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PubMed2002

Acute and prolonged reduction in joint stiffness in humans after exhausting stretch-shortening cycle exercise.

The purpose of the present study was to examine the acute and long-term fatigue effects of exhausting stretch-shortening cycle (SSC) exercise on the stiffness of ankle and knee joints. Five subjects were fatigued on a sledge apparatus by 100 maximal rebound jumps followed by continuous submaximal jumping until complete exhaustion. Neuromuscular fatigue effects were examined in submaximal hopping (HOP) and in maximal drop jumps (DJ) from 35 (DJ35) and 55 cm (DJ55) heights on a force plate. Additional force and reflex measurements were made using an ankle ergometer. Jumping tests and ankle ergometer tests were carried out before, immediately after, 2 h (2H), 2 days and 7 days (7D) after the SSC exercise. Kinematics, force and electromyography (EMG) recordings were complemented with inverse dynamics, which was used to calculate joint moments. The quotient of changes in joint moment divided by changes in joint angle was used as a value of joint stiffness (JS). In addition, blood lactate concentrations and serum creatine kinase activities were determined. The exercise induced a clear decrease in knee joint stiffness by [mean (SD)] 29 (13)% (P < 0.05) in HOP, 31 (6)% (P < 0.05) in DJ35 and 34 (14)% (P < 0.05) in DJ55. A similar trend was observed in the ankle joint stiffness with significant post-exercise reductions of 22 (8)% (P < 0.05) in DJ35 and of 27 (19)% (P < 0.05) at 2H in DJ55. The subsequent recovery of JS was slow and in some cases incomplete still at 7D. Generally, all the EMG parameters were fully recovered by 2H, whereas the force recovery was still incomplete at this time. These data indicate that the immediate reduction in JS was probably related to the effects of both central (neural) and peripheral (metabolic) fatigue, whereas the prolonged impairment was probably due to peripheral fatigue (muscle damage).

Adult↗

PubMed2002

Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training.

OBJECTIVES: To compare the effect of respiratory muscle stretch gymnastics (RMSG), proposed as a possible additional form of rehabilitation for patients with chronic obstructive pulmonary disease (COPD), with that of inspiratory muscle training (IMT). PATIENTS: Twelve naive outpatients with COPD at a university hospital. METHOD: The patients performed IMT (2 sessions of 10 minutes of training at 30% of PImax, daily) for 4 weeks and RMSG (3 sessions of 5 RMSG patterns 4 times each, daily) for 4 weeks, in randomized order, with a 4-week washout period between the two interventions. MEASUREMENTS AND RESULTS: PImax increased with IMT (mean 66.1 to 79.1 cmH2O), but not with RMSG (mean 66.0 to 69.4 cmH2O). RMSG and IMT similarly increased maximum chest wall expansion. FRC was significantly decreased by 158 ml with RMSG, but not with IMT. There were no significant changes in VC, FEV1, or PEF nor in arterial blood gases with either form of rehabilitation. Six-minute walking distance was more significantly increased with RMSG (mean 383 to 430 m), than with IMT (mean 386 to 412 m). CONCLUSIONS: RMSG may have clinically significant benefits, which may be somewhat different from the benefits of IMT, in patients with COPD.

Aged↗

PubMed2006

A pilot randomised controlled trial of eccentric exercise to prevent hamstring injuries in community-level Australian Football.

Hamstring injuries are the most common injury sustained by Australian Football players. Eccentric training has been proposed as a potential preventative strategy. This pilot randomised controlled trial (RCT) evaluated the effectiveness of a pre-season eccentric training program for preventing hamstring injuries at the community level of Australian Football. Seven amateur clubs (n=220 players) were recruited. Players were randomised within clubs to the intervention (eccentric exercise) or control (stretching) groups and randomisation was stratified according to previous history of hamstring injury. Five exercise sessions were completed over a 12-week period, three during the pre-season and two during the first 6 weeks of the season. Compliance was recorded and players were monitored for the season to collect injury and participation data. There was no difference between the control (n=106) or intervention (n=114) groups with respect to baseline characteristics. Only 46.8% of all players completed at least two program sessions. Compliance was poorest for the intervention group. Intention-to-treat analysis suggested that players in the intervention group were not at reduced risk of hamstring injury (RR 1.2, 95% CI: 0.5, 2.8). When only control and intervention group players who participated in at least the first two sessions were analysed, 4.0% of intervention and 13.2% of control group players sustained a hamstring injury (RR 0.3, 95% CI: 0.1, 1.4; p=0.098). The findings suggest that a simple program of eccentric exercise could reduce the incidence of hamstring injuries in Australian Football but widespread implementation of this program is not likely because of poor compliance.

Adolescent↗

PubMed2002

Mechanics of human triceps surae muscle in walking, running and jumping.

Length changes of the muscle-tendon complex (MTC) during activity are in part the result of length changes of the active muscle fibres, the contractile component (CC), and also in part the result of stretch of elastic structures [series-elastic component (SEC)]. We used a force platform and kinematic measurements to determine force and length of the human calf muscle during walking, running and squat jumping. The force-length relation of the SEC was determined in dynamometer experiments on the same four subjects. Length of the CC was calculated as total muscle-tendon length minus the force dependent length of the SEC. The measured relations between force and length or velocity were compared with the individually determined force-length and force-velocity relations of the CC. In walking or running the negative work performed in the eccentric phase was completely stored as elastic energy. This elastic energy was released in the concentric phase, at speeds well exceeding the maximum shortening speed predicted by the Hill force-velocity relation. Speed of the CC, in contrast, was positive and low, well within the range predicted by the measured force-velocity properties and compatible with a favourable muscular efficiency. These effects were also present in purely concentric contractions, like the squatted jump. Contractile component length usually started at the far end of the force-length relation. Inter-individual differences in series-elastic stiffness were reflected in the force and length recordings during natural activity.

Adult↗

PubMed2006

The optimal complex training rest interval for athletes from anaerobic sports.

Complex training research has indicated that 3-4 minutes may be an optimum intracomplex rest interval. The purpose of this study was to determine if a heavy resistive exercise causes performance enhancement of a slow stretch-shortening cycle exercise and if there is an optimal rest interval. Eighteen subjects performed countermovement jumps (CMJs) before and after a 5 repetition maximum back squat lifting protocol. This procedure was repeated 4 times over 2 days using rest intervals of 30 seconds and 2, 4, and 6 minutes. Flight time and peak ground reaction force (GRF) were the dependent variables. All jumps were performed on a specially constructed sledge and force platform apparatus. Repeated measures analysis of variance found a significant reduction in flight time at the 30-second and 6-minute interval (p < 0.05). No significant difference was found between men and women. Only the men showed an enhancement in jump performance after the 4-minute interval. The improvement window was different for each subject, and an analysis of the greatest increase and decrease in flight time and peak GRF was conducted, showing a significant decrease for men and women and a significant increase in flight time for men and peak ground reaction force for women. The results suggest that complex training can benefit or inhibit CMJ performance depending on the rest interval. The individual determination of the intracomplex rest interval may be necessary in the practical setting.

Adult↗

PubMed1999

Treatment of iliopsoas syndrome with a hip rotation strengthening program: a retrospective case series.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To review the effectiveness of a home-based rehabilitation program in the treatment of iliopsoas syndrome. BACKGROUND: Conservative management strategies for iliopsoas bursitis (syndrome) have not been well documented in the literature. This study relates the outcome of an exercise program (hip rotation exercises and stretching) to address clinical deficiencies observed in iliopsoas syndrome. METHODS AND MEASURES: A retrospective chart review and phone follow-up were done to determine pain and activity limitation for 9 patients (mean age, 35.6 +/- 12.7 years; 8 women, 1 man) before and after application of the rehabilitation program. As a group, symptoms of iliopsoas syndrome were present for a mean of 12.6 (+/- 18.4) months prior to diagnosis and rehabilitation. Activity restrictions related to presenting symptoms were measured using a 4-point ordinal scale (from a score of 1 [pain and unable to do sport] to a score of 4 [pain-free, full activity]). RESULTS: Pain and function improvement occurred in 7 of 9 (77%) patients. Five patients improved by at least 2 pain/activity levels at the time of follow-up (13.2 +/- 9.8 months following diagnosis); all but 2 patients were able to return to full activity. CONCLUSIONS: This study gives preliminary evidence that a specific exercise regimen incorporating hip rotation might improve function and reduce pain for patients with iliopsoas syndrome.

Adolescent↗

PubMed2006

Force enhancement at different levels of voluntary contraction in human adductor pollicis.

There is substantial evidence that the steady-state isometric force following active muscle stretch is greater than the corresponding isometric force for sub-maximal and maximal electrically induced contractions, and for maximal voluntary contractions (MVC). This so-called force enhancement (FE) has not been investigated systematically for sub-MVC. Recently, we found that FE only occurred in about half of all tested subjects at 30% of MVC in the adductor pollicis muscle, suggesting that FE for voluntary contractions might depend on the level of activation. Therefore, the purpose of this study was to determine if FE during voluntary contractions is associated with activation. We hypothesized that FE increases with increasing levels of activation, and thus increasing levels of effort. Subjects (n=12) performed voluntary contractions of the adductor pollicis using a custom-built dynamometer at 10 and 60% of maximal effort. There was consistent FE in 4 of 12 subjects at 10% and in 10 of 12 subjects at 60% of maximal voluntary effort. Furthermore, the absolute FE increased from 10 to 60% of maximal voluntary effort. The results of this study, together with previous results on the same subject group at 30% and other subjects at 100% of maximal voluntary effort, suggest that FE systematically increases with increasing levels of voluntary contraction. The mechanisms responsible for this increased FE remain unclear.

Adult↗

PubMed1991

Eccentric and posteccentric contractile behaviour of skeletal muscle: a comparative study in frog single fibres and in humans.

Eccentric and posteccentric force behaviour in human skeletal muscle and in isolated frog muscle fibres was studied by imposing stretch-and-hold loading conditions during contractions with maximal voluntary effort or under tetanic stimulation in the isolated preparations. The investigations on human muscle were made on the forearm flexors of a group of kayak racers (n = 16; age: 17-22 years) and of schoolgirls (n = 15; age: 17-18 years) with both groups participating in a strength-training programme over 4 (kayak racers) or 3 (girls) months. Half of the training regime consisted of eccentric elements. In the isolated muscle fibres, it could be shown that in the posteccentric hold phase the enhanced force decayed exponentially to the original isometric value with a mean time-constant of 0.35 s (10 degrees C) and of 0.23 (20 degrees C). In the forearm flexor of human subjects similar results were obtained not only qualitatively but even quantitatively (time constant of posteccentric force decay: 0.25-0.37 s). Strength training in both groups did not lead to an enhancement in maximal isometric force alone [mean increase in force 17 (SD 10)%], a well-known and generally accepted fact, but also to a parallel shift in eccentric [21 (SD 10)%] and posteccentric force level. The close similarity between the findings in isolated muscle fibres and in human muscle in situ suggests that the eccentric and posteccentric behaviour must be primarily ascribed to the contractile properties of the muscle fibres themselves. A three-element muscle model with variable visco-elastic properties would appear to be most suitable for simulating the experimental findings.

Adolescent↗

PubMed1975

Long-term results of functional treatment of condylar fractures with the long bridle according to A. Rehrmann.

Long-term results in 23 cases with condylar fractures are presented. The method of treatment consisted in forward extension of the mandible by means of a long rubber bridle stretched between a steel hook at the chin and a strong sagittal wave-like, bent wire incorporated in a head cap. Strength and direction of the bridle can be modified. It provieds perfect repositioning of the mandible and a normal occlusion within some hours. The idea of this functional method is to eliminate the displacing muscular pull and dorsally-directed deviation of the mandible, and to restore muscular balance even with full range of mouth-opening. The distraction of the mandible from the glenoid fossa creates space and enables the dislocated condyles to upright themselves spontaneously. In cases of intracapsular or subcondylar fracture the active movements of the mandible, under the conditions of equilibrium, lead to a remodelling of the damaged condylar heads to a new form, induced by function. Ankylosis is avoided with certainty. Mandibular splinting or osteosynthesis are needed only in concomitant fractures of the rest of the mandible. The temporo-mandibular joint area and the rest of the mandible are considered to be independant entities in the treatment of condylar fractures. The method described is simple. Full mandibular mobility was obtained in all cases and spontaneous uprighting of dislocated condyles observed. There was no need for subsequent opening exercises.

Child↗

PubMed1999

Oestrogen attenuates post-exercise myeloperoxidase activity in skeletal muscle of male rats.

The effects of 2 weeks of oestrogen (40 microg kg BW-1 beta-estradiol 3-benzoate) injection on 24 h post-exercise myeloperoxidase (MPO) activities were determined in plantaris and soleus muscles and liver of sexually mature male and female rats. The treadmill running protocol (45-60 min, at 28 m min-1, 15% grade) induced significant elevations in muscle MPO activities 24 h post-exercise in male rats, while prior oestrogen administration to male rats eliminated the post-exercise elevations in muscle MPO activities. Female rats experienced no significant post-exercise elevations in muscle MPO activities. Hence oestrogen administration to male rats attenuated post-exercise muscle MPO activities to levels found in female animals. Liver MPO activities were not significantly affected by exercise, gender or oestrogen administration. Oestrogen may be a factor in diminishing 24 h post-exercise skeletal muscle leukocyte infiltration and inflammatory response in both male and female muscle.

Animals↗

PubMed2001

Musculoskeletal fitness, health outcomes and quality of life.

The health benefits and quality-of-life outcomes of a fit musculoskeletal system (musculoskeletal fitness) are reviewed in this article. The World Health Organization suggests health is a state of complete physical, mental or social well-being and not merely the absence of disease or infirmity. Physical health includes such characteristics as body size and shape, sensory acuity, susceptibility to disease and disorders, body functioning, recuperative ability and the ability to perform certain tasks. One aspect of physical health is the musculoskeletal system, which consists of 3 components; muscular strength, endurance and flexibility. Muscular strength (dynamic) is defined as the maximum force a muscle or muscle group can generate at a specific velocity. Muscular endurance is the ability of a muscle or muscle group to perform repeated contractions against a load for an extended period of time. Flexibility has 2 components, dynamic or static, where dynamic flexibility is the opposition or resistance of a joint to motion, that is, the forces opposing movement rather than the range of movement itself. Static flexibility is the range of motion about ajoint, typically measured as the degree of arc at the end of joint movement. If strength, endurance and flexibility are not maintained, musculoskeletal fitness is then compromised which can significantly impact physical health and well-being. Many health benefits are associated with musculoskeletal fitness, such as reduced coronary risk factors, increased bone mineral density (reduced risk of osteoporosis), increased flexibility, improved glucose tolerance, and greater success in completion of activities of daily living (ADL). With aging, the performance of daily tasks can become a challenge. Additionally, falls, bone fractures and the need for institutional care indicate a musculoskeletal weakness as we age. The earlier in life an individual becomes physically active the greater the increase in positive health benefits; however, becoming physically active at any age will benefit overall health. Improved musculoskeletal fitness (for example, through resistance training combined with stretching) is associated with an enhanced health status. Thus, maintaining musculoskeletal fitness can increase overall quality of life.

Activities of Daily Living↗

PubMed2000

On the origin of the soleus H-reflex modulation pattern during human walking and its task-dependent differences.

Recently, Brooke and colleagues have suggested "that the strong inhibition arising from passive movement about the knee and hip joints, lays down the base for the soleus H-reflex gain modulation seen during human gait." In particular stretch-evoked afferent activity from the quadriceps muscle was emphasized as the most important source of movement-induced inhibition of the H-reflex. To test this hypothesis we examined the kinematics and electromyographic (EMG) activity of the leg during human walking and correlated these with the modulation pattern of the soleus H-reflex. To further test the possible contribution of stretch-evoked quadriceps afferent activity to the soleus H-reflex modulation pattern during walking different walking gaits were studied. In one condition subjects were asked to walk with their knee locked in full extension by a rigid knee brace. In a second condition subjects were asked to walk backwards. During normal walking, the soleus H-reflex modulation pattern is strongly correlated with the EMG events of the soleus and tibialis anterior (TA), but not with hip, knee, or ankle angular displacement or velocity. When subjects walked with the knee locked in full extension, the amplitude of the H-reflex, its modulation pattern, and the task-dependent changes of its amplitude were the same as during normal walking. During backward walking, the H-reflex increases in late swing before activity of the soleus has begun and while the knee is flexing, an observation that highlights central control of the H-reflex amplitude. The effects of imposed flexion of the knee in passive subjects were also reexamined. The knee flexion imposed by the experimenter followed the same trajectory as that which occurred during the swing phase of the subject's step cycle. It was found that imposed knee flexions elicited a burst of TA EMG activity with an average latency of 81.6 ms (SD = 21 ms) in six out of eight subjects. Inhibition of the H-reflex, when it occurred, was associated with the occurrence of this burst. When subjects voluntarily flexed their right knee from an initial quiet standing posture, the inhibition of the soleus H-reflex began before flexion of the knee or that of any other leg segment. Once again the onset of inhibition was closely associated with the onset of activity in the TA. In the discussion section the present observations are examined in light of the predictions made by the movement-induced inhibition hypothesis of Brooke et al. It will be concluded that none of the predictions of this hypothesis were corroborated by present tests done during human walking. In consequence, we suggest that the modulation pattern of the H-reflex observed during normal human walking is centrally determined, as are the task-dependent differences of its amplitude (e.g., standing versus the stance phase of human walking).

Adult↗

PubMed1997

The development of an isokinetic squat device: reliability and relationship to functional performance.

This study was performed to determine the reliability and validity of a new isokinetic squat device in comparison to knee-extension tests performed using a Cybex. Athletic male subjects (n = 29) performed a series of isokinetic squat tests at 0.4 m.s-1, knee-extension tests at 1.05, 2.09 and 3.14 rad.s-1, and a 6-s stationary cycle test which was used as the measure of functional performance. The squat tests included a purely concentric squat without pre-load, a test with pre-load and a stretch-shorten cycle test. Two trials of each test were performed on one testing occasion. Intraclass correlation co-efficients (r = 0.89-0.96) and co-efficients of variation (3.1-8.7%) were determined between trials, and these indicated that all of the tests were highly reliable. The velocity characteristics of the newly developed system demonstrated that it was an effective isokinetic device, with the mean velocity of 0.41 m.s-1 varying within narrow limits, a relatively small velocity overshoot and an isokinetic portion of movement of approximately 80%. The squat tests demonstrated a higher relationship to cycling performance (r = 0.57-0.65) as compared to the knee-extension tests (r = 0.45-0.51). This difference was amplified when a more homogeneous group of subjects was examined. Further, the squat tests were superior to the knee-extension tests in discriminating between differing levels of cycling performance ability. These differences were believed to be due to the greater specificity of the squat movement, in comparison to the knee extension, to the performance of interest.

Adolescent↗

PubMed1988

Protein synthesis in a fish heart: responses to increased power output.

The effects of exercise on the rates of protein synthesis in the chambers of the trout heart were investigated in vitro and in vivo. An in vitro rainbow trout heart preparation was developed which permitted perfusion of the coronary supply to the compact region of the ventricular muscle. This preparation was used to examine the mechanical responses to preload pressures, the oxygen consumption at different power outputs and the rates of protein synthesis in the various heart components. By increasing preload pressure it was possible to double cardiac output, oxygen consumption and power output without changing heart rate. Mechanical efficiency of the hearts was approximately 20%. Perfusion of the coronary vessels improved cardiac output. Protein synthesis was measured in isolated hearts by the incorporation of [3H]phenylalanine added at high concentration (1.35 mmol l-1) to the perfusion medium. The various chambers of the heart showed marked differences in their rates of protein synthesis. Increasing cardiac output and power output in vitro by twofold over 20 min increased the fractional rate of protein synthesis by approximately 2.5-fold in the atrium and ventricle but did not affect the rates in the bulbus arteriosus. Perfusion of the coronary vessels significantly increased the rates of protein synthesis of the compact layer of the ventricle. In vivo there were no significant differences in the fractional protein synthesis rates between the atrium and ventricle; slow-speed continuous swimming over 40 min (1.5 body lengths s-1) caused an increase in the rates of protein synthesis in all the chambers except the bulbus arteriosus. The stimulation in the fractional rates of protein synthesis by approximately 32% was not as great as in vitro. Both in vivo and in vitro the increased rates of protein synthesis occurred without any change in RNA to protein ratios, indicating an improved activity of protein synthesis per unit of RNA. It is concluded that short-term increases in cardiac contractility, possibly acting through the mechanical stretch on the cardiac muscle, stimulated protein synthesis, particularly in the ventricle, through increased ribosomal activity.

Animals↗

PubMed2003

Counseling and physical therapy as treatment for myofascial pain of the masticatory system.

AIMS: To prospectively evaluate the effectiveness of a treatment regimen comprising counseling and physical therapy in patients with myofascial pain of the masticatory system, and to explore whether the duration of the physical therapy offered (4 vs 6 weeks) would influence the treatment result. METHODS: Twenty-six patients were randomly distributed over 2 groups. All patients received reassuring information, advice regarding relaxation of the jaws, avoiding parafunctions, and limited use of the jaws. In addition, a physical therapy program (heat application, massage, ultrasound and muscle stretching) was initiated 2 weeks after the start of the study (group I, receiving 4 weeks of physical therapy) or immediately from the start of the study (group II, receiving 6 weeks of physical therapy). The following parameters were taken at baseline, 2, 4, and 6 weeks: visual analog scale (VAS) scores of present pain; lowest and highest pain over the past period; percentage of pain relief; jaw function assessment by the Mandibular Function Impairment Questionnaire (MFIQ); and pressure pain thresholds (PPTs) of the masseter, temporalis, and thumb muscles. Statistical analysis used a linear mixed model and corrected for multiple testing (Tukey test). RESULTS: Pain and MFIQ scores decreased while PPTs increased in both groups. Only after 4 and 6 weeks, significant differences were present for the PPT of the masseter in group I (P < .02) and the temporalis in both groups (P < .01). Also, the VAS scores of present (P < .02), minimal (P < .01), and maximal (P < .0001) pain and the MFIQ score (P < .001) improved. After 6 weeks, a mean of 60% pain decrease was reported (P < .0001). There were no significant differences between the groups receiving 4 weeks vs 6 weeks of physical therapy. CONCLUSION: A conservative approach involving counseling and physical therapy resulted in significant improvement in parameters of pain and jaw function in patients with myofascial pain. A controlled study will be necessary to elucidate the specific effectiveness of physical therapy over counseling or no treatment.

Adolescent↗

PubMed1992

Stretch shorten cycle performance enhancement through flexibility training.

Sixteen experienced male powerlifters served as subjects in a training study designed to examine the effect of flexibility training on: (i) the stiffness of the series elastic components (SEC) of the upper body musculature and (ii) rebound and purely concentric bench press performance. Nine of the subjects participated in two sessions of flexibility training twice per week for 8 wk. Prior to and after the training period the subjects' static flexibility, SEC stiffness, rebound bench press (RBP), and purely concentric bench press (PCBP) performance were recorded. The flexibility training induced a significant reduction in the maximal stiffness of the SEC. Furthermore, the experimental subjects produced significantly more work during the initial concentric portion of the RBP lift, enabling a significantly greater load to be lifted in the post-training testing occasion. The benefits to performance achieved by the experimental group consequent to flexibility training were greater during the RBP lift as compared with the PCBP lift. The control subjects exhibited no change in any variable over the training period. These results implied that the RBP performance enhancement observed consequent to flexibility training was directly caused by a reduction in SEC stiffness, increasing the utilization of elastic strain energy during the RBP lift.

Adult↗

PubMedDate not supplied

Anterior tibial translation during a maximum quadriceps contraction: is it clinically significant?

Quadriceps exercises are used sparingly in the early rehabilitation of ACL reconstructions because of concern about prematurely stretching the ACL graft. The aim of this study was to determine if a maximum isometric quadriceps contraction significantly translates the tibia anteriorly at 15 degrees, 30 degrees, 45 degrees, 60 degrees, and 75 degrees of flexion. Secondly, the role of the ACL in knee stability was analyzed by comparing the amount of tibial translation in normal, ACL deficient, and reconstructed knees. Thirdly, the location in the motion arc where a quadriceps contraction produces anterior tibial translation was determined. Anterior tibial translation was measured using an arthrometer (KT-1000) during an 89 N and manual maximum translation applied to the knee at rest. The manual maximum translation test determines the magnitude of anterior tibial translation produced by a high anterior force applied directly to the proximal calf. These translations were compared to the tibial translation intrinsically induced by a quadriceps contraction. Testing was performed in normal (N = 22), ACL deficient (N = 10), and reconstructed (N = 10) knees. Anterior tibial translation produced by a maximum quadriceps contraction was measured at 15 degrees, 30 degrees, 45 degrees, 60 degrees, and 75 degrees of flexion. The extension exercise resulted in less anterior tibial displacement than an 89 N drawer and half the translation produced by a manual maximum translation (P less than 0.001). Instrumented laxity testing produced greater anterior translation of the tibia than a maximum isometric quadriceps contraction. Anterior tibial translation was the same during maximum isometric knee extension in all tested knees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Physiological improvements and health benefits during an exercise-based comprehensive rehabilitation program in medically complex patients.

OBJECTIVES: To determine the effects of an exercise-based comprehensive rehabilitation program on the physiological, health, and cost benefit in medically complex patients. DESIGN: Case series SETTING: Comprehensive rehabilitation centers. PARTICIPANTS: Elderly chronically ill men (n = 39, age = 75.3 +/- 1.4) and women (n = 74, age = 76.5 +/- 0.9 years). INTERVENTION: Patients participated in individualized physical therapy with therapeutic exercises (stretching, strengthening, endurance, balance, sitting and standing dynamic exercises) three times/week for three months under the supervision of a physician. MEASUREMENTS: Upper (back) and lower (leg flexors) extremity strength, aerobic power as measured by metabolic equivalents (METS) at 80% of age predicted maximal heart rate (APMHR), physical functioning and mental health as assessed by the Short Form-36 (SF-36) questionnaire, and medical events (falls, physician visits, and hospitalizations) questionnaire was collected at baseline and after three months of the program. RESULTS: Strength measures improved by approximately 30% (P < 0.05) as well as aerobic power improved by approximately 25% (P < 0.05) over the three-month period. There were significant improvements in two of the SF-36 Physical Component Scales: Physical Functioning (P < 0.05) and Role Physical (P < 0.05); plus, there were significant improvements in all four of the Mental Component Scales: Vitality (P < 0.05), Social Functioning (P < 0.05), Role Emotional (P < 0.05), and Mental Health (P < 0.05). There were significant reductions in fall rate (P < 0.05), physician visits (P < 0.05), and hospitalizations (P < 0.05). CONCLUSION: Patients improve physical capacity, which result in improvements in health status with concurrent reductions in healthcare utilization during a comprehensive rehabilitation program.

Aged↗