Comparable Neutrophil Responses for Arm and Intensity-matched Leg Exercise.

PubMed

Leicht, Christof A; Goosey-Tolfrey, Victoria L; Bishop, Nicolette C

2017-08-01

Arm exercise is performed at lower absolute intensities than lower body exercise. This may impact on intensity-dependent neutrophil responses, and it is unknown whether individuals restricted to arm exercise experience the same changes in the neutrophil response as found for lower body exercise. Therefore, we aimed to investigate the importance of exercise modality and relative exercise intensity on the neutrophil response. Twelve moderately trained men performed three 45-min constant load exercise trials after determination of peak oxygen uptake for arm exercise (V˙O2peak arms) and cycling (V˙O2peak legs): 1) arm cranking exercise at 60% V˙O2peak arms, 2) moderate cycling at 60% V˙O2peak legs, and 3) easy cycling at 60% V˙O2peak arms. Neutrophil numbers in the circulation increased for all exercise trials, but were significantly lower for easy cycling when compared with arm exercise (P = 0.009), mirroring the blunted increase in HR and epinephrine during easy cycling. For all trials, exercising HR explained some of the variation of the neutrophil number 2 h postexercise (R = 0.51-0.69), epinephrine explaining less of this variation (R = 0.21-0.34). The number of neutrophils expressing CXCR2 decreased in the recovery from exercise in all trials (P < 0.05). Arm and leg exercise elicits the same neutrophil response when performed at the same relative intensity, implying that populations restricted to arm exercise might achieve a similar exercise induced neutrophil response as those performing lower body exercise. A likely explanation for this is the higher sympathetic activation and cardiac output for arm and relative intensity-matched leg exercise when compared with easy cycling, which is partly reflected in HR. This study further shows that the downregulation of CXCR2 may be implicated in exercise-induced neutrophilia.

Central and peripheral hemodynamics in exercising humans: leg vs arm exercise.

PubMed

Calbet, J A L; González-Alonso, J; Helge, J W; Søndergaard, H; Munch-Andersen, T; Saltin, B; Boushel, R

2015-12-01

In humans, arm exercise is known to elicit larger increases in arterial blood pressure (BP) than leg exercise. However, the precise regulation of regional vascular conductances (VC) for the distribution of cardiac output with exercise intensity remains unknown. Hemodynamic responses were assessed during incremental upright arm cranking (AC) and leg pedalling (LP) to exhaustion (Wmax) in nine males. Systemic VC, peak cardiac output (Qpeak) (indocyanine green) and stroke volume (SV) were 18%, 23%, and 20% lower during AC than LP. The mean BP, the rate-pressure product and the associated myocardial oxygen demand were 22%, 12%, and 14% higher, respectively, during maximal AC than LP. Trunk VC was reduced to similar values at Wmax. At Wmax, muscle mass-normalized VC and fractional O2 extraction were lower in the arm than the leg muscles. However, this was compensated for during AC by raising perfusion pressure to increase O2 delivery, allowing a similar peak VO2 per kg of muscle mass in both extremities. In summary, despite a lower Qpeak during arm cranking the cardiovascular strain is much higher than during leg pedalling. The adjustments of regional conductances during incremental exercise to exhaustion depend mostly on the relative intensity of exercise and are limb-specific. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men.

PubMed

Vaegter, H B; Hoeger Bement, M; Madsen, A B; Fridriksson, J; Dasa, M; Graven-Nielsen, T

2017-01-01

Exercise causes an acute decrease in the pain sensitivity known as exercise-induced hypoalgesia (EIH), but the specificity to certain pain modalities remains unknown. This study aimed to compare the effect of isometric exercise on the heat and pressure pain sensitivity. On three different days, 20 healthy young men performed two submaximal isometric knee extensions (30% maximal voluntary contraction in 3 min) and a control condition (quiet rest). Before and immediately after exercise and rest, the sensitivity to heat pain and pressure pain was assessed in randomized and counterbalanced order. Cuff pressure pain threshold (cPPT) and pain tolerance (cPTT) were assessed on the ipsilateral lower leg by computer-controlled cuff algometry. Heat pain threshold (HPT) was recorded on the ipsilateral foot by a computer-controlled thermal stimulator. Cuff pressure pain tolerance was significantly increased after exercise compared with baseline and rest (p < 0.05). Compared with rest, cPPT and HPT were not significantly increased by exercise. No significant correlation between exercise-induced changes in HPT and cPPT was found. Test-retest reliability before and after the rest condition was better for cPPT and CPTT (intraclass correlation > 0.77) compared with HPT (intraclass correlation = 0.54). The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the pain threshold. These data contribute to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. The effect of isometric exercise on pain tolerance may be relevant for patients in chronic musculoskeletal pain as a pain-coping strategy. WHAT DOES THIS STUDY ADD?: The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the heat and pressure pain

Cardiovascular control during concomitant dynamic leg exercise and static arm exercise in humans

PubMed Central

Strange, S

1999-01-01

Skeletal muscle blood flow is thought to be determined by a balance between sympathetic vasoconstriction and metabolic vasodilatation. The purpose of this study was to assess the importance of high levels of sympathetic vasoconstrictor activity in control of blood flow to human skeletal muscle during dynamic exercise.Muscle sympathetic nerve activity to the exercising leg was increased by static or static ischaemic arm exercise added to on-going dynamic leg exercise. Ten subjects performed light (20 W) or moderate (40 W) dynamic knee extension for 6 min with one leg alone or concomitant with bilateral static handgrip at 20% of maximal voluntary contraction force with or without forearm muscle ischaemia or post-exercise forearm muscle ischaemia.Muscle sympathetic nerve activity was measured by microneurography (peroneal nerve) and leg muscle blood flow by a constant infusion thermodilution technique (femoral vein).Activation of an exercise pressor reflex from the arms, causing a 2- to 4-fold increase in muscle sympathetic nerve activity and a 15–32% increase in mean arterial blood pressure, did not affect blood flow to the dynamically exercising leg muscles at any level of leg exercise. Leg vascular conductance was reduced in line with the higher perfusion pressure.The results demonstrate that the vasoconstrictor effects of high levels of muscle sympathetic nerve activity does not affect blood flow to human skeletal muscle exercising at moderate intensities. One question remaining is whether the observed decrease in muscle vascular conductance is the result of sympathetic vasoconstriction or metabolic autoregulation of muscle blood flow. PMID:9831733

The susceptibility of the knee extensors to eccentric exercise-induced muscle damage is not affected by leg dominance but by exercise order.

PubMed

Hody, S; Rogister, B; Leprince, P; Laglaine, T; Croisier, J-L

2013-09-01

The aims of this study were first to compare the response of dominant and non-dominant legs to eccentric exercise and second, to examine whether there is an effect of exercise order on the magnitude of symptoms associated with intense eccentric protocols. Eighteen young men performed three sets of 30 maximal eccentric isokinetic (60° s(-1)) contractions of the knee extensors (range of motion, ROM: 0°-100°, 0 = full extension) using either dominant or non-dominant leg. They repeated a similar eccentric bout using the contralateral leg 6 weeks later. The sequence of leg's use was allocated to create equally balanced groups. Four indirect markers of muscle damage including subjective pain intensity, maximal isometric strength, muscle stiffness and plasma creatine kinase (CK) activity were measured before and 24 h after exercise. All markers changed significantly following the eccentric bout performed either by dominant or non-dominant legs, but no significant difference was observed between legs. Interestingly, the comparison between the first and second eccentric bouts revealed that muscle soreness (-42%, P<0.001), CK activity (-62%, P<0.05) and strength loss (-54%, P<0.01) were significantly lower after the second bout. This study suggests that leg dominance does not influence the magnitude of exercise-induced muscle damage and supports for the first time the existence of a contralateral protection against exercise-induced muscle damage in the lower limbs. © 2013 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Low back related leg pain: an investigation of construct validity of a new classification system.

PubMed

Schäfer, Axel G M; Hall, Toby M; Rolke, Roman; Treede, Rolf-Detlef; Lüdtke, Kerstin; Mallwitz, Joachim; Briffa, Kathryn N

2014-01-01

Leg pain is associated with back pain in 25-65% of all cases and classified as somatic referred pain or radicular pain. However, distinction between the two may be difficult as different pathomechanisms may cause similar patterns of pain. Therefore a pathomechanism based classification system was proposed, with four distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization (NS) comprising major features of neuropathic pain with sensory sensitization; Denervation (D) arising from significant axonal compromise; Peripheral Nerve Sensitization (PNS) with marked nerve trunk mechanosensitivity; and Musculoskeletal (M) with pain referred from musculoskeletal structures. To investigate construct validity of the classification system. Construct validity was investigated by determining the relationship of nerve functioning with subgroups of patients and asymptomatic controls. Thus somatosensory profiles of subgroups of patients with low back related leg pain (LBRLP) and healthy controls were determined by a comprehensive quantitative sensory test (QST) protocol. It was hypothesized that subgroups of patients and healthy controls would show differences in QST profiles relating to underlying pathomechanisms. 77 subjects with LBRLP were recruited and classified in one of the four groups. Additionally, 18 age and gender matched asymptomatic controls were measured. QST revealed signs of pain hypersensitivity in group NS and sensory deficits in group D whereas Groups PNS and M showed no significant differences when compared to the asymptomatic group. These findings support construct validity for two of the categories of the new classification system, however further research is warranted to achieve construct validation of the classification system as a whole.

Improvement in upper leg muscle strength underlies beneficial effects of exercise therapy in knee osteoarthritis: secondary analysis from a randomised controlled trial.

PubMed

Knoop, J; Steultjens, M P M; Roorda, L D; Lems, W F; van der Esch, M; Thorstensson, C A; Twisk, J W R; Bierma-Zeinstra, S M A; van der Leeden, M; Dekker, J

2015-06-01

Although exercise therapy is effective for reducing pain and activity limitations in patients with knee osteoarthritis (OA), the underlying mechanisms are unclear. This study aimed to evaluate if improvements in neuromuscular factors (i.e. upper leg muscle strength and knee proprioception) underlie the beneficial effects of exercise therapy in patients with knee OA. Secondary analyses from a randomised controlled trial, with measurements at baseline, 6 weeks, 12 weeks and 38 weeks. Rehabilitation centre. One hundred and fifty-nine patients diagnosed with knee OA. Exercise therapy. Changes in pain [numeric rating scale (NRS)] and activity limitations [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale and get-up-and-go test] during the study period. Independent variables were changes in upper leg muscle strength and knee joint proprioception (i.e. motion sense) during the study period. Longitudinal regression analyses (generalised estimating equation) were performed to analyse associations between changes in upper leg muscle strength and knee proprioception with changes in pain and activity limitations. Improved muscle strength was significantly associated with reductions in NRS pain {B coefficient -2.5 [95% confidence interval (CI) -3.7 to -1.4], meaning that every change of 1 unit of strength was linked to a change of -2.5 units of pain}, WOMAC physical function (-8.8, 95% CI -13.4 to -4.2) and get-up-and-go test (-1.7, 95% CI -2.4 to -1.0). Improved proprioception was not significantly associated with better outcomes of exercise therapy (P>0.05). Upper leg muscle strengthening is one of the mechanisms underlying the beneficial effects of exercise therapy in patients with knee OA. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain

PubMed Central

Konstantinou, Kika; Ogollah, Reuben; Hay, Elaine M.; Dunn, Kate M.

2018-01-01

Background Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. Methods Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. Results Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). Conclusion Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients. PMID:29621243

Effect of hand-arm exercise on venous blood constituents during leg exercise

NASA Technical Reports Server (NTRS)

Wong, N.; Silver, J. E.; Greenawalt, S.; Kravik, S. E.; Geelen, G.

1985-01-01

Contributions by ancillary hand and arm actions to the changes in blood constituents effected by leg exercises on cycle ergometer were assessed. Static or dynamic hand-arm exercises were added to the leg exercise (50 percent VO2 peak)-only control regimens for the subjects (19-27 yr old men) in the two experimental groups. Antecubital venous blood was analyzed at times 0, 15, and 30 min (T0, T15, and T30) for serum Na(+), K(+), osmolality, albumin, total CA(2+), and glucose; blood hemoglobin, hematocrit, and lactic acid; and change in plasma volume. Only glucose and lactate values were affected by additional arm exercise. Glucose decreased 4 percent at T15 and T30 after static exercise, and by 2 percent at T15 (with no change at T30) after dynamic arm exercise. Conversely, lactic acid increased by 20 percent at T30 after static exercise, and by 14 percent by T15 and 6 percent at T30 after dynamic arm exercise. It is concluded that additional arm movements, performed usually when gripping the handle-bar on the cycle ergometer, could introduce significant errors in measured venous concentrations of glucose and lactate in the leg-exercised subjects.

Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain.

PubMed

Walsh, Jeremy; Hall, Toby

2009-01-01

The straight leg raise (SLR) and slump tests have traditionally been used to identify nerve root compression arising from disk herniation. However, they may be more appropriate as tests of lumbosacral neural tissue mechanosensitivity. The aim of this study was to determine agreement and correlation between the SLR and slump tests in a population presenting with back and leg pain. This was an observational, cross-sectional study design. Forty-five subjects with unilateral leg pain were recruited from an outpatient Back Pain Screening Clinic at a large teaching hospital in Ireland. The SLR and slump tests were performed on each side. In the event of symptom reproduction, the ankle was dorsiflexed. Reproduction of presenting symptoms, which were intensified by ankle dorsiflexion, was interpreted as a positive test. An inclinometer was used to measure range of motion (ROM). There was substantial agreement between SLR and slump test interpretation (kappa = 0.69) with good correlation in ROM between the 2 tests (r = 0.64) on the symptomatic side. In subjects who had positive results, ROM for both tests was significantly reduced compared to ROM on the contralateral side and ROM in subjects who had negative results. When the SLR and slump tests are interpreted as positive in the event of reproduction of presenting leg pain that are intensified by ankle dorsiflexion, these tests show substantial agreement and good correlation in the leg pain population. When interpreted in this way, these tests may be appropriate tests of neural tissue mechanosensitivity, but further criteria must be met before a definitive conclusion in relation to neural tissue mechanosensitivity may be drawn.

Voluntary Movement Frequencies in Submaximal One- and Two-Legged Knee Extension Exercise and Pedaling

PubMed Central

Stang, Julie; Wiig, Håvard; Hermansen, Marte; Hansen, Ernst Albin

2016-01-01

Understanding of behavior and control of human voluntary rhythmic stereotyped leg movements is useful in work to improve performance, function, and rehabilitation of exercising, healthy, and injured humans. The present study aimed at adding to the existing understanding within this field. To pursue the aim, correlations between freely chosen movement frequencies in relatively simple, single-joint, one- and two-legged knee extension exercise were investigated. The same was done for more complex, multiple-joint, one- and two-legged pedaling. These particular activities were chosen because they could be considered related to some extent, as they shared a key aspect of knee extension, and because they at the same time were different. The activities were performed at submaximal intensities, by healthy individuals (n = 16, thereof eight women; 23.4 ± 2.7 years; 1.70 ± 0.11 m; 68.6 ± 11.2 kg). High and fair correlations (R-values of 0.99 and 0.75) occurred between frequencies generated with the dominant leg and the nondominant leg during knee extension exercise and pedaling, respectively. Fair to high correlations (R-values between 0.71 and 0.95) occurred between frequencies performed with each of the two legs in an activity, and the two-legged frequency performed in the same type of activity. In general, the correlations were higher for knee extension exercise than for pedaling. Correlations between knee extension and pedaling frequencies were of modest occurrence. The correlations between movement frequencies generated separately by each of the legs might be interpreted to support the following working hypothesis, which was based on existing literature. It is likely that involved central pattern generators (CPGs) of the two legs share a common frequency generator or that separate frequency generators of each leg are attuned via interneuronal connections. Further, activity type appeared to be relevant. Thus, the apparent common rhythmogenesis for the two legs appeared

The effects of elevated pain inhibition on endurance exercise performance.

PubMed

Flood, Andrew; Waddington, Gordon; Keegan, Richard J; Thompson, Kevin G; Cathcart, Stuart

2017-01-01

The ergogenic effects of analgesic substances suggest that pain perception is an important regulator of work-rate during fatiguing exercise. Recent research has shown that endogenous inhibitory responses, which act to attenuate nociceptive input and reduce perceived pain, can be increased following transcranial direct current stimulation of the hand motor cortex. Using high-definition transcranial direct current stimulation (HD-tDCS; 2 mA, 20 min), the current study aimed to examine the effects of elevated pain inhibitory capacity on endurance exercise performance. It was hypothesised that HD-tDCS would enhance the efficiency of the endogenous pain inhibitory response and improve endurance exercise performance. Twelve healthy males between 18 and 40 years of age ( M  = 24.42 ± 3.85) were recruited for participation. Endogenous pain inhibitory capacity and exercise performance were assessed before and after both active and sham (placebo) stimulation. The conditioned pain modulation protocol was used for the measurement of pain inhibition. Exercise performance assessment consisted of both maximal voluntary contraction (MVC) and submaximal muscular endurance performance trials using isometric contractions of the non-dominant leg extensors. Active HD-tDCS (pre-tDCS, -.32 ± 1.33 kg; post-tDCS, -1.23 ± 1.21 kg) significantly increased pain inhibitory responses relative to the effects of sham HD-tDCS (pre-tDCS, -.91 ± .92 kg; post-tDCS, -.26 ± .92 kg; p  = .046). Irrespective of condition, peak MVC force and muscular endurance was reduced from pre- to post-stimulation. HD-tDCS did not significantly influence this reduction in maximal force (active: pre-tDCS, 264.89 ± 66.87 Nm; post-tDCS, 236.33 ± 66.51 Nm; sham: pre-tDCS, 249.25 ± 88.56 Nm; post-tDCS, 239.63 ± 67.53 Nm) or muscular endurance (active: pre-tDCS, 104.65 ± 42.36 s; post-tDCS, 93.07 ± 33.73 s; sham: pre-tDCS, 123.42 ± 72.48 s; post-tDCS, 100.27 ± 44.25 s). Despite increasing pain

Leg pain and psychological variables predict outcome 2-3 years after lumbar fusion surgery.

PubMed

Abbott, Allan D; Tyni-Lenné, Raija; Hedlund, Rune

2011-10-01

Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

The prefrontal oxygenation and ventilatory responses at start of one-legged cycling exercise have relation to central command.

PubMed

Asahara, Ryota; Matsukawa, Kanji; Ishii, Kei; Liang, Nan; Endo, Kana

2016-11-01

When performing exercise arbitrarily, activation of central command should start before the onset of exercise, but when exercise is forced to start with cue, activation of central command should be delayed. We examined whether the in-advance activation of central command influenced the ventilatory response and reflected in the prefrontal oxygenation, by comparing the responses during exercise with arbitrary and cued start. The breath-by-breath respiratory variables and the prefrontal oxygenated-hemoglobin concentration (Oxy-Hb) were measured during one-legged cycling. Minute ventilation (V̇e) at the onset of arbitrary one-legged cycling was augmented to a greater extent than cued cycling, while end-tidal carbon dioxide tension (ETco 2 ) decreased irrespective of arbitrary or cued start. Symmetric increase in the bilateral prefrontal Oxy-Hb occurred before and at the onset of arbitrary one-legged cycling, whereas such an increase was absent with cued start. The time course and magnitude of the increased prefrontal oxygenation were not influenced by the extent of subjective rating of perceived exertion and were the same as those of the prefrontal oxygenation during two-legged cycling previously reported. Mental imagery or passive performance of the one-legged cycling increased V̇e and decreased ETco 2 Neither intervention, however, augmented the prefrontal Oxy-Hb. The changes in ETco 2 could not explain the prefrontal oxygenation response during voluntary or passive one-legged cycling. Taken together, it is likely that the in-advance activation of central command influenced the ventilatory response by enhancing minute ventilation at the onset of one-legged cycling exercise and reflected in the preexercise increase in the prefrontal oxygenation. Copyright © 2016 the American Physiological Society.

Association of restless legs syndrome, pain, and mood disorders in Parkinson's disease.

PubMed

Rana, Abdul Qayyum; Qureshi, Abdul Rehman M; Rahman, Labiba; Jesudasan, Ajantha; Hafez, Kevin K; Rana, Mohammad A

2016-01-01

The objectives of the study were to analyze the association between Parkinson's disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. This study included 123 Parkinson's disease patients and 123 non-Parkinson's disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. Parkinson's disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinson's disease patients' comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinson's disease only, Parkinson's disease anxiety, and Parkinson's disease depression patients. Pain interference, pain severity, and pain disability is greater among Parkinson's disease patients with anxiety and depression, in comparison to Parkinson's disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

Examining the relationship between endogenous pain modulation capacity and endurance exercise performance.

PubMed

Flood, Andrew; Waddington, Gordon; Cathcart, Stuart

2017-01-01

The aim of the current study was to examine the relationship between pain modulatory capacity and endurance exercise performance. Twenty-seven recreationally active males between 18 and 35 years of age participated in the study. Pain modulation was assessed by examining the inhibitory effect of a noxious conditioning stimulus (cuff occlusion) on the perceived intensity of a second noxious stimulus (pressure pain threshold). Participants completed two, maximal voluntary contractions followed by a submaximal endurance time task. Both performance tasks involved an isometric contraction of the non-dominant leg. The main analysis uncovered a correlation between pain modulatory capacity and performance on the endurance time task (r = -.425, p = .027), such that those with elevated pain modulation produced longer endurance times. These findings are the first to demonstrate the relationship between pain modulation responses and endurance exercise performance.

Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

PubMed Central

2011-01-01

ABSTRACT Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry. Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain. Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture. Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free. Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation. PMID:22379254

Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial.

PubMed

Wasser, Joseph G; Herman, Daniel C; Horodyski, MaryBeth; Zaremski, Jason L; Tripp, Brady; Page, Phillip; Vincent, Kevin R; Vincent, Heather K

2017-12-29

Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18-60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRS pain ). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count. The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that

Are differences in leg length predictive of lateral patello-femoral pain?

PubMed

Carlson, Mary; Wilkerson, Jerry

2007-03-01

Lateral patello-femoral pain can shorten an athletic career and generally decrease an individual's physical activity and functional level, such as preventing stair climbing and reducing the ability to rise from a chair. Leg length inequality is associated with patello-femoral pain. A leg length test that best distinguishes the difference between people who have lateral patello-femoral pain and those who do not would have clinical utility. The purpose of the present study was, first, to determine if unilateral, lateral patello-femoral pain was associated with the longer leg when inequality of leg lengths existed and, second, to determine if leg length direct measurement, indirect measurement or quadriceps angle (Q angle) could correctly classify participants according to the presence or absence of patello-femoral pain. The study used an ex post facto, two-group quasi-experimental design. A volunteer sample of 52 participants (14 males, 38 females), ranged in age from 18 to 52 years. Three methods were used to measure leg lengths: palpation meter (PALM) on anterior superior iliac spines (ASIS) while participants maintained centred weight-bearing position on a high resolution pressure mat; tape measurement from ASIS to medial malleolus (supine); tape measurement from ASIS to lateral malleolus (supine). Additionally, Q angle was measured in supine position. Patellar grind test, medial retinacular and lateral patellar palpation screened for patello-femoral pain. Logistic regression analysis determined correctness of membership in painful and non-painful patello-femoral groups. The PALM method of indirect measurement of leg length differences overall correctly classified approximately 83 % of the participants. Tape measure to medial and lateral malleoli as well as Q angle did not yield significant results. The results suggested that the PALM method of measuring leg length differences may have clinical utility in differentiating between patients who are likely to sustain

Pulmonary and leg VO2 during submaximal exercise: implications for muscular efficiency

NASA Technical Reports Server (NTRS)

Poole, D. C.; Gaesser, G. A.; Hogan, M. C.; Knight, D. R.; Wagner, P. D.

1992-01-01

Insights into muscle energetics during exercise (e.g., muscular efficiency) are often inferred from measurements of pulmonary gas exchange. This procedure presupposes that changes of pulmonary O2 (VO2) associated with increases of external work reflect accurately the increased muscle VO2. The present investigation addressed this issue directly by making simultaneous determinations of pulmonary and leg VO2 over a range of work rates calculated to elicit 20-90% of maximum VO2 on the basis of prior incremental (25 or 30 W/min) cycle ergometry. VO2 for both legs was calculated as the product of twice one-leg blood flow (constant-infusion thermodilution) and arteriovenous O2 content difference across the leg. Measurements were made 3-5 min after each work rate imposition to avoid incorporation of the VO2 slow component above the lactate threshold. For all 17 subjects, the slope of pulmonary VO2 (9.9 +/- 0.2 ml O2.W-1.min-1) was not different (P greater than 0.05) from that for leg VO2 (9.2 +/- 0.6 ml O2.W-1.min-1). Estimation of "delta" efficiency (i.e., delta work accomplished divided by delta energy expended, calculated from slope of VO2 vs. work rate and a caloric equivalent for O2 of 4.985 cal/ml) using pulmonary VO2 measurements (29.1 +/- 0.6%) was likewise not significantly different (P greater than 0.05) from that made using leg VO2 measurements (33.7 +/- 2.4%). These data suggest that the net VO2 cost of metabolic "support" processes outside the exercising legs changes little over a relatively broad range of exercise intensities. Thus, under the conditions of this investigation, changes of VO2 measured from expired gas reflected closely those occurring within the exercising legs.

Acute experimental hip muscle pain alters single-leg squat balance in healthy young adults.

PubMed

Hatton, Anna L; Crossley, Kay M; Hug, François; Bouma, James; Ha, Bonnie; Spaulding, Kara L; Tucker, Kylie

2015-05-01

Clinical musculoskeletal pain commonly accompanies hip pathology and can impact balance performance. Due to the cross-sectional designs of previous studies, and the multifactorial nature of musculoskeletal pain conditions, it is difficult to determine whether pain is a driver of balance impairments in this population. This study explored the effects of experimentally induced hip muscle pain on static and dynamic balance. Twelve healthy adults (4 women, mean[SD]: 27.1[3] years) performed three balance tasks on each leg, separately: single-leg standing (eyes closed), single-leg squat (eyes open), forward step (eyes open); before and after hypertonic saline injection (1ml, 5% NaCl) into the right gluteus medius. Range, standard deviation (SD), and velocity of the centre of pressure (CoP) in medio-lateral (ML) and anterior-posterior (AP) directions were considered. During the single-leg squat task, experimental hip pain was associated with significantly reduced ML range (-4[13]%, P=0.028), AP range (-14[21]%, P=0.005), APSD (-15[28]%, P=0.009), and AP velocity (-6[13]%, P=0.032), relative to the control condition, in both legs. No effect of pain was observed during single-leg standing and forward stepping. Significant between-leg differences in ML velocity were observed during the forward stepping task (P=0.034). Pain is a potentially modifiable patient-reported outcome in individuals with hip problems. This study demonstrates that acute hip muscle pain alone, without interference of musculoskeletal pathology, does not lead to the same impairments in balance as exhibited in clinical populations with hip pathologies. This is the first step in understanding how and why balance is altered in painful hip pathologies. Copyright © 2015 Elsevier B.V. All rights reserved.

Haemoglobin saturation during incremental arm and leg exercise.

PubMed Central

Powers, S. K.; Dodd, S.; Woodyard, J.; Beadle, R. E.; Church, G.

1984-01-01

There are few reports concerning the alterations in the percent of haemoglobin saturated with oxygen (%SO2) during non-steady state incremental exercise. Further, no data exist to describe the %SO2 changes during arm exercise. Therefore, the purpose of this study was made to assess the dynamic changes in %SO2 during incremental arm and leg work. Nine trained subjects (7 males and 2 females) performed incremental arm and leg exercise to exhaustion on an arm crank ergometer and a cycle ergometer, respectively. Ventilation and gas exchange measurements were obtained minute by minute via open circuit spirometry and changes in %SO2 were recorded via an ear oximeter. No significant difference (p greater than 0.05) existed between arm and leg work in end-tidal oxygen (PETO2), end-tidal carbon dioxide (PETCO2), or %SO2 when compared as a function of percent VO2 max. These results provide evidence that arterial O2 desaturation occurs in a similar fashion in both incremental arm and leg work with the greatest changes in %SO2 occurring at work rates greater than 70% VO2 max. PMID:6435715

Carotid baroreflex control of leg vasculature in exercising and non-exercising skeletal muscle in humans

PubMed Central

Melvin Keller, David; Fadel, Paul J; Ogoh, Shigehiko; Matthew Brothers, Robert; Hawkins, Megan; Olivencia-Yurvati, Al; Raven, Peter B

2004-01-01

Carotid baroreflex (CBR) function was examined in five men and three women (25 ± 1 years) using the variable-pressure neck collar technique at rest and during dynamic, one-legged knee extension exercise at 7 W and 25 W. The CBR exhibited control of leg vascular conductance (LVC) at rest and during exercise in both an exercising leg (EL) and a non-exercising leg (NEL) across a wide range of pressures from +40 Torr neck pressure (NP) to −80 Torr neck suction (NS). Specifically, increases in LVC (% change) in response to NS were no different across −20 to −80 Torr in either EL or NEL compared to rest, P > 0.05. However, CBR-mediated decreases in percentage LVC in response to NP were attenuated in EL at both 7 W (16 ± 1%) and 25 W (12 ± 1%) compared to rest (40 ± 3%; P < 0.05) as well as compared to responses in the NEL (36 ± 6% at 7 W and 36 ± 7% at 25 W; P < 0.05). This decrease in vascular responsiveness in EL was associated with a reduction in the gain of the percentage muscle sympathetic nerve activity (%MSNA)–%LVC relationship compared to rest (P < 0.05). Collectively, these data indicate that, despite a clear attenuation of the vascular response to MSNA in the exercising leg, CBR-mediated changes in mean arterial pressure were no different between rest and exercise. PMID:15388778

Novel approach to characterising individuals with low back-related leg pain: cluster identification with latent class analysis and 12-month follow-up.

PubMed

Stynes, Siobhán; Konstantinou, Kika; Ogollah, Reuben; Hay, Elaine M; Dunn, Kate M

2018-04-01

Traditionally, low back-related leg pain (LBLP) is diagnosed clinically as referred leg pain or sciatica (nerve root involvement). However, within the spectrum of LBLP, we hypothesised that there may be other unrecognised patient subgroups. This study aimed to identify clusters of patients with LBLP using latent class analysis and describe their clinical course. The study population was 609 LBLP primary care consulters. Variables from clinical assessment were included in the latent class analysis. Characteristics of the statistically identified clusters were compared, and their clinical course over 1 year was described. A 5 cluster solution was optimal. Cluster 1 (n = 104) had mild leg pain severity and was considered to represent a referred leg pain group with no clinical signs, suggesting nerve root involvement (sciatica). Cluster 2 (n = 122), cluster 3 (n = 188), and cluster 4 (n = 69) had mild, moderate, and severe pain and disability, respectively, and response to clinical assessment items suggested categories of mild, moderate, and severe sciatica. Cluster 5 (n = 126) had high pain and disability, longer pain duration, and more comorbidities and was difficult to map to a clinical diagnosis. Most improvement for pain and disability was seen in the first 4 months for all clusters. At 12 months, the proportion of patients reporting recovery ranged from 27% for cluster 5 to 45% for cluster 2 (mild sciatica). This is the first study that empirically shows the variability in profile and clinical course of patients with LBLP including sciatica. More homogenous groups were identified, which could be considered in future clinical and research settings.

Back pain was less explained than leg pain: a cross-sectional study using magnetic resonance imaging in low back pain patients with and without radiculopathy.

PubMed

Jensen, Ole Kudsk; Nielsen, Claus Vinther; Sørensen, Joan Solgaard; Stengaard-Pedersen, Kristian

2015-12-03

Cross-sectional studies have shown associations between lumbar degenerative manifestations on magnetic resonance imaging (MRI) and low back pain (LBP). Disc herniations and other degenerative manifestations, however, frequently occur in asymptomatic individuals. The purpose of this cross-sectional study was to analyze for associations between pain intensity and degenerative manifestations and other pain variables in patients for whom prognostic factors have been published previously. Included were 141 consecutive patients with and without radiculopathy, all sick-listed 1-4 months due to low back pain and subsequently examined by MRI of the lumbar spine. Using different methods of grouping the degenerative manifestations, linear regression analyses were performed with the intensity of back + leg pain, back pain and leg pain as dependent variables covering actual pain and pain the preceding 2 weeks. The clinical classification into +/- radiculopathy was established before and independently of the standardised description of MRI findings. Radiculopathy was present in 43 % of the patients. Pain was best explained using rank-ordered degenerative manifestations on MRI. Back pain and leg pain were differently associated, and back pain was less explained than leg pain in the multivariate analyses (15 % vs. 31 % of the variation). Back pain intensity was higher in patients with type 1 Modic changes and in some patients with nerve root touch, but was not associated with disc herniations. Leg pain intensity was well explained by disc herniations causing MRI nerve root compromise and radiculopathy. In patients with radiculopathy, nerve root touch caused as much leg pain as nerve root displacement or compression. High intensity zones and osteophytes were not associated with back pain, but only associated with leg pain in patients with radiculopathy. Tender points explained some of the back pain, and widespread pain explained leg pain in some of the patients without

[Pseudo-radicular referred leg pain].

PubMed

von Heymann, W

2015-12-01

Pseudo-radicular leg pain as initially described by Bruegger more than 55 years ago was at that time a genius explanation for so many non-radicular pain syndromes that needed not any kind of surgical intervention but in first line a manual treatment or a treatment by therapeutic local anesthetics. Today we describe this pain as a "referred pain" originating from other anatomic structures that may occur during the development of chronic pain. Nevertheless this pain is found in many patients and it still seems to be a big problem for many physicians and surgeons. Imaging does not help either. The history and the clinical symptoms, the examinations, the chain reactions in the motor system as well as the treatment options from the point of view of manual medicine are described.

Prior exercise and standing as strategies to circumvent sitting-induced leg endothelial dysfunction.

PubMed

Morishima, Takuma; Restaino, Robert M; Walsh, Lauren K; Kanaley, Jill A; Padilla, Jaume

2017-06-01

We have previously shown that local heating or leg fidgeting can prevent prolonged sitting-induced leg endothelial dysfunction. However, whether physical activity prevents subsequent sitting-induced leg endothelial dysfunction remains unknown. Herein, we tested the hypothesis that sitting-induced leg endothelial dysfunction would be prevented by prior exercise. We also examined if, in the absence of exercise, standing is an effective alternative strategy to sitting for conserving leg endothelial function. Fifteen young healthy subjects completed three randomized experimental trials: (1) sitting without prior exercise; (2) sitting with prior exercise; and (3) standing without prior exercise. Following baseline popliteal artery flow-mediated dilation (FMD) measurements, subjects maintained a supine position for 45 min in the sitting and standing trials, without prior exercise, or performed 45 min of leg cycling before sitting (i.e. sitting with prior exercise trial). Thereafter, subjects were positioned into a seated or standing position, according to the trial, for 3 h. Popliteal artery FMD measures were then repeated. Three hours of sitting without prior exercise caused a significant impairment in popliteal artery FMD (baseline: 3.8±0.5%, post-sitting: 1.5±0.5%, P <0.05), which was prevented when sitting was preceded by a bout of cycling exercise (baseline: 3.8±0.5%, post-sitting: 3.6±0.7%, P >0.05). Three hours of standing did not significantly alter popliteal artery FMD (baseline: 4.1±0.4%, post-standing: 4.3±0.4%, P >0.05). In conclusion, prolonged sitting-induced leg endothelial dysfunction can be prevented by prior aerobic exercise. In addition, in the absence of exercise, standing represents an effective substitute to sitting for preserving leg conduit artery endothelial function. © 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

Exercise does not produce hypoalgesia when performed immediately after a painful stimulus.

PubMed

Gajsar, Hannah; Nahrwold, Katharina; Titze, Christina; Hasenbring, Monika I; Vaegter, Henrik B

2018-04-25

Exercise-induced hypoalgesia (EIH) and conditioned pain modulation (CPM) are assumed to reflect descending pain inhibition. Potential interactions between EIH and CPM may be important in the therapy of chronic pain, as reduced CPM and increased pain after exercise are frequently observed. This study compared the EIH response after CPM was activated using a cold pressor task with the EIH response after a control condition. Thirty-one participants (age: 27.7±9.8; 15 female) completed two sessions: a cold pressor task (CPT) session, i.e. testing EIH with preceding CPM activation induced using a 2 min CPT at approximately 2°C, and a control session, i.e. testing EIH after a control condition (2 min of quiet rest). EIH was induced using a 15 min bicycling exercise at a target heart rate corresponding to 75% VO2 max. Repeated measures ANOVAs on pressure pain thresholds (PPTs) at the hand, back and leg were used to determine the effects of exercise after the cold pressor test and control condition. Furthermore, correlations between CPM and EIH, in the CPT session as well as control session, were calculated at each assessment site. A significant time x condition interaction (F(1, 30)=43.61, p<0.001, partial η2=0.59), with Bonferroni-corrected post-hoc t-tests showed that PPTs increased after exercise in the control session (p<0.001), but not in the CPT session (p=0.125). Furthermore, there was a small positive correlation of EIH in the control session and CPM at the hand (r=0.37, p=0.043). There was a moderate negative correlation of EIH in the CPT session and CPM at the hand (r=-0.50, p=0.004), and smaller negative correlations at the back (r=-0.37, p=0.036) and at the leg (r=-0.35, p=0.054). Attenuated EIH after the CPM activation in comparison to a control condition suggests that EIH and CPM may share underlying pain inhibitory mechanisms on a systemic level. This assumption is further supported by the finding of small to moderate significant correlations between EIH

Effects of functional training on pain, leg strength, and balance in women with fibromyalgia.

PubMed

Latorre Román, Pedro Ángel; Santos E Campos, María Aparecida; García-Pinillos, Felipe

2015-01-01

The aim of this study was to analyze the effect of 18-week functional training (FT) program consisting in two sessions a week of in-water exercise and one of on-land exercise on pain, strength, and balance in women with fibromyalgia. A sample consisting of 36 fibromyalgia patients was included in the study. The patients were allocated randomly into the experimental group (EG, n = 20), and control group (CG, n = 16). Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand and handgrip strength) and agility/dynamic balance and static balance. Fibromyalgia impact and pain were analyzed by Fibromyalgia Impact Questionnaire (FIQ), tender points (TPs), visual analog scale (VAS). We observed a significant reduction in the FIQ (p = 0.042), the algometer scale of TP (p = 0.008), TP (p < 0.001), and VAS (p < 0.001) in the EG. The EG shows better results in leg strength (p < 0.001), handgrip strength (p = 0.025), agility/dynamic balance (p = 0.032) and balance (p = 0.006). An 18-week intervention consisting in two sessions of in-water exercise and one session of on-land exercise of FT reduces pain and improves functional capacity in FM patients. These results suggested that FT could play an important role in maintaining an independent lifestyle in patients with FM.

Patients' Attitudes Toward Nonphysician Screening of Low Back and Low Back Related Leg Pain Complaints Referred for Surgical Assessment.

PubMed

Rempel, Joshua; Busse, Jason W; Drew, Brian; Reddy, Kesava; Cenic, Aleksa; Kachur, Edward; Murty, Naresh; Candelaria, Henry; Moore, Ainsley E; Riva, John J

2017-03-01

A questionnaire survey. The aim of this study was to explore patient attitudes toward screening to assess suitability for low back surgery by nonphysician health care providers. Canadian spine surgeons have shown support for nonphysician screening to assess and triage patients with low back pain and low back related leg pain. However, patients' attitudes toward this proposed model are largely unknown. We administered a 19-item cross-sectional survey to adults with low back and/or low back related leg pain who were referred for elective surgical assessment at one of five spine surgeons' clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by nonphysician health care providers. Eighty low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a nonphysician health care provider to establish whether they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a nonphysician health care provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons' and nonphysicians' determination of surgical candidates. Patients referred for surgical consultation for low back or low back related leg pain are largely willing to accept screening by nonphysician health care providers. Future research should explore the concordance of screening results between surgeon and nonphysician health care providers. 3.

(31)P cardiac magnetic resonance spectroscopy during leg exercise at 3 Tesla.

PubMed

Hudsmith, Lucy E; Tyler, Damian J; Emmanuel, Yaso; Petersen, Steffen E; Francis, Jane M; Watkins, Hugh; Clarke, Kieran; Robson, Matthew D; Neubauer, Stefan

2009-12-01

Investigation of phosphorus ((31)P) magnetic resonance spectroscopy under stress conditions provides a non-invasive tool to examine alterations in cardiac high-energy phosphate metabolism that may not be evident at rest. Our aim was to establish cardiac (31)P MR spectroscopy during leg exercise at 3T. The increased field strength should provide a higher signal to noise ratio than at lower field strengths. Furthermore, relatively high temporal resolution at a sufficiently fine spatial resolution should be feasible. (31)P MR spectra were obtained with a 3D acquisition weighted chemical shift imaging sequence in 20 healthy volunteers at rest, during dynamic physiological leg exercise and after recovery at 3T. Haemodynamic measurements were made throughout and the rate pressure product calculated. With exercise, the mean heart rate increased by 73%, achieving a mean increase in rate pressure product of 115%. The corrected PCr/ATP ratio for subjects at rest was 2.02 +/- 0.43, exercise 2.14 +/- 0.67 (P = 0.54 vs. rest) and at recovery 2.03 +/- 0.52 (P = 0.91 vs. rest, P = 0.62 vs. exercise). A cardiac (31)P MR spectroscopy physiological exercise-recovery protocol is feasible at 3T. There was no significant change in high-energy cardiac phosphate metabolite concentrations in healthy volunteers at rest, during physiological leg exercise or during recovery. When applied to patients with heart disease, this protocol should provide insights into physiological and pathological cardiac metabolism.

Decreased muscle oxygenation and increased arterial blood flow in the non-exercising limb during leg exercise.

PubMed

Shiroishi, Kiyoshi; Kime, Ryotaro; Osada, Takuya; Murase, Norio; Shimomura, Kousuke; Katsumura, Toshihito

2010-01-01

We evaluated arterial blood flow, muscle tissue oxygenation and muscle metabolism in the non-exercising limb during leg cycling exercise. Ten healthy male volunteers performed a graded leg cycling exercise at 0, 40, 80, 120 and 160 watts (W) for 5 min each. Tissue oxygenation index (TOI) of the non-exercising left forearm muscle was measured using a near-infrared spatially resolved spectroscopy (NIR(SRS)), and non-exercising forearm blood flow ((NONEX)FBF) in the brachial artery was also evaluated by a Doppler ultrasound system. We also determined O(2) consumption of the non-exercising forearm muscle (NONEXV(O)(2mus)) by the rate of decrease in O(2)Hb during arterial occlusion at each work rate. TOI was significantly decreased at 160 W (p < 0.01) compared to the baseline. The (NONEX)V(O)(2mus) at each work rate was not significantly increased. In contrast, (NONEX)FBF was significantly increased at 120 W (p < 0.05) and 160 W (p < 0.01) compared to the baseline. These results suggest that the O(2) supply to the non-exercising muscle may be reduced, even though (NONEX)FBF increases at high work rates during leg cycling exercise.

Radiating leg pain and positive straight leg raising in spondylolysis in children.

PubMed

Halperin, N; Copeliovitch, L; Schachner, E

1983-09-01

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain.

PubMed

Sandal, L F; Roos, E M; Bøgesvang, S J; Thorlund, J B

2016-04-01

Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with acute exercise-induced pain flares in persons with knee or hip pain. Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. Joint pain was reduced from baseline (NRS 3.6; 95% CI 3.2-4.1) to 8-weeks follow-up (2.6; 95% CI 2.1-3.1), (P < 0.01). Pain decreased 0.04 NRS (95% CI 0.02-0.05, P < 0.01) on average per exercise session and pre- to post-exercise pain decreased 0.04 NRS (95% CI 0.03-0.05, P < 0.01) on average per session, approaching no acute exercise-induced pain in the last weeks. This study found a clear decrease in size of acute exercise-induced pain flares with increasing number of exercise sessions. In parallel, pain ratings decreased over the 8 weeks exercise period. Our findings provide helpful information for clinicians, which can be used to educate and balance patient expectation when starting supervised neuromuscular exercise. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The effect of exercise on vaccine-related pain, anxiety and fear during HPV vaccinations in adolescents.

PubMed

Lee, V Y; Booy, R; Skinner, R; Edwards, K M

2018-05-31

With increased school-based vaccinations for improved coverage rates and practicality, the World Health Organization (WHO) recently endorsed research to identify possible interventions to reduce vaccine-related pain in mass clinical and school-based settings. In particular, the lack of research in adolescents indicate a particular need in this population. Acute exercise has analgesic effects and has been used as a behavioural adjuvant to vaccination. Here, we examine the effect of exercise on vaccine-related pain, anxiety and fear in adolescents, during a school-based program for HPV vaccinations. 116 students (Female: 61, Male: 55) aged 11-13 years were randomly allocated to either an Exercise (n = 60) or Control (n = 56) group. All participants completed demographic and Trait-anxiety questionnaires prior to receiving the vaccine according to usual care. The Exercise group also performed upper body exercise for 15 min prior to receiving the vaccine. Immediately after the vaccine administration, all participants reported on pain, anxiety and fear at the time of receiving the vaccine. Female adolescents in the Exercise group reported significantly less pain (3.64; 95% CI, 2.98-4.30) than Controls (4.58; 95% CI, 3.96-5.19; p = 0.04). Further, females reported greater pain and anxiety than males in the Control group but not the Exercise group. This study supports the use of exercise prior to vaccine administration, especially in female adolescents who are particularly vulnerable to negative experiences during vaccination procedures. Furthermore, the ease of application, as well as the benefit of exercise, provides support for the use of simple exercise prior to vaccination in mass vaccination settings. Clinical trial registry: ANZCTR, ACTRN12614001185651. Copyright © 2018 Elsevier Ltd. All rights reserved.

Atorvastatin Increases Exercise Leg Blood Flow in Healthy Adults

PubMed Central

Parker, Beth A.; Capizzi, Jeffrey A.; Augeri, Amanda L.; Grimaldi, Adam S.; White, C. Michael; Thompson, Paul D.

2011-01-01

OBJECTIVES We sought to examine the effect of atorvastatin therapy on exercise leg blood flow in healthy middle-aged and older, men and women. BACKGROUND The vasodilatory response to exercise decreases in humans with aging and disease and this reduction may contribute to reduced exercise capacity. METHODS We used a double-blind, randomly assigned, placebo-controlled protocol to assess the effect of atorvastatin treatment on exercising leg hemodynamics. We measured femoral artery blood flow (FBF) using Doppler ultrasound and calculated femoral vascular conductance (FVC) from brachial mean arterial pressure (MAP) before and during single knee-extensor exercise in healthy adults (ages 40–71) before (PRE) and after (POST) 6 months of 80 mg atorvastatin (A: 14 men, 16 women) or placebo (P: 14 men, 22 women) treatment. FBF and FVC were normalized to exercise power output and estimated quadriceps muscle mass. RESULTS Atorvastatin reduced LDL cholesterol by approximately 50%, but not in the placebo group (p < 0.01). Atorvastatin also increased exercise FBF from 44.2 ± 19.0 to 51.4 ± 22.0 mL/min/W/kg muscle whereas FBF in the placebo group was unchanged (40.1 ± 16.0 vs 39.5 ± 16.1) (p <0.01). FVC also increased with atorvastatin from 0.5 ± 0.2 to. 0.6 ± 0.2 mL/min/mmHg/W/kg muscle, but not in the placebo subjects (P: 0.4 ± 0.2 vs 0.4 ± 0.2) ( p < 0.01). CONCLUSIONS High-dose atorvastatin augments exercising leg hyperemia. Statins may mitigate reductions in the exercise vasodilatory response in humans that are associated with aging and disease. PMID:22018642

Effect Of Leg Exercise On Vascular Volumes During Bed Rest

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Vernikos, J.; Wade, C. E.; Barnes, P. R.

1993-01-01

Report describes experiments on effects of no-exercise regimen and of two leg-exercise regimens on volumes of plasma, volumes of red blood cells, densities of bodies, and water balances of 19 men (32 to 42 years old) confined to minus 6 degrees-head-down bed rest for 30 days. Purpose of study to determine whether either or both exercise regimens maintain plasma volume and to relate levels of hypovolemia to body fluid balances. Results showed during bed rest, plasma volume maintained in isotomic group but not in other two groups, and no significant differences in body densities, body weights, or water balances among three groups. Concludes isotonic-exercise regimen better than isokinetic-exercise regimen for maintaining plasma volume during prolonged exposure to bed rest.

Modest Amounts of Voluntary Exercise Reduce Pain- and Stress-Related Outcomes in a Rat Model of Persistent Hind Limb Inflammation.

PubMed

Pitcher, Mark H; Tarum, Farid; Rauf, Imran Z; Low, Lucie A; Bushnell, Catherine

2017-06-01

Aerobic exercise improves outcomes in a variety of chronic health conditions, yet the support for exercise-induced effects on chronic pain in humans is mixed. Although many rodent studies have examined the effects of exercise on persistent hypersensitivity, the most used forced exercise paradigms that are known to be highly stressful. Because stress can also produce analgesic effects, we studied how voluntary exercise, known to reduce stress in healthy subjects, alters hypersensitivity, stress, and swelling in a rat model of persistent hind paw inflammation. Our data indicate that voluntary exercise rapidly and effectively reduces hypersensitivity as well as stress-related outcomes without altering swelling. Moreover, the level of exercise is unrelated to the analgesic and stress-reducing effects, suggesting that even modest amounts of exercise may impart significant benefit in persistent inflammatory pain states. Modest levels of voluntary exercise reduce pain- and stress-related outcomes in a rat model of persistent inflammatory pain, independently of the amount of exercise. As such, consistent, self-regulated activity levels may be more relevant to health improvement in persistent pain states than standardized exercise goals. Published by Elsevier Inc.

The bothersomeness of sciatica: patients' self-report of paresthesia, weakness and leg pain.

PubMed

Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar; Grotle, Margreth

2010-02-01

The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A cross-sectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica.

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

PubMed Central

Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju

2015-01-01

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests. PMID:26024534

Effect of Exercise Intensity on Percent Body Fat Determined by Leg-to-Leg and Segmental Bioelectrical Impedance Analyses in Adults

ERIC Educational Resources Information Center

Andreacci, Joseph L.; Nagle, Trisha; Fitzgerald, Elise; Rawson, Eric S.; Dixon, Curt B.

2013-01-01

Purpose: We examined the impact that cycle ergometry exercise had on percent body fat (%BF) estimates when assessed using either leg-to-leg or segmental bioelectrical impedance analysis (LBIA; SBIA) and whether the intensity of the exercise bout impacts the %BF magnitude of change. Method: Seventy-four college-aged adults participated in this…

The effect of exercise frequency on neuropathic pain and pain-related cellular reactions in the spinal cord and midbrain in a rat sciatic nerve injury model

PubMed Central

Sumizono, Megumi; Otsuka, Shotaro; Terashi, Takuto; Nakanishi, Kazuki; Ueda, Koki; Takada, Seiya; Kikuchi, Kiyoshi

2018-01-01

Background Exercise regimens are established methods that can relieve neuropathic pain. However, the relationship between frequency and intensity of exercise and multiple cellular responses of exercise-induced alleviation of neuropathic pain is still unclear. We examined the influence of exercise frequency on neuropathic pain and the intracellular responses in a sciatic nerve chronic constriction injury (CCI) model. Materials and methods Rats were assigned to four groups as follows: CCI and high-frequency exercise (HFE group), CCI and low-frequency exercise (LFE group), CCI and no exercise (No-Ex group), and naive animals (control group). Rats ran on a treadmill, at a speed of 20 m/min, for 30 min, for 5 (HFE) or 3 (LFE) days a week, for a total of 5 weeks. The 50% withdrawal threshold was evaluated for mechanical sensitivity. The activation of glial cells (microglia and astrocytes), expression of brain-derived neurotrophic factor (BDNF) and μ-opioid receptor in the spinal dorsal horn and endogenous opioid in the midbrain were examined using immunohistochemistry. Opioid receptor antagonists (naloxone) were administered using intraperitoneal injection. Results The development of neuropathic pain was related to the activation of glial cells, increased BDNF expression, and downregulation of the μ-opioid receptor in the ipsilateral spinal dorsal horn. In the No-Ex group, neuropathic pain showed the highest level of mechanical hypersensitivity at 2 weeks, which improved slightly until 5 weeks after CCI. In both exercise groups, the alleviation of neuropathic pain was accelerated through the regulation of glial activation, BDNF expression, and the endogenous opioid system. The expression of BDNF and endogenous opioid in relation to exercise-induced alleviation of neuropathic pain differed in the HFE and LFE groups. The effects of exercise-induced alleviation of mechanical hypersensitivity were reversed by the administration of naloxone. Conclusion The LFE and HFE

Exercise reduces C-reactive protein and improves physical function in automotive workers with low back pain.

PubMed

Kim, Sang Kook; Jung, Ilho; Kim, Jae Hee

2008-06-01

Little is known about the effect of exercise on C-reactive protein (CRP) in patients with low back pain (LBP). The aim of the study was to investigate the effects of 8-week exercise intervention on CRP and physical function in automotive workers with LBP. Thirteen male workers (40 +/- 6 years) with LBP completed an 8-week multicomponent exercise intervention program which consisted of resistance training, swimming, stretching and hiking. Serum CRP concentration and physical functions were measured at baseline and after 8-week exercise intervention. Compared to baseline, CRP levels decreased by 38% (P = 0.005), back flexibility improved, isokinetic leg strengths increased (all P < 0.05), and back strength tended to increase. The results of the present study show that CRP levels decrease with exercise in subjects with LBP and physical function improves. This suggests that exercise-related decreases in inflammation in persons with LBP are associated with improvements in physical function.

Habitual exercise training in older adults offsets the age-related prolongation in leg vasodilator kinetics during single limb lower body exercise.

PubMed

Hughes, William E; Kruse, Nicholas T; Ueda, Kenichi; Casey, Darren P

2018-06-01

We tested the hypothesis that aging is associated with prolonged leg vasodilator kinetics and habitual exercise training in older adults improves these responses relative to untrained older adults. Additionally, we examined the relationship between contraction-induced rapid onset vasodilation (ROV) and vasodilator kinetics. Young (n=10), older untrained (n=13) and older trained (n=14) adults performed single and rhythmic knee-extension contractions at 20% and 40% work-rate maximum (WR max ). Femoral artery diameter and mean blood velocity were measured by Doppler ultrasound. Vascular conductance (VC; ml·min -1 ·mmHg-1) was calculated using blood flow (ml·min -1 ) and mean arterial pressure (mmHg). The primary outcome was the kinetic response (mean response time; MRT), modeled using an exponential model, expressed as the number of duty cycles to change 63% of the steady-state amplitude. There was no age or training related differences in VC MRT between the groups at 20% WR max . Older untrained adults exhibited prolonged VC MRT at 40% WR max relative to young (37{plus minus}16 vs. 24{plus minus}10 duty-cycles; P<0.05) and older trained adults (37{plus minus}16 vs. 23{plus minus}14 duty-cycles; P<0.05). There were no differences in VC MRT between young and older trained adults at 40% WR max (P=0.96). There were no associations between peak ROV and VC MRT at 20% or 40% WR max (r=-0.08 and 0.22; P=0.67 and 0.20, respectively) in the group as a whole. Our data suggest 1) advancing age prolongs leg vasodilator kinetics; 2) habitual exercise training in older adults offsets this age-related prolongation; and 3) contraction-induced ROV is not related to vasodilator kinetics within a group of young and older adults.

Prediction of adaptive self-regulatory responses to arthritis pain anxiety in exercising adults: does pain acceptance matter?

PubMed

Cary, Miranda Ashley; Gyurcsik, Nancy C; Brawley, Lawrence R

2015-01-01

Exercising for ≥ 150 min/week is a recommended strategy for self-managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear-avoidance model, individuals may confront their pain anxiety by using adaptive self-regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety-self-regulatory responses relationship may vary as a function of individuals' pain acceptance levels. To investigate pain acceptance as a moderator of the pain anxiety-adaptive self-regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain-related and self-regulatory responses. Adults (mean [± SD] age 49.75 ± 13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain-related variables and self-regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified. Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety-adaptive self-regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose. Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self-regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule).

Prediction of adaptive self-regulatory responses to arthritis pain anxiety in exercising adults: Does pain acceptance matter?

PubMed Central

Cary, Miranda A; Gyurcsik, Nancy C; Brawley, Lawrence R

2015-01-01

BACKGROUND: Exercising for ≥150 min/week is a recommended strategy for self-managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear-avoidance model, individuals may confront their pain anxiety by using adaptive self-regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety-self-regulatory responses relationship may vary as a function of individuals’ pain acceptance levels. OBJECTIVES: To investigate pain acceptance as a moderator of the pain anxiety-adaptive self-regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain-related and self-regulatory responses. METHODS: Adults (mean [± SD] age 49.75±13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain-related variables and self-regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified. RESULTS: Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety-adaptive self-regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose. CONCLUSIONS: Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self-regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule). PMID:25621990

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

PubMed Central

Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar; Grotle, Margreth

2009-01-01

The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A cross-sectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica. PMID:19488793

Carryover effect of hip and knee exercises program on functional performance in individuals with patellofemoral pain syndrome

PubMed Central

Ahmed Hamada, Hamada; Hussein Draz, Amira; Koura, Ghada Mohamed; Saab, Ibtissam M.

2017-01-01

[Purpose] This study was carried out to investigate the carryover effect of hip and knee exercises program on functional performance (single legged hop test as functional performance test and Kujala score for functional activities). [Subjects and Methods] Thirty patients with patellofemoral pain syndrome were randomly assigned into two equal groups. Group (A) consisted of 15 patients undergoing hip strengthening exercises for four weeks then measuring all variables followed by additional four weeks of knee exercises program then measuring all variables again. Group (B): consisted of 15 patients undergoing knee exercises program for four weeks then measuring all variables followed by additional four weeks of hip strengthening exercises then measuring all variables. Functional abilities and knee muscles performance were assessed using Kujala questionnaire and single legged hop test respectively pre and after the completion of the first 4 weeks then after 8 weeks for both groups. [Results] Significantly increase in Kujala questionnaire in group A compared with group B was observed. While, there were significant increase in single legged hop performance test in group B compared with group A. [Conclusion] Starting with hip exercises improve the performance of subjects more than functional activities while starting with knee exercises improve the functional activities of subjects more than performance. PMID:28878459

Carryover effect of hip and knee exercises program on functional performance in individuals with patellofemoral pain syndrome.

PubMed

Ahmed Hamada, Hamada; Hussein Draz, Amira; Koura, Ghada Mohamed; Saab, Ibtissam M

2017-08-01

[Purpose] This study was carried out to investigate the carryover effect of hip and knee exercises program on functional performance (single legged hop test as functional performance test and Kujala score for functional activities). [Subjects and Methods] Thirty patients with patellofemoral pain syndrome were randomly assigned into two equal groups. Group (A) consisted of 15 patients undergoing hip strengthening exercises for four weeks then measuring all variables followed by additional four weeks of knee exercises program then measuring all variables again. Group (B): consisted of 15 patients undergoing knee exercises program for four weeks then measuring all variables followed by additional four weeks of hip strengthening exercises then measuring all variables. Functional abilities and knee muscles performance were assessed using Kujala questionnaire and single legged hop test respectively pre and after the completion of the first 4 weeks then after 8 weeks for both groups. [Results] Significantly increase in Kujala questionnaire in group A compared with group B was observed. While, there were significant increase in single legged hop performance test in group B compared with group A. [Conclusion] Starting with hip exercises improve the performance of subjects more than functional activities while starting with knee exercises improve the functional activities of subjects more than performance.

A system for evaluation and exercise-conditioning of paralyzed leg muscles.

PubMed

Gruner, J A; Glaser, R M; Feinberg, S D; Collins, S R; Nussbaum, N S

1983-07-01

The purpose of this project was to develop instrumentation and protocols in which electrical stimulation is used to induce exercise in paralyzed quadriceps muscles strength and endurance evaluation and conditioning. A computer-controlled electrical stimulation system, using surface electrodes, automatically regulates the bouts of leg extension exercise. Load weights attached just above the ankles can be progressively increased over a number of training sessions in such a manner that a measure of the fitness of the legs can be obtained. With three exercise sessions per week for 9 weeks, the strength and endurance of the quadriceps muscles of two paraplegic and four quadriplegic subjects were gradually and safely increased. During exercise at a means load weight of 5.4 kg, means heart rate did not rise above rest, whereas systolic blood pressure increased about 20 mm Hg, and skin temperature above the active muscles increased about 1.75 degrees C. Such exercise conditioning appears to be safe and may provide important health benefits, including improved fitness of the muscles and bones, better circulation in the paralyzed limbs, and enhanced self-image. Conditioned electrically stimulated paralyzed leg muscles may be used for locomotion in conjunction with special vehicles.

Simvastatin-lnduced nocturnal leg pain disappears with pravastatin substitution.

PubMed

Stojaković, Natasa; Igić, Rajko

2013-01-01

Statins have similar side effects that do not always occur at the same rate among the various statins. We present a case of simvastatin-induced muscle toxicity that disappeared when pravastatin was substituted for the original drug. A 74-year-old male, a nonsmoker, complained of severe nocturnal leg cramps. The patient also complained that similar painful cramping occurred when he walked rapidly or jogged. Because some components of his lipid panel exceeded the'desirable' range, and as he had a history of myocardial infarction, his family physician prescribed simvastatin (40 mg/day). The patient had taken this medication for the past eight years. The painful nocturnal episodes started two years ago and affected either one or the other leg. Four months ago we discontinued his simvastatin and prescribed pravastatin (80 mg/day). At a follow-up visit six weeks later, the patient reported that his leg pains at night and the pain experienced after brisk walking had disappeared. Four months after the substitution of pravastatin for simvastatin, the patient reported that his complete lack of symptoms had continued. These painful muscle cramps were probably caused by an inadequate vascular supply to the calf and foot muscles. Perhaps a combination of advanced age and atherosclerotic changes created a predisposition for the simvastatin-induced leg cramps. Pravastatin differs from simvastatin in several ways.l It is not metabolized by cytochrome P450 (CYP) 3A4 oxidases, and thus is not influenced by CYP 3A4 inhibitors like simvastatin. Also, simvastatin is associated with single-nucleotide polymorphisms located within the SLCO1B1 gene on the chromosome 12 and established myopathy, while pravastatin lacks this association. These differences may contribute to increased tolerance to pravastatin in this particular case.

Haemodynamic responses to dehydration in the resting and exercising human leg.

PubMed

Pearson, James; Kalsi, Kameljit K; Stöhr, Eric J; Low, David A; Barker, Horace; Ali, Leena; González-Alonso, José

2013-06-01

Dehydration and hyperthermia reduces leg blood flow (LBF), cardiac output ([Formula: see text]) and arterial pressure during whole-body exercise. It is unknown whether the reductions in blood flow are associated with dehydration-induced alterations in arterial blood oxygen content (C aO2) and O2-dependent signalling. This study investigated the impact of dehydration and concomitant alterations in C aO2 upon LBF and [Formula: see text]. Haemodynamics, arterial and femoral venous blood parameters and plasma [ATP] were measured at rest and during one-legged knee-extensor exercise in 7 males in four conditions: (1) control, (2) mild dehydration, (3) moderate dehydration, and (4) rehydration. Relative to control, C aO2 and LBF increased with dehydration at rest and during exercise (C aO2: from 199 ± 1 to 208 ± 2, and 202 ± 2 to 210 ± 2 ml L(-1) and LBF: from 0.38 ± 0.04 to 0.77 ± 0.09, and 1.64 ± 0.09 to 1.88 ± 0.1 L min(-1), respectively). Similarly, [Formula: see text] was unchanged or increased with dehydration at rest and during exercise, whereas arterial and leg perfusion pressures declined. Following rehydration, C aO2 declined (to 193 ± 2 mL L(-1)) but LBF remained elevated. Alterations in LBF were unrelated to C aO2 (r (2) = 0.13-0.27, P = 0.48-0.64) and plasma [ATP]. These findings suggest dehydration and concomitant alterations in C aO2 do not compromise LBF despite reductions in plasma [ATP]. While an additive or synergistic effect cannot be excluded, reductions in LBF during exercise with dehydration may not necessarily be associated with alterations in C aO2 and/or intravascular [ATP].

Musculoskeletal pains in relation to different sport and exercise activities in youth.

PubMed

Auvinen, Juha P; Tammelin, Tuija H; Taimela, Simo P; Zitting, Paavo J; Mutanen, Pertti O A; Karppinen, Jaro I

2008-11-01

We examined the associations between participation in different sports and exercise activities and neck, shoulder, and low back pains in adolescents. This population-based study included the members of the Northern Finland Birth Cohort 1986, who, at the age of 15 to 16 yr, completed a questionnaire including items about their musculoskeletal pains and participation in various sport and exercise activities (N = 6945). Logistic regression analysis was used to evaluate how musculoskeletal pains are associated a) with participation in a certain type of sport or exercise activity and b) with the clusters formed by latent class analysis (LCA) according to the adolescents' profiles of participation in different sport and exercise activities. Participation in certain sports showed some direct and inverse associations with musculoskeletal pains when adjusted for participation in other sports and for the amount of physical activity. However, after grouping the individuals into clusters by their participation in different sports, these associations vanished. Only the cluster characterized by boys' active participation in several sports (i.e., ice hockey, cycling, ice-skating, soccer, floorball, rinkball/bandy, swimming, roller-skating/skateboarding, Finnish baseball) had lower prevalence of neck pain compared with the physically inactive group. Physically active adolescents usually engage in several different sport and exercise activities, which make associations between single sports and musculoskeletal pains inconsequential in the general population of adolescents. Participation in several sports seemed to protect from harmful effects of a single risk sport. However, this finding cannot be generalized to adolescent elite athletes who are often involved in intense training for a single sport.

Muscle pain perception and sympathetic nerve activity to exercise during opioid modulation

NASA Technical Reports Server (NTRS)

Cook, D. B.; O'Connor, P. J.; Ray, C. A.

2000-01-01

The purpose of this experiment was to examine the effects of the endogenous opioid system on forearm muscle pain and muscle sympathetic nerve activity (MSNA) during dynamic fatiguing exercise. Twelve college-age men (24 +/- 4 yr) performed graded (1-min stages; 30 contractions/min) handgrip to fatigue 1 h after the ingestion of either 60 mg codeine, 50 mg naltrexone, or placebo. Pain (0-10 scale) and exertion (0-10 and 6-20 scales) intensities were measured during the last 15 s of each minute of exercise and every 15 s during recovery. MSNA was measured continuously from the peroneal nerve in the left leg. Pain threshold occurred earlier [1.8 +/- 1, 2. 2 +/- 1, 2.2 +/- 1 J: codeine, naltrexone, and placebo, respectively] and was associated with a lower rating of perceived exertion (RPE) (2.7 +/- 2, 3.6 +/- 2, 3.8 +/- 2: codeine, naltrexone, and placebo, respectively) in the codeine condition compared with either the naltrexone or placebo conditions. There were no main effects (i.e., drugs) or interaction (i.e., drugs x time) for either forearm muscle pain or RPE during exercise [pain: F (2, 22) = 0.69, P = 0.51]. There was no effect of drug on MSNA, heart rate, or blood pressure during baseline, exercise, or recovery. Peak exercise MSNA responses were 21 +/- 1, 21 +/- 2.0, and 21 +/- 2.0 bursts/30 s for codeine, naltrexone, and placebo conditions, respectively. Peak mean arterial pressure responses were 135 +/- 4, 131 +/- 3, and 132 +/- 4 mmHg for codeine, naltrexone, and placebo conditions, respectively. It is concluded that neither 60 mg codeine nor 50 mg naltrexone has an effect on forearm muscle pain, exertion, or MSNA during high- intensity handgrip to fatigue.

Older Age and Leg Pain Are Good Predictors of Pain and Disability Outcomes in 2710 Patients Who Receive Lumbar Fusion.

PubMed

Cook, Chad E; Frempong-Boadu, Anthony K; Radcliff, Kristen; Karikari, Isaac; Isaacs, Robert

2015-10-01

Identifying appropriate candidates for lumbar spine fusion is a challenging and controversial topic. The purpose of this study was to identify baseline characteristics related to poor/favorable outcomes at 1 year for a patient who received lumbar spine fusion. The aims of this study were to describe baseline characteristics of those who received lumbar surgery and to identify baseline characteristics from a spine repository that were related to poor and favorable pain and disability outcomes for patient who received lumbar fusion (with or without decompression), who were followed up for 1 full year and discriminate predictor variables that were either or in contrast to prognostic variables reported in the literature. This study analyzed data from 2710 patients who underwent lumbar spine fusion. All patient data was part of a multicenter, multi-national spine repository. Ten relatively commonly captured data variables were used as predictors for the study. Univariate/multivariate logistic regression analyses were run against outcome variables of pain/disability. Multiple univariate findings were associated with pain/disability outcomes at 1 year including age, previous surgical history, baseline disability, baseline pain, baseline quality of life scores, and leg pain greater than back pain. Notably significant multivariate findings for both pain and disability include older age, previous surgical history, and baseline mental summary scores, disability, and pain. Leg pain greater than back pain and older age may yield promising value when predicting positive outcomes. Other significant findings may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.

Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.

PubMed

Celli, B R; Rassulo, J; Make, B J

1986-06-05

Some patients with chronic airflow obstruction experience dyspnea with mild arm exercise but not with more-intense leg exercise. To investigate why these patients have limited endurance during arm exertion, we studied ventilatory responses to exercise with unsupported arms in 12 patients with chronic airflow obstruction (mean [+/- SD] forced expiratory volume in one second, 0.68 +/- 0.28 liters). Unloaded leg cycling was also studied for comparison. In the five patients who had the most severe airflow obstruction, arm exercise was limited by dyspnea after 3.3 +/- 0.7 minutes, and dyssynchronous thoracoabdominal breathing developed. In the other seven patients, arm exercise was limited by the sensation of muscle fatigue after 6.1 +/- 2.0 minutes (P less than 0.05), and dyssynchronous breathing did not occur. None of the 12 patients had dyssynchronous breathing during unloaded leg cycling. Maximal transdiaphragmatic pressure, a measure of diaphragmatic fatigue, declined similarly after arm and leg exercise in both groups. During unsupported arm work, the accessory muscles of inspiration help position the torso and arms. We hypothesize that the extra demand placed on these muscles during arm exertion leads to early fatigue, an increased load on the diaphragm, and dyssynchronous thoracoabdominal inspirations. This sequence may contribute to dyspnea and limited endurance during upper-extremity exercise.

Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis.

PubMed

Augustsson, J; Thomeé, R; Lindén, C; Folkesson, M; Tranberg, R; Karlsson, J

2006-04-01

A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and

The effect of starting or stopping skin cooling on the thermoregulatory responses during leg exercise in humans.

PubMed

Demachi, K; Yoshida, T; Kume, M; Tsuneoka, H

2012-07-01

To assess the effects of starting or stopping leg cooling on the thermoregulatory responses during exercise, 60 min of cycling exercise at 30% of maximal oxygen uptake was performed under 4 conditions using tube trouser perfused with water at 10 °C; no leg cooling (NC), starting of leg cooling after 30 min of exercise (delayed cooling, DC), continuous leg cooling (CC), and stopping of continuous leg cooling after 30 min of exercise (SC) at an environmental temperature of 28.5 °C. During exercise under the DC conditions, an instantaneous increase in the esophageal temperature (Tes), a suppression of the cutaneous vascular conductance at the forearm (%CVC), and a decrease in the mean skin temperature (Tsk) were observed after leg cooling. The total sweat loss (Δm sw,tot) was lower under the DC than the NC condition. In the SC study, however, the Tes remained constant, while the %CVC increased gradually after leg cooling was stopped, and the Δm sw,tot was greater than that under the CC condition. These results suggest that during exercise, rapid skin cooling of the leg may cause an increase in core temperature, while also enhancing thermal stress. However, stopping skin cooling did not significantly affect the core temperature long-term, because the skin blood flow and sweat rate subsequently increased. © Georg Thieme Verlag KG Stuttgart · New York.

Influence of respiratory muscle work on VO(2) and leg blood flow during submaximal exercise.

PubMed

Wetter, T J; Harms, C A; Nelson, W B; Pegelow, D F; Dempsey, J A

1999-08-01

The work of breathing (W(b)) normally incurred during maximal exercise not only requires substantial cardiac output and O(2) consumption (VO(2)) but also causes vasoconstriction in locomotor muscles and compromises leg blood flow (Q(leg)). We wondered whether the W(b) normally incurred during submaximal exercise would also reduce Q(leg). Therefore, we investigated the effects of changing the W(b) on Q(leg) via thermodilution in 10 healthy trained male cyclists [maximal VO(2) (VO(2 max)) = 59 +/- 9 ml. kg(-1). min(-1)] during repeated bouts of cycle exercise at work rates corresponding to 50 and 75% of VO(2 max). Inspiratory muscle work was 1) reduced 40 +/- 6% via a proportional-assist ventilator, 2) not manipulated (control), or 3) increased 61 +/- 8% by addition of inspiratory resistive loads. Increasing the W(b) during submaximal exercise caused VO(2) to increase; decreasing the W(b) was associated with lower VO(2) (DeltaVO(2) = 0.12 and 0.21 l/min at 50 and 75% of VO(2 max), respectively, for approximately 100% change in W(b)). There were no significant changes in leg vascular resistance (LVR), norepinephrine spillover, arterial pressure, or Q(leg) when W(b) was reduced or increased. Why are LVR, norepinephrine spillover, and Q(leg) influenced by the W(b) at maximal but not submaximal exercise? We postulate that at submaximal work rates and ventilation rates the normal W(b) required makes insufficient demands for VO(2) and cardiac output to require any cardiovascular adjustment and is too small to activate sympathetic vasoconstrictor efferent output. Furthermore, even a 50-70% increase in W(b) during submaximal exercise, as might be encountered in conditions where ventilation rates and/or inspiratory flow resistive forces are higher than normal, also does not elicit changes in LVR or Q(leg).

The effect of age and unilateral leg immobilization for 2 weeks on substrate utilization during moderate‐intensity exercise in human skeletal muscle

PubMed Central

Gram, M.; Dybboe, R.; Kuhlman, A. B.; Prats, C.; Greenhaff, P. L.; Constantin‐Teodosiu, D.; Birk, J. B.; Wojtaszewski, J. F. P.; Dela, F.; Helge, J. W.

2016-01-01

Key points This study aimed to provide molecular insight into the differential effects of age and physical inactivity on the regulation of substrate metabolism during moderate‐intensity exercise.Using the arteriovenous balance technique, we studied the effect of immobilization of one leg for 2 weeks on leg substrate utilization in young and older men during two‐legged dynamic knee‐extensor moderate‐intensity exercise, as well as changes in key proteins in muscle metabolism before and after exercise.Age and immobilization did not affect relative carbohydrate and fat utilization during exercise, but the older men had higher uptake of exogenous fatty acids, whereas the young men relied more on endogenous fatty acids during exercise.Using a combined whole‐leg and molecular approach, we provide evidence that both age and physical inactivity result in intramuscular lipid accumulation, but this occurs only in part through the same mechanisms. Abstract Age and inactivity have been associated with intramuscular triglyceride (IMTG) accumulation. Here, we attempt to disentangle these factors by studying the effect of 2 weeks of unilateral leg immobilization on substrate utilization across the legs during moderate‐intensity exercise in young (n = 17; 23 ± 1 years old) and older men (n = 15; 68 ± 1 years old), while the contralateral leg served as the control. After immobilization, the participants performed two‐legged isolated knee‐extensor exercise at 20 ± 1 W (∼50% maximal work capacity) for 45 min with catheters inserted in the brachial artery and both femoral veins. Biopsy samples obtained from vastus lateralis muscles of both legs before and after exercise were used for analysis of substrates, protein content and enzyme activities. During exercise, leg substrate utilization (respiratory quotient) did not differ between groups or legs. Leg fatty acid uptake was greater in older than in young men, and although young men demonstrated net

Bed rest attenuates sympathetic and pressor responses to isometric exercise in antigravity leg muscles in humans.

PubMed

Kamiya, Atsunori; Michikami, Daisaku; Shiozawa, Tomoki; Iwase, Satoshi; Hayano, Junichiro; Kawada, Toru; Sunagawa, Kenji; Mano, Tadaaki

2004-05-01

Although spaceflight and bed rest are known to cause muscular atrophy in the antigravity muscles of the legs, the changes in sympathetic and cardiovascular responses to exercises using the atrophied muscles remain unknown. We hypothesized that bed rest would augment sympathetic responses to isometric exercise using antigravity leg muscles in humans. Ten healthy male volunteers were subjected to 14-day 6 degrees head-down bed rest. Before and after bed rest, they performed isometric exercises using leg (plantar flexion) and forearm (handgrip) muscles, followed by 2-min postexercise muscle ischemia (PEMI) that continues to stimulate the muscle metaboreflex. These exercises were sustained to fatigue. We measured muscle sympathetic nerve activity (MSNA) in the contralateral resting leg by microneurography. In both pre- and post-bed-rest exercise tests, exercise intensities were set at 30 and 70% of the maximum voluntary force measured before bed rest. Bed rest attenuated the increase in MSNA in response to fatiguing plantar flexion by approximately 70% at both exercise intensities (both P < 0.05 vs. before bed rest) and reduced the maximal voluntary force of plantar flexion by 15%. In contrast, bed rest did not alter the increase in MSNA response to fatiguing handgrip and had no effects on the maximal voluntary force of handgrip. Although PEMI sustained MSNA activation before bed rest in all trials, bed rest entirely eliminated the PEMI-induced increase in MSNA in leg exercises but partially attenuated it in forearm exercises. These results do not support our hypothesis but indicate that bed rest causes a reduction in isometric exercise-induced sympathetic activation in (probably atrophied) antigravity leg muscles.

The effects of surface condition on abdominal muscle activity during single-legged hold exercise.

PubMed

Ha, Sung-min; Oh, Jae-seop; Jeon, In-cheol; Kwon, Oh-yun

2015-02-01

To treat low-back pain, various spinal stability exercises are commonly used to improve trunk muscle function and strength. Because human movement for normal daily activity occurs in multi-dimensions, the importance of exercise in multi-dimensions or on unstable surfaces has been emphasized. Recently, a motorized rotating platform (MRP) for facilitating multi-dimensions dynamic movement was introduced for clinical use. However, the abdominal muscle activity with this device has not been reported. The purpose of this study was to compare the abdominal muscle activity (rectus abdominis, external and internal oblique muscles) during an active single-leg-hold (SLH) exercise on a floor (stable surface), foam roll, and motorized rotating platform (MRP). Thirteen healthy male subjects participated in this study. Using electromyography, the abdominal muscle activity was measured while the subjects performed SLH exercises on floor (stable surface), foam roll, and MRP. There were significant differences in the abdominal muscle activities among conditions (P<.05), except for left EO (P>.05) (Fig. 2). After the Bonferroni correction, however, no significant differences among conditions remained, except for differences in both side IO muscle activity between the floor and foam roll conditions (padj<0.017). The findings suggest that performing the SLH exercises on a foam roll and MRP is more effective increased activities of both side of RA and IO, and Rt. EO compared to floor condition. However, there were no significant differences in abdominal muscles activity in the multiple comparison between conditions (mean difference were smaller than the standard deviation in the abdominal muscle activities) (padj>0.017), except for differences in both side IO muscle activity between the floor (stable surface) and foam roll (padj<0.017) (effect size: 0.79/0.62 (non-supporting/supporting leg) for foam-roll versus floor). Copyright © 2014 Elsevier Ltd. All rights reserved.

Altered neuromuscular control of leg stiffness following soccer-specific exercise.

PubMed

Oliver, Jon L; De Ste Croix, Mark B A; Lloyd, Rhodri S; Williams, Craig A

2014-11-01

To examine changes to neuromuscular control of leg stiffness following 42 min of soccer-specific exercise. Ten youth soccer players, aged 15.8 ± 0.4 years, stature 1.73 ± 0.06 m and mass 59.8 ± 9.7 kg, hopped on a force plate at a self-selected frequency before and after simulated soccer exercise performed on a non-motorised treadmill. During hopping, muscle activity was measured using surface electromyography from four lower limb muscles and analysed to determine feedforward- and feedback-mediated activity, as well as co-contraction. There was a small, non-significant change in stiffness following exercise (26.6 ± 10.6 vs. 24.0 ± 7.0 kN m(-1), p > 0.05, ES = 0.25), with half the group increasing and half decreasing their stiffness. Changes in stiffness were significantly related to changes in centre of mass (CoM) displacement (r = 0.90, p < 0.01, extremely large correlation) but not changes in peak ground reaction force (r = 0.58, p > 0.05, large correlation). A number of significant relationships were observed between changes in stiffness and CoM displacement with changes in feedforward, feedback and eccentric muscle activity of the soleus and vastus lateralis muscles following exercise (r = 0.64-0.98, p < 0.05, large-extremely large correlations), but not with changes in co-contraction (r = 0.11-0.55, p > 0.05, small-large correlations). Following soccer-specific exercise individual changes in feedforward- and reflex-mediated activity of the soleus and vastus lateralis, and not co-contraction around the knee and ankle, modulate changes in CoM displacement and leg stiffness.

Effect of therapeutic exercises on pregnancy-related low back pain and pelvic girdle pain: Secondary analysis of a randomized controlled trial.

PubMed

Sklempe Kokic, Iva; Ivanisevic, Marina; Uremovic, Melita; Kokic, Tomislav; Pisot, Rado; Simunic, Bostjan

2017-03-06

To investigate the effect of a supervised, structured exercise programme on the occurrence and severity of pregnancy-related lumbopelvic pain. Randomized controlled trial. A total of 45 pregnant women were randomly assigned to 2 groups: an experimental group (n = 20; mean age 32.8 (standard deviation (SD) 3.6) years) and a control group (n = 22; mean age 32.2 years (SD 4.9)). Exercise intervention for the experimental group consisted of aerobic and resistance exercises performed bi-weekly from the date of inclusion into the study until the end of pregnancy, together with at least 30 min of brisk daily walks. A numeric rating scale, Roland-Morris Disability Questionnaire (RMDQ), and Pelvic Girdle Questionnaire (PGQ) were used to measure outcomes. The control group received only standard antenatal care. There were significant differences between the 2 groups on the numeric rating scale, PGQ and RMDQ scores in the 36th week of pregnancy (p = 0.017; p = 0.005; p < 0.001, respectively) in favour of the experimental group. The exercise programme had a beneficial effect on the severity of lumbopelvic pain in pregnancy, reducing the intensity of pain and the level of disability experienced as a result.

Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial.

PubMed

Hooten, W Michael; Qu, Wenchun; Townsend, Cynthia O; Judd, Jeffrey W

2012-04-01

Strength training and aerobic exercise have beneficial effects on pain in adults with fibromyalgia. However, the equivalence of strengthening and aerobic exercise has not been reported. The primary aim of this randomized equivalence trial involving patients with fibromyalgia admitted to an interdisciplinary pain treatment program was to test the hypothesis that strengthening (n=36) and aerobic (n=36) exercise have equivalent effects (95% confidence interval within an equivalence margin ± 8) on pain, as measured by the pain severity subscale of the Multidimensional Pain Inventory. Secondary aims included determining the effects of strengthening and aerobic exercise on peak Vo(2) uptake, leg strength, and pressure pain thresholds. In an intent-to-treat analysis, the mean (± standard deviation) pain severity scores for the strength and aerobic groups at study completion were 34.4 ± 11.5 and 37.6 ± 11.9, respectively. The group difference was -3.2 (95% confidence interval, -8.7 to 2.3), which was within the equivalence margin of Δ8. Significant improvements in pain severity (P<.001), peak Vo(2) (P<.001), strength (P<.001), and pain thresholds (P<.001) were observed from baseline to week 3 in the intent-to-treat analysis; however, patients in the aerobic group (mean change 2.0 ± 2.6 mL/kg/min) experienced greater gains (P<.013) in peak Vo(2) compared to the strength group (mean change 0.4 ± 2.6 mL/kg/min). Knowledge of the equivalence and physiological effects of exercise have important clinical implications that could allow practitioners to target exercise recommendations on the basis of comorbid medical conditions or patient preference for a particular type of exercise. This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

[Acute leg compartment syndrome after exertion].

PubMed

Misović, Sidor; Kronja, Goran; Ignjatović, Dragan; Tomić, Aleksandar

2005-03-01

A case of a 22-year old soldier, with a history of pain in the leg during heavy exercise, which desisted at rest, was presented. One day before admission, the patient had felt an extreme exertion-induced pain in his right leg which had not lessenned at rest. At the same time, the patient noticed persistent severe leg edema. On physical examination, the intracompartmental pressure was 62 mmHg (> 30 mmHg). The patient was urgently operated on, and fasciotomy according to Mubarak was used. At second surgery, the debridement of the muscles of the posterior group of the leg, and the evacuation of hemathoma from the anterior and lateral group of the right leg muscles were perfomed. Postoperative recovery was uneventful. Fasciotomy wounds were closed within 14 days of the surgery. The complete physical treatment was done. Follow-up examinations 1, 3, and 6 months afterwards were satisfactory. The soldier completed his compulsory military service without any sequelae. Laboratory results were normal. Overlooked, unrecognized or surgically untreated compartment syndrome can cause severe damage, including even the loss of the extremity.

Leg blood flow is impaired during small muscle mass exercise in patients with COPD.

PubMed

Iepsen, U W; Munch, G W; Rugbjerg, M; Ryrsø, C K; Secher, N H; Hellsten, Y; Lange, P; Pedersen, B K; Thaning, P; Mortensen, S P

2017-09-01

Skeletal muscle blood flow is regulated to match the oxygen demand and dysregulation could contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). We measured leg hemodynamics and metabolites from vasoactive compounds in muscle interstitial fluid and plasma at rest, during one-legged knee-extensor exercise, and during arterial infusions of sodium nitroprusside (SNP) and acetylcholine (ACh), respectively. Ten patients with moderate to severe COPD and eight age- and sex-matched healthy controls were studied. During knee-extensor exercise (10 W), leg blood flow was lower in the patients compared with the controls (1.82 ± 0.11 vs. 2.36 ± 0.14 l/min, respectively; P < 0.05), which compromised leg oxygen delivery (372 ± 26 vs. 453 ± 32 ml O 2 /min, respectively; P < 0.05). At rest, plasma endothelin-1 (vasoconstrictor) was higher in the patients with COPD ( P < 0.05) and also tended to be higher during exercise ( P = 0.07), whereas the formation of interstitial prostacyclin (vasodilator) was only increased in the controls. There was no difference between groups in the nitrite/nitrate levels (vasodilator) in plasma or interstitial fluid during exercise. Moreover, patients and controls showed similar vasodilatory capacity in response to both endothelium-independent (SNP) and endothelium-dependent (ACh) stimulation. The results suggest that leg muscle blood flow is impaired during small muscle mass exercise in patients with COPD possibly due to impaired formation of prostacyclin and increased levels of endothelin-1. NEW & NOTEWORTHY This study demonstrates that chronic obstructive pulmonary disease (COPD) is associated with a reduced blood flow to skeletal muscle during small muscle mass exercise. In contrast to healthy individuals, interstitial prostacyclin levels did not increase during exercise and plasma endothelin-1 levels were higher in the patients with COPD. Copyright © 2017 the American Physiological

Meta-analysis: exercise therapy for nonspecific low back pain.

PubMed

Hayden, Jill A; van Tulder, Maurits W; Malmivaara, Antti V; Koes, Bart W

2005-05-03

Exercise therapy is widely used as an intervention in low back pain. To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent

Arm mechanical efficiency and arm exercise capacity are relatively preserved in chronic obstructive pulmonary disease.

PubMed

Franssen, Frits M E; Wouters, Emiel F M; Baarends, Erica M; Akkermans, Marco A; Schols, Annemie M W J

2002-10-01

Previous studies indicate that energy expenditure related to physical activity is enhanced and that mechanical efficiency of leg exercise is reduced in patients with chronic obstructive pulmonary disease (COPD). However, it is yet unclear whether an inefficient energy expenditure is also present during other activities in COPD. This study was carried out to examine arm efficiency and peak arm exercise performance relative to leg exercise in 33 (23 male) patients with COPD ((mean +/- SEM) age: 61 +/- 2 yr; FEV : 40 +/- 2% of predicted) and 20 sex- and age-matched healthy controls. Body composition, pulmonary function, resting energy expenditure (REE), and peak leg and arm exercise performance were determined. To calculate mechanical efficiency, subjects performed submaximal leg and arm ergometry at 50% of achieved peak loads. During exercise testing, metabolic and ventilatory parameters were measured. In contrast to a reduced leg mechanical efficiency in patients compared with controls (15.6 +/- 0.6% and 22.5 +/- 0.6%, respectively; < 0.001), arm mechanical efficiency was comparable in both groups (COPD: 18.3 +/- 0.9%, controls: 21.0 +/- 1.2%; NS). Arm efficiency was not related to leg efficiency, pulmonary function, work of breathing, or REE. Also, arm exercise capacity was relatively preserved in patients with COPD (ratio arm peak work rate/leg peak work rate in patients: 89% vs 53% in controls; < 0.001). Mechanical efficiency and exercise capacity of the upper and lower limbs are not homogeneously affected in COPD, with a relative preservation of the upper limbs. This may have implications for screening of exercise tolerance and prescription of training interventions in patients with COPD. Future studies need to elucidate the mechanism behind this observation.

The effect of topical arnica on muscle pain.

PubMed

Adkison, Julie D; Bauer, David W; Chang, Terence

2010-10-01

The herb Arnica montana, in topical formulations, has been reputed to decrease bruising and muscle pain. This claim has been inadequately and incompletely addressed. To determine whether topical A. montana cream could decrease subjective leg pain following calf raises. Secondary outcomes were effects on ankle range of motion and muscle tenderness. A randomized, double-blind, placebo-controlled trial was conducted in 53 subjects. Active range of motion was measured in both ankles, and then a series of calf-raises were completed according to a standardized protocol. Each participant received 2 tubes of cream, 1 with active arnica and 1 with placebo. The creams were applied to the lower legs immediately after the exercise, and again at 24 and 48 hours postexercise according to the "RIGHT" or "LEFT" labels. At 48 hours postexercise, subjects had their ankle range of motion and muscle tenderness measured. Subjects used the analog scale to rate pain in each leg at baseline, 24 hours, 48 hours, and 72 hours. No significant differences in pain scores were seen before exercise (arnica: 0.07 vs placebo: 0.09, p = 0.32). Pain scores on legs treated with arnica were higher than scores on those receiving placebo 24 hours after exercise (3.04 vs 2.36, respectively; p < 0.005). Pain scores on day 3 (arnica: 3.44 vs placebo: 3.20, p = 0.66) and day 4 (arnica: 2.36 vs placebo: 2.31, p = 0.62) were not significantly different. There was no difference in muscle tenderness (arnica: 1.05 vs placebo: 1.05, p = 1.0). Ankle range of motion did not differ significantly on either day 1 (arnica: 64.70 degrees vs placebo: 66.15, p = 0.352 or day 3 (arnica: 63.32 degrees vs placebo: 65.94, p = 0.058). Rather than decreasing leg pain, arnica was found to increase leg pain 24 hours after eccentric calf exercises. This effect did not extend to the 48-hour measurement.

The effect of aroma stimulation during isotonic exercise on the rating of perceived exertion and blood fatigue factors of athletes with patellofemoral pain syndrome

PubMed Central

Kim, Sangsoo; Choo, JongHoo; Ju, Sungbum

2018-01-01

[Purpose] The purpose of this study is to examine the effect of aroma stimulation during isotonic exercise on the rating of perceived exertion (RPE) and the blood fatigue factors of athletes who have patellofemoral pain syndrome (PFPS). [Subjects and Methods] The research subjects were seven athletes in their twenties who suffer from PFPS. They were divided into a control group and an aroma stimulation group and performed isotonic exercises repeatedly. After exercising, the RPE and blood fatigue factors, including creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and ammonia, were measured through blood sampling. [Results] The aroma stimulus group showed significantly lower RPE than the control group immediately after exercising, which included leg presses, leg curls, bicep curls, and leg extensions. Among the blood fatigue factors, the change in LDH indicated the effect of aroma stimulation. [Conclusion] We confirmed that aroma stimulation during isotonic exercise has the positive effect of reducing the RPE and blood fatigue factors, such as blood LDH, of the athletes with PFPS. PMID:29545683

Oral antioxidants improve leg blood flow during exercise in patients with chronic obstructive pulmonary disease

PubMed Central

Rossman, Matthew J.; Trinity, Joel D.; Garten, Ryan S.; Ives, Stephen J.; Conklin, Jamie D.; Barrett-O'Keefe, Zachary; Witman, Melissa A. H.; Bledsoe, Amber D.; Morgan, David E.; Runnels, Sean; Reese, Van R.; Zhao, Jia; Amann, Markus; Wray, D. Walter

2015-01-01

The consequence of elevated oxidative stress on exercising skeletal muscle blood flow as well as the transport and utilization of O2 in patients with chronic obstructive pulmonary disease (COPD) is not well understood. The present study examined the impact of an oral antioxidant cocktail (AOC) on leg blood flow (LBF) and O2 consumption during dynamic exercise in 16 patients with COPD and 16 healthy subjects. Subjects performed submaximal (3, 6, and 9 W) single-leg knee extensor exercise while LBF (Doppler ultrasound), mean arterial blood pressure, leg vascular conductance, arterial O2 saturation, leg arterial-venous O2 difference, and leg O2 consumption (direct Fick) were evaluated under control conditions and after AOC administration. AOC administration increased LBF (3 W: 1,604 ± 100 vs. 1,798 ± 128 ml/min, 6 W: 1,832 ± 109 vs. 1,992 ± 120 ml/min, and 9W: 2,035 ± 114 vs. 2,187 ± 136 ml/min, P < 0.05, control vs. AOC, respectively), leg vascular conductance, and leg O2 consumption (3 W: 173 ± 12 vs. 210 ± 15 ml O2/min, 6 W: 217 ± 14 vs. 237 ± 15 ml O2/min, and 9 W: 244 ± 16 vs 260 ± 18 ml O2/min, P < 0.05, control vs. AOC, respectively) during exercise in COPD, whereas no effect was observed in healthy subjects. In addition, the AOC afforded a small, but significant, improvement in arterial O2 saturation only in patients with COPD. Thus, these data demonstrate a novel beneficial role of AOC administration on exercising LBF, O2 consumption, and arterial O2 saturation in patients with COPD, implicating oxidative stress as a potential therapeutic target for impaired exercise capacity in this population. PMID:26188020

The effect of age and unilateral leg immobilization for 2 weeks on substrate utilization during moderate-intensity exercise in human skeletal muscle.

PubMed

Vigelsø, A; Gram, M; Dybboe, R; Kuhlman, A B; Prats, C; Greenhaff, P L; Constantin-Teodosiu, D; Birk, J B; Wojtaszewski, J F P; Dela, F; Helge, J W

2016-04-15

This study aimed to provide molecular insight into the differential effects of age and physical inactivity on the regulation of substrate metabolism during moderate-intensity exercise. Using the arteriovenous balance technique, we studied the effect of immobilization of one leg for 2 weeks on leg substrate utilization in young and older men during two-legged dynamic knee-extensor moderate-intensity exercise, as well as changes in key proteins in muscle metabolism before and after exercise. Age and immobilization did not affect relative carbohydrate and fat utilization during exercise, but the older men had higher uptake of exogenous fatty acids, whereas the young men relied more on endogenous fatty acids during exercise. Using a combined whole-leg and molecular approach, we provide evidence that both age and physical inactivity result in intramuscular lipid accumulation, but this occurs only in part through the same mechanisms. Age and inactivity have been associated with intramuscular triglyceride (IMTG) accumulation. Here, we attempt to disentangle these factors by studying the effect of 2 weeks of unilateral leg immobilization on substrate utilization across the legs during moderate-intensity exercise in young (n = 17; 23 ± 1 years old) and older men (n = 15; 68 ± 1 years old), while the contralateral leg served as the control. After immobilization, the participants performed two-legged isolated knee-extensor exercise at 20 ± 1 W (∼50% maximal work capacity) for 45 min with catheters inserted in the brachial artery and both femoral veins. Biopsy samples obtained from vastus lateralis muscles of both legs before and after exercise were used for analysis of substrates, protein content and enzyme activities. During exercise, leg substrate utilization (respiratory quotient) did not differ between groups or legs. Leg fatty acid uptake was greater in older than in young men, and although young men demonstrated net leg glycerol release during

Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial.

PubMed

Klonizakis, M; Tew, G A; Gumber, A; Crank, H; King, B; Middleton, G; Michaels, J A

2018-05-01

Venous leg ulcers (VLUs) are typically painful and heal slowly. Compression therapy offers high healing rates; however, improvements are not usually sustained. Exercise is a low-cost, low-risk and effective strategy for improving physical and mental health. Little is known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy patients with VLUs. To assess the feasibility of a 12-week supervised exercise programme as an adjunct therapy to compression in patients with VLUs. This was a two-centre, two-arm, parallel-group, randomized feasibility trial. Thirty-nine patients with venous ulcers were recruited and randomized 1 : 1 either to exercise (three sessions weekly) plus compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow-up and patient preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year, with healing rate and time, ulcer recurrence and infection incidents documented. Intervention and healthcare utilization costs were calculated. Qualitative data were collected to assess participants' experiences. Seventy-two per cent of the exercise group participants attended all scheduled exercise sessions. No serious adverse events and only two exercise-related adverse events (both increased ulcer discharge) were reported. Loss to follow-up was 5%. At 12 months, median ulcer healing time was lower in the exercise group (13 vs. 34·7 weeks). Mean National Health Service costs were £813·27 for the exercise and £2298·57 for the control group. The feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures is supported. © 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Musical Agency during Physical Exercise Decreases Pain.

PubMed

Fritz, Thomas H; Bowling, Daniel L; Contier, Oliver; Grant, Joshua; Schneider, Lydia; Lederer, Annette; Höer, Felicia; Busch, Eric; Villringer, Arno

2017-01-01

Objectives: When physical exercise is systematically coupled to music production, exercisers experience improvements in mood, reductions in perceived effort, and enhanced muscular efficiency. The physiology underlying these positive effects remains unknown. Here we approached the investigation of how such musical agency may stimulate the release of endogenous opioids indirectly with a pain threshold paradigm. Design: In a cross-over design we tested the opioid-hypothesis with an indirect measure, comparing the pain tolerance of 22 participants following exercise with or without musical agency. Method: Physical exercise was coupled to music by integrating weight-training machines with sensors that control music-synthesis in real time. Pain tolerance was measured as withdrawal time in a cold pressor test. Results: On average, participants tolerated cold pain for ~5 s longer following exercise sessions with musical agency. Musical agency explained 25% of the variance in cold pressor test withdrawal times after factoring out individual differences in general pain sensitivity. Conclusions: This result demonstrates a substantial pain reducing effect of musical agency in combination with physical exercise, probably due to stimulation of endogenous opioid mechanisms. This has implications for exercise endurance, both in sports and a multitude of rehabilitative therapies in which physical exercise is effective but painful.

Musical Agency during Physical Exercise Decreases Pain

PubMed Central

Fritz, Thomas H.; Bowling, Daniel L.; Contier, Oliver; Grant, Joshua; Schneider, Lydia; Lederer, Annette; Höer, Felicia; Busch, Eric; Villringer, Arno

2018-01-01

Objectives: When physical exercise is systematically coupled to music production, exercisers experience improvements in mood, reductions in perceived effort, and enhanced muscular efficiency. The physiology underlying these positive effects remains unknown. Here we approached the investigation of how such musical agency may stimulate the release of endogenous opioids indirectly with a pain threshold paradigm. Design: In a cross-over design we tested the opioid-hypothesis with an indirect measure, comparing the pain tolerance of 22 participants following exercise with or without musical agency. Method: Physical exercise was coupled to music by integrating weight-training machines with sensors that control music-synthesis in real time. Pain tolerance was measured as withdrawal time in a cold pressor test. Results: On average, participants tolerated cold pain for ~5 s longer following exercise sessions with musical agency. Musical agency explained 25% of the variance in cold pressor test withdrawal times after factoring out individual differences in general pain sensitivity. Conclusions: This result demonstrates a substantial pain reducing effect of musical agency in combination with physical exercise, probably due to stimulation of endogenous opioid mechanisms. This has implications for exercise endurance, both in sports and a multitude of rehabilitative therapies in which physical exercise is effective but painful. PMID:29387030

Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain.

PubMed

Kibsgård, Thomas J; Röhrl, Stephan M; Røise, Olav; Sturesson, Bengt; Stuge, Britt

2017-08-01

The Active Straight Leg Raise is a functional test used in the assessment of pelvic girdle pain, and has shown to have good validity, reliability and responsiveness. The Active Straight Leg Raise is considered to examine the patients' ability to transfer load through the pelvis. It has been hypothesized that patients with pelvic girdle pain lack the ability to stabilize the pelvic girdle, probably due to instability or increased movement of the sacroiliac joint. This study examines the movement of the sacroiliac joints during the Active Straight Leg Raise in patients with pelvic girdle pain. Tantalum markers were inserted in the dorsal sacrum and ilium of 12 patients with long-lasting pelvic girdle pain scheduled for sacroiliac joint fusion surgery. Two to three weeks later movement of the sacroiliac joints during the Active Straight Leg Raise was measured with radiostereometric analysis. Small movements were detected. There was larger movement of the sacroiliac joint of the rested leg's sacroiliac joint compared to the lifted leg's side. A mean backward rotation of 0.8° and inward tilt of 0.3° were seen in the rested leg's sacroiliac joint. The movements of the sacroiliac joints during the Active Straight Leg Raise are small. There was a small backward rotation of the innominate bone relative to sacrum on the rested leg's side. Our findings contradict an earlier understanding that a forward rotation of the lifted leg's innominate occur while performing the Active Straight Leg Raise. Copyright © 2017. Published by Elsevier Ltd.

Exercise therapy for treatment of non-specific low back pain.

PubMed

Hayden, J A; van Tulder, M W; Malmivaara, A; Koes, B W

2005-07-20

Exercise therapy is widely used as an intervention in low-back pain. To evaluate the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic low-back pain versus no treatment and other conservative treatments. The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE, EMBASE, PsychInfo, CINAHL databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized controlled trials evaluating exercise therapy for adult non-specific low-back pain and measuring pain, function, return-to-work/absenteeism, and/or global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short, intermediate, and long-term follow-up. Sixty-one randomized controlled trials (6390 participants) met inclusion criteria: acute (11), subacute (6) and chronic (43) low-back pain (1 unclear). Evidence was found of effectiveness in chronic populations relative to comparisons at all follow-up periods; pooled mean improvement was 7.3 points (95% CI, 3.7 to 10.9) for pain (out of 100), 2.5 points (1.0 to 3.9) for function (out of 100) at earliest follow-up. In studies investigating patients (i.e. presenting to healthcare providers) mean improvement was 13.3 points (5.5 to 21.1) for pain, 6.9 (2.2 to 11.7) for function, representing significantly greater improvement over studies where participants included those recruited from a general population (e.g. with advertisements). There is some evidence of effectiveness of graded-activity exercise program in subacute low-back pain in occupational settings, though the evidence for other types of exercise therapy in other populations is inconsistent. There was evidence of equal effectiveness relative to comparisons in acute populations [pain: 0.03 points (95% CI, -1.3 to 1.4)]. This review largely reflects limitations of the literature, including low quality studies with heterogeneous

The development and evaluation of a program for leg-strengthening exercises and balance assessment using Kinect.

PubMed

Choi, Jin-Seung; Kang, Dong-Won; Seo, Jeong-Woo; Kim, Dae-Hyeok; Yang, Seung-Tae; Tack, Gye-Rae

2016-01-01

[Purpose] In this study, a program was developed for leg-strengthening exercises and balance assessment using Microsoft Kinect. [Subjects and Methods] The program consists of three leg-strengthening exercises (knee flexion, hip flexion, and hip extension) and the one-leg standing test (OLST). The program recognizes the correct exercise posture by comparison with the range of motion of the hip and knee joints and provides a number of correct action examples to improve training. The program measures the duration of the OLST and presents this as the balance-age. The accuracy of the program was analyzed using the data of five male adults. [Results] In terms of the motion recognition accuracy, the sensitivity and specificity were 95.3% and 100%, respectively. For the balance assessment, the time measured using the existing method with a stopwatch had an absolute error of 0.37 sec. [Conclusion] The developed program can be used to enable users to conduct leg-strengthening exercises and balance assessments at home.

Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized With Acute Sciatica.

PubMed

Fjeld, Olaf; Grotle, Margreth; Siewers, Vibeke; Pedersen, Linda M; Nilsen, Kristian Bernhard; Zwart, John-Anker

2017-03-01

Prospective cohort study. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72-2.38, P < 0.001), not receiving surgical treatment (1.11, 95% CI 0.29-1.93, P = 0.01), not actively employed upon admission (1.47, 95% CI 0.63-2.31, P < 0.01), and self-reported leg-pain recorded 6 weeks posthospital admission (0.49, 95% CI 0.34-0.63, P < 0.001). Interaction analysis showed that the Örebro Musculosceletal Pain Questionnaire had significant prognostic value only on the nonsurgically treated patients (3.26, 95% CI 1.89-4.63, P < 0.001). The results suggest that a psychosocial screening tool and the implementation of a 6-week postadmission follow-up has prognostic value in the hospital management of severe sciatica. 2.

Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon.

PubMed

Dawson, Lance G; Dawson, Kimberley A; Tiidus, Peter M

2004-11-01

Massage therapy is commonly used following endurance running races with the expectation that it will enhance post-run recovery of muscle function and reduce soreness. A limited number of studies have reported little or no influence of massage therapy on post-exercise muscle recovery. However, no studies have been conducted in a field setting to assess the potential for massage to influence muscle recovery following an actual endurance running race. To evaluate the potential for repeated massage therapy interventions to influence recovery of quadriceps and hamstring muscle soreness, recovery of quadriceps and hamstring muscle strength and reduction of upper leg muscle swelling over a two week recovery period following an actual road running race. Twelve adult recreational runners (8 male, 4 female) completed a half marathon (21.1 km) road race. On days 1,4, 8, and 11 post-race, subjects received 30 minutes of standardized massage therapy performed by a registered massage therapist on a randomly assigned massage treatment leg, while the other (control) leg received no massage treatment. Two days prior to the race (baseline) and preceding the treatments on post-race days 1, 4, 8, and 11 the following measures were conducted on each of the massage and control legs: strength of quadriceps and hamstring muscles, leg swelling, and soreness perception. At day 1, post-race quadriceps peak torque was significantly reduced (p < 0.05), and soreness and leg circumference significantly elevated (p < 0.05) relative to pre-race values with no difference between legs. This suggested that exercise-induced muscle disruption did occur. Comparing the rate of return to baseline measures between the massaged and control legs, revealed no significant differences (p > 0.05). All measures had returned to baseline at day 11. Massage did not affect the recovery of muscles in terms of physiological measures of strength, swelling, or soreness. However, questionnaires revealed that 7 of the 12

Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study.

PubMed

Anwer, Shahnawaz; Alghadir, Ahmad

2014-05-01

[Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40-65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.

Brief submaximal isometric exercise improves cold pressor pain tolerance.

PubMed

Foxen-Craft, Emily; Dahlquist, Lynnda M

2017-10-01

Exercise-induced hypoalgesia (EIH), or the inhibition of pain following physical exercise, has been demonstrated in adults, but its mechanisms have remained unclear due to variations in methodology. This study aimed to address methodological imitations of past studies and contribute to the literature demonstrating the generalizability of EIH to brief submaximal isometric exercise and cold pressor pain. Young adults (n = 134) completed a baseline cold pressor trial, maximal voluntary contraction (hand grip strength) assessment, 10-min rest, and either a 2-min submaximal isometric handgrip exercise or a sham exercise in which no force was exerted, followed by a cold pressor posttest. Results indicated that cold pressor pain tolerance significantly increased during the exercise condition, but not during the sham exercise condition. Exercise did not affect pain intensity and marginally affected pain unpleasantness ratings. These findings suggest that submaximal isometric exercise can improve cold pressor pain tolerance but may have an inconsistent analgesic effect on ratings of cold pressor pain.

Emerging Relationships between Exercise, Sensory Nerves, and Neuropathic Pain

PubMed Central

Cooper, Michael A.; Kluding, Patricia M.; Wright, Douglas E.

2016-01-01

The utilization of physical activity as a therapeutic tool is rapidly growing in the medical community and the role exercise may offer in the alleviation of painful disease states is an emerging research area. The development of neuropathic pain is a complex mechanism, which clinicians and researchers are continually working to better understand. The limited therapies available for alleviation of these pain states are still focused on pain abatement and as opposed to treating underlying mechanisms. The continued research into exercise and pain may address these underlying mechanisms, but the mechanisms which exercise acts through are still poorly understood. The objective of this review is to provide an overview of how the peripheral nervous system responds to exercise, the relationship of inflammation and exercise, and experimental and clinical use of exercise to treat pain. Although pain is associated with many conditions, this review highlights pain associated with diabetes as well as experimental studies on nerve damages-associated pain. Because of the global effects of exercise across multiple organ systems, exercise intervention can address multiple problems across the entire nervous system through a single intervention. This is a double-edged sword however, as the global interactions of exercise also require in depth investigations to include and identify the many changes that can occur after physical activity. A continued investment into research is necessary to advance the adoption of physical activity as a beneficial remedy for neuropathic pain. The following highlights our current understanding of how exercise alters pain, the varied pain models used to explore exercise intervention, and the molecular pathways leading to the physiological and pathological changes following exercise intervention. PMID:27601974

The effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema: a single-blind, randomized controlled trial.

PubMed

Park, Jin-Hyuck

2017-07-01

This study was to investigate the effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema. 69 women participated in this study and then they were randomly allocated to complex exercise group (n = 35) or the conventional decongestive therapy group (n = 34). All subjects received 8 sessions for 4 weeks. To identify the effects on shoulder range of motion and pain, goniometer and visual analog scale were used, respectively. The outcome measurements were performed before and after the 4 week intervention. After 4 weeks, complex exercise group had greater improvements in shoulder range of motion and pain compared with the conventional decongestive therapy group (p < 0.05). These results suggest that complex exercise is beneficial to improve shoulder range of motion as well as pain of the women with breast cancer-related lymphedema. Complex exercise would be useful to improve shoulder range of motion and pain of the women with breast cancer-related lymphedema.

Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol

PubMed Central

2012-01-01

Background Low-back related leg pain with or without nerve root involvement is associated with a poor prognosis compared to low back pain (LBP) alone. Compared to the literature investigating prognostic indicators of outcome for LBP, there is limited evidence on prognostic factors for low back-related leg pain including the group with nerve root pain. This 1 year prospective consultation-based observational cohort study will describe the clinical, imaging, demographic characteristics and health economic outcomes for the whole cohort, will investigate differences and identify prognostic indicators of outcome (i.e. change in disability at 12 months), for the whole cohort and, separately, for those classified with and without nerve root pain. In addition, nested qualitative studies will provide insights on the clinical consultation and the impact of diagnosis and treatment on patients' symptom management and illness trajectory. Methods Adults aged 18 years and over consulting their General Practitioner (GP) with LBP and radiating leg pain of any duration at (n = 500) GP practices in North Staffordshire and Stoke-on-Trent, UK will be invited to participate. All participants will receive a standardised assessment at the clinic by a study physiotherapist and will be classified according to the clinically determined presence or absence of nerve root pain/involvement. All will undergo a lumbar spine MRI scan. All participants will be managed according to their clinical need. The study outcomes will be measured at 4 and 12 months using postal self-complete questionnaires. Data will also be collected each month using brief postal questionnaires to enable detailed description of the course of low back and leg pain over time. Clinical observations and patient interviews will be used for the qualitative aspects of the study. Discussion This prospective clinical observational cohort will combine self-reported data, comprehensive clinical and MRI assessment, together with

Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation.

PubMed

Alsouhibani, Ali; Vaegter, Henrik Bjarke; Hoeger Bement, Marie

2018-04-03

Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated. Experimental, randomized crossover study. Laboratory at Marquette University. Thirty healthy adults (19.3±1.5 years, 15 males). Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in two separate experimental sessions. Pressure pain thresholds (PPTs) at the quadriceps and upper trapezius muscles were assessed before, during, and after ice water immersions. PPTs increased during ice water immersion (i.e., CPM), and quadriceps PPT increased after exercise (P < 0.05). CPM decreased similarly following exercise and quiet rest (P > 0.05). CPM within-session reliability was fair to good (intraclass correlation coefficient [ICC] = 0.43-0.70), and the between-session reliability was poor (ICC = 0.20-0.35). Due to the variability in the systemic exercise-induced hypoalgesia (EIH) response, participants were divided into systemic EIH responders (N = 9) and nonresponders (N = 21). EIH responders experienced attenuated CPM following exercise (P = 0.03), whereas the nonresponders showed no significant change (P > 0.05). Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. These results may improve the understanding of increased pain after exercise in patients with chronic pain and potentially attenuated CPM.

Pain catastrophizing mediates the relationship between self-reported strenuous exercise involvement and pain ratings: moderating role of anxiety sensitivity.

PubMed

Goodin, Burel R; McGuire, Lynanne M; Stapleton, Laura M; Quinn, Noel B; Fabian, Lacy A; Haythornthwaite, Jennifer A; Edwards, Robert R

2009-11-01

To investigate the cross-sectional associations among self-reported weekly strenuous exercise bouts, anxiety sensitivity, and their interaction with pain catastrophizing and pain responses to the cold pressor task (CPT) in healthy, ethnically diverse young adults (n = 79). Exercise involvement has been shown to have hypoalgesic effects and cognitive factors may partially explain this effect. Particularly, alterations in pain catastrophizing have been found to mediate the positive pain outcomes of multidisciplinary treatments incorporating exercise. Further, recent evidence suggests that exercise involvement and anxiety sensitivity may act together, as interacting factors, to exert an effect on catastrophizing and pain outcomes; however, further research is needed to clarify the nature of this interaction. Before the CPT, participants were asked to complete the Godin Leisure-Time Exercise Questionnaire, the Beck Depression Inventory, and the Anxiety Sensitivity Index. After the CPT, participants completed a modified version of the Pain Catastrophizing Scale and the Short Form-McGill Pain Questionnaire. At a high level of anxiety sensitivity, controlling for depressive symptoms, CPT immersion time, and sex differences, a bias-corrected (BC), bootstrapped confidence interval revealed that pain catastrophizing significantly mediated the relationship between self-reported weekly strenuous exercise bouts and pain response (95% BC Confidence Interval = -9.558, -0.800 with 1000 resamples). At intermediate and low levels of anxiety sensitivity, no significant mediation effects were found. These findings support that, for pain catastrophizing to mediate the strenuous exercise-pain response relation, individuals must possess a high level of anxiety sensitivity.

Effects of graded exercise-induced dehydration and rehydration on circulatory markers of oxidative stress across the resting and exercising human leg.

PubMed

Laitano, Orlando; Kalsi, Kameljit Kaur; Pearson, James; Lotlikar, Makra; Reischak-Oliveira, Alvaro; González-Alonso, José

2012-05-01

Exercise in the heat enhances oxidative stress markers in the human circulation, but the contribution of active skeletal muscle and the influence of hydration status remain unknown. To address this question, we measured leg exchange of glutathione (GSH), glutathione disulfide (GSSG), superoxide dismutase activity (SOD) and isoprostanes in seven males at rest and during submaximal one-legged knee extensor exercise in the following four conditions: (1) control euhydration (0% reduction in body mass), (2) mild-dehydration (2%), (3) moderate-dehydration (3.5%), (4) rehydration (0%). In all resting and control exercise conditions, a net GSH uptake was observed across the leg. In contrast, a significant leg release of GSH into the circulation (-354 ± 221 μmol/min, P < 0.05) was observed during exercise with moderate-dehydration, which was still present following full rehydration (-206 ± 122 μmol/min, P < 0.05). During exercise, mild and moderate-dehydration decreased both femoral venous erythrocyte SOD activity (195 ± 6 vs. 180 ± 5 U/L, P < 0.05) and plasma isoprostanes (30 ± 1.1 vs. 25.9 ± 1.3 pg/L, P < 0.05), but during rehydration these were not different from control. In conclusion, these findings suggest that active skeletal muscles release GSH into the circulation under moderate dehydration and subsequent rehydration, possibly to enhance the antioxidant defense.

Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial.

PubMed

Pires, Diogo; Cruz, Eduardo Brazete; Caeiro, Carmen

2015-06-01

The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients. Single-blind randomized controlled trial. Outpatient clinic. Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme. The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia). Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: -25.4± 26.7 vs -6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01-2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time. This study's findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise. © The Author(s) 2014.

Core Stability Exercise Versus General Exercise for Chronic Low Back Pain.

PubMed

Coulombe, Brian J; Games, Kenneth E; Neil, Elizabeth R; Eberman, Lindsey E

2017-01-01

Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?  The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica.  Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals.  The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given.  Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD = -1.29, 95% CI = -2.47, -0.11; P

Exercise therapy for office workers with nonspecific neck pain: a systematic review.

PubMed

Sihawong, Rattaporn; Janwantanakul, Prawit; Sitthipornvorakul, Ekalak; Pensri, Praneet

2011-01-01

The purpose of this study was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers. Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain. Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Arm and Intensity-Matched Leg Exercise Induce Similar Inflammatory Responses.

PubMed

Leicht, Christof A; Paulson, Thomas A W; Goosey-Tolfrey, Victoria L; Bishop, Nicolette C

2016-06-01

The amount of active muscle mass can influence the acute inflammatory response to exercise, associated with reduced risk for chronic disease. This may affect those restricted to upper body exercise, for example, due to injury or disability. The purpose of this study was to compare the inflammatory responses for arm exercise and intensity-matched leg exercise. Twelve male individuals performed three 45-min constant load exercise trials after determination of peak oxygen uptake for arm exercise (V˙O2peak A) and cycling (V˙O2peak C): 1) arm cranking exercise at 60% V˙O2peak A, 2) moderate cycling at 60% V˙O2peak C, and 3) easy cycling at 60% V˙O2peak A. Cytokine, adrenaline, and flow cytometric analysis of monocyte subsets were performed before and up to 4 h postexercise. Plasma IL-6 increased from resting concentrations in all trials; however, postexercise concentrations were higher for arm exercise (1.73 ± 1.04 pg·mL) and moderate cycling (1.73 ± 0.95 pg·mL) compared with easy cycling (0.87 ± 0.41 pg·mL; P < 0.04). Similarly, the plasma IL-1ra concentration in the recovery period was higher for arm exercise (325 ± 139 pg·mL) and moderate cycling (316 ± 128 pg·mL) when compared with easy cycling (245 ± 77 pg·mL, P < 0.04). Arm exercise and moderate cycling induced larger increases in monocyte numbers and larger increases of the classical monocyte subset in the recovery period than easy cycling (P < 0.05). The postexercise adrenaline concentration was lowest for easy cycling (P = 0.04). Arm exercise and cycling at the same relative exercise intensity induces a comparable acute inflammatory response; however, cycling at the same absolute oxygen uptake as arm exercise results in a blunted cytokine, monocyte, and adrenaline response. Relative exercise intensity appears to be more important to the acute inflammatory response than modality, which is of major relevance for populations restricted to upper body exercise.

Immediate Effects of Smoking on Cardiorespiratory Responses During Dynamic Exercise: Arm Vs. Leg Ergometry.

PubMed

Chen, Chien-Liang; Tang, Jing-Shia; Li, Ping-Chia; Chou, Pi-Ling

2015-01-01

This study compared the immediate effects of smoking on cardiorespiratory responses to dynamic arm and leg exercises. This randomized crossover study recruited 14 college students. Each participant underwent two sets of arm-cranking (AC) and leg-cycling (LC) exercise tests. The testing sequences of the control trial (participants refrained from smoking for 8 h before testing) and the experimental trial (participants smoked two cigarettes immediately before testing) were randomly chosen. We observed immediate changes in pulmonary function and heart rate variability after smoking and before the exercise test. The participants then underwent graded exercise tests of their arms and legs until reaching exhaustion. We compared the peak work achieved and time to exhaustion during the exercise tests with various cardiorespiratory indices [i.e., heart rate, oxygen consumption (VO2), minute ventilation (VE)]. The differences between the smoking and control trials were calculated using paired t-tests. For the exercise test periods, VO2, heart rate, and VE values were calculated at every 10% increment of the maximal effort time. The main effects of the time and trial, as well as their trial-by-time (4 × 10) interaction effects on the outcome measures, were investigated using repeated measure ANOVA with trend analysis. 5 min after smoking, the participants exhibited reduced forced vital capacities and forced expiratory volumes in the first second (P < 0.05), in addition to elevated resting heart rates (P < 0.001). The high-frequency, low-frequency, and the total power of the heart rate variability were also reduced (P < 0.05) at rest. For the exercise test periods, smoking reduced the time to exhaustion (P = 0.005) and the ventilatory threshold (P < 0.05) in the LC tests, whereas no significant effects were observed in the AC tests. A trend analysis revealed a significant trial-by-time interaction effect for heart rate, VO2, and VE during the graded exercise test (all P < 0

Leg extensor muscle strength, postural stability, and fear of falling after a 2-month home exercise program in women with severe knee joint osteoarthritis.

PubMed

Rätsepsoo, Monika; Gapeyeva, Helena; Sokk, Jelena; Ereline, Jaan; Haviko, Tiit; Pääsuke, Mati

2013-01-01

BACKGROUND AND OBJECTIVE. The aim of this study was to compare the leg extensor muscle strength, the postural stability, and the fear of falling in the women with severe knee joint osteoarthritis (OA) before and after a 2-month home exercise program (HEP). MATERIAL AND METHODS. In total, 17 women aged 46-72 years with late-stage knee joint OA scheduled for total knee arthroplasty participated in this study before and after the 2-month HEP with strengthening, stretching, balance, and step exercises. The isometric peak torque (PT) of the leg extensors and postural stability characteristics when standing on a firm or a foam surface for 30 seconds were recorded. The fear of falling and the pain intensity (VAS) were estimated. RESULTS. A significant increase in the PT and the PT-to-body weight (PT-to-BW) ratio of the involved leg as well as the bilateral PT and the PT-to-BW ratio was found after the 2-month HEP compared with the data before the HEP (P<0.05). The PT and the PT-to-BW ratio of the involved leg were significantly lower compared with the uninvolved leg before the HEP (P<0.05). The center of the pressure sway length (foam surface) decreased significantly after the HEP (P<0.05). Significant correlations were found between the PT of the involved leg and the bilateral PT and the fear of falling and between the PT of the involved leg and the postural sway (foam surface) before the HEP. CONCLUSIONS. After the 2-month HEP, the leg extensor muscle strength increased and the postural sway length on a foam surface decreased. The results indicate that the increased leg extensor muscle strength improves postural stability and diminishes the fear of falling in women with late-stage knee joint OA.

Gas exchange kinetics following concentric-eccentric isokinetic arm and leg exercise.

PubMed

Drescher, U; Mookerjee, S; Steegmanns, A; Knicker, A; Hoffmann, U

2017-06-01

To evaluate the effects of exercise velocity (60, 150, 240deg∙s -1 ) and muscle mass (arm vs leg) on changes in gas exchange and arterio-venous oxygen content difference (avDO 2 ) following high-intensity concentric-eccentric isokinetic exercise. Fourteen subjects (26.9±3.1years) performed a 3×20-repetition isokinetic exercise protocol. Recovery beat-to-beat cardiac output (CO) and breath-by-breath gas exchange were recorded to determine post-exercise half-time (t 1/2 ) for oxygen uptake (V˙O 2 pulm), carbon dioxide output (V˙CO 2 pulm), and ventilation (V˙ E ). Significant differences of the t 1/2 values were identified between 60 and 150deg∙s -1 . Significant differences in the t 1/2 values were observed between V˙O 2 pulm and V˙CO 2 pulm and between V˙CO 2 pulm and V˙ E . The time to attain the first avDO 2 -peak showed significant differences between arm and leg exercise. The present study illustrates, that V˙O 2 pulm kinetics are distorted due to non-linear CO dynamics. Therefore, it has to be taken into account, that V˙O 2 pulm may not be a valuable surrogate for muscular oxygen uptake kinetics in the recovery phases. Copyright © 2017 Elsevier B.V. All rights reserved.

Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up.

PubMed

Ris, I; Søgaard, K; Gram, B; Agerbo, K; Boyle, E; Juul-Kristensen, B

2016-12-01

To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. A multicentre randomised controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, EuroQol-5D, Beck Depression Inventory-II, Neck Disability Index, Pain Bothersomeness, Patient-Specific Functioning Scale, Tampa Scale of Kinesiophobia, Global Perceived Effect) and clinical tests (Aastrand Physical Fitness, cervical Range of Motion, Pressure Pain Threshold at infraspinatus, tibialis anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold, cervical extension movement, muscle function, and oculomotion. Per protocol analyses confirmed these results with additional significant improvements in the exercise group compared with controls. This multimodal intervention may be an effective intervention for chronic neck pain patients. The trial was registered on www.ClinicalTrials.govNCT01431261 and at the Regional Scientific Ethics Committee of Southern Denmark S-20100069. Copyright © 2016 Elsevier Ltd. All rights reserved.

Human thermal responses during leg-only exercise in cold water.

PubMed

Golden, F S; Tipton, M J

1987-10-01

1. Exercise during immersion in cold water has been reported by several authors to accelerate the rate of fall of core temperature when compared with rates seen during static immersion. The nature of the exercise performed, however, has always been whole-body in nature. 2. In the present investigation fifteen subjects performed leg exercise throughout a 40 min head-out immersion in water at 15 degrees C. The responses obtained were compared with those seen when the subjects performed an identical static immersion. 3. Aural and rectal temperatures were found to fall by greater amounts during static immersion. 4. It is concluded that 'the type of exercise performed' should be included in the list of factors which affect core temperature during cold water immersion.

Neuroleptic-induced "painful legs and moving toes" syndrome: successful treatment with clonazepam and baclofen.

PubMed

Sandyk, R

1990-12-01

The syndrome of "painful legs and moving toes" is characterised by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the toes and feet. It has been observed after a variety of lesions affecting the posterior nerve roots, the spinal ganglia and the peripheral nerves. The pathophysiology of the syndrome is unknown. I report a patient who developed the syndrome during treatment for schizophrenia with the antipsychotic agent molindone hydrochloride. The patient's response to the combination of clonazepam and baclofen suggests that the pathophysiology of the "painful legs and moving toes" may be linked to impairment of spinal serotonergic and GABA functions.

Development of exercise-induced arm-leg blood pressure gradient and abnormal arterial compliance in patients with repaired coarctation of the aorta.

PubMed

Markham, Larry W; Knecht, Sandra K; Daniels, Stephen R; Mays, Wayne A; Khoury, Philip R; Knilans, Timothy K

2004-11-01

Often, the lack of systemic arterial hypertension and the lack of a resting arm-leg blood pressure gradient are used to assess the adequacy of the anatomic result after intervention for coarctation of the aorta (CoA). Some patients with no arm-leg gradient at rest may develop a gradient with exercise, leading caregivers to question the success of the repair. It is not clear what the prevalence is of patients who have undergone a successful intervention for CoA and have no arm-leg gradient at rest but develop a significant gradient with exercise and which factors may predict the development of an arm-leg gradient with exercise. This study evaluates the prevalence and predictors of an exercise-induced arm-leg gradient in subjects who have undergone an apparently successful intervention for CoA.

Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation

PubMed Central

Hughes, William E.; Ueda, Kenichi

2016-01-01

Aging is associated with attenuated contraction-induced rapid onset vasodilation (ROV). We sought to examine whether chronic exercise training would improve ROV in older adults. Additionally, we examined whether a relationship between cardiorespiratory fitness and ROV exists in young and older adults. Chronically exercise-trained older adults (n = 16; 66 ± 2 yr, mean ± SE) performed single muscle contractions in the forearm and leg at various intensities. Brachial and femoral artery diameter and blood velocity were measured using Doppler ultrasound. Vascular conductance (VC) was calculated as the quotient of blood flow (ml/min) and mean arterial pressure (mmHg). These data were compared with our previously published work from an identical protocol in 16 older untrained (66 ± 1 yr, mean ± SE) and 14 young (23 ± 1 yr) adults. Peak (ΔVCpeak) and total vasodilator (VCtotal) responses were greater in trained compared with untrained older adults across leg exercise intensities (P < 0.05). There were no differences in responses between trained older and young adults in the arm or leg at any exercise intensity (P > 0.05). Comparison of ΔVCpeak in a subset of subjects at an absolute workload in the leg revealed that trained older adults exhibited augmented responses relative to untrained older adults. Exercise capacity (V̇o2 peak) was associated with ΔVCpeak and VCtotal across arm (r = 0.59–0.64) and leg exercise intensities (r = 0.55–0.68, P < 0.05) in older adults. Our data demonstrate that 1) chronic exercise training improves ROV in the arm and leg of trained older adults, such that age-related differences in ROV are abolished, and 2) VO2peak is associated with ΔVCpeak responses in both limbs of older adults. PMID:27032899

Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation.

PubMed

Hughes, William E; Ueda, Kenichi; Casey, Darren P

2016-06-01

Aging is associated with attenuated contraction-induced rapid onset vasodilation (ROV). We sought to examine whether chronic exercise training would improve ROV in older adults. Additionally, we examined whether a relationship between cardiorespiratory fitness and ROV exists in young and older adults. Chronically exercise-trained older adults (n = 16; 66 ± 2 yr, mean ± SE) performed single muscle contractions in the forearm and leg at various intensities. Brachial and femoral artery diameter and blood velocity were measured using Doppler ultrasound. Vascular conductance (VC) was calculated as the quotient of blood flow (ml/min) and mean arterial pressure (mmHg). These data were compared with our previously published work from an identical protocol in 16 older untrained (66 ± 1 yr, mean ± SE) and 14 young (23 ± 1 yr) adults. Peak (ΔVCpeak) and total vasodilator (VCtotal) responses were greater in trained compared with untrained older adults across leg exercise intensities (P < 0.05). There were no differences in responses between trained older and young adults in the arm or leg at any exercise intensity (P > 0.05). Comparison of ΔVCpeak in a subset of subjects at an absolute workload in the leg revealed that trained older adults exhibited augmented responses relative to untrained older adults. Exercise capacity (V̇o2 peak) was associated with ΔVCpeak and VCtotal across arm (r = 0.59-0.64) and leg exercise intensities (r = 0.55-0.68, P < 0.05) in older adults. Our data demonstrate that 1) chronic exercise training improves ROV in the arm and leg of trained older adults, such that age-related differences in ROV are abolished, and 2) VO2peak is associated with ΔVCpeak responses in both limbs of older adults. Copyright © 2016 the American Physiological Society.

The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients.

PubMed

Shahgholian, Nahid; Jazi, Shahrzad Khojandi; Karimian, Jahangir; Valiani, Mahboubeh

2016-01-01

Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30-40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA), paired t-test, and least significant difference (LSD) post hoc test]. There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P < 0.001), but there was no significant difference between the two study groups (P < 0.001). Changes in the mean score of restless leg syndrome severity were significantly higher in reflexology and stretching exercises groups compared to the control group (P < 0.001), but it showed no significant difference between reflexology massage and stretching exercises groups. Our obtained results showed that reflexology and stretching exercises can reduce the severity of restless leg syndrome. These two methods of treatment are recommended to the patients.

The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients

PubMed Central

Shahgholian, Nahid; Jazi, Shahrzad Khojandi; Karimian, Jahangir; Valiani, Mahboubeh

2016-01-01

Background: Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. Materials and Methods: This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30–40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA), paired t-test, and least significant difference (LSD) post hoc test]. Results: There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P < 0.001), but there was no significant difference between the two study groups (P < 0.001). Changes in the mean score of restless leg syndrome severity were significantly higher in reflexology and stretching exercises groups compared to the control group (P < 0.001), but it showed no significant difference between reflexology massage and stretching exercises groups. Conclusions: Our obtained results showed that reflexology and stretching exercises can reduce the severity of restless leg syndrome. These two methods of treatment are recommended to the patients. PMID:27186197

Potential neurobiological benefits of exercise in chronic pain and posttraumatic stress disorder: Pilot study.

PubMed

Scioli-Salter, Erica; Forman, Daniel E; Otis, John D; Tun, Carlos; Allsup, Kelly; Marx, Christine E; Hauger, Richard L; Shipherd, Jillian C; Higgins, Diana; Tyzik, Anna; Rasmusson, Ann M

2016-01-01

This pilot study assessed the effects of cardiopulmonary exercise testing and cardiorespiratory fitness on plasma neuropeptide Y (NPY), allopregnanolone and pregnanolone (ALLO), cortisol, and dehydroepiandrosterone (DHEA), and their association with pain sensitivity. Medication-free trauma-exposed participants were either healthy (n = 7) or experiencing comorbid chronic pain/posttraumatic stress disorder (PTSD) (n = 5). Peak oxygen consumption (VO2) during exercise testing was used to characterize cardiorespiratory fitness. Peak VO2 correlated with baseline and peak NPY levels (r = 0.66, p < 0.05 and r = 0.69, p < 0.05, respectively), as well as exercise-induced changes in ALLO (r = 0.89, p < 0.001) and peak ALLO levels (r = 0.71, p < 0.01). NPY levels at the peak of exercise correlated with pain threshold 30 min after exercise (r = 0.65, p < 0.05), while exercise-induced increases in ALLO correlated with pain tolerance 30 min after exercise (r = 0.64, p < 0.05). In contrast, exercise-induced changes in cortisol and DHEA levels were inversely correlated with pain tolerance after exercise (r = -0.69, p < 0.05 and r = -0.58, p < 0.05, respectively). These data suggest that cardiorespiratory fitness is associated with higher plasma NPY levels and increased ALLO responses to exercise, which in turn relate to pain sensitivity. Future work will examine whether progressive exercise training increases cardiorespiratory fitness in association with increases in NPY and ALLO and reductions in pain sensitivity in chronic pain patients with PTSD.

Electromyographic Analysis of Single-Leg, Closed Chain Exercises: Implications for Rehabilitation After Anterior Cruciate Ligament Reconstruction

PubMed Central

Beutler, Anthony I.; Cooper, Leslie W.; Kirkendall, Don T.; Garrett, William E.

2002-01-01

Objective: Many knee rehabilitation studies have examined open and closed kinetic chain exercises. However, most studies focus on 2-legged, closed chain exercise. The purpose of our study was to characterize 1-legged, closed chain exercise in young, healthy subjects. Subjects: Eighteen normal subjects (11 men, 7 women; age, 24.6 ± 1.6 years) performed unsupported, 1-legged squats and step-ups to approximately tibial height. Measurements: Knee angle data and surface electromyographic activity from the thigh muscles were recorded. Results: The maximum angle of knee flexion was 111 ± 23° for squats and 101 ± 16° for step-ups. The peak quadriceps activation was 201 ± 66% maximum voluntary isometric contraction, occurring at an angle of 96 ± 16° for squats. Peak quadriceps activation was 207 ± 50% maximum voluntary isometric contraction and occurred at 83 ± 12° for step-ups. Conclusions: The high and sustained levels of quadriceps activation indicate that 1-legged squats and step-ups would be effective in muscle rehabilitation. As functional, closed chain activities, they may also be protective of anterior cruciate ligament grafts. Because these exercises involve no weights or training equipment, they may prove more cost effective than traditional modes of rehabilitation. PMID:12937438

Back pain and leg complaints that revealed non–small cell carcinoma: a case study

PubMed Central

Crisp, Casey A.; Pierce, Angela N.

2011-01-01

Objective The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer. Clinical Features A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain. Intervention and Outcome Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed. Conclusion Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain. PMID:22014908

Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT)

PubMed Central

Pearson, Adam; Blood, Emily; Lurie, Jon; Abdu, William; Sengupta, Dilip; Frymoyer, John W.; Weinstein, James

2010-01-01

Study Design As-treated analysis of the Spine Patient Outcomes Research Trial (SPORT). Objective To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e. leg vs. back). Summary of Background Data Evidence suggests that degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients with predominant leg pain may have better surgical outcomes than patients with predominant low back pain (LBP). Methods The DS cohort included 591 patients (62% underwent surgery), and the SpS cohort included 615 patients (62% underwent surgery). Patients were classified as leg pain predominant, LBP predominant or having equal pain according to baseline pain scores. Baseline characteristics were compared between the three predominant pain location groups within each diagnostic category, and changes in surgical and nonoperative outcome scores were compared through two years. Longitudinal regression models including baseline covariates were used to control for confounders. Results Among DS patients at baseline, 34% had predominant leg pain, 26% had predominant LBP, and 40% had equal pain. Similarly, 32% of SpS patients had predominant leg pain, 26% had predominant LBP, and 42% had equal pain. DS and SpS patients with predominant leg pain had baseline scores indicative of less severe symptoms. Leg pain predominant DS and SpS patients treated surgically improved significantly more than LBP predominant patients on all primary outcome measures at one and two years. Surgical outcomes for the equal pain groups were intermediate to those of the predominant leg pain and LBP groups. The differences in nonoperative outcomes were less consistent. Conclusions Predominant leg pain patients improved significantly more with surgery than predominant LBP patients. However, predominant LBP patients still improved significantly more with surgery than with

Chronic Pain and Exercise Therapy.

ERIC Educational Resources Information Center

Raithel, Kathryn Simmons

1989-01-01

Aerobic and resistance exercise are currently prescribed by physicians to treat chronic pain. However, patient fitness level must improve before he/she feels better. Pain management programs help patients become more active so they can function at work and home. (SM)

Trigger point-related sympathetic nerve activity in chronic sciatic leg pain: a case study.

PubMed

Skorupska, Elżbieta; Rychlik, Michał; Pawelec, Wiktoria; Bednarek, Agata; Samborski, Włodzimierz

2014-10-01

Sciatica has classically been associated with irritation of the sciatic nerve by the vertebral disc and consequent inflammation. Some authors suggest that active trigger points in the gluteus minimus muscle can refer pain in similar way to sciatica. Trigger point diagnosis is based on Travel and Simons criteria, but referred pain and twitch response are significant confirmatory signs of the diagnostic criteria. Although vasoconstriction in the area of a latent trigger point has been demonstrated, the vasomotor reaction of active trigger points has not been examined. We report the case of a 22-year-old Caucasian European man who presented with a 3-year history of chronic sciatic-type leg pain. In the third year of symptoms, coexistent myofascial pain syndrome was diagnosed. Acupuncture needle stimulation of active trigger points under infrared thermovisual camera showed a sudden short-term vasodilatation (an autonomic phenomenon) in the area of referred pain. The vasodilatation spread from 0.2 to 171.9 cm(2) and then gradually decreased. After needling, increases in average and maximum skin temperature were seen as follows: for the thigh, changes were +2.6°C (average) and +3.6°C (maximum); for the calf, changes were +0.9°C (average) and +1.4°C (maximum). It is not yet known whether the vasodilatation observed was evoked exclusively by dry needling of active trigger points. The complex condition of the patient suggests that other variables might have influenced the infrared thermovision camera results. We suggest that it is important to check if vasodilatation in the area of referred pain occurs in all patients with active trigger points. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Back pain and leg complaints that revealed non-small cell carcinoma: a case study.

PubMed

Crisp, Casey A; Pierce, Angela N

2011-09-01

The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer. A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain. Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed. Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain. Copyright © 2011 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Work-Related Pain in Extrinsic Finger Extensor Musculature of Instrumentalists Is Associated with Intracellular pH Compartmentation during Exercise

PubMed Central

Moreno-Torres, Angel; Rosset-Llobet, Jaume; Pujol, Jesus; Fàbregas, Sílvia; Gonzalez-de-Suso, Jose-Manuel

2010-01-01

Background Although non-specific pain in the upper limb muscles of workers engaged in mild repetitive tasks is a common occupational health problem, much is unknown about the associated structural and biochemical changes. In this study, we compared the muscle energy metabolism of the extrinsic finger extensor musculature in instrumentalists suffering from work-related pain with that of healthy control instrumentalists using non-invasive phosphorus magnetic resonance spectroscopy (31P-MRS). We hypothesize that the affected muscles will show alterations related with an impaired energy metabolism. Methodology/Principal Findings We studied 19 volunteer instrumentalists (11 subjects with work-related pain affecting the extrinsic finger extensor musculature and 8 healthy controls). We used 31P-MRS to find deviations from the expected metabolic response to exercise in phosphocreatine (PCr), inorganic phosphate (Pi), Pi/PCr ratio and intracellular pH kinetics. We observed a reduced finger extensor exercise tolerance in instrumentalists with myalgia, an intracellular pH compartmentation in the form of neutral and acid compartments, as detected by Pi peak splitting in 31P-MRS spectra, predominantly in myalgic muscles, and a strong association of this pattern with the condition. Conclusions/Significance Work-related pain in the finger extrinsic extensor muscles is associated with intracellular pH compartmentation during exercise, non-invasively detectable by 31P-MRS and consistent with the simultaneous energy production by oxidative metabolism and glycolysis. We speculate that a deficit in energy production by oxidative pathways may exist in the affected muscles. Two possible explanations for this would be the partial and/or local reduction of blood supply and the reduction of the muscle oxidative capacity itself. PMID:20161738

Effects of Exercise on Select Biomarkers and Associated Outcomes in Chronic Pain Conditions: Systematic Review.

PubMed

Kawi, Jennifer; Lukkahatai, Nada; Inouye, Jillian; Thomason, Diane; Connelly, Kirsten

2016-03-01

Chronic pain is highly prevalent. Current management is challenged by lack of validated objective measures like biological markers. Clinical pain studies employing exercise interventions have evaluated biomarkers; however, it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes. This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured. Published research studies from several databases were examined using the Jadad Scale for assessing the quality of clinical studies. Twelve research studies were reviewed. Jadad scores ranged from 5 to 11 out of 13 points. Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes. After exercise interventions, changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect. Significant biomarker associations were found with pain intensity, fatigue, depression, anxiety, and quality of life. However, there were varying methodologies in the studies reviewed. It remains a question whether biomarkers can be used as objective measures for risk assessment, diagnosis, or evaluation or as surrogate endpoints in chronic pain. Adequate sample sizes, optimal exercise dose determination, study replications, and longitudinal research studies with consistent methodologies are warranted. Regardless, the potential translational value of biomarkers in chronic pain is evident. Advancing nursing research in biomarkers is vital for moving the nursing discipline and clinical chronic pain practice forward. Developing a biobehavioral perspective in chronic pain is also necessary for comprehensive management. © The Author(s) 2015.

Pain Response after Maximal Aerobic Exercise in Adolescents across Weight Status

PubMed Central

Stolzman, Stacy; Danduran, Michael; Hunter, Sandra K; Bement, Marie Hoeger

2015-01-01

Introduction Pain reports are greater with increasing weight status, and exercise can reduce pain perception. It is unknown however, whether exercise can relieve pain in adolescents of varying weight status. The purpose of this study was to determine if adolescents across weight status report pain relief following high intensity aerobic exercise (exercise-induced hypoalgesia [EIH]). Methods 62 adolescents (15.1±1.8 years, 29 males) participated in three sessions: 1) Pressure pain thresholds (PPTs) before and after quiet rest, clinical pain (McGill Pain Questionnaire), and physical activity levels (self-report and ActiSleep Plus Monitors) were measured; 2) PPTs were measured with a computerized algometer at the 4th finger nailbed, middle deltoid muscle, and quadriceps muscle before and after maximal oxygen uptake test (VO2 max Bruce Treadmill Protocol); and 3) Body composition was measured with Dual-energy X-ray absorptiometry. Results All adolescents met criteria for VO2 max. Based on body mass index z-score, adolescents were categorized as normal weight (n=33) or overweight/obese (n=29). PPTs increased following exercise (EIH) and were unchanged with quiet rest (trial × session: p=0.02). EIH was similar across the 3 sites and between normal weight and overweight/obese adolescents. Physical activity and clinical pain were not correlated with EIH. Overweight/obese adolescents had similar absolute VO2 max (L·min-1) but lower relative VO2 max (ml·kg-1·min-1) compared with normal weight adolescents. When adolescents were categorized using FitnessGram standards as unfit (n=15) and fit (n=46), the EIH response was similar between fitness levels. Conclusion This study is the first to establish that adolescents experience EIH in both overweight and normal weight youth. EIH after high intensity aerobic exercise was robust in adolescents regardless of weight status and not influenced by physical fitness. PMID:25856681

Prior leg massage decreases pain responses to heel stick in preterm babies.

PubMed

Jain, Sunil; Kumar, Praveen; McMillan, Douglas D

2006-09-01

Leg massage could inhibit the transmission of pain by 'closing the gate' or by activating the endogenous opioid pathway to decrease nociceptive transmission of pain associated with heel stick. The aim of this study is to determine the effects of massage therapy prior to heel stick on responses assessed by the Neonatal Infant Pain Scale (NIPS) (primary outcome), heart rate, respiratory rate and oxygen saturation (secondary outcomes) in infants who required a heel stick for blood sampling. This randomised, double-blind, crossover trial with infants from 1 to 7 days post birth excluded those with prior surgery, septicaemia, current assisted ventilation or an analgesic within 48 h. After informed consent, 13 infants received a 2-min massage of the ipsilateral leg prior to heel stick on the first study sampling and no massage on the next sampling 2-7 days later and 10 infants had the reverse order. The bedside nurse, blinded to the intervention, measured NIPS, heart rate, respiratory rate, and oxygen saturation prior to massage, after massage, and 5 min after heel stick. Serum cortisol was measured with the blood sampling. In 23 infants (birthweight 795-2507 g), there were no adverse physiologic effects of massage. After heel stick, NIPS (P < 0.001) and heart rate (P = 0.03) were increased in the no-massage group compared with the massage group. Respiratory rate, oxygen saturation and serum cortisol were not significantly different. Gentle massage of the leg prior to heel stick is safe and decreases pain responses in preterm infants.

Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; a systematic review.

PubMed

Runhaar, J; Luijsterburg, P; Dekker, J; Bierma-Zeinstra, S M A

2015-07-01

Although physical exercise is the commonly recommended for osteoarthritis (OA) patients, the working mechanism behind the positive effects of physical exercise on pain and function is a black box phenomenon. In the present study we aimed to identify possible mediators in the relation between physical exercise and improvements of pain and function in OA patients. A systematic search for all studies evaluating the effects of physical exercise in OA patients and select those that additionally reported the change in any physiological factor from pre-to post-exercise. In total, 94 studies evaluating 112 intervention groups were included. Most included studies evaluated subjects with solely knee OA (96 out of 112 groups). Based on the measured physiological factors within the included studies, 12 categories of possible mediators were formed. Muscle strength and ROM/flexibility were the most measured categories of possible mediators with 61 and 21 intervention groups measuring one or more physiological factors within these categories, respectively. 60% (31 out of 52) of the studies showed a significant increase in knee extensor muscle strength and 71% (22 out of 31) in knee flexor muscle strength over the intervention period. All 5 studies evaluating extension impairments and 10 out of 12 studies (83%) measuring proprioception found a significant change from pre-to post-intervention. An increase of upper leg strength, a decrease of extension impairments and improvement in proprioception were identified as possible mediators in the positive association between physical exercise and OA symptoms. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Patellofemoral Pain Syndrome

MedlinePlus

... But do this slowly, increasing the amount of time you do the sports activity a little at a time. Talk to ... 20 seconds. Do the exercise 6 to 10 times and then switch legs. Citations Management of Patellofemoral Pain Syndrome by S Dixit, M.D., ...

Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program

PubMed Central

Patti, Antonino; Bianco, Antonino; Paoli, Antonio; Messina, Giuseppe; Montalto, Maria Alessandra; Bellafiore, Marianna; Battaglia, Giuseppe; Iovane, Angelo; Palma, Antonio

2016-01-01

Abstract Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP. Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T1). Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P < 0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7 ± 5.0 compared with T1, 6.5 ± 4.0 (P < 0.001); and CG, T0, 10.7 ± 7.8 compared with T1, 8.4 ± 7.8 (P < 0.01). A greater extent of reduction in pain was achieved in the EG. The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings. PMID:26765419

Effect of pain-free range exercise on shoulder pain and range of motion in an amateur skier.

PubMed

Yoo, Won-Gyu

2016-12-01

[Purpose] This study prescribed pain-free range exercises for a female amateur skier who complained of limitations in her shoulder range of motion, and pain caused by protective spasms; the tester evaluated the effects of such exercise on pain. [Subject and Methods] A 23-year-old female who complained of pain of 3 weeks in duration in the right glenohumoral and scapulothoracic joints was enrolled. [Results] After pain-free range exercises, the visual analog pain score was 2 and the shoulder flexion and abduction angles improved compared to the initial values. [Conclusion] Thus, this study suggests muscle-strengthening exercises within the pain-free range, rather than simple pain treatments, as therapy for acute muscle injuries in skiers.

Management of nerves during leg amputation--a neglected area in our understanding of the pathogenesis of phantom limb pain.

PubMed

Rasmussen, S; Kehlet, H

2007-09-01

Chronic neuropathic pain after leg amputation is a significant problem, with a reported incidence during the first year as high as 70%. Intra-operative handling of the nerves during amputation has not been discussed in the literature on post-amputation pain and, in major textbooks, it is recommended that the ischial nerve be ligated, despite the fact that the experimental literature uses nerve ligations to produce neuropathic pain. The purpose of this study was to investigate the clinical practice of nerve handling during leg amputation. Trainees with at least 2 years of practice received a questionnaire regarding handling of the nerves during leg amputation; 128 of 149 questionnaires sent (86%) were returned. Ligation of the nerves was used by 31% of surgeons. There is no consistency in the management of the large nerves during lower leg amputation. The recommendations in major textbooks may not be appropriate when compared with the experimental literature on nerve ligature models to produce neuropathic pain. Future studies on post-amputation pain should consider intra-operative nerve management.

Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg

NASA Technical Reports Server (NTRS)

Mohler, L. R.; Styf, J. R.; Pedowitz, R. A.; Hargens, A. R.; Gershuni, D. H.

1997-01-01

Currently, the definitive diagnosis of chronic compartment syndrome is based on invasive measurements of intracompartmental pressure. We measured the intramuscular pressure and the relative oxygenation in the anterior compartment of the leg in eighteen patients who were suspected of having chronic compartment syndrome as well as in ten control subjects before, during, and after exercise. Chronic compartment syndrome was considered to be present if the intramuscular pressure was at least fifteen millimeters of mercury (2.00 kilopascals) before exercise, at least thirty millimeters of mercury (4.00 kilopascals) one minute after exercise, or at least twenty millimeters of mercury (2.67 kilopascals) five minutes after exercise. Changes in relative oxygenation were measured with use of the non-invasive method of near-infrared spectroscopy. In all patients and subjects, there was rapid relative deoxygenation after the initiation of exercise, the level of oxygenation remained relatively stable during continued exercise, and there was reoxygenation to a level that exceeded the pre-exercise resting level after the cessation of exercise. During exercise, maximum relative deoxygenation in the patients who had chronic compartment syndrome (mean relative deoxygenation [and standard error], -290 +/- 39 millivolts) was significantly greater than that in the patients who did not have chronic compartment syndrome (-190 +/- 10 millivolts) and that in the control subjects (-179 +/- 14 millivolts) (p < 0.05 for both comparisons). In addition, the interval between the cessation of exercise and the recovery of the pre-exercise resting level of oxygenation was significantly longer for the patients who had chronic compartment syndrome (184 +/- 54 seconds) than for the patients who did not have chronic compartment syndrome (39 +/- 19 seconds) and the control subjects (33 +/- 10 seconds) (p < 0.05 for both comparisons).

Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

PubMed Central

Zdziarski, Laura Ann; Wasser, Joseph G; Vincent, Heather K

2015-01-01

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons. PMID:25709495

Leg Stiffness in Female Soccer Players: Intersession Reliability and the Fatiguing Effects of Soccer-Specific Exercise.

PubMed

De Ste Croix, Mark B A; Hughes, Jonathan D; Lloyd, Rhodri S; Oliver, Jon L; Read, Paul J

2017-11-01

De Ste Croix, MBA, Hughes, JD, Lloyd, RS, Oliver, JL, and Read, PJ. Leg stiffness in female soccer players: intersession reliability and the fatiguing effects of soccer-specific exercise. J Strength Cond Res 31(11): 3052-3058, 2016-Low levels of leg stiffness and reduced leg stiffness when fatigue is present compromise physical performance and increase injury risk. The purpose of this study was to (a) determine the reliability of leg stiffness measures obtained from contact mat data and (b) explore age-related differences in leg stiffness after exposure to a soccer-specific fatigue protocol in young female soccer players. Thirty-seven uninjured female youth soccer players divided into 3 subgroups based on chronological age (under 13 [U13], under 15 [U15], and under 17 [U17] year-olds) volunteered to participate in the study. After baseline data collection, during which relative leg stiffness, contact time, and flight time were collected, participants completed an age-appropriate soccer-specific fatigue protocol (SAFT). Upon completion of the fatigue protocol, subjects were immediately retested. Intersession reliability was acceptable and could be considered capable of detecting worthwhile changes in performance. Results showed that leg stiffness decreased in the U13 year-olds, was maintained in the U15 age group, and increased in the U17 players. Contact times and flight times did not change in the U13 and U15 year-olds, but significantly decreased and increased, respectively, in the U17 age group. The data suggest that age-related changes in the neuromuscular control of leg stiffness are present in youth female soccer players. Practitioners should be aware of these discrepancies in neuromuscular responses to soccer-specific fatigue, and should tailor training programs to meet the needs of individuals, which may subsequently enhance performance and reduce injury risk.

Effects of prior heavy exercise on VO(2) kinetics during heavy exercise are related to changes in muscle activity.

PubMed

Burnley, Mark; Doust, Jonathan H; Ball, Derek; Jones, Andrew M

2002-07-01

We hypothesized that the elevated primary O(2) uptake (VO(2)) amplitude during the second of two bouts of heavy cycle exercise would be accompanied by an increase in the integrated electromyogram (iEMG) measured from three leg muscles (gluteus maximus, vastus lateralis, and vastus medialis). Eight healthy men performed two 6-min bouts of heavy leg cycling (at 70% of the difference between the lactate threshold and peak VO(2)) separated by 12 min of recovery. The iEMG was measured throughout each exercise bout. The amplitude of the primary VO(2) response was increased after prior heavy leg exercise (from mean +/- SE 2.11 +/- 0.12 to 2.44 +/- 0.10 l/min, P < 0.05) with no change in the time constant of the primary response (from 21.7 +/- 2.3 to 25.2 +/- 3.3 s), and the amplitude of the VO(2) slow component was reduced (from 0.79 +/- 0.08 to 0.40 +/- 0.08 l/min, P < 0.05). The elevated primary VO(2) amplitude after leg cycling was accompanied by a 19% increase in the averaged iEMG of the three muscles in the first 2 min of exercise (491 +/- 108 vs. 604 +/- 151% increase above baseline values, P < 0.05), whereas mean power frequency was unchanged (80.1 +/- 0.9 vs. 80.6 +/- 1.0 Hz). The results of the present study indicate that the increased primary VO(2) amplitude observed during the second of two bouts of heavy exercise is related to a greater recruitment of motor units at the onset of exercise.

Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis.

PubMed

Roper, Jaimie A; Bressel, Eadric; Tillman, Mark D

2013-03-01

To examine the acute effects of aquatic and land treadmill exercise on gait kinematics as well as the level of disease-specific and movement-related pain for individuals with osteoarthritis. Quasi-experimental crossover design. Biomechanics laboratory. Participants (N=14; age, 43-64y) diagnosed with osteoarthritis at the knee (n=12), osteoarthritis at the knee and ankle (n=1), or osteoarthritis at the knee and hip (n=1). Participants performed 3 exercise sessions separated by at least 24 hours in 1 week for each mode of exercise (aquatic treadmill and land treadmill). Gait kinematics and pain were measured before and after each intervention. The angular velocity gain score during stance for left knee extension was improved by 38% after aquatic treadmill exercise (P=.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (P=.004, P=.008, respectively). During stance, the joint angle gain score for left hip flexion was 7.23% greater after land exercise (P=.007). During swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (P=.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher after land exercise (4.72%, P=.003). No other joint angle gain scores for either stance or swing were significantly different for either condition (P=.06-.96). Perceived pain was 100% greater after land than aquatic treadmill exercise (P=.02). Step rate and step length were not different between conditions (P=.31-.92). An acute training period on an aquatic treadmill positively influenced joint angular velocity and arthritis-related joint pain. Acute aquatic treadmill exercise may be useful as a conservative treatment to improve angular speed of the lower-extremity joints and pain related to osteoarthritis. Copyright © 2013 American Congress of Rehabilitation Medicine. Published

Reduced Modulation of Pain in Older Adults After Isometric and Aerobic Exercise.

PubMed

Naugle, Kelly M; Naugle, Keith E; Riley, Joseph L

2016-06-01

Laboratory-based studies show that acute aerobic and isometric exercise reduces sensitivity to painful stimuli in young healthy individuals, indicative of a hypoalgesic response. However, little is known regarding the effect of aging on exercise-induced hypoalgesia (EIH). The purpose of this study was to examine age differences in EIH after submaximal isometric exercise and moderate and vigorous aerobic exercise. Healthy older and younger adults completed 1 training session and 4 testing sessions consisting of a submaximal isometric handgrip exercise, vigorous or moderate intensity stationary cycling, or quiet rest (control). The following measures were taken before and after exercise/quiet rest: 1) pressure pain thresholds, 2) suprathreshold pressure pain ratings, 3) pain ratings during 30 seconds of prolonged noxious heat stimulation, and 4) temporal summation of heat pain. The results revealed age differences in EIH after isometric and aerobic exercise, with younger adults experiencing greater EIH compared with older adults. The age differences in EIH varied across pain induction techniques and exercise type. These results provide evidence for abnormal pain modulation after acute exercise in older adults. This article enhances our understanding of the influence of a single bout of exercise on pain sensitivity and perception in healthy older compared with younger adults. This knowledge could help clinicians optimize exercise as a method of pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial.

PubMed

Lopes, Susana; Correia, Christophe; Félix, Gonçalo; Lopes, Mário; Cruz, Ana; Ribeiro, Fernando

2017-10-01

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5±3.4 to 9.7±2.7cm 2 , p=0.002 and CoP velocity: 2.8±0.6 to 2.3±0.5cm/s, p<0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group. Pilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial.

PubMed

Inani, Sumit B; Selkar, Sohan P

2013-01-01

Low Back Pain (LBP) results in significant level of disability, producing significant restriction on usual activity such as an inability to work. Nearly two third of the adults are affected by non-specific low back pain at some point in their lives. The purpose of the study was to determine the effect of core stabilization exercises in comparison with conventional exercises on pain, functional status in patients with non-specific LBP. Thirty patients diagnosed with non-specific LBP participated with age group between 20-50 years and divided in to 2 groups, one with core stabilization exercises and other conventional exercises, 15 subjects each. Three months study, pre and post treatment outcome measures used were VAS for pain intensity and Modified Oswestry Low Back Pain Disability Index for functional status (disability). Data were analyzed using student 't' test (paired and unpaired). Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (p<0.001) improvements regarding pain and functional status for experimental group compared to control group. Core stabilization exercises were found to be more effective in reducing pain and improving functional status by decreasing disability of patients with non-specific low back pain in comparison with conventional exercises.

Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis

PubMed Central

Hendrick, Paul; Smith, Toby O; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael S; Selfe, James; Logan, Pip

2017-01-01

Background Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. Methods Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. Results The literature search identified 9081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short- term significant difference in pain, with moderate quality evidence for a small effect size of −0.27 (−0.54 to −0.05) in favour of painful exercises. For pain in the medium and long term, and function and disability in the short, medium and long term, there was no significant difference. Conclusion Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO registration CRD42016038882. PMID:28596288

Blood ammonia and lactate as markers of muscle metabolites during leg press exercise.

PubMed

Gorostiaga, Esteban M; Navarro-Amézqueta, Ion; Calbet, Jose A L; Sánchez-Medina, Luis; Cusso, Roser; Guerrero, Mario; Granados, Cristina; González-Izal, Miriam; Ibáñez, Javier; Izquierdo, Mikel

2014-10-01

To examine whether blood lactate and ammonia concentrations can be used to estimate the functional state of the muscle contractile machinery with regard to muscle lactate and adenosine triphosphate (ATP) levels during leg press exercise. Thirteen men (age, 34 ± 5 years; 1 repetition maximum leg press strength 199 ± 33 kg) performed either 5 sets of 10 repetitions to failure (5×10RF), or 10 sets of 5 repetitions not to failure (10×5RNF) with the same initial load (10RM) and interset rests (2 minutes) on 2 separate sessions in random order. Capillary blood samples were obtained before and during exercise and recovery. Six subjects underwent vastus lateralis muscle biopsies at rest, before the first set and after the final exercise set. The 5×10RF resulted in a significant and marked decrease in power output (37%), muscle ATP content (24%), and high levels of muscle lactate (25.0 ± 8.1 mmol·kg wet weight), blood lactate (10.3 ± 2.6 mmol·L), and blood ammonia (91.6 ± 40.5 μmol·L). During 10×5RNF no or minimal changes were observed. Significant correlations were found between: (a) blood ammonia and muscle ATP (r = -0.75), (b) changes in peak power output and blood ammonia (r = -0.87) and blood lactate (r = -0.84), and (c) blood and muscle lactate (r = 0.90). Blood lactate and ammonia concentrations can be used as extracellular markers for muscle lactate and ATP contents, respectively. The decline in mechanical power output can be used to indirectly estimate blood ammonia and lactate during leg press exercise.

Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.

PubMed

Akhtar, Muhammad Waseem; Karimi, Hossein; Gilani, Syed Amir

2017-01-01

Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2 nd , 4 th and 6 th week post treatment. The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2 nd , 4 th and 6 th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain.

PubMed

Anderson, Barton E; Bliven, Kellie C Huxel

2017-09-01

Clinical Scenario: Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain. Focused Clinical Question: In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life? Summary of Key Findings: Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention. Clinical Bottom Line: Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2-3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician's own judgment and clinical expertise and the patient's preferences and values. Strength of Recommendation: Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

Attitudes towards exercise among substance using older adults living with HIV and chronic pain.

PubMed

Nguyen, Annie L; Lake, Jordan E; Reid, M Carrington; Glasner, Suzette; Jenkins, Jessica; Candelario, Jury; Soliman, Sarah; Del Pino, Homero E; Moore, Alison A

2017-09-01

Chronic pain and substance use disorders occur commonly among HIV-infected persons. Recent CDC guidelines recommend non-pharmacologic approaches over opioid medications for the management of chronic pain. This is particularly relevant for persons with substance use disorders. Structured physical activity may be an effective strategy for pain reduction. We developed a combined cognitive-behavioral therapy (CBT) + exercise intervention to reduce pain, pain-related disability and substance use and improve physical function in older HIV-infected adults with chronic pain and substance use. We employed established CBT protocols for the intervention, and sought feedback from potential end users when developing the exercise component of the intervention. A total of 27 HIV-infected adults ≥ 50 years of age participated in four focus group sessions. Transcripts were analyzed using thematic analysis. Participant demographics: mean age 54 years; male 81%; Hispanic 48%, Black 33%; treated for substance abuse in the past 52%. Exercise was seen as a desirable activity, but many participants expressed barriers to exercise including fear of pain exacerbation, low physical fitness, and lack of availability of perceived safe spaces for HIV-infected persons. Most participants were receptive to exercise for pain reduction, particularly modalities that provide added psychological benefits of reducing stress and anxiety. Exercise for pain management among older HIV-infected adults with chronic pain and substance use was found to be highly acceptable. However, interventions need to be tailored to the unique needs of this population to address their fears and concerns.

Exercise motivation and nonspecific back pain: A comparison of patients and nonpatients.

PubMed

Kleinert, Jens; Ott, Ida; Mierswa, Tobias; Levenig, Claudia G; Wenge, Kerstin; Hasenbring, Monika; Kellmann, Michael

2017-08-01

Motivation is a key variable to consider during exercise or exercise therapy of individuals with back pain. Based on organismic integration theory, this study aims to improve the understanding of exercise motivation in patients and nonpatients by evaluating the relationships between typical motivational profiles and personal characteristics, therapy parameters and pain related variables. One hundred nine women and 145 men with back pain (mean age 33.3 years; 31.9% currently under the care of a physician) involved in some kind of exercise for current nonspecific back pain voluntarily participated in this study. An adapted version of the Behavioral Regulation in Sport Questionnaire was used to measure exercise motivation. Furthermore, data on pain, disability status, level of sport activity, body concept, and the type of treatment or exercise were gathered. Autonomous forms of regulation were most prevalent among subjects. Of 4 motivational profiles found, 2 showed a positive pattern (29.1% highly motivated individuals, 21.7% autonomously convinced individuals), and 2 showed a more negative pattern (19.7% controlled convinced individuals, 29.5% less motivated individuals). Relationships between profiles and age, body concept, involvement in sport competition, and type of exercise were found. The different motivational profiles respectively reveal specific practical relevance. In particular, the controlled convinced pattern is supposed to be more maladaptive than all other profiles. The insights provided by this study supports the development of motivation-oriented treatments based on the assessment of individuals' motivational profiles. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome.

PubMed

Alaca, Ridvan; Yilmaz, Bilge; Goktepe, A Salim; Mohur, Haydar; Kalyon, Tunc Alp

2002-11-01

To assess the effect of an isokinetic exercise program on symptoms and functions of patients with patellofemoral pain syndrome. A total of 22 consecutive patients with the complaint of anterior knee pain who met the inclusion criteria were recruited to assess the efficacy of isokinetic exercise on functional capacity, isokinetic parameters, and pain scores in patients with patellofemoral pain syndrome. A total of 37 knees were examined. Six-meter hopping, three-step hopping, and single-limb hopping course tests were performed for each patient with the measurements of the Lysholm scale and visual analog scale. Tested parameters were peak torque, total work, average power, and endurance ratios. Statistical analyses revealed that at the end of the 6-wk treatment period, functional and isokinetic parameters improved significantly, as did pain scores. There was not statistically significant correlation between different groups of parameters. The isokinetic exercise treatment program used in this study prevented the extensor power loss due to patellofemoral pain syndrome, but the improvement in the functional capacity was not correlated with the gained power.

Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis.

PubMed

Smith, Benjamin E; Hendrick, Paul; Smith, Toby O; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael S; Selfe, James; Logan, Pip

2017-12-01

Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient's pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. The literature search identified 9081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short- term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain in the medium and long term, and function and disability in the short, medium and long term, there was no significant difference. Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. CRD42016038882. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial

PubMed Central

2014-01-01

Background Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. Method/design This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. Discussion This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can

Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis.

PubMed

Taylor, Rod S; Desai, Mehul J; Rigoard, Philippe; Taylor, Rebecca J

2014-07-01

We sought to assess the extent to which pain relief in chronic back and leg pain (CBLP) following spinal cord stimulation (SCS) is influenced by patient-related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following SCS, we also sought pain score (pre- and post-SCS). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow-up, publication year, continent of data collection, study design, quality score, method of SCS lead implant, and type of SCS lead. Between-study association in predictive factors and pain relief were assessed by meta-regression. Seventy-four studies (N = 3,025 patients with CBLP) met the inclusion criteria; 63 reported data to allow inclusion in a quantitative analysis. Evidence of substantial statistical heterogeneity (P < 0.0001) in level of pain relief following SCS was noted. The mean level of pain relief across studies was 58% (95% CI: 53% to 64%, random effects) at an average follow-up of 24 months. Multivariable meta-regression analysis showed no predictive patient or technology factors. SCS was effective in reducing pain irrespective of the location of CBLP. This review supports SCS as an effective pain relieving treatment for CBLP with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost-effectiveness of SCS in the CLBP population with predominant low back pain. © 2013 The Authors Pain Practice Published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.

Cardiorespiratory deconditioning with static and dynamic leg exercise during bed rest.

PubMed

Stremel, R W; Convertino, V A; Bernauer, E M; Greenleaf, J E

1976-12-01

Bed rest deconditioning was assessed in seven healthy men (19-22 yr) following three 14-day periods of controlled activity during recumbency by measuring submaximal and maximal oxygen uptake (VO2), ventilation (VE), heart rate, and plasma volume. Exercise regimens were performed in the supine position and included a) two 30-min periods daily of intermittent static exercise at 21% of maximal leg extension force, and b) two 30-min periods of dynamic bicycle ergometer exercise daily at 68% of VO2max. No prescribed exercise was performed during the third bed rest period. Compared with their respective pre-bed rest control values, VO2max decreased (P less than 0.05) under all exercise conditions; -12.3% with no exercise, -9.2% with dynamic exercise, but only -4.8% with static exercise. Maximal heart rate was increased by 3.3% to 4.9% (P less than 0.05) under the three exercise conditions, while plasma volume decreased (P less than 0.05) -15.1% with no exercise and -10.1% with static, but only -7.8% (NS) with dynamic exercise. Since neither the static nor dynamic exercise training regimes minimized the changes in all the variables studied, some combination of these two types of exercise may be necessary for maximum protection from the effects of the bed deconditioning.

Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry and their relationship to self-reported back pain.

PubMed

Knutson, Gary A

2002-02-01

To determine the incidence of pelvic unleveling, foot rotation, and supine leg length alignment asymmetry in a nonclinical population and to examine the validity (sensitivity, specificity, positive and negative predictive values) of these visual tests and their relationship to self-reported back pain. Volunteers answered a questionnaire regarding back pain and were then examined by a chiropractor who was unaware of the status of their back pain. Seventy-four unscreened volunteers answered the questionnaire. The association of visual tests with back pain and their validity indices; Visual Analogue Scale ratings. Fifty-one percent (n = 74) of volunteers examined had supine leg length alignment asymmetry (LLA). Pain intensity on a Visual Analogue Scale was significantly higher (P <.001) for those demonstrating supine LLA than for those without LLA. Those with back pain and recurrent back pain were significantly (P <.001) more likely to have supine LLA. The validity indices of the supine leg check showed acceptable levels for sensitivity (74%), specificity (78%), and positive predictive value (82%) [corrected] in recurrent back pain. Findings also indicated a high incidence of supine LLA in volunteers with chronic back pain (85%). The results indicated that, in this group of volunteers, the supine leg length alignment check had clinical validity as a stand-alone test for recurring back pain. Further testing on a larger, statistically defined cross-section of the population is recommended.

Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain

PubMed Central

Thorborg, Kristian; Branci, Sonia; Nielsen, Martin Peter; Tang, Lars; Nielsen, Michael Bachmann; Hölmich, Per

2014-01-01

Background: Adductor-related pain is the most common clinical finding in soccer players with groin pain and can be a long-standing problem affecting physical function and performance. Hip adductor weakness has been suggested to be associated with this clinical entity, although it has never been investigated. Purpose: To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction strength than players without adductor-related groin pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male elite and subelite players from 40 teams were contacted. In total, 28 soccer players with adductor-related groin pain and 16 soccer players without adductor-related groin pain (asymptomatic controls) were included in the study. In primary analysis, the dominant legs of 21 soccer players with adductor-related groin pain (≥4 weeks duration) were compared with the dominant legs of 16 asymptomatic controls using a cross-sectional design. The mean age of the symptomatic players was 24.5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor. Results: Eccentric hip adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P < .001). No other hip strength differences were observed between symptomatic players and asymptomatic controls for the dominant leg (P = .35-.84). Conclusion: Large eccentric hip adduction strength deficits were found in soccer players with adductor-related

The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain.

PubMed

Khan, Muhammad; Soomro, Rabail Rani; Ali, Syed Shahzad

2014-09-01

To evaluate the effectiveness of isometric exercises as compared to general exercises in chronic non-specific neck pain. For this randomised controlled trial total 68 patients (34 each group) with chronic non-specific neck pain were recruited from Alain Poly Clinic and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences, Karachi between May, 2012 and August, 2012. Simple randomisation method was used to assign participants into isometric exercise group and general exercise groups. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises group performed active range of movement exercises for all neck movements. Patients in both groups received 3 supervised treatment sessions per week for 12 weeks. Visual Analogue Scale (VAS), North wick Park Neck Pain Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 12 weeks. Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001f or isometric exercise group, p = 0.04 for general exercises group and p = 0.001 for range of movement. However, mean improvements in post intervention VAS score and North wick Park Neck Pain Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non-specific neck pain however; isometric exercises are clinically more effective than general exercises.

Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial.

PubMed

Baldon, Rodrigo de Marche; Serrão, Fábio Viadanna; Scattone Silva, Rodrigo; Piva, Sara Regina

2014-04-01

Randomized clinical trial. To compare the effects of functional stabilization training (FST) versus standard training on knee pain and function, lower-limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee muscle strength in women with patellofemoral pain. A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain. However, there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity. Thirty-one women were randomized to either the FST group or standard-training group. Patients attended a baseline assessment session, followed by an 8-week intervention, and were reassessed at the end of the intervention and at 3 months after the intervention. Assessment measures were a 10-cm visual analog scale for pain, the Lower Extremity Functional Scale, and the single-leg triple-hop test. A global rating of change scale was used to measure perceived improvement. Kinematics were assessed during the single-leg squat. Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment. The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the standard-training group. Lesser ipsilateral trunk inclination, pelvis contralateral depression, hip adduction, and knee abduction, along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat, were only observed in the FST group after the intervention. Only those in the FST group had greater eccentric hip abductor and knee flexor strength, as well as greater endurance of the anterior, posterior, and lateral trunk muscles, after training. An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was

Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis.

PubMed

Lim, Edwin Choon Wyn; Poh, Ruby Li Choo; Low, Ai Ying; Wong, Wai Pong

2011-02-01

A systematic review with meta-analysis. To compare pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to minimal or other interventions. Searches of Medline, CINAHL, Embase, Cochrane library, PEDro, and ProQuest Dissertations and Thesis databases were conducted. Randomized controlled trials (RCTs) were selected and reviewed if they compared pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to other treatment approaches. Quality of the trials was evaluated. Data for pain and disability scores were extracted. Narrative synthesis plus meta-analyses were performed, with either a fixed-effects or random-effects model, standardized mean differences (SMDs), and tests for heterogeneity. Seven RCTs were identified and included in the meta-analyses. Data pooling was performed using RevMan 5. When compared to minimal intervention, Pilates-based exercise provided superior pain relief (pooled SMD, -2.72; 95% CI: -5.33, -0.11; P = .04) but the pooled disability scores were not significantly different (pooled SMD, -0.74; 95% CI: -1.81, 0.33;P = .17). No significant differences were found when comparing Pilates-based exercise to other forms of exercise for pain (pooled SMD, 0.03; 95% CI: -0.52, 0.58; P = .92) or disability scores (pooled SMD, -0.41; 95% CI: -0.96, 0.14; P = .14). Pilates-based exercises are superior to minimal intervention for pain relief. Existing evidence does not establish superiority of Pilates-based exercise to other forms of exercise to reduce pain and disability for patients with persistent nonspecific low back pain. However, the relatively low quality of existing studies and the heterogeneity of pooled studies in this systematic review combine to suggest that these results should be interpreted with caution. Therapy, level 1a.

The influence of estradiol on muscle damage and leg strength after intense eccentric exercise.

PubMed

Minahan, Clare; Joyce, Sarah; Bulmer, Andrew C; Cronin, Neil; Sabapathy, Surendran

2015-07-01

To examine the influence of estradiol on muscle damage and leg strength after intense eccentric exercise. Eight men (MEN), eight normally menstruating women (WomenNM), and eight women using oral contraceptives (WomenOC) participated in this study. Subjects performed 240 maximal-effort bilateral eccentric contractions of the quadriceps muscle groups designed to elicit exercise-induced muscle damage (EiMD). Serum creatine kinase (CK), myoglobin (Mb), and fatty acid-binding protein (FABP) concentrations were measured before (pre-) EiMD, as well as 0, 6, 24, and 48 h post-EiMD. Peak isometric quadriceps torque (i.e., leg strength) was measured pre-EiMD, as well as 24 and 48 h post-EiMD. The increases in CK, Mb, and FABP concentrations from pre- to post-EiMD were greater in MEN (10-fold, 15-fold, and fourfold, respectively) and WomenOC (sevenfold, 11-fold, and ninefold) compared with WomenNM (five-, six-, and threefold; p < 0.05). The decline in leg strength was about 10 % pre- to 24 h post-EiMD in all groups and decreased a further 10-15 % by 48 h post-EiMD in the MEN and WomenOC only. Our findings suggest an important role of estradiol in blunting the muscle damage response to intense eccentric exercise and preserving muscle function after EiMD.

Physical exercise: does it help in relieving pain and increasing mobility among older adults with chronic pain?

PubMed

Tse, Mimi M Y; Wan, Vanessa T C; Ho, Suki S K

2011-03-01

To provide a physical exercise programme for older adults living in nursing homes. Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function. A quasi-experimental single group pretest-posttest design. Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme. There were 75 older adult participants (57 female and 18 male, mean age 85.14 SD 5.30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4.89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2.89 (SD 2.14) (p < 0.01). There was a significant increase in range of movement in the neck, shoulder, back, hip and knee rotation, flex and abduction (p < 0.01). Mobility level was significantly increased post intervention, yet activities of daily living remained unchanged. The present study demonstrated the effectiveness of a physical exercise programme in relieving pain and enhancing functional mobility for older persons. Relevance

Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain.

PubMed

Standaert, Christopher J; Friedly, Janna; Erwin, Mark W; Lee, Michael J; Rechtine, Glenn; Henrikson, Nora B; Norvell, Daniel C

2011-10-01

Systematic review. We sought to answer the following clinical questions: (1) Is structured exercise more effective in the treatment of chronic low back pain (LBP) than spinal manipulative therapy (SMT)? (2) Is structured exercise more effective in the treatment of chronic LBP than acupuncture? (3) Is SMT more effective in the treatment of chronic LBP than acupuncture? (4) Do certain subgroups respond more favorably to specific treatments? (5) Are any of these treatments more cost-effective than the others? Exercise, SMT, and acupuncture are widely used interventions in the treatment of chronic LBP. There is evidence that all of these approaches may offer some benefit for patients with chronic LBP when compared with usual care or no treatment. The relative benefits or cost-effectiveness of any one of these treatments when compared with the others are less well-defined, and it is difficult to identify specific subgroups of those with chronic LBP who may preferentially respond to a particular treatment modality. A systematic review of the literature was performed to identify randomized controlled trials comparing a structured exercise program, SMT, or acupuncture with one another in patients with chronic LBP. Two studies were identified comparing the use of structured exercise with SMT that met our inclusion criteria. Although these studies utilized different approaches for the exercise and SMT treatment groups, patients in both groups improved in terms of pain and function in both studies. Using random-effects modeling, there was no difference between the exercise and SMT groups when the data from these studies were pooled. We identified no studies meeting our inclusion criteria that compared acupuncture with either structured exercise or SMT or that addressed the relative cost-effectiveness of these approaches in the treatment of patients with chronic LBP. The studies identified indicate that structured exercise and SMT appear to offer equivalent benefits in terms

Exercise adherence, cardiopulmonary fitness and anthropometric changes improve exercise self-efficacy and health-related quality of life.

PubMed

Imayama, Ikuyo; Alfano, Catherine M; Mason, Caitlin E; Wang, Chiachi; Xiao, Liren; Duggan, Catherine; Campbell, Kristin L; Foster-Schubert, Karen E; Wang, Ching-Yun; McTiernan, Anne

2013-07-01

Regular exercise increases exercise self-efficacy and health-related quality of life (HRQOL); however, the mechanisms are unknown. We examined the associations of exercise adherence and physiological improvements with changes in exercise self-efficacy and HRQOL. Middle-aged adults (N = 202) were randomized to 12 months aerobic exercise (360 minutes/week) or control. Weight, waist circumference, percent body fat, cardiopulmonary fitness, HRQOL (SF-36), and exercise self-efficacy were assessed at baseline and 12 months. Adherence was measured in minutes/day from activity logs. Exercise adherence was associated with reduced bodily pain, improved general health and vitality, and reduced role-emotional scores (P(trend) ≤ 0.05). Increased fitness was associated with improved physical functioning, bodily pain and general health scores (P(trend) ≤ 0.04). Reduced weight and percent body fat were associated with improved physical functioning, general health, and bodily pain scores (P(trend) < 0.05). Decreased waist circumference was associated with improved bodily pain and general health but with reduced role-emotional scores (P(trend) ≤ 0.05). High exercise adherence, increased cardiopulmonary fitness and reduced weight, waist circumference and percent body fat were associated with increased exercise self-efficacy (P(trend) < 0.02). Monitoring adherence and tailoring exercise programs to induce changes in cardiopulmonary fitness and body composition may lead to greater improvements in HRQOL and self-efficacy that could promote exercise maintenance.

Exercise adherence, cardiopulmonary fitness and anthropometric changes improve exercise self-efficacy and health-related quality of life

PubMed Central

Imayama, Ikuyo; Alfano, Catherine M.; Mason, Caitlin E.; Wang, Chiachi; Xiao, Liren; Duggan, Catherine; Campbell, Kristin L.; Foster-Schubert, Karen E.; McTiernan, Anne

2014-01-01

Background Regular exercise increases exercise self-efficacy and health-related quality of life (HRQOL); however, the mechanisms are unknown. We examined the associations of exercise adherence and physiological improvements with changes in exercise self-efficacy and HRQOL. Methods Middle-aged adults (N=202) were randomized to 12 months aerobic exercise (360 minutes/week) or control. Weight, waist circumference, percent body fat, cardiopulmonary fitness, HRQOL (SF-36), and exercise self-efficacy were assessed at baseline and 12 months. Adherence was measured in minutes/day from activity logs. Results Exercise adherence was associated with reduced bodily pain, improved general health and vitality, and reduced role-emotional scores (Ptrend≤0.05). Increased fitness was associated with improved physical functioning, bodily pain and general health scores (Ptrend≤0.04). Reduced weight and percent body fat were associated with improved physical functioning, general health, and bodily pain scores (Ptrend<0.05). Decreased waist circumference was associated with improved bodily pain and general health but with reduced role-emotional scores (Ptrend≤0.05). High exercise adherence, increased cardiopulmonary fitness and reduced weight, waist circumference and percent body fat were associated with increased exercise self-efficacy (Ptrend<0.02). Conclusions Monitoring adherence and tailoring exercise programs to induce changes in cardiopulmonary fitness and body composition may lead to greater improvements in HRQOL and self-efficacy that could promote exercise maintenance. PMID:23036856

Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain.

PubMed

George, Steven Z; Wittmer, Virgil T; Fillingim, Roger B; Robinson, Michael E

2010-11-01

Quasi-experimental clinical trial. This study compared outcomes from graded exercise and graded exposure activity prescriptions for patients participating in a multidisciplinary rehabilitation program for chronic low back pain. Our primary purpose was to investigate whether pain and disability outcomes differed based on treatment received (graded exercise or graded exposure). Our secondary purpose was to investigate if changes in selected psychological factors were associated with pain and disability outcomes. Behavioral interventions have been advocated for decreasing pain and disability from low back pain, yet relatively few comparative studies have been reported in the literature. Consecutive sample with chronic low back pain recruited over a 16-month period from an outpatient chronic pain clinic. Patients received physical therapy supplemented with either graded exercise (n=15) or graded exposure (n=18) principles. Graded exercise included general therapeutic activities and was progressed with a quota-based system. Graded exposure included specific activities that were feared due to back pain and was progressed with a hierarchical exposure paradigm. Psychological measures were pain-related fear (Fear-Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Fear of Pain Questionnaire), pain catastrophizing (Coping Strategies Questionnaire), and depressive symptoms (Beck Depression Inventory). Primary outcome measures were pain intensity (visual analog scale) and self-report of disability (modified Oswestry Disability Questionnaire). Statistically significant improvements (P<.01) were observed for pain intensity and disability at discharge. The rate of improvement did not differ based on behavioral intervention received (P>.05 for these comparisons). Overall, 50% of patients met criterion for minimally important change for pain intensity, while 30% met this criterion for disability. Change in depressive symptoms was associated with change in pain intensity

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia.

PubMed

Stébenne, Philippe; Bacon, Simon L; Austin, Anthony; Paine, Nicola J; Arsenault, André; Laurin, Catherine; Meloche, Bernard; Gordon, Jennifer; Dupuis, Jocelyn; Lavoie, Kim L

2017-05-01

Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.

Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: a pragmatic controlled trial.

PubMed

Cantarero-Villanueva, I; Fernández-Lao, C; Caro-Morán, E; Morillas-Ruiz, J; Galiano-Castillo, N; Díaz-Rodríguez, L; Arroyo-Morales, M

2013-02-01

To investigate the impact of aquatic exercise on pressure pain threshold in breast cancer survivors with hormone therapy-associated arthralgia. Single-blind, controlled trial. Two major metropolitan hospitals and a Sport and Spa Club in Granada, Spain. Forty women aged 29-71 years with stage I-III breast cancer who reported arthralgia. Patients were allocated alternately to either aquatic exercise in a chest-high pool or usual care while on the waiting list; control patients received treatment later. The two-month hydrotherapy intervention consisted of 24 sessions 3 days per week. Each session included 5 minutes of warm-up, 15-20 minutes of aerobic exercise, 15 minutes of mobility exercise and 20 minutes of recovery techniques. Pressure pain threshold at neck, shoulder, hand and leg were evaluated as primary outcomes. Cancer-related fatigue, as measured by the Piper Fatigue Scale, body mass index and waist circumference were secondary outcomes. A 2 × 2 repeated-measure ANCOVA was used in this study. No adverse events or development of worsening of pain was observed. Almost all the participants in the intervention group (89%) adhered to the hydrotherapy programme. Participants experienced a decrease in pressure pain threshold measured in neck, hand, shoulder and leg, as measured by algometry pressure, and waist circumference; all P < 0.05. Cancer-related fatigue (P = 0.06) and body mass index (P = 0.42) did not show significant improvement. These data suggest that hydrotherapy in a chest-high pool may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia.

Low-Volume Intense Exercise Elicits Post-exercise Hypotension and Subsequent Hypervolemia, Irrespective of Which Limbs Are Exercised.

PubMed

Graham, Matthew J; Lucas, Samuel J E; Francois, Monique E; Stavrianeas, Stasinos; Parr, Evelyn B; Thomas, Kate N; Cotter, James D

2016-01-01

Exercise reduces arterial and central venous blood pressures during recovery, which contributes to its valuable anti-hypertensive effects and to facilitating hypervolemia. Repeated sprint exercise potently improves metabolic function, but its cardiovascular effects (esp. hematological) are less well-characterized, as are effects of exercising upper versus lower limbs. The purposes of this study were to identify the acute (<24 h) profiles of arterial blood pressure and blood volume for (i) sprint intervals versus endurance exercise, and (ii) sprint intervals using arms versus legs. Twelve untrained males completed three cycling exercise trials; 50-min endurance (legs), and 5(*)30-s intervals using legs or arms, in randomized and counterbalanced sequence, at a standardized time of day with at least 8 days between trials. Arterial pressure, hemoglobin concentration and hematocrit were measured before, during and across 22 h after exercise, the first 3 h of which were seated rest. The post-exercise hypotensive response was larger after leg intervals than endurance (AUC: 7540 ± 3853 vs. 3897 ± 2757 mm Hg·min, p = 0.049, 95% CI: 20 to 6764), whereas exercising different limbs elicited similar hypotension (arms: 6420 ± 3947 mm Hg·min, p = 0.48, CI: -1261 to 3896). In contrast, arterial pressure at 22 h was reduced after endurance but not after leg intervals (-8 ± 8 vs. 0 ± 7 mm Hg, p = 0.04, CI: 7 ± 7) or reliably after arm intervals (-4 ± 8 mm Hg, p = 0.18 vs. leg intervals). Regardless, plasma volume expansion at 22 h was similar between leg intervals and endurance (both +5 ± 5%; CI: -5 to 5%) and between leg and arm intervals (arms: +5 ± 7%, CI: -8 to 5%). These results emphasize the relative importance of central and/or systemic factors in post-exercise hypotension, and indicate that markedly diverse exercise profiles can induce substantive hypotension and subsequent hypervolemia. At least for endurance exercise, this hypervolemia may not depend on the

Clinical Model of Exercise-Related Dyspnea in Adult Patients With Cystic Fibrosis.

PubMed

Stevens, Daniel; Neyedli, Heather F

2018-05-01

Dyspnea is a highly distressing symptom of pulmonary disease that can make performing physical activities challenging. However, little is known regarding the strongest predictors of exercise-related dyspnea in adult cystic fibrosis (CF). Therefore, the purpose of the present study was to determine the best clinical model of exercise-related dyspnea in this patient group. A retrospective analysis of pulmonary function and cardiopulmonary exercise testing data from patients with CF being followed up at the Adult CF Program at St Michael's Hospital, Toronto, Canada, from 2002 to 2008 were used for the analysis. Patients (n = 88) were male 66%; aged 30.4 ± 9.4 years; body mass index (BMI) 23.1 ± 3.3 kg/m; forced expiratory volume in 1 second (FEV1) 70% ± 19% predicted; and peak oxygen uptake 74% ± 20% predicted. A multivariate linear regression model assessing the effects of age, sex, BMI, airway obstruction (FEV1), perceived muscular leg fatigue, and dynamic hyperinflation explained 54% of the variance in dyspnea severity at peak exercise (P < .01). Relative importance analysis showed that the presence of dynamic hyperinflation and perceived muscular leg fatigue were the largest contributors. Pulmonary rehabilitation programs may consider strategies to reduce dynamic hyperinflation and promote muscular function to best improve exercise-related dyspnea in this patient group.

Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review.

PubMed

Jansen, Mariette J; Viechtbauer, Wolfgang; Lenssen, Antoine F; Hendriks, Erik J M; de Bie, Rob A

2011-01-01

What are the effects of strength training alone, exercise therapy alone, and exercise with additional passive manual mobilisation on pain and function in people with knee osteoarthritis compared to control? What are the effects of these interventions relative to each other? A meta-analysis of randomised controlled trials. Adults with osteoarthritis of the knee. INTERVENTION TYPES: Strength training alone, exercise therapy alone (combination of strength training with active range of motion exercises and aerobic activity), or exercise with additional passive manual mobilisation, versus any non-exercise control. Comparisons between the three interventions were also sought. The primary outcome measures were pain and physical function. 12 trials compared one of the interventions against control. The effect size on pain was 0.38 (95% CI 0.23 to 0.54) for strength training, 0.34 (95% CI 0.19 to 0.49) for exercise, and 0.69 (95% CI 0.42 to 0.96) for exercise plus manual mobilisation. Each intervention also improved physical function significantly. No randomised comparisons of the three interventions were identified. However, meta-regression indicated that exercise plus manual mobilisations improved pain significantly more than exercise alone (p = 0.03). The remaining comparisons between the three interventions for pain and physical function were not significant. Exercise therapy plus manual mobilisation showed a moderate effect size on pain compared to the small effect sizes for strength training or exercise therapy alone. To achieve better pain relief in patients with knee osteoarthritis physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs. Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.

Sympathetic adaptations to one-legged training

NASA Technical Reports Server (NTRS)

Ray, C. A.

1999-01-01

The purpose of the present study was to determine the effect of leg exercise training on sympathetic nerve responses at rest and during dynamic exercise. Six men were trained by using high-intensity interval and prolonged continuous one-legged cycling 4 day/wk, 40 min/day, for 6 wk. Heart rate, mean arterial pressure (MAP), and muscle sympathetic nerve activity (MSNA; peroneal nerve) were measured during 3 min of upright dynamic one-legged knee extensions at 40 W before and after training. After training, peak oxygen uptake in the trained leg increased 19 +/- 2% (P < 0.01). At rest, heart rate decreased from 77 +/- 3 to 71 +/- 6 beats/min (P < 0.01) with no significant changes in MAP (91 +/- 7 to 91 +/- 11 mmHg) and MSNA (29 +/- 3 to 28 +/- 1 bursts/min). During exercise, both heart rate and MAP were lower after training (108 +/- 5 to 96 +/- 5 beats/min and 132 +/- 8 to 119 +/- 4 mmHg, respectively, during the third minute of exercise; P < 0.01). MSNA decreased similarly from rest during the first 2 min of exercise both before and after training. However, MSNA was significantly less during the third minute of exercise after training (32 +/- 2 to 22 +/- 3 bursts/min; P < 0.01). This training effect on MSNA remained when MSNA was expressed as bursts per 100 heartbeats. Responses to exercise in five untrained control subjects were not different at 0 and 6 wk. These results demonstrate that exercise training prolongs the decrease in MSNA during upright leg exercise and indicates that attenuation of MSNA to exercise reported with forearm training also occurs with leg training.

Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities.

PubMed

Gutke, Annelie; Betten, Carola; Degerskär, Kristina; Pousette, Sara; Olsén, Monika Fagevik

2015-11-01

To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. For lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. The levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals.

PubMed

Wasser, Joseph G; Vasilopoulos, Terrie; Zdziarski, Laura Ann; Vincent, Heather K

2017-02-01

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Pessimistic back beliefs and lack of exercise: a longitudinal risk study in relation to shoulder, neck, and back pain.

PubMed

Elfering, Achim; Müller, Urs; Rolli Salathé, Cornelia; Tamcan, Özgür; Mannion, Anne F

2015-01-01

This cross-lagged-panel study tested the validity of the German version of the back beliefs questionnaire (BBQ) in predicting pain in the shoulders, neck, and back. A random sample of 2860 individuals participated at baseline, and 73% responded at one-year follow-up. Structural equation modeling was used to carry out a model comparison to evaluate whether paths differed between individuals with and without initial back pain and between those who exercised at baseline and those who did not. Factor analysis showed eight of the nine original items loaded on the expected common factor. High BBQ scores at baseline significantly predicted an increase in shoulder, neck, and back pain in individuals with current back pain (β = .11, p < .05), but not in other respondents (β = .02, p = .259). Similarly, baseline BBQ scores predicted the increase in shoulder, neck, and back pain among those who did not exercise (β = .15, p < .05), but not in those who did (β = .04, ns). The risk of negative back beliefs preceding an increase in shoulder, neck, and back pain was greatest for those with current back pain who did not exercise (β = .29, p < .05). The findings confirmed the validity of the German BBQ. Cognitive behavioral interventions should address pessimistic back beliefs in high-risk groups.

Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial

PubMed Central

Patil, Radhika; Karinkanta, Saija; Tokola, Kari; Kannus, Pekka

2017-01-01

Introduction. Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the older population. Although exercise is an effective treatment for knee OA, there is lack of evidence regarding hip OA. The aim of this trial was to test the safety and feasibility of a specifically designed exercise program in relieving hip pain and improving function in hip OA participants and to evaluate various methods to measure changes in their physical functioning. Materials and Methods. 13 women aged ≥ 65 years with hip OA were recruited in this 12-week pilot study. Results. Pain declined significantly over 30% from baseline, and joint function and health-related quality of life improved slightly. Objective assessment of physical functioning showed statistically significant improvement in the maximal isometric leg extensor strength by 20% and in the hip extension range of motion by 30%. Conclusions. The exercise program was found to be safe and feasible. The present evidence indicates that the exercise program is effective in the short term. However, adequate powered RCTs are needed to determine effects of long-term exercise therapy on pain and progression of hip OA. PMID:28116214

Painful legs and moving toes syndrome: a 76-patient case series.

PubMed

Hassan, Anhar; Mateen, Farrah J; Coon, Elizabeth A; Ahlskog, J Eric

2012-08-01

To better characterize the clinical features, electrophysiologic features, and treatment outcomes of painful legs and moving toes (PLMT) syndrome. Large case series. Neurology outpatient clinic at a tertiary referral center, 1983-2011. All cases of PLMT seen at our institution during an 18-year period were identified using our medical record linkage system. Key demographic, clinical, imaging, and electrophysiologic features of PLMT. Treatment outcomes and long-term follow-up are also reported. Of 76 cases identified (including 50 women [66%]), the mean age at onset was 58 years (range, 24-86 years) and at neurologic evaluation was 63 years (range, 26-88 years). Pure lower limb involvement was most common (69 patients [91%]), and 44 cases (58%) were bilateral. The most frequently diagnosed causes were peripheral neuropathy (21 cases [28%]), previous trauma (8 [11%]), and radiculopathy (7 [9%]); 32 cases (42%) were cryptogenic. Electromyography consistently showed irregular 50-millisecond to 1-second bursts of normal motor unit potential firing at 2 to 200 Hz accompanying the movements. Pain occurred first in nearly all cases and was more distressing to patients than the movements. Both components were difficult to treat, with no consistent benefit from a variety of drugs and therapeutic modalities. The syndrome persisted in most patients (83%) during the mean follow-up of 4.6 years, suggesting low likelihood of spontaneous resolution. Painful legs and moving toes syndrome is a debilitating clinical syndrome, not because of the movements but rather because of the pain, which often is refractory to treatment. Segmental lower limb involvement is most common, and neurophysiologic findings support a pathophysiologic process localizing to a central generator at the spinal cord or brainstem level.

Functional and Neuromuscular Changes in the Hamstrings After Drop Jumps and Leg Curls

PubMed Central

Sarabon, Nejc; Panjan, Andrej; Rosker, Jernej; Fonda, Borut

2013-01-01

The purpose of this study was to use a holistic approach to investigate changes in jumping performance, kinaesthesia, static balance, isometric strength and fast stepping on spot during a 5-day recovery period, following an acute bout of damaging exercise consisted of drop jumps and leg curls, where specific emphasis was given on the hamstring muscles. Eleven young healthy subjects completed a series of highly intensive damaging exercises for their hamstring muscles. Prior to the exercise, and during the 5-day recovery period, the subjects were tested for biochemical markers (creatine kinase, aspartate aminotransferase, and lactate dehydrogenase), perceived pain sensation, physical performance (squat jump, counter movement jump, maximal frequency leg stamping, maximal isometric torque production and maximally explosive isometric torque production), kinaesthesia (active torque tracking) and static balance. We observed significant decreases in maximal isometric knee flexion torque production, the rate of torque production, and majority of the parameters for vertical jump performance. No alterations were found in kinaesthesia, static balance and fast stepping on spot. The highest drop in performance and increase in perceived pain sensation generally occurred 24 or 48 hours after the exercise. Damaging exercise substantially alters the neuromuscular functions of the hamstring muscles, which is specifically relevant for sports and rehabilitation experts, as the hamstrings are often stretched to significant lengths, in particular when the knee is extended and hip flexed. These findings are practically important for recovery after high-intensity trainings for hamstring muscles. Key Points Hamstring function is significantly reduced following specifically damaging exercise. It fully recovers 120 hours after the exercise. Prevention of exercise-induced muscle damage is cruicial for maintaining normal training regime. PMID:24149148

Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury.

PubMed

Tweedy, Sean M; Beckman, Emma M; Geraghty, Timothy J; Theisen, Daniel; Perret, Claudio; Harvey, Lisa A; Vanlandewijck, Yves C

2017-02-01

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain. Copyright © 2016 Sports Medicine Australia

The effects of aerobic exercise and strengthening exercise on pain pressure thresholds.

PubMed

Lee, Han Suk

2014-07-01

[Purpose] We assessed the effects of aerobic exercise and strengthening exercise on pain pressure thresholds (PPTs) over time. [Subjects and Methods] Fifteen healthy participants were recruited and randomly divided into 3 groups: aerobic exercise, strengthening exercise, and control. The subjects in the aerobic group walked on a treadmill for 40 min at 6.5 km/h. The subjects in the strength group performed circuit training that included bench press, lat pull down, biceps curl, triceps extension, and shoulder press based on the perceived exertion for 40 min. The subjects in the control group rested without any exercise in a quiet room for 40 min. The PPTs of 5 potential muscle trigger points before exercise, and immediately after 10 and 40 min of exercise or rest were measured using an electronic algometer (JTECH Medical, USA). The Friedman's, Kruskal-Wallis, and Mann-Whitney tests were performed using SPSS 18.0 (IBM, Korea). [Results] The PPTs of all subjects decreased after 10 min of exercise, but the difference was not statistically significant. The PPTs of the control group decreased after 40 min. Furthermore, the PPTs of 3 muscles increased after 40 min of aerobic exercise and of 6 muscles after 40 min of strengthening exercise. No significant difference in PPTs was noted among the groups. [Conclusion] The results show that 40 min is a more appropriate exercise time, although the efficacy of controlling pain did not differ between strengthening exercise and aerobic exercise.

Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis--treatment effects of neuromuscular exercise and total joint replacement.

PubMed

Kosek, E; Roos, E M; Ageberg, E; Nilsdotter, A

2013-09-01

To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters. The dataset consisted of knee (n = 66) and hip (n = 47) OA patients assigned for total joint replacement at Lund University Hospital undergoing pre-operative neuromuscular exercise and 43 matched controls. Sensitivity to pressure pain was assessed by pressure algometry at 10 sites. Subjects were then instructed to perform a standardized static knee extension. Pressure pain thresholds (PPTs) were assessed at the contracting quadriceps muscle (Q) and at the resting deltoid muscle (D) before and during contraction. The relative increase in PPTs during contraction was taken as a measure of localized (Q) or generalized (D) EIA. Patients were assessed at baseline, following on average 12 weeks of neuromuscular exercise and 3 months following surgery. We found a normal function of EIA in OA patients at baseline. Previous studies have reported beneficial effects of physical exercise on pain modulation in healthy subjects. However, no treatment effects on EIA were seen in OA patients despite the increase in muscle strength following neuromuscular exercise and reduced pain following surgery. Compared to controls, OA patients had increased pain sensitivity and no beneficial effects on pain sensitivity were seen following treatment. To our knowledge, this is the first study of EIA in OA patients. Despite increased pain sensitivity, OA patients had a normal function of EIA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Low Back Pain and Leg Pain in Failed Back Surgery Syndrome: Four-Year Follow-Up.

PubMed

Hamm-Faber, Tanja E; Aukes, Hans; van Gorp, Eric-Jan; Gültuna, Ismail

2015-10-01

The objective of this study is to investigate the efficacy of long-term follow-up of subcutaneous stimulation (SubQ) as an additional therapy for patients with failed back surgery syndrome (FBSS) with chronic refractory pain, for whom spinal cord stimulation (SCS) alone was unsuccessful in treating low back pain. Prospective case series. FBSS patients with leg and/or low back pain whose conventional therapies had failed, received a combination of SCS (8-contact Octad lead, 3877-45 cm, Medtronic, Minneapolis, MN, USA) and/or SubQ (4-contact Quad Plus lead (s), 2888-28 cm, Medtronic). Initially, an Octad lead was placed in the epidural space for SCS for a trial stimulation to assess the suppression of leg and/or low back pain. Where SCS alone was insufficient in treating low back pain, lead(s) were placed superficially in the subcutaneous tissue of the lower back, exactly in the middle of the pain area. A pulse generator (Prime Advanced, 37702, Medtronic) was implanted if the patient reported more than 50% pain relief during the trial period. We investigated the long-term effect of neuromodulation on pain with the visual analog scale (VAS), and disability using the Quebec Pain Disability Scale. The results after 46 months are presented. Eleven patients, five men and six women (age 51 ± 8 years, mean ± SD) were included in the pilot study. In nine cases, SCS was used in combination with SubQ leads. Two patients received only SubQ leads. In one patient, the SCS + SubQ system was removed after nine months and these results were not taken into account for the analysis. Baseline scores for leg (N = 8) and low back pain (N = 10) were VASbl: 59 ± 15 and VASbl: 63 ± 14, respectively. The long-term follow-up period was 46 ± 4 months. SCS significantly reduced leg pain after 12 months (VAS12: 20 ± 11, p12 = 0.001) and 46 months (VAS46: 37 ± 17, p46 = 0.027). Similarly, SubQ significantly reduced back pain after 12 months(VAS12: 33 ± 16, p12 = 0.001) and 46 months

[Musculoskeletal-related chest pain].

PubMed

Sturm, C; Witte, T

2017-01-01

Approximately 10-50% of chest pains are caused by musculoskeletal disorders. The association is twice as frequent in primary care as in emergency admissions. This article provides an overview of the most important musculoskeletal causes of chest pain and on the diagnostics and therapy. A selective search and analysis of the literature related to the topic of musculoskeletal causes of chest pain were carried out. Non-inflammatory diseases, such as costochondritis and fibromyalgia are frequent causes of chest pain. Inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus are much less common but are more severe conditions and therefore have to be diagnosed and treated. The diagnostics and treatment often necessitate interdisciplinary approaches. Chest pain caused by musculoskeletal diseases always represents a diagnosis by exclusion of other severe diseases of the heart, lungs and stomach. Physiotherapeutic and physical treatment measures are particularly important, including manual therapy, transcutaneous electrical stimulation and stabilization exercises, especially for functional myofascial disorders.

Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis.

PubMed

Gomes-Neto, Mansueto; Lopes, Jordana Moura; Conceição, Cristiano Sena; Araujo, Anderson; Brasileiro, Alécio; Sousa, Camila; Carvalho, Vitor Oliveira; Arcanjo, Fabio Luciano

2017-01-01

We performed a systematic review with a meta-analysis to examine the efficacy of stabilization exercises versus general exercises or manual therapy in patients with low back pain. We searched MEDLINE, Cochrane Controlled Trials, Scielo, and CINAHL (from the earliest date available to November 2014) for randomized controlled trials that examined the efficacy of stabilization exercises compared to general exercises or manual therapy on pain, disability, and function in patients with low back pain. Weighted mean differences (WMD) and 95% confidence intervals were calculated. Eleven studies met the inclusion criteria (413 stabilization exercises patients, 297 general exercises patients, and 185 manual therapy patients). Stabilization exercises may provide greater benefit than general exercise for pain reduction and improvement in disability. Stabilization exercise improved pain with a WMD of -1.03 (95% CI: -1.29 to -0.27) and improved disability with a WMD of -5.41 (95% CI: -8.34 to -2.49). There were no significant differences in pain and disability scores among participants in the stabilization exercise group compared to those in the manual therapy group. Stabilization exercises were as efficacious as manual therapy in decreasing pain and disability and should be encouraged as part of musculoskeletal rehabilitation for low back pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

Strength, body composition, and functional outcomes in the squat versus leg press exercises.

PubMed

Rossi, Fabrício E; Schoenfeld, Brad J; Ocetnik, Skyler; Young, Jonathan; Vigotsky, Andrew; Contreras, Bret; Krieger, James W; Miller, Michael G; Cholewa, Jason

2018-03-01

The purpose of this study was to compare strength, body composition, and functional outcome measures following performance of the back squat, leg press, or a combination of the two exercises. Subjects were pair-matched based on initial strength levels and then randomly assigned to 1 of 3 groups: a squat-only group (SQ) that solely performed squats for the lower body; a leg press-only group (LP) that solely performed leg presses for the lower body, or a combined squat and leg press group (SQ-LP) that performed both squats and leg presses for the lower body. All other RT variables were held constant. The study period lasted 10 weeks with subjects performing 2 lower body workouts per week comprising 6 sets per session at loads corresponding to 8-12 RM with 90- to 120-second rest intervals. Results showed that SQ had greater transfer to maximal squat strength compared to the leg press. Effect sizes favored SQ and SQ-LP versus LP with respect to countermovement jump while greater effect sizes for dynamic balance were noted for SQ-LP and LP compared to SQ, although no statistical differences were noted between conditions. These findings suggest that both free weights and machines can improve functional outcomes, and that the extent of transfer may be specific to the given task.

Effects of yogic exercise on nonspecific neck pain in university students.

PubMed

Kim, Sang Dol

2018-05-01

To assess the effects of yogic exercise on nonspecific neck pain in university students. This study is a pretest-posttest design with a non-equivalent control group. Thirty-eight university students were selected by convenience sampling, with 18 assigned to an exercise group and 20 assigned to a control group. The yoga group participated in one-hour sessions of yogic exercise two days a week for eight weeks. The exercise comprised eight stages: relaxation, flexion of neck, extension of neck, right lateral flexion of neck, left lateral flexion of neck, right rotation of neck, left rotation of neck, and relaxation. Neck pain intensity was measured using a 100 mm visual analogue scale. The yoga group showed significantly decreased neck pain scores compared with those of the control group. These findings indicate that yogic exercises could reduce neck pain in university students. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pain sensitivity in patients with haemophilia following moderate aerobic exercise intervention.

PubMed

Krüger, S; Weitz, C; Runkel, B; Hilberg, T

2016-11-01

Physical activity is influenced by pain and vice versa. Although studies recommend exercise therapy for patients with haemophilia (PwH), the influence of physical activity on the pain condition in PwH has not been investigated so far. Aim of this study was to examine the effect of a treadmill intervention with self-chosen velocity on the acute pain sensitivity in PwH. Twenty PwH [aged 24-58 years, moderate (n = 3) to severe (n = 17) haemophilia A (n = 17) or B (n = 3)] and 20 control subjects (aged 26-61 years) were included in this study. Eighteen PwH and all controls completed a treadmill intervention for 30 min. Pressure pain thresholds (PPT) in Newton (N) were measured at both the knees, ankles and elbows, sternum and forehead before (pre) and immediately after walking (post). PwH and controls walked with comparable speed (mean speed in km h -1 ; PwH: 3.5, controls: 3.8), resulting in significantly different values of performance-related parameters such as heart rate (mean heart rate per minute; PwH: 102, controls: 86; P ≤ 0.01). Compared to baseline values, PPT remained unaltered at all landmarks in both groups after walking (e.g. pre/post in Newton; knee right: PwH: 63.1/63.0, controls: 93.8/93.8; left knee: PwH: 62.1/62.7, controls: 90.0/93.4), indicating a non-increasing pain condition. Findings of unaltered PPT following moderate aerobic exercise showed initial evidence that PwH are able to perform an endurance exercise with self-chosen velocity for 30 min as recommended, without increasing the acute pain condition. By doing so, PwH can benefit from the positive effects of endurance exercise. © 2016 John Wiley & Sons Ltd.

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

PubMed Central

Geneen, Louise J; Moore, R Andrew; Clarke, Clare; Martin, Denis; Colvin, Lesley A; Smith, Blair H

2017-01-01

available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period. Physical activity and exercise for chronic pain in adults - an overview of Cochrane Reviews Background Chronic (long-term) pain is pain that has lasted beyond the body's usual healing time. It is often described as pain that has lasted for at least three months. Chronic pain causes many problems, beyond the pain itself, including fatigue, anxiety, depression, and a poor quality of life. In the past, people with chronic pain were told to rest. However, general advice now is to keep active - whether to affect the pain directly or to combat the other problems associated with it. Therefore, research studies have attempted to examine the effect of physical activity in people with chronic pain. This overview aimed to bring together and analyse any reviews published by Cochrane that looked at physical activity and exercise studies in any chronic pain condition, including arthritis, back and neck pain, and menstrual (period) pain. Key results and quality of the evidence In January 2016, we identified 21 Cochrane Reviews which covered 10 different diagnoses (osteoarthritis (a joint disease), rheumatoid arthritis (joint pain and swelling), fibromyalgia (widespread pain condition), low back pain, intermittent claudication (cramping pain in the legs), dysmenorrhoea (period pain), mechanical neck disorders (neck pain), spinal cord injury, postpolio syndrome (a condition occurring in people who have had polio), patellofemoral pain (pain at the front of the knee)). The physical activity or exercise programme used in the trials ranged in frequency, intensity, and type, including

Closed kinetic chain exercises with or without additional hip strengthening exercises in management of patellofemoral pain syndrome: a randomized controlled trial.

PubMed

Ismail, M M; Gamaleldein, M H; Hassa, K A

2013-10-01

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor. Isolated open kinetic chain hip abductors and lateral rotators exercises were added by many authors to the rehabilitation program. However, Closed Kinetic Chain (CKC) exercises focusing on hip and knee muscles were not investigated if they can produce similar effect of hip strengthening and decreasing pain without the need of isolated exercises for hip musculature. The aim of the present study was to determine the effect of a CKC exercises program with or without additional hip strengthening exercises on pain and hip abductors and lateral rotators peak torque. Prospective randomized clinical trial. Patients with patellofemoral pain syndrome referred to the outpatient physical therapy clinic of the faculty of physical therapy, cairo university. Thirty two patients who had patellofemoral pain syndrome with age ranged from eighteen to thirty years. Patients were randomly assigned into two groups: CKC group and CKC with hip muscles strengthening exercises as a control (CO) group. Treatment was given 3 times/week, for 6 weeks. Patients were evaluated pre- and post-treatment for their pain severity using VAS, function of knee joint using Kujala questionnaire, hip abductors and external rotators concentric/eccentric peak torque. There were significant improvements in pain, function and hip muscles peak torque in both groups (P<0.05). However, there was no statistically significant difference between groups in hip muscles torque (P<0.05) but pain and function improvements were significantly greater in the CO group (P<0.05). Six weeks CKC program focusing on knee and hip strengthening has similar effect in improving hip muscles torque in patients with PFPS as a CKC exercises with additional hip strengthening exercises. However, adding isolated hip strengthening exercises has the advantage of more

Exercise Helps Ease Arthritis Pain and Stiffness

MedlinePlus

... you control your weight Enhance your quality of life Improve your balance Though you might think exercise will aggravate your ... involved. Your doctor or a physical therapist can work with you to find the exercise plan that gives you the most benefit with the least aggravation of your joint pain. ...

Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis.

PubMed

Fernandez, Matt; Hartvigsen, Jan; Ferreira, Manuela L; Refshauge, Kathryn M; Machado, Aryane F; Lemes, Ítalo R; Maher, Chris G; Ferreira, Paulo H

2015-09-15

A systematic review and meta-analysis. To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica. Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches. Data Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence. Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71-22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, -2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes. There is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term. 1.

Differential Responses of Post-Exercise Recovery of Leg Blood Flow and Oxygen Uptake Kinetics in HFpEF versus HFrEF.

PubMed

Thompson, Richard B; Pagano, Joseph J; Mathewson, Kory W; Paterson, Ian; Dyck, Jason R; Kitzman, Dalane W; Haykowsky, Mark J

2016-01-01

The goals of the current study were to compare leg blood flow, oxygen extraction and oxygen uptake (VO2) after constant load sub-maximal unilateral knee extension (ULKE) exercise in patients with heart failure with reduced ejection fraction (HFrEF) compared to those with preserved ejection fraction (HFpEF). Previously, it has been shown that prolonged whole body VO2 recovery kinetics are directly related to disease severity and all-cause mortality in HFrEF patients. To date, no study has simultaneously measured muscle-specific blood flow and oxygen extraction post exercise recovery kinetics in HFrEF or HFpEF patients; therefore it is unknown if muscle VO2 recovery kinetics, and more specifically, the recovery kinetics of blood flow and oxygen extraction at the level of the muscle, differ between HF phenotypes. Ten older (68±10yrs) HFrEF (n = 5) and HFpEF (n = 5) patients performed sub-maximal (85% of maximal weight lifted during an incremental test) ULKE exercise for 4 minutes. Femoral venous blood flow and venous O2 saturation were measured continuously from the onset of end-exercise, using a novel MRI method, to determine off-kinetics (mean response times, MRT) for leg VO2 and its determinants. HFpEF and HFrEF patients had similar end-exercise leg blood flow (1.1±0.6 vs. 1.2±0.6 L/min, p>0.05), venous saturation (42±12 vs. 41±11%, p>0.05) and VO2 (0.13±0.08 vs. 0.11±0.05 L/min, p>0.05); however HFrEF had significantly delayed recovery MRT for flow (292±135sec. vs 105±63sec., p = 0.004) and VO2 (95±37sec. vs. 47±15sec., p = 0.005) compared to HFpEF. Impaired muscle VO2 recovery kinetics following ULKE exercise differentiated HFrEF from HFpEF patients and suggests distinct underlying pathology and potential therapeutic approaches in these populations.

Short-term effects of Theracurmin dose and exercise type on pain, walking ability, and muscle function in patients with knee osteoarthritis

PubMed Central

Shin, Yun-A; Suk, Min-Hwa; Jang, Hee-Seung; Choi, Hye-Jung

2017-01-01

The purpose of this study was to investigate the short-term of Theracurmin dose and exercise type on pain, walking ability, and muscle function in patients with knee osteoarthritis. Twenty-five patients with knee osteoarthritis randomly selected to Theracurmin intake (T) group and Theracurmin in combined with exercise (T+E) group. T group (n= 13) was taken orally a capsule of 700 mg, 3 times per day, (total 2,100 mg, 35 mg/kg-body weight). T+E group (n= 12) performed aerobic training of 30-min walking and weight training for increasing leg muscular strength. After treatment, the number of steps, muscle mass, range of motion of knee, and the muscle strength in flexion and extension significantly increased. The percent body fat, visual analogue scale, The Western Ontario and McMaster score, centers of pressure with closed eye, 10-m walking ability, stair ascending speed were significantly decreased after treatment. Although no difference observed between the T and T+E groups, the 4-week intake of Theracurmin with and without exercise appeared to be effective in reducing the pain and enhancing muscular and balancing function. Therefore, Theracurmin intake for early symptoms and additional exercise as symptoms alleviate might be an effective way of delaying and managing osteoarthritis, and additional studies investigating the effects of Theracurmin and exercise on osteoarthritis could be beneficial. PMID:29326901

Alterations in Pain Responses in Treated and Untreated Patients with Restless Legs Syndrome: Associations with Sleep Disruption

PubMed Central

Edwards, Robert R; Quartana, Phillip J.; Allen, Richard P; Greenbaum, Seth; Earley, Christopher J; Smith, Michael T

2011-01-01

Objective There has been recent interest in characterizing potential abnormalities of pain processing in patients with sleep disorders such as Restless Legs Syndrome (RLS). The aim of this study was to evaluate psychophysical responses to noxious heat and pressure stimuli in both treated and untreated RLS patients, compared to matched controls. Methods This study is a cross-sectional group comparison of RLS patients with matched controls. A total of 31 patients (15 treated, 16 untreated) with a confirmed diagnosis of RLS were compared to 18 controls with no history of RLS or related sleep disorders. Results RLS patients (both treated and untreated) demonstrated reduced pain thresholds and reported greater clinical pain relative to controls. Moreover, RLS patients demonstrated enhanced temporal summation of heat pain (p< .05), which may reflect aberrant central nervous system facilitation of pain transmission. Both treated and untreated RLS patients reported disrupted sleep relative to controls, and mediation analyses suggested that the reduced pain thresholds in RLS were attributable to sleep disturbance. However, the effect of RLS on the magnitude of temporal summation of heat pain was independent of sleep disturbance. Conclusions These findings suggest that central nervous system pain processing may be amplified in RLS, perhaps partially as a consequence of sleep disruption. RLS patients, even those whose symptoms are managed pharmacologically, may be at elevated long-term risk for the development or maintenance of persistent pain conditions. Further studies in larger samples could help to improve the prospects for pain management in RLS patients. PMID:21570347

Whole body vibration exercise for chronic low back pain: study protocol for a single-blind randomized controlled trial.

PubMed

Wang, Xue-Qiang; Pi, Yan-Lin; Chen, Pei-Jie; Chen, Bin-Lin; Liang, Lei-Chao; Li, Xin; Wang, Xiao; Zhang, Juan

2014-04-02

Low back pain affects approximately 80% of people at some stage in their lives. Exercise therapy is the most widely used nonsurgical intervention for low back pain in practice guidelines. Whole body vibration exercise is becoming increasingly popular for relieving musculoskeletal pain and improving health-related quality of life. However, the efficacy of whole body vibration exercise for low back pain is not without dispute. This study aims to estimate the effect of whole body vibration exercise for chronic low back pain. We will conduct a prospective, single-blind, randomized controlled trial of 120 patients with chronic low back pain. Patients will be randomly assigned into an intervention group and a control group. The intervention group will participate in whole body vibration exercise twice a week for 3 months. The control group will receive general exercise twice a week for 3 months. Primary outcome measures will be the visual analog scale for pain, the Oswestry Disability Index and adverse events. The secondary outcome measures will include muscle strength and endurance of spine, trunk proprioception, transversus abdominis activation capacity, and quality of life. We will conduct intention-to-treat analysis if any participants withdraw from the trial. Important features of this study include the randomization procedures, single-blind, large sample size, and a standardized protocol for whole body vibration in chronic low back pain. This study aims to determine whether whole body vibration exercise produces more beneficial effects than general exercise for chronic low back pain. Therefore, our results will be useful for patients with chronic low back pain as well as for medical staff and health-care decision makers. Chinese Clinical Trial Registry: ChiCTR-TRC-13003708.

Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review.

PubMed

Bailey, Daniel L; Holden, Melanie A; Foster, Nadine E; Quicke, Jonathan G; Haywood, Kirstie L; Bishop, Annette

2018-06-06

To establish the meaning of the term 'adherence' (including conceptual and measurement definitions) in the context of therapeutic exercise (TE) for musculoskeletal (MSK) pain. Systematic review using a search strategy including terms for: adherence, TE and MSK pain. Identified studies were independently screened for inclusion by two researchers. Two independent researchers extracted data on: study type; MSK pain population; type of TE used; definitions, parameters, measurement methods and values of adherence. Seven electronic databases were searched from inception to December 2016. Any study type featuring TE for adults with MSK pain and containing a definition of adherence, or a description of how adherence was measured. 459 studies were identified and 86 were included in the review. Most were prospective cohort studies and featured back and/or neck pain. Strengthening and stretching were the most common types of TE. A clearly identifiable definition of adherence was provided in 40% of the studies, with 12% using the same definition. Exercise frequency was the most commonly measured parameter of adherence, with self-report logs the most common measurement method. The most common value range used to determine satisfactory adherence was 80%-99% of the recommended exercise dose. No single definition of adherence to TE was apparent. We found no definition of adherence that specifically related to TE for MSK pain or described the dimensions of TE that should be measured. We recommend conceptualising adherence to TE for MSK pain from the perspective of all relevant stakeholders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Involvement of mesolimbic dopaminergic network in neuropathic pain relief by treadmill exercise

PubMed Central

Wakaizumi, Kenta; Kondo, Takashige; Hamada, Yusuke; Narita, Michiko; Kawabe, Rui; Narita, Hiroki; Watanabe, Moe; Kato, Shigeki; Senba, Emiko; Kobayashi, Kazuto; Yamanaka, Akihiro

2016-01-01

Background Exercise alleviates pain and it is a central component of treatment strategy for chronic pain in clinical setting. However, little is known about mechanism of this exercise-induced hypoalgesia. The mesolimbic dopaminergic network plays a role in positive emotions to rewards including motivation and pleasure. Pain negatively modulates these emotions, but appropriate exercise is considered to activate the dopaminergic network. We investigated possible involvement of this network as a mechanism of exercise-induced hypoalgesia. Methods In the present study, we developed a protocol of treadmill exercise, which was able to recover pain threshold under partial sciatic nerve ligation in mice, and investigated involvement of the dopaminergic reward network in exercise-induced hypoalgesia. To temporally suppress a neural activation during exercise, a genetically modified inhibitory G-protein-coupled receptor, hM4Di, was specifically expressed on dopaminergic pathway from the ventral tegmental area to the nucleus accumbens. Results The chemogenetic-specific neural suppression by Gi-DREADD system dramatically offset the effect of exercise-induced hypoalgesia in transgenic mice with hM4Di expressed on the ventral tegmental area dopamine neurons. Additionally, anti-exercise-induced hypoalgesia effect was significantly observed under the suppression of neurons projecting out of the ventral tegmental area to the nucleus accumbens as well. Conclusion Our findings suggest that the dopaminergic pathway from the ventral tegmental area to the nucleus accumbens is involved in the anti-nociception under low-intensity exercise under a neuropathic pain-like state. PMID:27909152

Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain: An Assessor-Blinded Comparison.

PubMed

Thorborg, Kristian; Branci, Sonia; Nielsen, Martin Peter; Tang, Lars; Nielsen, Michael Bachmann; Hölmich, Per

2014-02-01

Adductor-related pain is the most common clinical finding in soccer players with groin pain and can be a long-standing problem affecting physical function and performance. Hip adductor weakness has been suggested to be associated with this clinical entity, although it has never been investigated. To investigate whether isometric and eccentric hip strength are decreased in soccer players with adductor-related groin pain compared with asymptomatic soccer controls. The hypothesis was that players with adductor-related groin pain would have lower isometric and eccentric hip adduction strength than players without adductor-related groin pain. Cross-sectional study; Level of evidence, 3. Male elite and subelite players from 40 teams were contacted. In total, 28 soccer players with adductor-related groin pain and 16 soccer players without adductor-related groin pain (asymptomatic controls) were included in the study. In primary analysis, the dominant legs of 21 soccer players with adductor-related groin pain (≥4 weeks duration) were compared with the dominant legs of 16 asymptomatic controls using a cross-sectional design. The mean age of the symptomatic players was 24.5 ± 2.5 years, and the mean age of the asymptomatic controls was 22.9 ± 2.4 years. Isometric hip strength (adduction, abduction, and flexion) and eccentric hip strength (adduction) were assessed with a handheld dynamometer using reliable test procedures and a blinded assessor. Eccentric hip adduction strength was lower in soccer players with adductor-related groin pain in the dominant leg (n = 21) compared with asymptomatic controls (n = 16), namely 2.47 ± 0.49 versus 3.12 ± 0.43 N·m/kg, respectively (P < .001). No other hip strength differences were observed between symptomatic players and asymptomatic controls for the dominant leg (P = .35-.84). Large eccentric hip adduction strength deficits were found in soccer players with adductor-related groin pain compared with asymptomatic soccer players

Virtual reality pain control during physical therapy range of motion exercises for a patient with multiple blunt force trauma injuries.

PubMed

Hoffman, Hunter G; Patterson, David R; Soltani, Maryam; Teeley, Aubriana; Miller, William; Sharar, Sam R

2009-02-01

Patients with severe blunt force trauma injuries (e.g., multiple fractures and/or internal injuries) often experience severe to excruciating pain during medical procedures. We explored the adjunctive use of immersive virtual reality (VR) to distract a patient with multiple blunt trauma injuries from his procedural pain during physical therapy. The patient was a 32-year-old male hospitalized after suffering upper and lower extremity injuries when he was hit by a semi truck as a pedestrian. While a nurse assisted the patient's passive range of motion (ROM) leg exercises over two days, the patient spent a total of 10 minutes of physical therapy with no distraction and 10 minutes in VR (within-subjects design, order randomized). Three 0 to 10 graphic-rating-scale pain scores for each of the two treatment conditions served as the primary dependent variables. The patient reported a reduction in pain when distracted with VR. "Pain unpleasantness" ratings during physical therapy dropped from "severe" (mean = 8.5) to "mild/moderate" (4.5). The patient's ROM was 1 degree less during VR on day 1, but the patient achieved 15 degrees greater ROM during VR on day 2. The present study provides preliminary evidence that immersive VR can be an effective adjunctive, nonpharmacologic pain-reduction technique for a patient with multiple blunt trauma injuries experiencing severe pain during physical therapy. The potential utility of VR analgesia for movement or exercise therapy for patients with blunt force trauma injuries should be explored in controlled studies.

Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: An examination of patellar alignment.

PubMed

Peng, Hsien-Te; Song, Chen-Yi

2015-12-01

Closed kinetic chain and quadriceps strengthening, combined with flexibility exercises of the lower limb musculature, is a common treatment for patellofemoral pain syndrome (PFPS). The effectiveness has been well documented; however, very little is known about which factors predict treatment success. A total of 43 female subjects with PFPS participated in an eight-week progressive leg press (LP) strengthening and stretching exercise program. A decrease of 1.5 cm on a 10 cm visual analog scale (VAS) score was used as an indicator for treatment success. The baseline patellar tilt angle difference (PTA-d) due to quadriceps contraction prior to treatment was evaluated as a predictor of treatment success. The logistic regression and receiver operating characteristics (ROC) curve analysis were performed to investigate the predictive value of PTA-d. PTA-d could significantly predict the treatment success of LP strengthening and stretching exercises. The odds ratio (OR) for having an unsuccessful outcome was 1.19 (95% confidence interval (CI), 1.03-1.39, P<0.021) per degree increment of PTA-d. The most optimal cut-off value for the clinical discrimination of treatment success after LP strengthening and stretching exercise was -1.5° of PTA-d (sensitivity=0.74, specificity=0.71). The area under the ROC curve was 0.73 (standard error=0.08). Female patients with PFPS whose quadriceps contraction reduced the lateral patellar tilt prior to LP strengthening and stretching exercise treatment are more likely to experience pain relief. It seems clinically important to check dynamic patellar tilt characteristics before treatment to aid in clinical decision making. Copyright © 2014 Elsevier B.V. All rights reserved.

Influence of exercise on visceral pain: an explorative study in healthy volunteers

PubMed Central

van Weerdenburg, Laura JGM; Brock, Christina; Drewes, Asbjørn Mohr; van Goor, Harry; de Vries, Marjan; Wilder-Smith, Oliver HG

2017-01-01

Background and objectives Contradictory results have been found about the effect of different exercise modalities on pain. The aim of this study was to investigate the early effects of aerobic and isometric exercise on different types of experimental pain, including visceral pain, compared to an active control condition. Methods Fifteen healthy subjects (6 women, mean [standard deviation] age 25 [6.5] years) completed 3 interventions consisting of 20 minutes of aerobic cycling, 12 minutes of isometric knee extension and a deep breathing procedure as active control. At baseline and after each intervention, psychophysical tests were performed, including electrical stimulation of the esophagus, pressure pain thresholds and the cold pressor test as a measure for conditioned pain modulation. Participants completed the Medical Outcome Study Short-Form 36 and State-Trait Anxiety Inventory prior to the experiments. Data were analyzed using two-way repeated measures analysis of variance. Results No significant differences were found for the psychophysical tests after the interventions, compared to baseline pain tests and the control condition. Conclusion No hypoalgesic effect of aerobic and isometric exercise was found. The evidence for exercise-induced hypoalgesia appears to be not as consistent as initially thought, and caution is recommended when interpreting the effects of exercise on pain. PMID:28096689

Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy

PubMed Central

Yoo, Min; D’Silva, Linda; Martin, Katherine; Sharma, Neena; Pasnoor, Mamatha; LeMaster, Joseph

2015-01-01

Objective Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. While the beneficial effect of exercise on diabetes is well established, its effect specifically on painful DPN has not been thoroughly explored. The objective of this pilot study was to examine the effect of aerobic exercise on pain in people with DPN. Methods Fourteen sedentary individuals (mean age 57±5.11 years) with painful DPN were enrolled in a 16-week, supervised aerobic exercise program. The Brief Pain Inventory-Diabetic Peripheral Neuropathy (BPI-DPN) was used to assess pain intensity (worst, least, average, now) and pain interference with daily life (activity, mood, walk, normal work, relationship, sleep, enjoyment of life) pre- and post -intervention. Body mass index (BMI), maximum oxygen uptake (VO2max), hemoglobin A1c (HbA1c), and blood pressure were also measured pre-and post-intervention as secondary outcomes of interest. Results Significant reductions in pain interference were observed with walking (4.93±3.03 pre to 3.29±2.89 post, p=0.016), normal work (5.39±3.32 pre to 3.79±3.04 post, p=0.032), relationship with others (3.96±3.53 pre to 1.29±1.27 post, p=0.006), sleep (5.11±3.04 pre to 3.5±3.03 post, p=0.02), and the overall pain interference (4.65±2.70 pre to 2.97±2.22 post, p=0.013) following the intervention; however, there was no change in pain intensity. VO2max increased significantly post-intervention (16.02±3.84ml/kg/min pre to 17.18±4.19ml/kg/min, p=0.028), while BMI, HbA1c, and blood pressure remained unchanged. Conclusion These preliminary results suggest that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful DPN, without a change in pain intensity. Further validation by a RCT is needed. PMID:25800666

Effects of Cold Therapy on Pain and Breathing Exercises Among Median Sternotomy Patients.

PubMed

Zencir, Gülbanu; Eser, Ismet

2016-12-01

The most painful activities during the days following cardiac surgery are coughing and deep breathing exercises. Cold therapy is an effective nonpharmacological method that decreases the pain during coughing and mobilization. In this study, the effects of cold therapy on pain and breathing exercises among patients with median sternotomy following cardiac surgery were investigated in a randomized crossover clinical trial. Data were collected from patients with median sternotomy (N = 34) in the first two postoperative days. Because of the crossover design of the study, each patient was taken as a simultaneous control. Gel pack application was used as the cold therapy. Patients underwent four episodes of deep breathing and coughing exercises using an incentive spirometer (volumetric). Patients were evaluated according to the visual analogue scale for pain intensity before and after deep breathing and coughing exercise sessions. The pain score was 3.44 ± 2.45 at baseline for deep breathing and coughing exercises on the first day. The reported postoperative pain in the gel-pack group was not significantly different before and after the deep breathing and coughing exercises, but it significantly increased in the no-gel-pack group (p < .001). Although the interaction between the treatment and time was significant (partial eta-squared: .09), the gel-pack group had a lower change in average pain levels. This interaction was not significant in terms of spirometric values. In conclusion, cold therapy had a positive effect on pain management in the early period of post-cardiac surgery but was not effective for the pain associated with breathing exercises. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Exercise capacity in young adults with hypertension and systolic blood pressure difference between right arm and leg after repair of coarctation of the aorta.

PubMed

Instebø, Arne; Norgård, Gunnar; Helgheim, Vegard; Røksund, Ola Drange; Segadal, Leidulf; Greve, Gottfried

2004-10-01

Coarctation of the aorta represents 5-7% of congenital heart defects. Symptoms and prognosis depend on the degree of stenosis, age at surgery, surgical method and the presence of other heart defects. Postoperative complications are hypertension, restenosis and an abnormal blood pressure response during exercise. This study includes 41 patients, 15-40 years old, operated in the period 1975-1996. All were exercised on a treadmill until maximal oxygen consumption was achieved. Blood pressure was measured in the right arm and leg before and immediately after exercise, and in the right arm during exercise. Oxygen consumption was monitored and we defined an aerobic phase, an isocapnic buffering phase and a hypocapnic hyperventilation phase. The resting systolic blood pressure correlates with the resting systolic blood pressure difference between right arm and leg. A resting systolic blood pressure difference between the right arm and leg of 0.13 kPa (1 mmHg) to 2.67 kPa (20 mmHg) corresponds with a slight increase in resting systolic blood pressure. This rise in blood pressure increases the aerobic phase of the exercise test, helping the patients to achieve higher maximal oxygen consumption. A resting systolic blood pressure difference of more than 2.67 kPa (20 mmHg) corresponds with severe hypertension and causes reduction in the aerobic phase and maximal oxygen consumption. Resting systolic blood pressure and resting systolic blood pressure difference between the right arm and leg are not indicators for blood pressure response during exercise. Exercise testing is important to reveal exercise-induced hypertension and to monitor changes in transition from aerobic to anaerobic exercise and limitation to exercise capacity.

Blood temperature and perfusion to exercising and non-exercising human limbs.

PubMed

González-Alonso, José; Calbet, José A L; Boushel, Robert; Helge, Jørn W; Søndergaard, Hans; Munch-Andersen, Thor; van Hall, Gerrit; Mortensen, Stefan P; Secher, Niels H

2015-10-01

What is the central question of this study? Temperature-sensitive mechanisms are thought to contribute to blood-flow regulation, but the relationship between exercising and non-exercising limb perfusion and blood temperature is not established. What is the main finding and its importance? The close coupling among perfusion, blood temperature and aerobic metabolism in exercising and non-exercising extremities across different exercise modalities and activity levels and the tight association between limb vasodilatation and increases in plasma ATP suggest that both temperature- and metabolism-sensitive mechanisms are important for the control of human limb perfusion, possibly by activating ATP release from the erythrocytes. Temperature-sensitive mechanisms may contribute to blood-flow regulation, but the influence of temperature on perfusion to exercising and non-exercising human limbs is not established. Blood temperature (TB ), blood flow and oxygen uptake (V̇O2) in the legs and arms were measured in 16 healthy humans during 90 min of leg and arm exercise and during exhaustive incremental leg or arm exercise. During prolonged exercise, leg blood flow (LBF) was fourfold higher than arm blood flow (ABF) in association with higher TB and limb V̇O2. Leg and arm vascular conductance during exercise compared with rest was related closely to TB (r(2) = 0.91; P < 0.05), plasma ATP (r(2) = 0.94; P < 0.05) and limb V̇O2 (r(2) = 0.99; P < 0.05). During incremental leg exercise, LBF increased in association with elevations in TB and limb V̇O2, whereas ABF, arm TB and V̇O2 remained largely unchanged. During incremental arm exercise, both ABF and LBF increased in relationship to similar increases in V̇O2. In 12 trained males, increases in femoral TB and LBF during incremental leg exercise were mirrored by similar pulmonary artery TB and cardiac output dynamics, suggesting that processes in active limbs dominate central temperature and perfusion responses. The present data

Blood temperature and perfusion to exercising and non‐exercising human limbs

PubMed Central

Calbet, José A. L.; Boushel, Robert; Helge, Jørn W.; Søndergaard, Hans; Munch‐Andersen, Thor; van Hall, Gerrit; Mortensen, Stefan P.; Secher, Niels H.

2015-01-01

New Findings What is the central question of this study? Temperature‐sensitive mechanisms are thought to contribute to blood‐flow regulation, but the relationship between exercising and non‐exercising limb perfusion and blood temperature is not established. What is the main finding and its importance? The close coupling among perfusion, blood temperature and aerobic metabolism in exercising and non‐exercising extremities across different exercise modalities and activity levels and the tight association between limb vasodilatation and increases in plasma ATP suggest that both temperature‐ and metabolism‐sensitive mechanisms are important for the control of human limb perfusion, possibly by activating ATP release from the erythrocytes. Temperature‐sensitive mechanisms may contribute to blood‐flow regulation, but the influence of temperature on perfusion to exercising and non‐exercising human limbs is not established. Blood temperature (T B), blood flow and oxygen uptake (V˙O2) in the legs and arms were measured in 16 healthy humans during 90 min of leg and arm exercise and during exhaustive incremental leg or arm exercise. During prolonged exercise, leg blood flow (LBF) was fourfold higher than arm blood flow (ABF) in association with higher T B and limb V˙O2. Leg and arm vascular conductance during exercise compared with rest was related closely to T B (r 2 = 0.91; P < 0.05), plasma ATP (r 2 = 0.94; P < 0.05) and limb V˙O2 (r 2 = 0.99; P < 0.05). During incremental leg exercise, LBF increased in association with elevations in T B and limb V˙O2, whereas ABF, arm T B and V˙O2 remained largely unchanged. During incremental arm exercise, both ABF and LBF increased in relationship to similar increases in V˙O2. In 12 trained males, increases in femoral T B and LBF during incremental leg exercise were mirrored by similar pulmonary artery T B and cardiac output dynamics, suggesting that processes in active limbs dominate central

Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review.

PubMed

McCaskey, Michael A; Schuster-Amft, Corina; Wirth, Brigitte; Suica, Zorica; de Bruin, Eling D

2014-11-19

Proprioceptive training (PrT) is popularly applied as preventive or rehabilitative exercise method in various sports and rehabilitation settings. Its effect on pain and function is only poorly evaluated. The aim of this systematic review was to summarise and analyse the existing data on the effects of PrT on pain alleviation and functional restoration in patients with chronic (≥ 3 months) neck- or back pain. Relevant electronic databases were searched from their respective inception to February 2014. Randomised controlled trials comparing PrT with conventional therapies or inactive controls in patients with neck- or low back pain were included. Two review authors independently screened articles and assessed risk of bias (RoB). Data extraction was performed by the first author and crosschecked by a second author. Quality of findings was assessed and rated according to GRADE guidelines. Pain and functional status outcomes were extracted and synthesised qualitatively and quantitatively. In total, 18 studies involving 1380 subjects described interventions related to PrT (years 1994-2013). 6 studies focussed on neck-, 12 on low back pain. Three main directions of PrT were identified: Discriminatory perceptive exercises with somatosensory stimuli to the back (pPrT, n=2), multimodal exercises on labile surfaces (mPrT, n=13), or joint repositioning exercise with head-eye coordination (rPrT, n=3). Comparators entailed usual care, home based training, educational therapy, strengthening, stretching and endurance training, or inactive controls. Quality of studies was low and RoB was deemed moderate to high with a high prevalence of unclear sequence generation and group allocation (>60%). Low quality evidence suggests PrT may be more effective than not intervening at all. Low quality evidence suggests that PrT is no more effective than conventional physiotherapy. Low quality evidence suggests PrT is inferior to educational and behavioural approaches. There are few relevant

Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia--a randomized controlled trial.

PubMed

Larsson, Anette; Palstam, Annie; Löfgren, Monika; Ernberg, Malin; Bjersing, Jan; Bileviciute-Ljungar, Indre; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2015-06-18

Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Muscle strength in women with FM is reduced compared to healthy women. The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength, health status, and current pain intensity in women with FM. A total of 130 women with FM (age 22-64 years, symptom duration 0-35 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group. A person-centred model of exercise was used to support the participants' self-confidence for management of exercise because of known risks of activity-induced pain in FM. The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists. Primary outcome measure was isometric knee-extension force (Steve Strong®), secondary outcome measures were health status (FIQ total score), current pain intensity (VAS), 6MWT, isometric elbow-flexion force, hand-grip force, health related quality of life, pain disability, pain acceptance, fear avoidance beliefs, and patient global impression of change (PGIC). Outcomes were assessed at baseline and immediately after the intervention. Long-term follow up comprised the self-reported questionnaires only and was conducted after 13-18 months. Between-group and within-group differences were calculated using non-parametric statistics. Significant improvements were found for isometric knee-extension force (p = 0.010), health status (p = 0.038), current pain intensity (p = 0.033), 6MWT (p = 0.003), isometric elbow flexion force (p = 0.02), pain disability (p = 0.005), and pain acceptance (p = 0.043) in the resistance exercise group (n = 56) when compared to the control group (n = 49). PGIC differed significantly (p = 0.001) in favor of the resistance exercise group at post-treatment examinations

Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

PubMed

Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

2017-12-01

The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Automated Management of Exercise Intervention at the Point of Care: Application of a Web-Based Leg Training System.

PubMed

Dedov, Vadim N; Dedova, Irina V

2015-11-23

Recent advances in information and communication technology have prompted development of Web-based health tools to promote physical activity, the key component of cardiac rehabilitation and chronic disease management. Mobile apps can facilitate behavioral changes and help in exercise monitoring, although actual training usually takes place away from the point of care in specialized gyms or outdoors. Daily participation in conventional physical activities is expensive, time consuming, and mostly relies on self-management abilities of patients who are typically aged, overweight, and unfit. Facilitation of sustained exercise training at the point of care might improve patient engagement in cardiac rehabilitation. In this study we aimed to test the feasibility of execution and automatic monitoring of several exercise regimens on-site using a Web-enabled leg training system. The MedExercise leg rehabilitation machine was equipped with wireless temperature sensors in order to monitor its usage by the rise of temperature in the resistance unit (Δt°). Personal electronic devices such as laptop computers were fitted with wireless gateways and relevant software was installed to monitor the usage of training machines. Cloud-based software allowed monitoring of participant training over the Internet. Seven healthy participants applied the system at various locations with training protocols typically used in cardiac rehabilitation. The heart rates were measured by fingertip pulse oximeters. Exercising in home chairs, in bed, and under an office desk was made feasible and resulted in an intensity-dependent increase of participants' heart rates and Δt° in training machine temperatures. Participants self-controlled their activities on smart devices, while a supervisor monitored them over the Internet. Individual Δt° reached during 30 minutes of moderate-intensity continuous training averaged 7.8°C (SD 1.6). These Δt° were used as personalized daily doses of exercise with

Automated Management of Exercise Intervention at the Point of Care: Application of a Web-Based Leg Training System

PubMed Central

2015-01-01

Background Recent advances in information and communication technology have prompted development of Web-based health tools to promote physical activity, the key component of cardiac rehabilitation and chronic disease management. Mobile apps can facilitate behavioral changes and help in exercise monitoring, although actual training usually takes place away from the point of care in specialized gyms or outdoors. Daily participation in conventional physical activities is expensive, time consuming, and mostly relies on self-management abilities of patients who are typically aged, overweight, and unfit. Facilitation of sustained exercise training at the point of care might improve patient engagement in cardiac rehabilitation. Objective In this study we aimed to test the feasibility of execution and automatic monitoring of several exercise regimens on-site using a Web-enabled leg training system. Methods The MedExercise leg rehabilitation machine was equipped with wireless temperature sensors in order to monitor its usage by the rise of temperature in the resistance unit (Δt°). Personal electronic devices such as laptop computers were fitted with wireless gateways and relevant software was installed to monitor the usage of training machines. Cloud-based software allowed monitoring of participant training over the Internet. Seven healthy participants applied the system at various locations with training protocols typically used in cardiac rehabilitation. The heart rates were measured by fingertip pulse oximeters. Results Exercising in home chairs, in bed, and under an office desk was made feasible and resulted in an intensity-dependent increase of participants’ heart rates and Δt° in training machine temperatures. Participants self-controlled their activities on smart devices, while a supervisor monitored them over the Internet. Individual Δt° reached during 30 minutes of moderate-intensity continuous training averaged 7.8°C (SD 1.6). These Δt° were used as

Pronounced effects of acute endurance exercise on gene expression in resting and exercising human skeletal muscle.

PubMed

Catoire, Milène; Mensink, Marco; Boekschoten, Mark V; Hangelbroek, Roland; Müller, Michael; Schrauwen, Patrick; Kersten, Sander

2012-01-01

Regular physical activity positively influences whole body energy metabolism and substrate handling in exercising muscle. While it is recognized that the effects of exercise extend beyond exercising muscle, it is unclear to what extent exercise impacts non-exercising muscles. Here we investigated the effects of an acute endurance exercise bouts on gene expression in exercising and non-exercising human muscle. To that end, 12 male subjects aged 44-56 performed one hour of one-legged cycling at 50% W(max). Muscle biopsies were taken from the exercising and non-exercising leg before and immediately after exercise and analyzed by microarray. One-legged cycling raised plasma lactate, free fatty acids, cortisol, noradrenalin, and adrenalin levels. Surprisingly, acute endurance exercise not only caused pronounced gene expression changes in exercising muscle but also in non-exercising muscle. In the exercising leg the three most highly induced genes were all part of the NR4A family. Remarkably, many genes induced in non-exercising muscle were PPAR targets or related to PPAR signalling, including PDK4, ANGPTL4 and SLC22A5. Pathway analysis confirmed this finding. In conclusion, our data indicate that acute endurance exercise elicits pronounced changes in gene expression in non-exercising muscle, which are likely mediated by changes in circulating factors such as free fatty acids. The study points to a major influence of exercise beyond the contracting muscle.

Lack of Gender and Age Differences in Pain Measurements Following Exercise in People with Chronic Whiplash-Associated Disorders.

PubMed

Ickmans, Kelly; Malfliet, Anneleen; De Kooning, Margot; Goudman, Lisa; Hubloue, Ives; Schmitz, Tom; Goubert, Dorien; Aguilar-Ferrandiz, Maria Encarnacion

2017-09-01

Individuals with chronic whiplash associated disorders (WAD) present persistent pain in the absence of structural pathology. In these people, altered central pain processing and central sensitization are observed. The role of personal factors, such as gender and age, on pain processing mechanisms in chronic WAD, however, is still unclear. This study investigated possible gender- and age-related differences in self-reported and experimental pain measurements in people with chronic WAD. Besides the exercise-induced response on pain measurements between gender and age subgroups was recorded. Case-control study. University Hospital, Brussels. Self-reported pain and experimental pain measurements (pressure pain thresholds [PPT], occlusion cuff pressure, temporal summation, and conditioned pain modulation) were performed in 52 individuals (26 chronic WAD patients and 26 healthy controls), before and after a submaximal cycle exercise. Lower PPTs and occlusion cuff pressures were shown in chronic WAD in comparison with healthy controls. No gender and age differences regarding PPTs, occlusion cuff pressures and conditioned pain modulation were found in chronic WAD. Within the chronic WAD group, men showed higher self-reported pain compared to women and younger adults showed enhanced generalized pain facilitation compared to older adults. In addition, chronic WAD patients are able to inhibit exercise-induced hyperalgesia, but no gender and age differences in pain response following exercise were found. This study was sufficiently powered to detect differences between the chronic WAD and control group. However, a sufficient power was not reached when patients were divided in age and gender groups. Furthermore, only mechanical stimuli were included in the experimental pain measurements. Besides, psychosocial factors were not taken into account. Some alterations of altered pain processing are present in chronic WAD patients, however not in response to exercise. No gender and

Lack of age-specific influence on leg blood flow during incremental calf plantar-flexion exercise in men and women.

PubMed

Reilly, Heather; Lane, Louise M; Egaña, Mikel

2018-05-01

Age-related exercising leg blood flow (LBF) responses during dynamic knee-extension exercise and forearm blood flow responses during handgrip exercise are preserved in normally active men but attenuated in activity-matched women. We explored whether these age- and sex-specific effects are also apparent during isometric calf plantar-flexion incremental exercise. Normally active young men (YM, n = 15, 24 ± 2 years), young women (YW, n = 8, 22 ± 1 years), older men (OM, n = 13, 70 ± 7 years) and older women (OW, n = 10, 64 ± 7 years) were tested. LBF was measured between contractions using venous occlusion plethysmography. Peak force obtained was higher (P < 0.05) in men compared with women and in young compared with older individuals. However, peak LBF (YM; 971 ± 328 ml min -1 , OM; 985 ± 504 ml min -1 , YW; 844 ± 366 ml min -1 , OW; 960 ± 244 ml min -1 ) and peak leg vascular conductance [LVC = LBF/(MAP + hydrostatic pressure)] responses (YM; 6.0 ± 1.8 ml min -1  mmHg -1 , OM; 5.5 ± 2.8 ml min -1  mmHg -1 , YW; 5.3 ± 2.1 ml min -1  mmHg -1 , OW; 5.5 ± 1.6 ml min -1 mmHg -1 ) were similar among the four groups. Furthermore, the hyperaemic (YM; 8.8 ± 3.7 ml min -1  %F peak -1 OM; 8.3 ± 5.4 ml min -1  %F peak -1 , YW; 8.2 ± 3.5 ml min -1  %F peak -1 , OW; 9.6 ± 2.2 ml min -1  %F peak -1 ) and vasodilatory responses (YM; 0.053 ± 0.020 ml min -1  mmHg -1  %F peak -1 , OM; 0.048 ± 0.028 ml min -1  mmHg -1  %F peak -1 , YW; 0.051 ± 0.019 ml min -1  mmHg -1  %F peak -1 , OW; 0.055 ± 0.014 ml min -1  mmHg -1  %F peak -1 ) were not different among the four groups. These results were accompanied by similar resting LBF responses among groups and were not affected when data were normalised to estimated leg muscle mass. Our results demonstrate that exercising LBF responses during isometric incremental

Clinical Characteristics of Mixed Arteriovenous Leg Ulcers: A Descriptive Study.

PubMed

Marin, Joseph A; Woo, Kevin Y

The purpose of this study was to identify the clinical characteristics of mixed arteriovenous leg ulcers (MLU) that differentiated them from venous leg ulcers (VLU). Secondary analysis of data from larger electronic database. The sample comprised 1007 persons with lower extremity ulcers. Two hundred sixty three individuals with MLU were compared to 744 individuals with VLU; their ankle brachial indices were 0.51-0.90 and 0.91-.30 respectively. Subjects were drawn from community care settings from across Canada. Data concerning baseline demographic and pertinent clinical characteristics including ulcer history were collected using multiple validated instruments. The Leg Ulcer Assessment Tool was used to collect demographic and pertinent medical history, The Short Form Health Survey 12 and the Euro Wuol 5D (EQ-5D) were used to measure health related quality of life, the numeric pain scales was used to measure character and intensity of pain. Groups were compared using χ or Mann-Whitney U. Individuals with MLU were significantly older, has lower body mass index, a history of smoking, and more comorbid conditions than subjects with VLU. In many cases, clinical presentation was indicative of significant arterial insufficiency including cool extremities, shiny, cracked and inelastic skin, impaired capillary refill, and weak pedal pulses. Ulcer pain was highly prevalent, but overall pain rating was similar between groups. Mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities. Greater knowledge and understanding of the distinct characteristics of MLU is critical for appropriate screening, prevention, assessment and management of persons with this form of leg ulcer. Pain and health related quality of life factors are important considerations when evaluating and managing these patients.

Leg muscle volume during 30-day 6-degree head-down bed rest with isotonic and isokinetic exercise training

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Lee, P. L.; Ellis, S.; Selzer, R. H.; Ortendahl, D. A.

1994-01-01

Magnetic resonance imaging (MRI) was used to compare the effect of two modes of lower-extremity exercise training on the mass (volume) of posterior leg group (PLG) muscles (soleus, flexor hallucis longus, tibialis posterior, lateral and medial gastrocnemius, and flexor digitorum longus) on 19 men (ages 32-42 years) subjected to intense dynamic-isotonic (ITE, cycle ergometer, number of subjects (N) = 7), isokinetic (IKE, torque egrometer, N = 7), and no exercise (NOE, N = 5) training for 60 min/day during head-down bed rest (HDBR). Total volume of the PLG muscles decreased (p less than 0.05) similarly: ITE = 4.3 +/- SE 1.6%, IKE = 7.7 +/- 1.6%, and NOE = 6.3 +/- 0.8%; combined volume (N = 19) loss was 6.1 +/- 0.9%. Ranges of volume changes were 2.6% to -9.0% (ITE), -2.1% to -14.9% (IKE), and -3.4% to -8/1% (NOE). Correlation coefficients (r) of muscle volume versus thickness measured with ultrasonography were: ITE r + 0.79 (p less than 0.05), IKE r = 0.27 (not significant (NS)), and NOE r = 0.63 (NS). Leg-muscle volume and thickness were highly correlated (r = 0.79) when plasma volume was maintained during HDBR with ITE. Thus, neither intensive lower extremity ITE nor IKE training influence the normal non-exercised posterior leg muscle atrophy during HDBR. The relationship of muscle volume and thickness may depend on the mode of exercise training associated with the maintenance of plasma volume.

Does Eccentric Exercise Reduce Pain and Improve Strength in Physically Active Adults With Symptomatic Lower Extremity Tendinosis? A Systematic Review

PubMed Central

Wasielewski, Noah J; Kotsko, Kevin M

2007-01-01

Objective: To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. Data Sources: Databases used to locate randomized controlled trials (RCTs) included PubMed (1980–2006), CINAHL (1982–2006), Web of Science (1995–2006), SPORT Discus (1980–2006), Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration Database. Key words included tendon, tendonitis, tendinosis, tendinopathy, exercise, eccentric, rehabilitation, and therapy. Study Selection: The criteria for trial selection were (1) the literature was written in English, (2) the research design was an RCT, (3) the study participants were adults with a clinical diagnosis of tendinosis, (4) the outcome measures included pain or strength, and (5) eccentric exercise was used to treat lower extremity tendinosis. Data Extraction: Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. Data Synthesis: The calculated post hoc statistical power of the selected studies (n = 11) was low, and the average methodologic score was 5.3/10 based on PEDro criteria. Eccentric exercise was compared with no treatment (n = 1), concentric exercise (n = 5), an alternative eccentric exercise protocol (n = 1), stretching (n = 2), night splinting (n = 1), and physical agents (n = 1). In most trials, tendinosis-related pain was reduced with eccentric exercise over time, but only in 3 studies did eccentric exercise decrease pain relative to the control treatment. Similarly, the RCTs demonstrated that strength-related measures improved over time, but none revealed significant differences relative to the control treatment. Based on the best evidence available, it appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution

Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia.

PubMed

Gusi, N; Tomas-Carus, P; Häkkinen, A; Häkkinen, K; Ortega-Alonso, A

2006-02-15

To evaluate the short- and long-term efficacy of exercise therapy in a warm, waist-high pool in women with fibromyalgia. Thirty-four women (mean +/- SD tender points 17 +/- 1) were randomly assigned to either an exercise group (n = 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n = 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60 degrees /second and 210 degrees /second, and in the shoulder abductors and adductors in concentric contractions. Health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months. The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de-training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de-training. However, there were no changes in the control group during the entire period. The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.

Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: a Randomized Clinical Trial.

PubMed

de-Miguel-Valtierra, Lorena; Salom-Moreno, Jaime; Fernández-de-Las-Peñas, César; Cleland, Joshua A; Arias-Buría, José L

2018-05-16

This randomized clinical trial compared the effects of adding US-guided percutaneous electrolysis into a program consisting of manual therapy and exercise on pain, related-disability, function and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, one session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was Disabilities of the Arm, Shoulder and Hand (DASH). Secondary outcomes included pain, function (Shoulder Pain and Disability Index-SPADI) pressure pain thresholds (PPTs) and Global Rating of Change (GROC). They were assessed at baseline, post-treatment, and 3, and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all follow-ups (P=0.051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantly greater changes in shoulder pain (P<0.001) and SPADI (P<0.001) than those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (SMD>0.91) for shoulder pain and function at 3 and 6 months in favour of the percutaneous electrolysis group. No between-groups differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related-disability (DASH) than the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether or not these effects are reliable should be addressed in future studies Perspective This study found that the inclusion of US

Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy.

PubMed

Yoo, Min; D'Silva, Linda J; Martin, Katherine; Sharma, Neena K; Pasnoor, Mamatha; LeMaster, Joseph W; Kluding, Patricia M

2015-08-01

Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. While the beneficial effect of exercise on diabetes is well established, its effect specifically on painful DPN has not been thoroughly explored. The objective of this pilot study was to examine the effect of aerobic exercise on pain in people with DPN. Fourteen sedentary individuals (mean age 57 ± 5.11 years) with painful DPN were enrolled in a 16-week, supervised aerobic exercise program. The Brief Pain Inventory-Diabetic Peripheral Neuropathy was used to assess pain intensity (worst, least, average, now) and pain interference with daily life (activity, mood, walk, normal work, relationship, sleep, enjoyment of life) pre intervention and postintervention. Body mass index (BMI), maximum oxygen uptake (VO2max ), hemoglobin A1c (HbA1c), and blood pressure were also measured preintervention and postintervention as secondary outcomes of interest. Significant reductions in pain interference were observed with walking (4.93 ± 3.03 pre to 3.29 ± 2.89 post, P = 0.016), normal work (5.39 ± 3.32 pre to 3.79 ± 3.04 post, P = 0.032), relationship with others (3.96 ± 3.53 pre to 1.29 ± 1.27 post, P = 0.006), sleep (5.11 ± 3.04 pre to 3.5 ± 3.03 post, P = 0.02), and the overall pain interference (4.65 ± 2.70 pre to 2.97 ± 2.22 post, P = 0.013) following the intervention; however, there was no change in pain intensity. VO2max increased significantly postintervention (16.02 ± 3.84 ml/kg/min pre to 17.18 ± 4.19 ml/kg/min, P = 0.028), while BMI, HbA1c, and blood pressure remained unchanged. These preliminary results suggest that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful DPN, without a change in pain intensity. Further validation by a RCT is needed. Wiley Periodicals, Inc.

Voluntary enhanced cocontraction of hamstring muscles during open kinetic chain leg extension exercise: its potential unloading effect on the anterior cruciate ligament.

PubMed

Biscarini, Andrea; Benvenuti, Paolo; Botti, Fabio M; Brunetti, Antonella; Brunetti, Orazio; Pettorossi, Vito E

2014-09-01

A number of research studies provide evidence that hamstring cocontraction during open kinetic chain knee extension exercises enhances tibiofemoral (TF) stability and reduces the strain on the anterior cruciate ligament. To determine the possible increase in hamstring muscle coactivation caused by a voluntary cocontraction effort during open kinetic chain leg-extension exercises, and to assess whether an intentional hamstring cocontraction can completely suppress the anterior TF shear force during these exercises. Descriptive laboratory study. Knee kinematics as well as electromyographic activity in the semitendinosus (ST), semimembranosus (SM), biceps femoris (BF), and quadriceps femoris muscles were measured in 20 healthy men during isotonic leg extension exercises with resistance (R) ranging from 10% to 80% of the 1-repetition maximum (1RM). The same exercises were also performed while the participants attempted to enhance hamstring coactivation through a voluntary cocontraction effort. The data served as input parameters for a model to calculate the shear and compressive TF forces in leg extension exercises for any set of coactivation patterns of the different hamstring muscles. For R≤ 40% 1RM, the peak coactivation levels obtained with intentional cocontraction (l) were significantly higher (P < 10(-3)) than those obtained without intentional cocontraction (l 0). For each hamstring muscle, maximum level l was reached at R = 30% 1RM, corresponding to 9.2%, 10.5%, and 24.5% maximum voluntary isometric contraction (MVIC) for the BF, ST, and SM, respectively, whereas the ratio l/l 0 reached its maximum at R = 20% 1RM and was approximately 2, 3, and 4 for the BF, SM, and ST, respectively. The voluntary enhanced coactivation level l obtained for R≤ 30% 1RM completely suppressed the anterior TF shear force developed by the quadriceps during the exercise. In leg extension exercises with resistance R≤ 40% 1RM, coactivation of the BF, SM, and ST can be

The specific scintigraphic pattern of "shin splints in the lower leg": concise communication.

PubMed

Holder, L E; Michael, R H

1984-08-01

The clinical entity, "shin splints," is now being recognized, and more specifically characterized by the findings of exercise-induced pain and tenderness to palpation along the posterior medial border of the tibia. In this prospective study, ten patients with this syndrome were evaluated using three-phase bone scintigrams, and a specific scintigraphic pattern was determined. Radionuclide angiograms and blood-pool images were all normal. On delayed images, tibial lesions involved the posterior cortex, were longitudinally oriented, were long, involving one third of the length of the bone, and often showed varying tracer uptake along that length. Obtaining both lateral and medial views was crucial. The location of activity suggested that this entity is related to the soleus muscle. These scintigraphic findings can be used to differentiate shin splints from stress fractures or other conditions causing pain in the lower leg in athletes.

Transcutaneous electrical nerve stimulation reduces exercise-induced perceived pain and improves endurance exercise performance.

PubMed

Astokorki, Ali H Y; Mauger, Alexis R

2017-03-01

Muscle pain is a natural consequence of intense and prolonged exercise and has been suggested to be a limiter of performance. Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) have been shown to reduce both chronic and acute pain in a variety of conditions. This study sought to ascertain whether TENS and IFC could reduce exercise-induced pain (EIP) and whether this would affect exercise performance. It was hypothesised that TENS and IFC would reduce EIP and result in an improved exercise performance. In two parts, 18 (Part I) and 22 (Part II) healthy male and female participants completed an isometric contraction of the dominant bicep until exhaustion (Part I) and a 16.1 km cycling time trial as quickly as they could (Part II) whilst receiving TENS, IFC, and a SHAM placebo in a repeated measures, randomised cross-over, and placebo-controlled design. Perceived EIP was recorded in both tasks using a validated subjective scale. In Part I, TENS significantly reduced perceived EIP (mean reduction of 12%) during the isometric contraction (P = 0.006) and significantly improved participants' time to exhaustion by a mean of 38% (P = 0.02). In Part II, TENS significantly improved (P = 0.003) participants' time trial completion time (~2% improvement) through an increased mean power output. These findings demonstrate that TENS can attenuate perceived EIP in a healthy population and that doing so significantly improves endurance performance in both submaximal isometric single limb exercise and whole-body dynamic exercise.

The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

PubMed Central

Yousefzadeh, Abbas; Olyaei, Gholam Reza; Naseri, Nasrin; Khazaeipour, Zahra

2018-01-01

Objective The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with  IRCT2016080829269N1. PMID:29721339

Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis.

PubMed

Miyamoto, Gisela Cristiane; Lin, Chung-Wei Christine; Cabral, Cristina Maria Nunes; van Dongen, Johanna M; van Tulder, Maurits W

2018-04-20

To investigate the cost-effectiveness of exercise therapy in the treatment of patients with non-specific neck pain and low back pain. Systematic review of economic evaluations. The search was performed in 5 clinical and 3 economic electronic databases. We included economic evaluations performed alongside randomised controlled trials. Differences in costs and effects were pooled in a meta-analysis, if possible, and incremental cost-utility ratios (ICUR) were descriptively analysed. Twenty-two studies were included. On average, exercise therapy was associated with lower costs and larger effects for quality-adjusted life-year (QALY) in comparison with usual care for subacute and chronic low back pain from a healthcare perspective (based on ICUR). Exercise therapy had similar costs and effect for QALY in comparison with other interventions for neck pain from a societal perspective, and subacute and chronic low back pain from a healthcare perspective. There was limited or inconsistent evidence on the cost-effectiveness of exercise therapy compared with usual care for neck pain and acute low back pain, other interventions for acute low back pain and different types of exercise therapy for neck pain and low back pain. Exercise therapy seems to be cost-effective compared with usual care for subacute and chronic low back pain. Exercise therapy was not (more) cost-effective compared with other interventions for neck pain and low back pain. The cost-utility estimates are rather uncertain, indicating that more economic evaluations are needed. PROSPERO, CRD42017059025. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects.

PubMed

Mostagi, Fernanda Queiroz Ribeiro Cerci; Dias, Josilainne Marcelino; Pereira, Ligia Maxwell; Obara, Karen; Mazuquin, Bruno Fles; Silva, Mariana Felipe; Silva, Monica Angelica Cardoso; de Campos, Renata Rosa; Barreto, Maria Simone Tavares; Nogueira, Jéssyca Fernandes; Lima, Tarcísio Brandão; Carregaro, Rodrigo Luiz; Cardoso, Jefferson Rosa

2015-10-01

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohen'sd¯ = 0.34) and baseline and follow-up (P = .04; Cohen'sd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility. Copyright © 2014 Elsevier Ltd. All rights reserved.

Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain.

PubMed

Kibsgård, Thomas J; Røise, Olav; Sturesson, Bengt; Röhrl, Stephan M; Stuge, Britt

2014-04-01

Chamberlain's projections (anterior-posterior X-ray of the pubic symphysis) have been used to diagnose sacroiliac joint mobility during the single-leg stance test. This study examined the movement in the sacroiliac joint during the single-leg stance test with precise radiostereometric analysis. Under general anesthesia, tantalum markers were inserted into the dorsal sacrum and the ilium of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, a radiostereometric analysis was conducted while the subjects performed a single-leg stance. Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac join, a total of 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint. The movement in the sacroiliac joint during the single-leg stance is small and almost undetectable by the precise radiostereometric analysis. A complex movement pattern was seen during the test, with a combination of movements in the two joints. The interpretation of the results of this study is that, the Chamberlain examination likely is inadequate in the examination of sacroiliac joint movement in patients with pelvic girdle pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pronounced Effects of Acute Endurance Exercise on Gene Expression in Resting and Exercising Human Skeletal Muscle

PubMed Central

Catoire, Milène; Mensink, Marco; Boekschoten, Mark V.; Hangelbroek, Roland; Müller, Michael; Schrauwen, Patrick; Kersten, Sander

2012-01-01

Regular physical activity positively influences whole body energy metabolism and substrate handling in exercising muscle. While it is recognized that the effects of exercise extend beyond exercising muscle, it is unclear to what extent exercise impacts non-exercising muscles. Here we investigated the effects of an acute endurance exercise bouts on gene expression in exercising and non-exercising human muscle. To that end, 12 male subjects aged 44–56 performed one hour of one-legged cycling at 50% Wmax. Muscle biopsies were taken from the exercising and non-exercising leg before and immediately after exercise and analyzed by microarray. One-legged cycling raised plasma lactate, free fatty acids, cortisol, noradrenalin, and adrenalin levels. Surprisingly, acute endurance exercise not only caused pronounced gene expression changes in exercising muscle but also in non-exercising muscle. In the exercising leg the three most highly induced genes were all part of the NR4A family. Remarkably, many genes induced in non-exercising muscle were PPAR targets or related to PPAR signalling, including PDK4, ANGPTL4 and SLC22A5. Pathway analysis confirmed this finding. In conclusion, our data indicate that acute endurance exercise elicits pronounced changes in gene expression in non-exercising muscle, which are likely mediated by changes in circulating factors such as free fatty acids. The study points to a major influence of exercise beyond the contracting muscle. PMID:23226462

Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression.

PubMed

Gjestland, Kristin; Bø, Kari; Owe, Katrine Mari; Eberhard-Gran, Malin

2013-05-01

We describe exercise level in mid-pregnancy, associated sociodemographic variables, and investigate the association between exercise in mid-pregnancy and subsequent low-back pain, pelvic girdle pain and depression at 32 weeks of pregnancy. The study included 3482 pregnant women participating in the Akershus Birth Cohort study (response rate 80.5%). Data were collected by a questionnaire in pregnancy weeks 17-21, pregnancy week 32 and electronic birth journal. The results were analysed by logistic regression and are presented as crude (cOR) and adjusted OR (aOR) with 95% CI. Only 14.6% of the respondents followed the current exercise prescription for exercise during pregnancy (≥3 times a week, >20 min at moderate intensity). One-third of the study sample exercised less than once a week at pregnancy weeks 17-21. Women exercising either 1-2 times or ≥3 times a week at mid-pregnancy were more often primiparous, higher-educated and had less often prepregnacy body mass index >30 kg/m2 compared with women exercising less than once a week. Women who exercised ≥3 times a week were less likely to report pelvic girdle pain (aOR: 0.76, 95% CI 0.61 to 0.96), while women exercising 1-2 times a week were less likely to report low-back pain (aOR: 0.80, 95% CI 0.66 to 0.97) and depression (aOR: 0.66, 95% CI 0.48 to 0.91). Few Norwegian women follow current exercise prescriptions for exercise in mid-pregnancy. The results may indicate an association between exercising mid-pregnancy and lower prevalence of low-back pain, pelvic girdle pain and depression in late pregnancy.

Effect of Upper-Extremity Strengthening Exercises on the Lumbar Strength, Disability and Pain of Patients with Chronic Low Back Pain: A Randomized Controlled Study.

PubMed

Atalay, Erdem; Akova, Bedrettin; Gür, Hakan; Sekir, Ufuk

2017-12-01

The present study aimed to analyze the impacts of a low back rehabilitation program accompanied with neck, shoulder and upper back exercises on pain, disability, and physical characteristics of patients with chronic low back pain. Twenty sedentary male patients with chronic low back pain participated in the study on a voluntary basis. The patients were randomly allocated into two groups: a conventional low back exercise group (CE) and a supported exercise group (SE; CE plus upper back, neck, and shoulder exercises). The Modified Oswestry Disability Questionnaire (MODQ) was used to evaluate the disability status and the Visual Analog Scale (VAS) was used to identify the pain states of the patients. In addition, neck, lumbar and shoulder isokinetic and isometric strengths of the patients were evaluated. The CE group performed lumbar stretching, mobilization and stabilization exercises in addition to low-back and abdominal isometric and concentric strengthening exercises. The SE group performed static stretching and isotonic exercises for the neck, upper-back, and shoulder muscles, in addition to the exercises performed in CE group. The exercises were implemented 3 days a week for 6 weeks in both groups. Following the 6-week exercise periods in both groups, statistically significant (p < 0.01) improvements were observed in the patients' levels of pain and the scores of MODQ reflecting an easing of disability. With respect to the levels of pain and disability, the improvements observed in the SE group was significantly (p < 0.01) greater than the improvement observed in the CE group. Based on the findings of this study, we can conclude that a low back exercise program used in combination with neck, shoulder and upper back exercises reduces the level of pain and disability in patients with chronic low back pain more prominently than conventional low back exercises.

Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain?

PubMed

Maharaj, Sonill S; Yakasai, Abdulsalam M

2018-05-01

Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman and Wilcoxon signed rank tests. There were 136 participants (mean [SD] age = 36.79 [8.23] yrs) and the exercise groups completed the protocols without any adverse effects. Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement (P < 0.05) from baseline to 6 and 12 wks compared with the control (P > 0.05). This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy.

Twins Bed Rest Project: LBNP/Exercise Minimizes Changes in Lean Leg Mass, Strength and Endurance

NASA Technical Reports Server (NTRS)

Amorim, Fabiano T.; Schneider, Suzanne M.; Lee, Stuart M. C.; Boda, Wanda L.; Watenpaugh, Donald E.; Hargens, Alan R.

2006-01-01

Decreases in muscle strength and endurance frequently are observed in non-weightbearing conditions such as bed rest (BR), spaceflight or limb immobilization. Purpose: Ow purpose was to determine if supine treadmill exercise against simulated gravity, by application of lower body negative pressure (LBNP), prevents loss of lean leg mass, strength and endurance during 30 d of 6deg head-down bed rest (BR). Methods: Fifteen pairs of monozygous twins (8 male, 7 female pairs; 26+/-4 yrs; 170+/-12 cm; 62.6+/-11.3 kg; mean+/-SD) were subjects in the present study. One sibling of each pair of twins was randomly assigned to either an exercise (EX) or non-exercise (CON) group. The EX twin walked/jogged on a vertical treadmill within LBNP chamber 6 d/wk using a 40-min interval exercise protocol at 40-80% of pre-BR VO(sub 2peak). LBNP was adjusted individually for each subject such that footward force was between 1.0 and 1.2 times body weight (-53+/-5 mmHg LBNP). The CON twin performed no exercise during BR. Subjects performed isokinetic knee (60 and 120deg/s) and ankle (60deg/s) testing to assess strength and endurance (End) before and after BR. They also had their lean leg mass (L(sub mass)) evaluated by DEXA before and after BR. Results: Changes in peak torque (T(sub pk)) were smaller for flexion (flex) than for extension (ext) after BR and did not differ between groups. The CON group had larger decreases (P<0.05) in L(sub mass), knee and ankle ext T(sub pk), and knee ext End.

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

PubMed

Krøll, L S; Sjödahl Hammarlund, C; Gard, G; Jensen, R H; Bendtsen, L

2018-04-10

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour. © 2018 European Pain Federation - EFIC®.

Pain, opioids, and sleep: implications for restless legs syndrome treatment.

PubMed

Trenkwalder, Claudia; Zieglgänsberger, Walter; Ahmedzai, Sam H; Högl, Birgit

2017-03-01

Opioid receptor agonists are known to relieve restless legs syndrome (RLS) symptoms, including both sensory and motor events, as well as improving sleep. The mechanisms of action of opioids in RLS are still a matter of speculation. The mechanisms by which endogenous opioids contribute to the pathophysiology of this polygenetic disorder, in which there are a number of variants, including developmental factors, remains unknown. A summary of the cellular mode of action of morphine and its (partial) antagonist naloxone via α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and the involvement of dendritic spine activation is described. By targeting pain and its consequences, opioids are the first-line treatment in many diseases and conditions with both acute and chronic pain and have thus been used in both acute and chronic pain conditions over the last 40 years. Addiction, dependence, and tolerability of opioids show a wide variability interindividually, as the response to opioids is influenced by a complex combination of genetic, molecular, and phenotypic factors. Although several trials have now addressed opioid treatment in RLS, hyperalgesia as a complication of long-term opioid treatment, or opioid-opioid interaction have not received much attention so far. Therapeutic opioids may act not only on opioid receptors but also via histamine or N-methyl-d-aspartate (NMDA) receptors. In patients with RLS, one of the few studies investigating opioid bindings found that possible brain regions involved in the severity of RLS symptoms are similar to those known to be involved in chronic pain, such as the medial pain system (medial thalamus, amygdala, caudate nucleus, anterior cingulate gyrus, insular cortex, and orbitofrontal cortex). The results of this diprenorphine positron emission tomography study suggested that the more severe the RLS, the greater the release of endogenous opioids. Since 1993, when the first small controlled study was performed with

Arm blood flow and metabolism during arm and combined arm and leg exercise in humans

PubMed Central

Volianitis, S; Secher, N H

2002-01-01

The cardiovascular response to exercise with several groups of skeletal muscle suggests that work with the arms may decrease leg blood flow. This study evaluated whether intense exercise with the legs would have a similar effect on arm blood flow (Q̇arm) and O2 consumption (V̇O2,arm). Ten healthy male subjects (age 21 ± 1 year; mean ± S.D.) performed arm cranking at 80 % of maximum arm work capacity (A trial) and combined arm cranking with cycling at 60 % of maximum leg work capacity (A + L trial). The combined trial was a maximum effort for 5-6 min. Q̇arm measurement by thermodilution in the axilliary vein and arterial and venous blood samples permitted calculation of V̇O2,arm. During the combined trial, Q̇arm was reduced by 0.58 ± 0.25 l min−1 (19.1 ± 3.0 %, P < 0.05) from the value during arm cranking (3.00 ± 0.46 l min−1). The arterio-venous O2 difference increased from 122 ± 15 ml l−1 during the arm trial to 150 ± 21 ml l−1 (P < 0.05) during the combined trial. Thus, V̇O2,arm (0.45 ± 0.06 l min−1) was reduced by 9.6 ± 6.3 % (P < 0.05) and arm vascular conductance from 27 ± 4 to 23 ± 3 ml min−1 (mmHg)−1 (P < 0.05) as noradrenaline spillover from the arm increased from 7.5 ± 3.5 to 13.8 ± 4.2 nmol min−1 (P < 0.05). The data suggest that during maximal whole body exercise in humans, arm vasoconstriction is established to an extent that affects oxygen delivery to and utilisation by working skeletal muscles. PMID:12411540

The outcome of hip exercise in patellofemoral pain: A systematic review.

PubMed

Thomson, Catherine; Krouwel, Oliver; Kuisma, Raija; Hebron, Clair

2016-12-01

Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in clinical practice. Current evidence shows that there are hip strength deficits, delayed onset and shorter activation of gluteus medius in people with PFP. The aim of this review was to systematically review the literature to investigate the outcome of hip exercise in people with PFP. AMED, CINAHL, Cochrane, EMBASE, PEDro, Pubmed, Science direct and SPORTDiscus databases were searched from inception to November 2014 for RCTs, non-randomised studies and case studies. Two independent reviewers assessed each paper for inclusion and quality. Twenty one papers were identified; eighteen investigating strengthening exercise, two investigating the effect of neuromuscular exercise and one study investigated the effect of hip exercise for the prevention of PFP. Hip and knee strengthening programmes were shown to be equally effective. Limited evidence indicates that the addition of hip exercise to an exercise programme is beneficial. Limited evidence demonstrates that motor skill retraining in a participant group who displayed abnormal hip alignment in running improves pain. The evidence consistently demonstrated that both hip strengthening and neuromuscular exercise has a beneficial effect on pain and function in people with PFP. Strengthening exercise predominantly addressed abductor and external rotator muscle groups. A consensus from PFP researchers for standardisation of methodology is recommended to enable meaningful comparison between trials. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mcconnell's patellar taping does not alter knee and hip muscle activation differences during proprioceptive exercises: A randomized placebo-controlled trial in women with patellofemoral pain syndrome.

PubMed

Araújo, Cynthia Gobbi Alves; de Souza Guerino Macedo, Christiane; Ferreira, Daiene; Shigaki, Leonardo; da Silva, Rubens A

2016-12-01

The purpose of this study was to assess the effect of patellar taping on muscle activation of the knee and hip muscles in women with Patellofemoral Pain Syndrome during five proprioceptive exercises. Forty sedentary women with syndrome were randomly allocated in two groups: Patellar Taping (based in McConnell) and Placebo (vertical taping on patella without any stretching of lateral structures of the knee). Volunteers performed five proprioceptive exercises randomly: Swing apparatus, Mini-trampoline, Bosu balance ball, Anteroposterior sway on a rectangular board and Mediolateral sway on a rectangular board. All exercises were performed in one-leg stance position with injured knee at flexion of 30° during 15s. Muscle activation was measured by surface electromyography across Vastus Medialis, Vastus Lateralis and Gluteus medius muscles. Maximal voluntary contraction was performed for both hip and knee muscles in order to normalize electromyography signal relative to maximum effort during the exercises. ANOVA results reported no significant interaction (P>0.05) and no significant differences (P>0.05) between groups and intervention effects in all exercise conditions. Significant differences (P<0.01) were only reported between muscles, where hip presented higher activity than knee muscles. Patellar taping is not better than placebo for changes in the muscular activity of both hip and knee muscles during proprioceptive exercises. ClinicalTrials.gov NCT02322515. Copyright © 2016 Elsevier Ltd. All rights reserved.

Exercise interventions and prevention of fall-related fractures in older people: a meta-analysis of randomized controlled trials.

PubMed

Zhao, Renqing; Feng, Feifei; Wang, Xinzheng

2017-02-01

This meta-analysis aimed to determine whether exercise interventions were effective in preventing fall-related fractures in older people. The treatment effects on rate of falls, leg strength and balance were also examined. An electronic database search was conducted in PubMed, EMBASE, the Cochrane library and PEDro up to 1 September 2015. Randomized controlled trials (RCTs) that conducted exercise interventions and reported fall-related fracture data in older people were included. The primary outcome was the treatment effects on fall-related fractures determined by relative risk (RR) and 95% confidence interval (CI). The treatment effects on falls, leg strength and balance were also reported using rate ratio (RaR) with 95% CI and standardized mean difference (SMD) with 95% CI, respectively. Random effects models were used for meta-analysis. Fifteen studies including 3136 participants met the inclusion criteria. Exercise had a beneficial effect on reduction of fall-related fractures, with pooled estimates of RR 0.604 (95% CI 0.453 - 0.840, P  = 0.003, I 2  = 0%). The rate of falls (RaR 0.856, 95% CI 0.778 - 0.941, P  = 0.001, I 2  = 45%) and leg strength (SMD 0.613, 95% CI 0.119 - 1.107, P  = 0.015, I 2  = 76.7%) were also potentially affected by exercise interventions. These only had a marginally beneficial effect on balance (SMD 0.468, 95% CI -0.011 - 0.947, P  = 0.055, I 2  = 93.6%). Our findings implied that exercise interventions were effective in preventing fall-related fractures and reducing risk factors of fall-related fractures in older people. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial.

PubMed

Gutke, Annelie; Sjödahl, Jenny; Oberg, Birgitta

2010-11-01

To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain. A prospective, randomized, single-blinded, clinically controlled study. Eighty-eight women with pelvic girdle pain were recruited 3 months after delivery. The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had a single telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function. No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared with baseline, although the majority still experienced pelvic girdle pain. Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum pelvic girdle pain than the clinically natural course. Regardless of whether treatment with specific stabilizing exercises was carried out, the majority of women still experienced some back pain almost one year after pregnancy.

Energy Metabolism during Repeated Sets of Leg Press Exercise Leading to Failure or Not

PubMed Central

Gorostiaga, Esteban M.; Navarro-Amézqueta, Ion; Calbet, José A. L.; Hellsten, Ylva; Cusso, Roser; Guerrero, Mario; Granados, Cristina; González-Izal, Miriam; Ibañez, Javier; Izquierdo, Mikel

2012-01-01

This investigation examined the influence of the number of repetitions per set on power output and muscle metabolism during leg press exercise. Six trained men (age 34±6 yr) randomly performed either 5 sets of 10 repetitions (10REP), or 10 sets of 5 repetitions (5REP) of bilateral leg press exercise, with the same initial load and rest intervals between sets. Muscle biopsies (vastus lateralis) were taken before the first set, and after the first and the final sets. Compared with 5REP, 10REP resulted in a markedly greater decrease (P<0.05) of the power output, muscle PCr and ATP content, and markedly higher (P<0.05) levels of muscle lactate and IMP. Significant correlations (P<0.01) were observed between changes in muscle PCr and muscle lactate (R2 = 0.46), between changes in muscle PCr and IMP (R2 = 0.44) as well as between changes in power output and changes in muscle ATP (R2 = 0.59) and lactate (R2 = 0.64) levels. Reducing the number of repetitions per set by 50% causes a lower disruption to the energy balance in the muscle. The correlations suggest that the changes in PCr and muscle lactate mainly occur simultaneously during exercise, whereas IMP only accumulates when PCr levels are low. The decrease in ATP stores may contribute to fatigue. PMID:22808209

Disability predictors in chronic low back pain after aquatic exercise.

PubMed

Baena-Beato, Pedro Ángel; Delgado-Fernández, Manuel; Artero, Enrique G; Robles-Fuentes, Alejandro; Gatto-Cardia, María Claudia; Arroyo-Morales, Manuel

2014-07-01

The physical and psychological factors associated with reduction of disability after aquatic exercise are not well understood. Sixty participants (30 men and 30 women; age, 50.60 [9.69] yrs; body mass index, 27.21 [5.20] kg/m²) with chronic low back pain were prospectively recruited. The 8-wk aquatic therapy program was carried out in an indoor pool sized 25 × 6 m, with 140-cm water depth and 30°C (1°C) of water temperature, where patients exercised for 2-5 days a week. Each aquatic exercise session lasted 55-60 mins (10 mins of warm-up, 20-25 mins of aerobic exercise, 15-20 mins of resistance exercise, and 10 mins of cooldown). Demographic information, disability (Oswestry Disability Index), back pain (visual analog scale), quality-of-life (Short Form 36), abdominal muscular endurance (curl-up), handgrip strength, trunk flexion and hamstring length (sit and reach), resting heart rate, and body mass index were outcomes variables. Significant correlations between change in disability and visual analog scale (at rest, flexion, and extension), curl-up and handgrip (r ranged between -0.353 and 0.582, all Ps < 0.01) were found. Changes in pain and abdominal muscular endurance were significant predictors of change in disability after therapy.

An index for breathlessness and leg fatigue.

PubMed

Borg, E; Borg, G; Larsson, K; Letzter, M; Sundblad, B-M

2010-08-01

The features of perceived symptoms causing discontinuation of strenuous exercise have been scarcely studied. The aim was to characterize the two main symptoms causing the discontinuation of heavy work in healthy persons as well as describe the growth of symptoms during exercise. Breathlessness (b) and leg fatigue (l) were assessed using the Borg CR10 Scale and the Borg CR100 (centiMax) Scale, during a standardized exercise test in 38 healthy subjects (24-71 years). The b/l-relationships were calculated for terminal perceptions (ERI(b/l)), and the growth of symptoms determined by power functions for the whole test, as well as by growth response indexes (GRI). This latter index was constructed as a ratio between power levels corresponding to a very strong and a moderate perception. In the majority (71%) of the test subjects, leg fatigue was the dominant symptom at the conclusion of exercise (P<0.001) and the b/l ratio was 0.77 (CR10) and 0.75 (CR100), respectively. The GRI for breathlessness and leg fatigue was similar, with good correlations between GRI and the power function exponent (P<0.005). In healthy subjects, leg fatigue is the most common cause for discontinuing an incremental exercise test. The growth functions for breathlessness and leg fatigue during work are, however, almost parallel.

Influence of Pilates Mat and Apparatus Exercises on Pain and Balance of Businesswomen with Chronic Low Back Pain

PubMed Central

Lee, Chae-Woo; Hyun, Ju; Kim, Seong Gil

2014-01-01

[Purpose] The purpose of this study was to examine the influence of mat Pilates and apparatus Pilates on pain and static balance of businesswomen with chronic back pain. [Subjects and Methods] Participants were randomly allocated to Pilates mat exercises (PME) or Pilates apparatus exercise (PAE), and performed the appropriate Pilates exercises 3 days per week for 8 weeks. In order to measure the improvement in the participants’ static balance ability as a result of the exercise, the sway length and sway velocity of the subjects were measured before and after the experiment while the subjects stood on a Balance Performance Monitor (BPM) facing the front wall for 30 seconds with their eyes open. The visual analogue scale (VAS) was used to measure the degree of pain. [Results] The VAS score, sway length, and sway velocity of both groups decreased significantly after the experiment, but the PME group showed a greater decrease than the PAE group. [Conclusion] PME showed greater improvement in pain level and balance compared with PAE in this research. Since the subjects of this study were patients with low back pain, PME is assumed to have been more suitable and effective because it uses body weight to strengthen core muscles rather than heavier apparatuses as in PAE. PMID:24764614

Influence of pilates mat and apparatus exercises on pain and balance of businesswomen with chronic low back pain.

PubMed

Lee, Chae-Woo; Hyun, Ju; Kim, Seong Gil

2014-04-01

[Purpose] The purpose of this study was to examine the influence of mat Pilates and apparatus Pilates on pain and static balance of businesswomen with chronic back pain. [Subjects and Methods] Participants were randomly allocated to Pilates mat exercises (PME) or Pilates apparatus exercise (PAE), and performed the appropriate Pilates exercises 3 days per week for 8 weeks. In order to measure the improvement in the participants' static balance ability as a result of the exercise, the sway length and sway velocity of the subjects were measured before and after the experiment while the subjects stood on a Balance Performance Monitor (BPM) facing the front wall for 30 seconds with their eyes open. The visual analogue scale (VAS) was used to measure the degree of pain. [Results] The VAS score, sway length, and sway velocity of both groups decreased significantly after the experiment, but the PME group showed a greater decrease than the PAE group. [Conclusion] PME showed greater improvement in pain level and balance compared with PAE in this research. Since the subjects of this study were patients with low back pain, PME is assumed to have been more suitable and effective because it uses body weight to strengthen core muscles rather than heavier apparatuses as in PAE.

[The painful hemiplegic shoulder: effects of exercises program according to Bobath].

PubMed

Gialanella, B; Benvenuti, P; Santoro, R

2004-01-01

To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, p<0.04 respectively) after three months. The others variables measured did not change. This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.

PubMed

Bussières, André E; Stewart, Gregory; Al-Zoubi, Fadi; Decina, Philip; Descarreaux, Martin; Haskett, Danielle; Hincapié, Cesar; Pagé, Isabelle; Passmore, Steven; Srbely, John; Stupar, Maja; Weisberg, Joel; Ornelas, Joseph

2018-05-01

The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments. The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee. For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises). A multimodal approach including SMT, other commonly used active interventions, self

How Do Patients with Chronic Neck Pain Experience the Effects of Qigong and Exercise Therapy? A Qualitative Interview Study.

PubMed

Holmberg, Christine; Farahani, Zubin; Witt, Claudia M

2016-01-01

Background. The high prevalence of chronic neck pain in high income countries impacts quality of life and the social and work-related activities of those afflicted. We aimed to understand how mind-body therapies and exercise therapy may influence the experience of pain among patients with chronic neck pain. Methods. This qualitative interview study investigated how patients with chronic neck pain experienced the effects of exercise or qigong therapy at two time points: during an intervention at three months and after the intervention at six months. Interviews were analysed thematically across interviews and within person-cases. Based on other qualitative studies, a sample size of 20 participants was deemed appropriate. Results. The sample (n = 20) consisted of 16 women and four men (age range: 29 to 59). Patients' experiences differed according to the therapies' philosophies. Exercise therapy group interviewees described a focus on correct posture and muscle tension release. Qigong group interviewees discussed calming and relaxing effects. Maintaining regular exercise was easier to achieve with exercise therapy. Conclusions. The findings of this study may help health care providers when counselling chronic pain patients on self-help interventions by informing them of different bodily and emotional experiences of mind-body interventions compared to exercise therapy.

How Do Patients with Chronic Neck Pain Experience the Effects of Qigong and Exercise Therapy? A Qualitative Interview Study

PubMed Central

Holmberg, Christine; Farahani, Zubin; Witt, Claudia M.

2016-01-01

Background. The high prevalence of chronic neck pain in high income countries impacts quality of life and the social and work-related activities of those afflicted. We aimed to understand how mind-body therapies and exercise therapy may influence the experience of pain among patients with chronic neck pain. Methods. This qualitative interview study investigated how patients with chronic neck pain experienced the effects of exercise or qigong therapy at two time points: during an intervention at three months and after the intervention at six months. Interviews were analysed thematically across interviews and within person-cases. Based on other qualitative studies, a sample size of 20 participants was deemed appropriate. Results. The sample (n = 20) consisted of 16 women and four men (age range: 29 to 59). Patients' experiences differed according to the therapies' philosophies. Exercise therapy group interviewees described a focus on correct posture and muscle tension release. Qigong group interviewees discussed calming and relaxing effects. Maintaining regular exercise was easier to achieve with exercise therapy. Conclusions. The findings of this study may help health care providers when counselling chronic pain patients on self-help interventions by informing them of different bodily and emotional experiences of mind-body interventions compared to exercise therapy. PMID:27418938

Minimizing genital tract trauma and related pain following spontaneous vaginal birth.

PubMed

Albers, Leah L; Borders, Noelle

2007-01-01

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.

The effects of Clinical Pilates exercises on patients with shoulder pain: A randomised clinical trial.

PubMed

Atılgan, Esra; Aytar, Aydan; Çağlar, Aslıcan; Tığlı, Ayça Aytar; Arın, Gamze; Yapalı, Gökmen; Kısacık, Pınar; Berberoğlu, Utku; Şener, Hülya Özlem; Ünal, Edibe

2017-10-01

The purpose of this study was to determine the effect of Clinical Pilates exercises on patients with shoulder pain. Thirty-three patients, experiencing shoulder pain continuously for at least four weeks were selected as study subjects. The patients were randomly divided into two groups, namely Clinical Pilates exercise (n = 17) group and conventional exercise (n = 16) group. The patients were treated for five days a week, the total treatment being carried out for 10 days. The assessment of pain and disability amongst the patients were done at the baseline and at the end of the treatment sessions, using Visual Analogue Scale (VAS) and Shoulder Pain and Disability Index (SPADI). The clinical Pilates exercise group showed a significant improvement in all scores used for assessment (p < 0.05), while the conventional exercise group demonstrated a significant improvement only in the SPADI total score (p < 0.05). A comparison of scores for the VAS, SPADI-Pain and SPADI-Total between the two groups, revealed a significant improvement in the Clinical Pilates exercise group (p < 0.05). It was demonstrated by the study that Clinical Pilates exercise is an efficient technique for patients experiencing shoulder pain, as it helps reduce pain and disability among them. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders

PubMed Central

2014-01-01

Background Different types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions. Methods This parallel group randomized controlled trial included 57 women randomly allocated into two groups – a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH group’s training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four- to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X 2 test. Results At four- to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four- to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%. Conclusions No differences in the two primary outcomes between the two interventions were found, a finding that may be due to

Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain.

PubMed

Smith, Benjamin E; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

2018-01-01

Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8-10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self

A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain.

PubMed

Deyo, R A; Walsh, N E; Martin, D C; Schoenfeld, L S; Ramamurthy, S

1990-06-07

A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exercises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals for group differences excluded a major clinical benefit of TENS for most outcomes. By contrast, after one month patients in the exercise groups had significant improvement in self-rated pain scores, reduction in the frequency of pain, and greater levels of activity as compared with patients in the groups that did not exercise. The mean reported improvement in pain scores was 52 percent in the exercise groups and 37 percent in the nonexercise groups (P = 0.02). Two months after the active intervention, however, most patients had discontinued the exercises, and the initial improvements were gone. We conclude that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone.

Does intermittent pneumatic leg compression enhance muscle recovery after strenuous eccentric exercise?

PubMed

Cochrane, D J; Booker, H R; Mundel, T; Barnes, M J

2013-11-01

Intermittent pneumatic compression (IPC) has gained rapid popularity as a post-exercise recovery modality. Despite its widespread use and anecdotal claims for enhancing muscle recovery there is no scientific evidence to support its use. 10 healthy, active males performed a strenuous bout of eccentric exercise (3 sets of 100 repetitions) followed by IPC treatment or control performed immediately after exercise and at 24 and 48 h post-exercise. Muscular performance measurements were taken prior to exercise and 24, 48 and 72 h post-exercise and included single-leg vertical jump (VJ) and peak and average isometric [knee angle 75º] (ISO), concentric (CON) and eccentric (ECC) contractions performed at slow (30° · s⁻¹) and fast (180° · s⁻¹) velocities. Plasma creatine kinase (CK) samples were taken at pre- and post-exercise 24, 48 and 72 h. Strenuous eccentric exercise resulted in a significant decrease in peak ISO, peak and average CON (30° · s⁻¹) at 24 h compared to pre-exercise for both IPC and control, however VJ performance remained unchanged. There were no significant differences between conditions (IPC and control) or condition-time interactions for any of the contraction types (ISO, CON, ECC) or velocities (CON, ECC 30° · s⁻¹ and 180° · s⁻¹). However, CK was significantly elevated at 24 h compared to pre-exercise in both conditions (IPC and control). IPC did not attenuate muscle force loss following a bout of strenuous eccentric exercise in comparison to a control. While IPC has been used in the clinical setting to treat pathologic conditions, the parameters used to treat muscle damage following strenuous exercise in healthy participants are likely to be very different than those used to treat pathologic conditions. © Georg Thieme Verlag KG Stuttgart · New York.

Equipment-based Pilates reduces work-related chronic low back pain and disability: A pilot study.

PubMed

Stieglitz, Dana Duval; Vinson, David R; Hampton, Michelle De Coux

2016-01-01

This study investigated effectiveness of an equipment-based Pilates protocol for reducing pain and disability in individuals with work-related chronic low back pain (CLBP). Twelve workers with non-specific CLBP participated in a quasi-experimental, one-group, pretest-posttest pilot study of supervised 6-week equipment-based Pilates exercise. Pain severity was assessed using a 100-mm visual analog scale (VAS). Physical function was assessed using the Oswestry disability index (ODI). The Pilates intervention significantly reduced pain (mean decrease in VAS 30.75 ± 20.27, p < 0.0001) and disability (mean decrease in ODI 11.25 ± 13.20, p < 0.02) with large and borderline large effect sizes, respectively. Rehabilitative Pilates exercise reduced pain and disability in workers with CLBP. Further research is needed to investigate Pilates exercise for rehabilitation of work-related injuries in large populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Long-term effects of exercise programs among helicopter pilots with flying related LBP

PubMed Central

Andersen, Knut; Baardsen, Roald; Dalen, Ingvild; Larsen, Jan Petter

2017-01-01

BACKGROUND: Flying related transient Low Back Pain (LBP) among helicopter pilots is considered an occupational distress. OBJECTIVE: To examine if exercise programs can alleviate transient LBP. METHODS: Sixty-five helicopter pilots (92% males), all reporting flying related LBP, responded to an epidemiological survey and a long-term follow-up, 44.8 months later, comprising questions regarding transient LBP and number of sick leaves. Data from 37 pilots participating in two exercise programs, A; general for LBP, B; focused for lumbar trunk (LT), included information from clinical examinations and muscular endurance tests of the LT before and after intervention. Twenty-eight pilots did not participate in any intervention. RESULTS: At long-term follow-up 42% of the pilots still reported flying related transient LBP. Among participants in program B 26% had persistent pain, 70% in program A and 46% among pilots without intervention. Sick-leave reduction was only observed among participants in program B (30% to 4%). Upon re-occurrence of LBP symptoms, half of the pilots in program B again performed exercises to improve their pain. CONCLUSION: This study indicates that exercise programs focused towards lumbar trunk muscular endurance reduces flying related transient LBP and sick-leave among helicopter pilots. These findings may have implications for the pilots’ working conditions. PMID:29278872

Effects of caffeinated chewing gum on muscle pain during submaximal isometric exercise in individuals with fibromyalgia.

PubMed

Umeda, Masataka; Kempka, Laura; Weatherby, Amy; Greenlee, Brennan; Mansion, Kimberly

2016-04-01

Physical activity is important to manage symptom of fibromyalgia (FM); however, individuals with FM typically experience augmented muscle pain during exercise. This study examined the effects of caffeinated chewing gum on exercise-induced muscle pain in individuals with FM. This study was conducted with a double-blind, placebo-controlled, cross-over design. Twenty-three patients with FM completed a caffeine condition where they consumed a caffeinated chewing gum that contains 100mg of caffeine, and a placebo condition where they consumed a non-caffeinated chewing gum. They completed isometric handgrip exercise at 25% of their maximal strength for 3 min, and muscle pain rating (MPR) was recorded every 30s during exercise. Clinical pain severity was assessed in each condition using a pain questionnaire. The order of the two conditions was randomly determined. MPR increased during exercise, but caffeinated chewing gum did not attenuate the increase in MPR compared to placebo gum. Clinical pain severity was generally associated with the average MPR and the caffeine effects on MPR, calculated as difference in the average MPR between the two conditions. The results suggest that more symptomatic individuals with FM may experience greater exercise-induced muscle pain, but benefit more from caffeinated chewing gum to reduce exercise-induced muscle pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.

PubMed

Shamsi, Mohammad Bagher; Rezaei, Mandana; Zamanlou, Mehdi; Sadeghi, Mehdi; Pourahmadi, Mohammad Reza

2016-01-01

The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. After the intervention, test times increased and disability and pain decreased within groups. There was no significant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.

Validity of the Korean Version of the Face, Legs, Activity, Cry, and Consolability Scale for Assessment of Pain in Dementia Patients.

PubMed

Moon, Yeonsil; Kim, Yoon Sook; Lee, Jongmin; Han, Seol Heui

2017-11-01

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59-0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea. © 2017 The Korean Academy of Medical Sciences.

Muscle activity and spine load during anterior chain whole body linkage exercises: the body saw, hanging leg raise and walkout from a push-up.

PubMed

McGill, Stuart; Andersen, Jordan; Cannon, Jordan

2015-01-01

This study examined anterior chain whole body linkage exercises, namely the body saw, hanging leg raise and walkout from a push-up. Investigation of these exercises focused on which particular muscles were challenged and the magnitude of the resulting spine load. Fourteen males performed the exercises while muscle activity, external force and 3D body segment motion were recorded. A sophisticated and anatomically detailed 3D model used muscle activity and body segment kinematics to estimate muscle force, and thus sensitivity to each individual's choice of motor control for each task. Gradations of muscle activity and spine load characteristics were observed across tasks. On average, the hanging straight leg raise created approximately 3000 N of spine compression while the body saw created less than 2500 N. The hanging straight leg raise created the highest challenge to the abdominal wall (>130% MVC in rectus abdominis, 88% MVC in external oblique). The body saw resulted in almost 140% MVC activation of the serratus anterior. All other exercises produced substantial abdominal challenge, although the body saw did so in the most spine conserving way. These findings, along with consideration of an individual's injury history, training goals and current fitness level, should assist in exercise choice and programme design.

New exercise-integrated technology can monitor the dosage and quality of exercise performed against an elastic resistance band by adolescents with patellofemoral pain: an observational study.

PubMed

Rathleff, Michael S; Bandholm, Thomas; McGirr, Kate A; Harring, Stine I; Sørensen, Anders S; Thorborg, Kristian

2016-07-01

Is the exercise-integrated Bandcizer™ system feasible for recording exercise dosage (time under tension (TUT) and repetitions) and pain scores among adolescents with patellofemoral pain? Do adolescents practise the exercises as prescribed (TUT and repetitions)? Do adolescents accurately report the exercises they do in an exercise diary? Observational feasibility study. Twenty adolescents between 15 and 19 years of age with patellofemoral pain. Participants were prescribed three exercise sessions per week (one with and two without supervision) for 6 weeks. The exercises included three hip and one knee exercise with an elastic resistance band. Participants were instructed to perform three sets with a predefined TUT (3seconds concentric; 2seconds isometric; 3seconds eccentric; 2seconds pause), equating to 80seconds for 10 repetitions (one set). The exercise-integrated system consisted of a sensor attached to the elastic resistance band that was connected to the Bandtrainer app on an electronic tablet device. Pain intensity was reported on a visual analogue scale on the app. Participants also completed a self-report exercise diary. No major problems were reported with the system. Participants performed 2541 exercise sets during the 6 weeks; 5% were performed with the predefined TUT (ie, within 10seconds of the 80-second target) and 90% were performed below the target TUT. On average, the participants received 15% of the instructed exercise dosage based on TUT. The exercise dosage reported in the exercise diaries was 2.3 times higher than the TUT data from the electronic system. Pain intensity was successfully collected in 100% of the exercise sets. The system was feasible for adolescents with patellofemoral pain. The system made it possible to capture detailed data about the TUT, repetitions and sets during home-based exercises together with pain intensity before and after each exercise. [Rathleff MS, Bandholm T, McGirr KA, Harring SI, Sørensen AS, Thorborg K (2016

Effects of Pilates and trunk strengthening exercises on health-related quality of life in women with chronic low back pain.

PubMed

Kofotolis, Nikolaos; Kellis, Eleftherios; Vlachopoulos, Symeon P; Gouitas, Iraklis; Theodorakis, Yannis

2016-11-21

Pilates programs are widely used as a form of regular exercise in a broad range of populations investigating their effectiveness for chronic low back pain (CLBP) treatment. The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life (HRQOL) in women with nonspecific CLBP. A total of 101 volunteer women with CLBP provided data with a 3-month follow-up. They were randomized to either a Pilates (n= 37), trunk strengthening exercise (n= 36) or a control group (n= 28), exercising for a period of 8 weeks, three times a week. Data were collected on HRQOL using the Short-Form 36 Health Survey (SF-36v2), and functional disability using the Roland Morris Disability Questionnaire prior to program initiation, mid-intervention, immediately after program termination, and three months post-intervention. The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups (p < 0.05). The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group. An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP.

Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: a case series.

PubMed

Kline, Jessica Beckmann; Krauss, John R; Maher, Sara F; Qu, Xianggui

2013-01-01

Estimates of low back pain prevalence in USA ballet dancers range from 8% to 23%. Lumbar stabilization and extensor muscle training has been shown to act as a hypoalgesic for low back pain. Timing and coordination of multifidi and transverse abdominis muscles are recognized as important factors for spinal stabilization. The purpose of this study was to explore the effects of training methods using home exercises and a dynamic sling system on core strength, disability, and low back pain in pre-professional ballet dancers. Five participants were randomly assigned to start a traditional unsupervised lumbar stabilization home exercise program (HEP) or supervised dynamic sling training to strengthen the core and lower extremities. Measurements were taken at baseline and at weeks 3 and 6 for disability using the patient specific functional scale (PSFS), pain using the Numerical Pain Rating System (NPRS), core strength and endurance using timed plank, side-plank, and bridge positions, and sciatic nerve irritability using the straight leg raise (SLR). Data were analyzed using descriptive statistics. From initial to final measurements, all participants demonstrated an improvement in strength and SLR range, and those with initial pain and disability reported relief of symptoms. These results suggest that dynamic sling training and a HEP may help to increase strength, decrease pain, and improve function in dancers without aggravating sciatic nerve irritation.

Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

PubMed

do Carmo, Carolina Mendes; Almeida da Rocha, Bruna; Tanaka, Clarice

2017-11-01

[Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

Rehabilitation of a female dancer with patellofemoral pain syndrome: applying concepts of regional interdependence in practice.

PubMed

Welsh, Caitlyn; Hanney, William J; Podschun, Laura; Kolber, Morey J

2010-06-01

Due to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome.

Exercise reverses pain-related weight asymmetry and differentially modulates trabecular bone microarchitecture in a rat model of osteoarthritis.

PubMed

Cormier, Jim; Cone, Katherine; Lanpher, Janell; Kinens, Abigail; Henderson, Terry; Liaw, Lucy; Bilsky, Edward J; King, Tamara; Rosen, Clifford J; Stevenson, Glenn W

2017-07-01

There is great interest in developing and utilizing non-pharmacological/non-invasive forms of therapy for osteoarthritis (OA) pain including exercise and other physical fitness regimens. The present experiments determined the effects of prior wheel running on OA-induced weight asymmetry and trabecular bone microarchitecture. Wheel running included 7 or 21days of prior voluntary access to wheels followed by OA induction, followed by 21days post-OA access to wheels. OA was induced with monosodium iodoacetate (MIA), and weight asymmetry was measured using a hind limb weight bearing apparatus. Bone microarchitecture was characterized using ex vivo μCT. Relative to saline controls, MIA (3.2mg/25μl) produced significant weight asymmetry measured on post-days (PDs) 3, 7, 14, 21 in sedentary rats. Seven days of prior running failed to alter MIA-induced weight asymmetry. In contrast, 21days of prior running resulted in complete reversal of MIA-induced weight asymmetry on all days tested. As a comparator, the opioid agonist morphine (3.2-10mg/kg) dose-dependently reversed weight asymmetry on PDs 3, 7, 14, but was ineffective in later-stage (PD 21) OA. In runners, Cohen's d (effect sizes) for OA vs. controls indicated large increases in bone volume fraction, trabecular number, trabecular thickness, and connective density in lateral compartment, and large decreases in the same parameters in medial compartment. In contrast, effect sizes were small to moderate for sedentary OA vs. Results indicate that voluntary exercise may protect against OA pain, the effect varies as a function of prior exercise duration, and is associated with distinct trabecular bone modifications. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

PubMed Central

Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

2015-01-01

Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

Intra-dialytic electrostimulation of leg extensors may improve exercise tolerance and quality of life in hemodialyzed patients.

PubMed

Dobsak, Petr; Homolka, Pavel; Svojanovsky, Jan; Reichertova, Anna; Soucek, Miroslav; Novakova, Marie; Dusek, Ladislav; Vasku, Jaromir; Eicher, Jean-Christophe; Siegelova, Jarmila

2012-01-01

Hemodialyzed (HD) patients with end-stage renal disease (ESRD) exhibit lower fitness as a consequence of chronic uremic changes that trigger various structural, metabolic, and functional abnormalities in skeletal muscles. The aim of this randomized study was to compare the effect of rehabilitation (RHB) training on a bicycle ergometer and electromyostimulation (EMS) of leg extensors in HD patients with ESRD. Thirty-two HD patients (18 men/14 women; mean age 61.1 ± 8.8 years) were randomized into three groups: (i) exercise training (ET; n = 11) on bicycle ergometer 2 × 20 min; (ii) EMS (n = 11) where stimulation (10 Hz) of leg extensors was applied for 60 min; and (iii) controls (CON; n = 10) without exercise. Exercising was performed between the 2nd and the 3rd hour of HD, three times a week, 20 weeks in total. Ergometric test was performed in order to evaluate peak workload (W(peak)), 6-min corridor walking test (CWT) to evaluate the distance walked, and dynamometry of leg extensors to assess muscle power (F(max)). Urea clearance was monitored and expressed as standard parameters: spKt/V, spKt/V equilibrated (spKt/V-e), and the urea removal ratio (URR). Quality of life (QoL) was assessed by the questionnaire SF-36. A significant increase of F(max) (P = 0.040 in group ET; P = 0.032 in group EMS), of 6-min CWT (P < 0.001 in ET group; P = 0.042 in EMS group), and of W(peak) (P = 0.041 in ET group) was observed. In both exercising groups, significant increase of spKt/V, spKt/V-e, and URR was found as compared with initial values (P < 0.05). In both exercising groups, highly significant changes in summarized mental functions were found (P = 0.001); in summarized physical components, significant improvement was observed in the ET group (P = 0.006). Intradialytic RHB showed comparable positive effects on functional parameters, urea clearance, and QoL. Intradialytic EMS might represent wide therapeutic possibility in the near future. © 2011, Copyright the Authors

Effects of Pilates Exercise Programs in People With Chronic Low Back Pain

PubMed Central

Patti, Antonino; Bianco, Antonino; Paoli, Antonio; Messina, Giuseppe; Montalto, Maria Alessandra; Bellafiore, Marianna; Battaglia, Giuseppe; Iovane, Angelo; Palma, Antonio

2015-01-01

Abstract The Pilates method has recently become a fast-growing popular way of exercise recommended for healthy individuals and those engaged in rehabilitation. Several published studies have examined the effects of Pilates method in people with chronic low back pain (LBP). The objective of this study is to describe and provide an extensive overview of the scientific literature comparing the effectiveness of the Pilates method on pain and disability in patients with chronic nonspecific LBP. The study is based on the data from the following sources: MEDLINE-NLM, MEDLINE-EBSCO, Scopus Elsevier, Cochrane, DOAJ, SciELO, and PLOSONE. Original articles and systematic reviews of adults with chronic nonspecific LBP that evaluated pain and/or disability were included in this study; studies in which the primary treatment was based on Pilates method exercises compared with no treatment, minimal intervention, other types of intervention, or other types of exercises. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. The literature search included 7 electronic databases and the reference list of relevant systematic reviews and original articles to July 2014. Two independent investigators conducted the literature search and performed the synthesis as follows: Study Design; Sample (n); Disability measure; Intervention; and Main results. The searches identified a total of 128 articles. From these, 29 were considered eligible and were included in the analysis. The items were stratified as follows: Pilates method versus other kind of exercises (n = 6 trials) and Pilates method versus no treatment group or minimal intervention for short-term pain (n = 9 trials); the therapeutic effect of the Pilates method in randomized cohorts (n = 5); and analysis of reviews (n = 9). We found that there is a dearth of studies that clearly demonstrates the efficacy of a specific Pilates exercise program over another in the treatment of chronic pain. However

A hip abduction exercise prior to prolonged standing increased movement while reducing cocontraction and low back pain perception in those initially reporting low back pain.

PubMed

Viggiani, Daniel; Callaghan, Jack P

2016-12-01

Persons who develop low back pain from prolonged standing exhibit increased muscle cocontraction, decreased movement and increased spine extension. However, it is unclear how these factors relate to pain development. The purpose of this study was to use hip abductor fatigue to manipulate muscle activity patterns and determine its effects on standing behaviours and pain development. Forty participants stood for two hours twice, once following a hip abductor fatigue exercise (fatigue), and once without exercise beforehand (control). Trunk and gluteal muscle activity were measured to determine cocontraction. Lumbo-pelvic angles and force plates were used to assess posture and movement strategies. Visual analog scales differentiated pain (PDs) and non-pain developers (NPDs). PDs reported less low back pain during the fatigue session, with females having earlier reductions of similar scale than males. The fatigue session reduced gluteal and trunk cocontraction and increased centre of pressure movement; male and female PDs had opposing spine posture compensations. Muscle fatigue prior to standing reduced cocontraction, increased movement during standing and reduced the low back pain developed by PDs; the timing of pain reductions depended on spine postures adopted during standing. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effectiveness of Cognitive Behavioral Therapy (CBT) with general exercises versus general exercises alone in the management of chronic low back pain.

PubMed

Khan, Muhammad; Akhter, Saeed; Soomro, Rabail Rani; Ali, Syed Shahzad

2014-07-01

To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p=0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone.

Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain.

PubMed

Lewis, Cara L; Loverro, Kari L; Khuu, Anne

2018-04-01

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care

PubMed Central

2004-01-01

Objective To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise (“combined treatment”) to “best care” in general practice for patients consulting with low back pain. Design Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. Setting 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. Participants 1287 (96%) of 1334 trial participants. Main outcome measures Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Results Over one year, mean treatment costs relative to “best care” were £195 ($360; €279; 95% credibility interval £85 to £308) for manipulation, £140 (£3 to £278) for exercise, and £125 (£21 to £228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost £3800; in economic terms it had an “incremental cost effectiveness ratio” of £3800. Manipulation alone had a ratio of £8700 relative to combined treatment. If the NHS was prepared to pay at least £10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of £8300 relative to best care. Conclusions Spinal manipulation is a cost effective addition to “best care” for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. PMID:15556954

Sensitivity of sensor-based sit-to-stand peak power to the effects of training leg strength, leg power and balance in older adults.

PubMed

Regterschot, G Ruben H; Folkersma, Marjanne; Zhang, Wei; Baldus, Heribert; Stevens, Martin; Zijlstra, Wiebren

2014-01-01

Increasing leg strength, leg power and overall balance can improve mobility and reduce fall risk. Sensor-based assessment of peak power during the sit-to-stand (STS) transfer may be useful for detecting changes in mobility and fall risk. Therefore, this study investigated whether sensor-based STS peak power and related measures are sensitive to the effects of increasing leg strength, leg power and overall balance in older adults. A further aim was to compare sensitivity between sensor-based STS measures and standard clinical measures of leg strength, leg power, balance, mobility and fall risk, following an exercise-based intervention. To achieve these aims, 26 older adults (age: 70-84 years) participated in an eight-week exercise program aimed at improving leg strength, leg power and balance. Before and after the intervention, performance on normal and fast STS transfers was evaluated with a hybrid motion sensor worn on the hip. In addition, standard clinical tests (isometric quadriceps strength, Timed Up and Go test, Berg Balance Scale) were performed. Standard clinical tests as well as sensor-based measures of peak power, maximal velocity and duration of normal and fast STS showed significant improvements. Sensor-based measurement of peak power, maximal velocity and duration of normal STS demonstrated a higher sensitivity (absolute standardized response mean (SRM): ≥ 0.69) to the effects of training leg strength, leg power and balance than standard clinical measures (absolute SRM: ≤ 0.61). Therefore, the presented sensor-based method appears to be useful for detecting changes in mobility and fall risk. Copyright © 2013 Elsevier B.V. All rights reserved.

Precooling leg muscle improves intermittent sprint exercise performance in hot, humid conditions.

PubMed

Castle, Paul C; Macdonald, Adam L; Philp, Andrew; Webborn, Anthony; Watt, Peter W; Maxwell, Neil S

2006-04-01

We used three techniques of precooling to test the hypothesis that heat strain would be alleviated, muscle temperature (Tmu) would be reduced, and as a result there would be delayed decrements in peak power output (PPO) during exercise in hot, humid conditions. Twelve male team-sport players completed four cycling intermittent sprint protocols (CISP). Each CISP consisted of twenty 2-min periods, each including 10 s of passive rest, 5 s of maximal sprint against a resistance of 7.5% body mass, and 105 s of active recovery. The CISP, preceded by 20 min of no cooling (Control), precooling via an ice vest (Vest), cold water immersion (Water), and ice packs covering the upper legs (Packs), was performed in hot, humid conditions (mean +/- SE; 33.7 +/- 0.3 degrees C, 51.6 +/- 2.2% relative humidity) in a randomized order. The rate of heat strain increase during the CISP was faster in Control than Water and Packs (P < 0.01), but it was similar to Vest. Packs and Water blunted the rise of Tmu until minute 16 and for the duration of the CISP (40 min), respectively (P < 0.01). Reductions in PPO occurred from minute 32 onward in Control, and an increase in PPO by approximately 4% due to Packs was observed (main effect; P < 0.05). The method of precooling determined the extent to which heat strain was reduced during intermittent sprint cycling, with leg precooling offering the greater ergogenic effect on PPO than either upper body or whole body cooling.

Rehabilitation of a Female Dancer with Patellofemoral Pain Syndrome: Applying Concepts of Regional Interdependence in Practice

PubMed Central

Welsh, Caitlyn; Podschun, Laura; Kolber, Morey J.

2010-01-01

Due to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome. PMID:21589665

The effect of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females.

PubMed

Yu, Seong Hun; Sim, Yong Hyeon; Kim, Myung Hoon; Bang, Ju Hee; Son, Kyung Hyun; Kim, Jae Woong; Kim, Hyun Jin

2016-10-01

[Purpose] This study is designed to compare the effects of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females. [Subjects and Methods] Forty elderly females aged 65 or older who had complained of low back pain for three months or longer were selected as the subjects. They were randomly and equally assigned to either an abdominal drawing-in group or a myofascial release group. The subjects conducted exercise three times per week, 40 minutes each time, for eight weeks. As evaluation tools, visual analogue scale for pain, remodified schober test for flexibility, and upright posture with eye opening on hard platform, upright posture with eye closing on hard platform, upright posture with eye opening on soft platform, upright posture with eye closing on soft platform using tetrax for balance were used. [Results] The abdominal drawing-in exercise group saw significant difference in pain and balance after the exercise compared to before the exercise. The myofascial release group saw significant difference in pain and flexibility after exercise compared to before the exercise. [Conclusion] The above study showed that abdominal drawing-in exercise affected elderly females regarding pain and balance and myofascial release influenced their pain and flexibility.

Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects.

PubMed

Lemming, Dag; Börsbo, Björn; Sjörs, Anna; Lind, Eva-Britt; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas; Gerdle, Björn

2017-08-01

The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated. Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated. Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm ( P = 0.002), PTTs were lower in the arm and leg ( P < 0.001), and the VAS-PTT was higher in the arm and leg ( P < 0.033). Highly active participants compared with less active had higher PDT ( P = 0.027) in the leg. Women showed facilitated spatial summation ( P < 0.014) in the arm and leg and a steeper VAS slope (i.e., the slope of the VAS pressure curve between PDT and PPT) in the arm and leg ( P < 0.003). This study indicates that reduced pressure pain sensitivity is associated both with male sex and physical activity level. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study.

PubMed

Van Oosterwijck, Jessica; Nijs, Jo; Meeus, Mira; Van Loo, Michel; Paul, Lorna

2012-03-01

A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash-associated disorders (WAD). In addition, 2 types of exercise were compared. Twenty-two women with chronic WAD and 22 healthy controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds (PPT), health status, and activity levels were assessed in response to the 2 exercise bouts. In chronic WAD, PPT decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the self-paced, physiologically limited exercise, with exception of the PPT at the calf which increased. A worsening of the chronic WAD symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise. These observations suggest abnormal central pain processing during exercise in patients with chronic WAD. Submaximal exercise triggers post-exertional malaise, while a self-paced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic WAD patients. The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic WAD. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic WAD, and that the use of more individual, targeted exercise therapies is recommended. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

Exercise training in adults with Pompe disease: the effects on pain, fatigue, and functioning.

PubMed

Favejee, Marein M; van den Berg, Linda E M; Kruijshaar, Michelle E; Wens, Stephan C A; Praet, Stephan F E; Pim Pijnappel, W W M; van Doorn, Pieter A; Bussmann, Johannes B J; van der Ploeg, Ans T

2015-05-01

To assess if a 12-week exercise intervention to improve aerobic fitness, muscle strength, and core stability also had an impact on fatigue, pain, activity, and participation in adults with Pompe disease, an inherited neuromuscular disorder. Open-label trial. Change was assessed by the chi-square test and Wilcoxon signed-rank test. Physiotherapy practices. Mildly affected adult patients with Pompe disease who were not dependent on ventilators and/or walking devices and were receiving enzyme replacement therapy. Patients participated in a 12-week exercise program, which included 36 sessions of standardized aerobic, resistance, and core stability exercises. Before and after the training program we evaluated fatigue (Fatigue Severity Scale), pain (yes/no), motor function (Quantitative Muscle Function Test, Rasch-built Pompe-specific Activity Scale), amount of physical activity (activity monitor), and health status (Medical Outcomes Study 36-Item Short-Form Health Survey). Of the 25 patients enrolled, 23 completed the program. At the end of the program, levels of fatigue (median, 5.33 to 4.78, P=.01) and pain (56.5% to 21.7%, P=.04) improved. The quality of motor function and the amount of physical activity patients engaged in did not change. Changes in pain and fatigue were not related to improvements in aerobic fitness or muscle strength. This study in mildly affected adult patients with Pompe disease suggests that a combined training program aiming to increase aerobic fitness, muscle strength, and core stability also leads to improvements in fatigue and pain. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Shin splints: painful to have and to treat.

PubMed

Story, Julie; Cymet, Tyler Childs

2006-01-01

When people overuse their legs they develop an uncomfortable awareness of these limbs manifested as a dull burning or aching. The cause is often clear to the person with the problem as a result of the often obvious relationship to overdoing an exercise or activity and the pain. "Shin splints" is the lay term; physicians use the term medial tibial stress syndrome. The pathophysiology that leads to this pain is unclear, although there are a number of competing theories. Differential diagnosis includes stress fractures and compartment syndromes. Bone tumors or lipomas can also cause similar pain to shin splints. Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered. Treatment is still mostly supportive and symptom related. Rest is the most important aspect of treatment. Locally applied cold and anti-inflammatory medication have also been felt to be beneficial.

Effects of Lumbar Strengthening Exercise in Lower-Limb Amputees With Chronic Low Back Pain.

PubMed

Shin, Min Kyung; Yang, Hee Seung; Yang, Hea-Eun; Kim, Dae Hyun; Ahn, Bo Ram; Kwon, Hyup; Lee, Ju Hwan; Jung, Suk; Choi, Hyun Chul; Yun, Sun Keaung; Ahn, Dong Young; Sim, Woo Sob

2018-02-01

To analyze the effect of lumbar strengthening exercise in lower-limb amputees with chronic low back pain. We included in this prospective study 19 lower-limb amputees who had experienced low back pain for longer than 6 months. Participants were treated with 30-minute lumbar strengthening exercises, twice weekly, for 8 weeks. We used the visual analog scale (VAS), and Oswestry low back pain disability questionnaire, and measured parameters such as iliopsoas length, abdominal muscle strength, back extensor strength, and back extensor endurance. In addition, we assessed the isometric peak torque and total work of the trunk flexors and extensors using isokinetic dynamometer. The pre- and post-exercise measurements were compared. Compared with the baseline, abdominal muscle strength (from 4.4±0.7 to 4.8±0.6), back extensor strength (from 2.6±0.6 to 3.5±1.2), and back extensor endurance (from 22.3±10.7 to 46.8±35.1) improved significantly after 8 weeks. The VAS decreased significantly from 4.6±2.2 to 2.6±1.6 after treatment. Furthermore, the peak torque and total work of the trunk flexors and extensors increased significantly (p<0.05). Lumbar strengthening exercise in lower-limb amputees with chronic low back pain resulted in decreased pain and increased lumbar extensor strength. The lumbar strengthening exercise program is very effective for lower-limb amputees with chronic low back pain.

Aerobic Exercise Alters Analgesia and Neurotrophin-3 Synthesis in an Animal Model of Chronic Widespread Pain

PubMed Central

Ryals, Janelle M.; Gajewski, Byron J.; Wright, Douglas E.

2010-01-01

Background Present literature and clinical practice provide strong support for the use of aerobic exercise in reducing pain and improving function for individuals with chronic musculoskeletal pain syndromes. However, the molecular basis for the positive actions of exercise remains poorly understood. Recent studies suggest that neurotrophin-3 (NT-3) may act in an analgesic fashion in various pain states. Objective The purpose of the present study was to examine the effects of moderate-intensity aerobic exercise on pain-like behavior and NT-3 in an animal model of widespread pain. Design This was a repeated-measures, observational cross-sectional study. Methods Forty female mice were injected with either normal (pH 7.2; n=20) or acidic (pH 4.0; n=20) saline in the gastrocnemius muscle to induce widespread hyperalgesia and exercised for 3 weeks. Cutaneous (von Frey monofilament) and muscular (forceps compression) mechanical sensitivity were assessed. Neurotrophin-3 was quantified in 2 hind-limb skeletal muscles for both messenger RNA (mRNA) and protein levels after exercise training. Data were analyzed with 2-factor analysis of variance for repeated measures (group × time). Results Moderate-intensity aerobic exercise reduced cutaneous and deep tissue hyperalgesia induced by acidic saline and stimulated NT-3 synthesis in skeletal muscle. The increase in NT-3 was more pronounced at the protein level compared with mRNA expression. In addition, the increase in NT-3 protein was significant in the gastrocnemius muscle but not in the soleus muscle, suggesting that exercise can preferentially target NT-3 synthesis in specific muscle types. Limitations Results are limited to animal models and cannot be generalized to chronic pain syndromes in humans. Conclusions This is the first study demonstrating the effect of exercise on deep tissue mechanical hyperalgesia in a rodent model of pain and providing a possible molecular basis for exercise training in reducing muscular pain

Relevance of physical fitness levels and exercise-related beliefs for self-reported and experimental pain in fibromyalgia: an explorative study.

PubMed

de Bruijn, Saskia T; van Wijck, Albert J M; Geenen, Rinie; Snijders, Tom J; van der Meulen, Wout J T M; Jacobs, Johannes W G; Veldhuijzen, Dieuwke Swaantje

2011-09-01

It has been suggested that low physical fitness is a contributor to pain in fibromyalgia and that exercise-related beliefs play a role in the persistence of this association. Yet the association between physical fitness and pain is hardly explored in detail. The aim of this exploratory study in patients with fibromyalgia was to investigate the association of physical fitness levels with self-reported and experimental pain as well as with pain catastrophizing and activity-avoidance beliefs. Physical fitness of 18 patients with fibromyalgia was examined using maximal ergocycling and the 6-minute walking test (6MWT). Pain intensity was assessed using self-report scales and quantitative sensory testing. A reduced walking distance on the 6MWT was correlated with more severe self-reported pain on the Fibromyalgia Impact Questionnaire (r = -0.52, P < 0.05). Recovery of heart rate after ergocycling was correlated with cold pain thresholds (r = 0.70, P < 0.01), pressure pain thresholds (r = -0.70, P < 0.01), and heat wind-up (r = 0.66, P < 0.05). Activity-avoidance beliefs correlated with a lower peak VO2 on the cycle test (r = -0.52, P < 0.05), a shorter distance on the 6MWT (r = -0.56, P < 0.05), and more severe self-reported pain (r = 0.61, P < 0.05), reflecting that patients with activity-avoidance beliefs were less physically fit and experienced more severe pain. The results demonstrate some associations between physical fitness and pain in fibromyalgia and point to the importance of activity avoidance. Although the causal directionality of the associations needs substantiation in clinical research, the findings support the notion that low fitness and activity-avoidance beliefs should be targeted while treating pain in fibromyalgia.

The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review.

PubMed

Wells, Cherie; Kolt, Gregory S; Marshall, Paul; Hill, Bridget; Bialocerkowski, Andrea

2014-01-01

To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs). A search for RCTs was undertaken using Medical Search Terms and synonyms for "Pilates" and "low back pain" within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science. Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included. Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted. The methodological quality of RCTs ranged from "poor" to "excellent". A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period. Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than

Pain and fear avoidance partially mediate change in muscle strength during resistance exercise in women with fibromyalgia.

PubMed

Larsson, Anette; Palstam, Annie; Löfgren, Monika; Ernberg, Malin; Bjersing, Jan; Bileviciute-Ljungar, Indre; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2017-11-21

Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and questionnaires related to pain, fear avoidance and physical activity were carried out. Multivariable stepwise regression was used to analyse explanatory factors for change and predictors for final values of knee-extension force, elbow-flexion force and hand-grip force. Change in knee-extension force was explained by fear avoidance beliefs about physical activity at baseline, together with change in pain intensity, knee-extension force at baseline, age and body mass index (BMI) (R2=0.40, p = 0.013). Change in elbow-flexion force was explained by pain intensity at baseline, together with baseline fear avoidance beliefs about physical activity, BMI and elbow-flexion force at baseline (R2 = 0.32, p = 0.043). Change in hand-grip force was explained by hand-grip force at baseline, change in pain intensity and baseline fear avoidance (R2 = 0.37, p = 0.009). Final muscle strength was predicted by the same variables as change, except pain. Pain and fear avoidance are important factors to consider in rehabilitation using resistance exercise for women with fibromyalgia.

THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE.

PubMed

Sertel, Meral; Bakar, Yeşim; Şimşek, Tülay Tarsuslu

2017-01-01

This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH). Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally. When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly. BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.

A 27-Year-Old Man With Acute Severe Low Back Pain and Bilateral Leg Swelling That Prompted Renting a Wheelchair for Mobility.

PubMed

Williams, John G; Phan, Huy; Winston, Helena R; Fugit, Randolph V; Graney, Bridget; Jamroz, Brant; English, Benjamin; Chan, Edward D

2017-02-01

A 27-year-old man with OSA, posttraumatic stress disorder, and chronic mechanical back pain presented with a 3-day history of acute atraumatic worsening of his low back pain as well as right groin numbness that was exacerbated by walking. He also complained of bilateral leg "heaviness," pain, and swelling, all becoming so severe that he rented a wheelchair for mobility. Published by Elsevier Inc.

Active and Inactive Leg Hemodynamics during Sequential Single-Leg Interval Cycling.

PubMed

Gordon, Nicole; Abbiss, Chris R; Ihsan, Mohammed; Maiorana, Andrew J; Peiffer, Jeremiah J

2018-06-01

Leg order during sequential single-leg cycling (i.e., exercising both legs independently within a single session) may affect local muscular responses potentially influencing adaptations. This study examined the cardiovascular and skeletal muscle hemodynamic responses during double-leg and sequential single-leg cycling. Ten young healthy adults (28 ± 6 yr) completed six 1-min double-leg intervals interspersed with 1 min of passive recovery and, on a separate occasion, 12 (six with one leg followed by six with the other leg) 1-min single-leg intervals interspersed with 1 min of passive recovery. Oxygen consumption, heart rate, blood pressure, muscle oxygenation, muscle blood volume, and power output were measured throughout each session. Oxygen consumption, heart rate, and power output were not different between sets of single-leg intervals, but the average of both sets was lower than the double-leg intervals. Mean arterial pressure was higher during double-leg compared with sequential single-leg intervals (115 ± 9 vs 104 ± 9 mm Hg, P < 0.05) and higher during the initial compared with second set of single-leg intervals (108 ± 10 vs 101 ± 10 mm Hg, P < 0.05). The increase in muscle blood volume from baseline was similar between the active single leg and the double leg (267 ± 150 vs 214 ± 169 μM·cm, P = 0.26). The pattern of change in muscle blood volume from the initial to second set of intervals was significantly different (P < 0.05) when the leg was active in the initial (-52.3% ± 111.6%) compared with second set (65.1% ± 152.9%). These data indicate that the order in which each leg performs sequential single-leg cycling influences the local hemodynamic responses, with the inactive muscle influencing the stimulus experienced by the contralateral leg.

Single-leg squats can predict leg alignment in dancers performing ballet movements in "turnout".

PubMed

Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

2016-01-01

The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve "turning out" or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in "turned out" postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat.

Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

PubMed

Satkunskiene, Danguole; Mickevicius, Mantas; Snieckus, Audrius; Kamandulis, Sigitas

2017-01-01

Knee pain without knee degenerative symptoms is a common phenomenon among young basketball players. The aim of this study was to identify factors predisposing young basketball players to suffer from knee pain. The study involved 20 male adolescent (14-15 years) basketball players who were divided into two equal groups based on knee pain symptoms. Legs torque was tested on an isokinetic dynamometer. The length, elongation and the cross-sectional area (CSA) of the patellar tendon were measured with ultrasonography. Quadriceps angle (Q-angle), knee valgus motion, and joint angular displacement in the sagittal plane were analyzed using video recording during countermovement jump. Ground reaction force was measured using a force platform. Knee pain (KP) participants had a significantly lower Q-angle (P=0.045) and lower maximum varus knee angle (P=0.035), and a greater knee inside displacement (P=0.039) during squat phase. In the KP group, the CSA at the top of the tendon was significantly greater than in the middle (P=0.006) and at the bottom (P=0.039). Absolute tendon stiffness (P=0.013) and Young's modulus (P=0.034) were significantly lower in the KP group compared with controls. Leg stiffness during landing was significantly greater in the control group (P=0.015). Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol

PubMed Central

Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Haxby Abbott, J.; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S.

2015-01-01

Background Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. Objective The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist–instructed home exercise leads to greater reductions in pain and improvements in function. Design An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. Setting The study will be conducted in a community setting. Participants The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Intervention Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Measurements Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. Limitations A self-reported diagnosis of persistent hip pain will be used. Conclusions The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist–instructed home exercise is more effective than education and exercise

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

PubMed

Bennell, Kim L; Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S

2015-10-01

Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. The study will be conducted in a community setting. The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative

The Effects of Local Vibration on Balance, Power, and Self-Reported Pain After Exercise.

PubMed

Custer, Lisa; Peer, Kimberly S; Miller, Lauren

2017-05-01

Muscle fatigue and acute muscle soreness occur after exercise. Application of a local vibration intervention may reduce the consequences of fatigue and soreness. To examine the effects of a local vibration intervention after a bout of exercise on balance, power, and self-reported pain. Single-blind crossover study. Laboratory. 19 healthy, moderately active subjects. After a 30-min bout of full-body exercise, subjects received either an active or a sham vibration intervention. The active vibration intervention was performed bilaterally over the muscle bellies of the triceps surae, quadriceps, hamstrings, and gluteals. At least 1 wk later, subjects repeated the bout, receiving the other vibration intervention. Static balance, dynamic balance, power, and self-reported pain were measured at baseline, after the vibration intervention, and 24 h postexercise. After the bout of exercise, subjects had reduced static and dynamic balance and increased self-reported pain regardless of vibration intervention. There were no differences between outcome measures between the active and sham vibration conditions. The local vibration intervention did not affect balance, power, or self-reported pain.

Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension

PubMed Central

2013-01-01

Background Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment, and (ii) whether the range in which these exercises are performed affects outcomes. Methods A prospective, parallel-group, randomised controlled trial conducted in a tertiary hospital in Sydney, Australia compared an 8 week exercise programme performed into either the full hypermobile range or only to neutral knee extension, following a minimum 2 week baseline period without treatment. Randomisation was computer-generated, with allocation concealed by sequentially numbered opaque sealed envelopes. Knee pain was the primary outcome. Quality of life, thigh muscle strength, and function were also measured at (i) initial assessment, (ii) following the baseline period and (iii) post treatment. Assessors were blinded to the participants’ treatment allocation and participants blinded to the difference in the treatments. Results Children with JHS and knee pain (n=26) aged 7-16 years were randomly assigned to the hypermobile (n=12) or neutral (n=14) treatment group. Significant improvements in child-reported maximal knee pain were found following treatment, regardless of group allocation with a mean 14.5 mm reduction on the visual analogue scale (95% CI 5.2 – 23.8 mm, p=0.003). Significant differences between treatment groups were noted for parent-reported overall psychosocial health (p=0.009), specifically self-esteem (p=0.034), mental health (p=0.001) and behaviour (p=0.019), in favour of exercising into the hypermobile range (n=11) compared to neutral only (n=14). Conversely, parent

Night Leg Cramps

MedlinePlus

... feet or thighs might cramp as well. Forcefully stretching the contracted muscle relieves the pain. Most of ... include Drinking plenty of fluids to avoid dehydration Stretching your leg muscles or riding a stationary bicycle ...

Menstrual cycle effects on perceived exertion and pain during exercise among sedentary women.

PubMed

Hooper, Ann E Caldwell; Bryan, Angela D; Eaton, Melissa

2011-03-01

Increasing cardiovascular fitness through exercise participation among sedentary people is important for decreasing all-cause mortality. From an intervention perspective, identifying modifiable factors that maximize the successful initiation of exercise is of utmost importance. For women, cyclic hormonal variations can influence aspects of health and health behaviors, from smoking cessation efficacy to physiological responses to exercise. The purpose of this study was to examine the influence of menstrual cycle phase and hormonal contraceptive (HC) use on subjective response to an initial bout of moderate intensity exercise among previously sedentary women (n = 117). Women completed a treadmill exercise challenge session at 65% of their previously determined maximum oxygen consumption (Vo(2) max) during the early follicular, late follicular, or luteal phase. Participants reported ratings of perceived exertion and pain using Borg's Rating of Perceived Exertion (RPE) and CR10 scales at 10, 20, and 30 minutes during the exercise session. There was a significant menstrual phase x birth control interaction on change in RPE [F(2, 111) = 3.75, p < 0.05] and change in perceived pain [F(2, 110) = 3.31, p < 0.05]. Women in the early follicular phase who were not using HCs had significantly greater increases in RPE and increases in pain compared with women in the late follicular and luteal phases. Our results indicate that the use of HC and cycle phase influence sedentary women's subjective response to exercise. These results have important implications for the timing of exercise interventions aimed at increasing exercise among sedentary women.

Reliability of a Novel High Intensity One Leg Dynamic Exercise Protocol to Measure Muscle Endurance

PubMed Central

Lepers, Romuald; Marcora, Samuele M.

2016-01-01

We recently developed a high intensity one leg dynamic exercise (OLDE) protocol to measure muscle endurance and investigate the central and peripheral mechanisms of muscle fatigue. The aims of the present study were to establish the reliability of this novel protocol and describe the isokinetic muscle fatigue induced by high intensity OLDE and its recovery. Eight subjects performed the OLDE protocol (time to exhaustion test of the right leg at 85% of peak power output) three times over a week period. Isokinetic maximal voluntary contraction torque at 60 (MVC60), 100 (MVC100) and 140 (MVC140) deg/s was measured pre-exercise, shortly after exhaustion (13 ± 4 s), 20 s (P20) and 40 s (P40) post-exercise. Electromyographic (EMG) signal was analyzed via the root mean square (RMS) for all three superficial knee extensors. Mean time to exhaustion was 5.96 ± 1.40 min, coefficient of variation was 8.42 ± 6.24%, typical error of measurement was 0.30 min and intraclass correlation was 0.795. MVC torque decreased shortly after exhaustion for all angular velocities (all P < 0.001). MVC60 and MVC100 recovered between P20 (P < 0.05) and exhaustion and then plateaued. MVC140 recovered only at P40 (P < 0.05). High intensity OLDE did not alter maximal EMG RMS of the three superficial knee extensors during MVC. The results of this study demonstrate that this novel high intensity OLDE protocol could be reliably used to measure muscle endurance, and that muscle fatigue induced by high intensity OLDE should be examined within ~ 30 s following exhaustion. PMID:27706196

Effect of unilateral exercises on low back pain in an urban driver

PubMed Central

Yoo, Won-gyu

2016-01-01

[Purpose] This study aimed to develop unilateral exercises for urban drivers and investigate the effect of these exercises on low back pain (LBP). [Subject and Methods] A 40-year-old male driver, who complained of LBP on the left side at L3–5 levels, participated in this study. A two-session program was conducted, and LBP, pelvic tilt angle, and trunk range of motion were measured after each session. [Results] After the unilateral exercises, the anterior pelvic tilt angle was improved and the visual analog scale score of back pain decreased. [Conclusion] Analyzing car features and performing individual approaches are necessary in providing treatment for urban drivers with LBP. PMID:27942161

The Effectiveness of Neck Stretching Exercises Following Total Thyroidectomy on Reducing Neck Pain and Disability: A Randomized Controlled Trial.

PubMed

Ayhan, Hatice; Tastan, Sevinc; Iyigün, Emine; Oztürk, Erkan; Yildiz, Ramazan; Görgülü, Semih

2016-06-01

Although there are a limited number of studies showing effects of neck stretching exercises following a thyroidectomy in reducing neck discomfort symptoms, no study has specifically dealt with and examined the effect of neck stretching exercises on neck pain and disability. To analyze the effect of neck stretching exercises, following a total thyroidectomy, on reducing neck pain and disability. A randomized controlled trial was conducted. The participants were randomly assigned either to the stretching exercise group (n = 40) or to the control group (n = 40). The stretching exercise group learned the neck stretching exercises immediately after total thyroidectomy. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. When comparing neck pain and disability scale (NPDS) scores, neck sensitivity and pain with neck movement before thyroidectomy, after 1 week and after 1-month time-points, it was found that patients experienced significantly less pain and disability in the stretching exercise group than the control group (p < .001). At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. However, there was no significant difference between the groups with regard to the scores at the 1-month evaluation (p > .05). Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms. © 2016 Sigma Theta Tau International.