patients were identified and 11 were available for follow-up evaluation. Mean follow-up time was 66 months (range, 48-102 months). Four patients eventually underwent total wrist arthrodesis due to continued pain. Seven patients improved and each returned to work between 3 and 4 months after surgery. Wrist motion was 50% and grip strength 65% of the normal side. Midcarpal arthrodesis has a predictable fusion rate; however, it does not reliably relieve pain.

Adult↗

PubMed2001

Randomized, double-blind, placebo-controlled trial of albuterol in facioscapulohumeral dystrophy.

BACKGROUND/OBJECTIVES: Animal and human studies suggest that beta(2)-adrenergic agonists exert anabolic effects on muscles, inducing and preventing atrophy after a variety of insults. Based on data from an open-label trial of albuterol in 15 patients with facioscapulohumeral dystrophy (FSHD), the authors conducted a randomized, double-blind, placebo-controlled trial of sustained-release albuterol in this disease. METHODS: Ninety patients were randomized to three groups: placebo; 8.0 mg albuterol twice daily; or 16.0 mg albuterol twice daily. Patients were treated for 1 year with assessments at baseline and weeks 13, 26, and 52. The primary outcome was the 52-week change in global strength by maximum voluntary isometric contraction testing (MVICT). Secondary outcomes included changes at 52 weeks in strength by manual muscle testing (MMT), grip strength, functional testing, and muscle mass assessed by dual energy x-ray absorptiometry (DEXA). RESULTS: Eighty-four patients completed the study. The mean changes in composite MVICT scores were not significantly different between the groups (mean +/- SD: placebo 0.20 +/- 0.91; low dose -0.04 +/- 0.84; high dose 0.08 +/- 0.98). Similarly, there were no differences in the mean MMT change (placebo 0.04 +/- 0.16; low dose -0.03 +/- 0.13; high dose 0.00 +/- 0.15). Grip improved in both treatment groups compared to placebo (placebo -0.53 +/- 4.13, low dose +1.90 +/- 3.34 [p = 0.02], high dose +1.70 +/- 4.13 [p = 0.03]). The high-dose group had a significant increase in lean mass by DEXA (+1.57 +/- 1.71 kg) compared to placebo (0.25 +/- 2.24; p = 0.007). Albuterol was well tolerated; side effects included cramps, tremors, insomnia, and nervousness. CONCLUSIONS: Although albuterol did not improve global strength or function in patients with FSHD, it did increase muscle mass and improve some measures of strength.

Adrenergic beta-Agonists↗

PubMed1994

[Reconstruction of the traumatically amputated thumb by continuous Matev distraction. Experiences and results in 48 cases].

Continuous distraction can be considered as an alternative method of thumb reconstruction after traumatic loss. This technique is applicable if at least two thirds of the metacarpal length are retained and the stump is well covered by soft tissue. Elongation up to 100% of the initial length is then realizable. For a good functional precision grip it is necessary for the reconstructed thumb to reach the nail root of the opposite side. There is normal tactile gnosis after distraction. The strength of power grip is not decreased. Impaired, however, is the skillfulness of pulp-to-pulp pinch. We report on our experience in 48 cases.

Adult↗

PubMed2002

Differential effect of spinal cord injury and functional impairment on human brain activation.

Reorganization of human brain function after spinal cord injury (SCI) has been shown in electrophysiological studies. However, it is less clear how far changes of brain activation in SCI patients are influenced by the extent of SCI (neuronal lesion) or the consequent functional impairment. Positron emission tomography ([15O]-H2O-PET) was performed during an unilateral hand movement in SCI patients and healthy subjects. SCI patients with paraplegia and normal hand function were compared to tetraplegic patients with impaired hand movements. Intergroup comparison between paraplegic patients and healthy subjects showed an increased activation of contralateral sensorimotor cortex (SMC), contralateral thalamus, ipsilateral superior parietal lobe, and bilateral cerebellum. In contrast to this, tetraplegic patients with impaired upper limb function revealed only a significant activation of supplementary motor area (SMA). Correlational analysis in the tetraplegic patients showed that the strength of hand movement was related to the activation of contralateral SMC. However, the severity of upper limb sensorimotor deficit was related to a reduced activation of contralateral SMA and ipsilateral cerebellum. The findings suggest that in paraplegic patients with normal hand function the spinal neuronal lesion itself induces a reorganization of brain activation unrelated to upper limb function. Compared to this, in tetraplegic patients changes of brain activation are related to the impaired upper limb function. Therefore, in patients with SCI a differential impact of spinal lesion and functional impairment on brain activation can be shown. The effect of impaired afferent feedback and/or increased compensatory use of non-impaired limbs in SCI patients needs further evaluation.

Adult↗

PubMed2005

Handgrip maximum force and the visual horizontal-vertical illusion.

The visual horizontal-vertical illusion (HVI) refers to the tendency to overestimate vertical distances relative to horizontals in both 2-D and 3-D presentations. Although the HVI is evident across a wide range of different stimuli, no general theoretical account fully explains the illusion. Some recent authors have proposed the 'effort' account of HVI, contending that vertical overestimation is mediated by effort assessment of gravitational challenges offered by the stimulus. The theory has been supported by a set of studies showing that the height overestimation of large-scale 3-D objects is inversely related to perceivers' fitness and strength. We explored if the large-scale HVI/strength dependence extends to the evaluation of small-scale 2-D line stimuli, traditionally used in HVI studies. We measured the maximum handgrip strength, and assessed the HVI with a computerised line-adjustment task in thirty-two individuals. Compatible with earlier findings in the context of large-scale 3-D stimuli, a significant negative correlation was found between the strength of the dominant hand and amount of HVI. In addition, the variability of HVI was negatively correlated with maximum grip strength of both hands. The results are discussed with reference to the 'effort' account of HVI.

Female↗

PubMed1999

Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up.

A consecutive series of 40 trapeziectomies in 30 patients with basal thumb joint osteoarthritis was reviewed. Sixteen thumbs had pan-trapezial and 24 thumbs trapeziometacarpal osteoarthritis. Simple excision without soft tissue interposition was performed by the same surgeon using an identical surgical technique. Twenty-eight patients were female (mean age 57 years) with a mean follow-up of 11 (3-19) years. Twenty-eight patients were satisfied with their operation, with 26 thumbs being pain free. Thumb pinch strength was improved by 40% compared to preoperative values, but still remained 22% weaker than the non-operated side.

Adult↗