The mechanical loading and muscle activation of four common exercises used in osteoporosis prevention for early postmenopausal women

High impact exercise can reduce postmenopausal bone loss, however stimulus frequency (loading cycles per second) can affect osteogenesis. We aimed to examine the effect of stimulus frequency on the mechanical loading of four common osteoporosis prevention exercises, measuring body acceleration and muscle activation with accelerometry and electromyography (EMG), respectively. Fourteen early postmenopausal women completed randomised countermovement jumps (CMJ), box-drops (BD), heel-drops (HD) and stamp (STP) exercises for continuous and intermittent stimulus frequencies. Sacrum accelerometry and surface electromyography (EMG) of four muscles were recorded. CMJ (mean ± SD: 10.7 ± 4.8 g & 10.0 ± 5.0 g), BD (9.6 ± 4.1 g & 9.5 ± 4.0 g) and HD (7.3 ± 3.8 g & 8.6 ± 4.4 g) conditions generated greater peak acceleration than STP (3.5 ± 1.4 g & 3.6 ± 1.7 g) across continuous and intermittent trials. CMJ and BD generated greater acceleration gradients than STP across continuous and intermittent trials. CMJ generated greater rectus femoris EMG than all other exercises, CMJ and BD generated greater semitendinosus and tibialis anterior EMG than HD across continuous and intermittent trials. CMJ and BD provide greater peak acceleration than STP and remain similar during different stimulus frequencies. CMJ, BD and HD may exceed STP in maintaining postmenopausal bone health.University of Hul

The effects of continuous, intermittent and mode of exercise on mechanical bone remodelling

Bone health is known to deteriorate with age, which can increase the risk of osteoporotic fractures and subsequently all-cause mortality. Current life expectancies are higher than ever before and with our ageing population, osteoporosis and low bone density levels are an ever growing problem that command a lot of medical attention and resources. Women are at a greater risk than men due to increased rates of bone loss that occur in the early years following the menopause. Mechanical loading in the form of exercise is known to reduce the rates of postmenopausal bone loss although an optimal exercise programme is yet to be established. Furthermore, investigations conducted with animals have found intermittent mechanical loading to provide a greater stimulus for bone adaptation than continuous mechanical loading, this has not been investigated in human populations to date. The aim of this thesis was to establish a sufficient exercise mode for stimulating bone adaptation in postmenopausal women and investigate the effects of continuous and intermittent exercise on postmenopausal bone loss. This was attempted with a 12 month randomised controlled trial with postmenopausal women.The first study gave a systematic review of the current literature that investigated continuous or intermittent exercise. The review found that as the studies were not designed to specifically analyse continuous or intermittent exercise, there were numerous problems regarding the control of previous exercise programmes with regards to defined exercise and rest intervals. This was due to the design of the included studies, as many of them were not specifically designed to analyse the different effects of continuous and intermittent exercise on bone mineral density (BMD). In addition, BMD outcomes were not reported in a standardized manner, which complicated the comparisons drawn. From this investigation, it was evident that well-controlled exercise interventions (using a single exercise), are required for the comparison of the effect of continuous and intermittent exercise on BMD in human populations.The second study investigated the feasibility of developing a non-motorised treadmill exercise intervention that included both continuous and intermittent exercise groups. Non-motorised treadmill (NMT) locomotion allows for the instantaneous quantification of ground reaction forces (GRF) and is well suited to both continuous exercise and intermittent exercise with the potential for the use of a range of intermittent running based protocols. In order to establish the osteogenic potential of this mode of exercise, it was necessary to quantify the mechanical loading parameters. This study found that loading parameters showed large reductions during NMT locomotion when compared to overground or motorised treadmill locomotion (24 to 29 %), which could potentially compromise the level of bone adaptation if this mode of exercise was used for intervention purposes.The third study investigated the loading parameters of more traditional high impact exercises in a population of postmenopausal women. All exercises were performed under both continuous and intermittent conditions to assess for consistency during the two conditions. This project showed that countermovement jumps (CMJ) and box drops (BD) produced the highest loading parameters when compared to heel drops (HD) and stamping (STP) (d = 0.83 – 2.38), along with no statistical differences between continuous and intermittent conditions (continuous: 10.7 ± 4.8 g for CMJ, 9.6 ± 4.1 g for BD; intermittent 10.0 ± 5.0 g for CMJ, 9.5 ± 4.0 g for BD). CMJ, BD and HD exercises all appeared to generate a sufficient level of peak acceleration and acceleration gradient for osteogenic adaptation however. For consistency purposes and the fact that no equipment was required, CMJs were selected as the most appropriate home-based exercise for use in a 12 month intervention to reduce postmenopausal bone loss.The fourth study investigated the effects of continuous and intermittent exercise on BMD in early postmenopausal women over the course of a 12 month randomised control trial. Unfortunately the study was underpowered and in addition, the findings showed no statistically significant differences in the bone response between groups. Only the control group experienced a statistically significant loss in both lumbar spine (-2.7% [95%CI: -3.9 to -1.4]) and femoral neck (-3.0% [95%CI: -5.1 to -0.8]) BMD, which exceeded the 95% least significant change at the lumbar spine and femoral neck in 57% of control group participants. There appeared to be no beneficial effect of continuous or intermittent exercise on BMD, hip structural analysis (HSA) parameters or muscular force characteristics when compared to a control group however. In conclusion, this thesis has identified that future research should further investigate the effects of continuous and intermittent exercise on BMD with appropriately controlled randomised control trials, with greater participant numbers. Whilst CMJ and BD provide adequate loading parameters, this does not translate into BMD adaptations. Continuous and intermittent CMJ exercises had no effect on reducing postmenopausal BMD loss at the lumbar spine and the femoral neck, although further investigation is required in an adequately powered study

Fisioterapia manual instrumentada y recuperación funcional acuática

La presente tesis doctoral muestra varios objetivos y metodologías. Por un lado, tiene el objetivo de analizar comparativamente las respuestas neuromusculares obtenidas mediante electromiografía de superficie sobre diversos músculos del miembro inferior, miembro superior y tronco que se adquieren durante la implementación de ejercicio terapéutico en un ambiente terrestre y acuático mediante la realización de una revisión sistemática de la literatura y de tres estudios transversales en los que se analizan diferentes tareas funcionales (time get up and go, levantarse de una silla y girar). Por otro lado, pretende analizar los efectos clínicos, así como la seguridad de los diferentes procedimientos de masaje terapéutico que se llevan a cabo con instrumentos de masaje en pacientes con diversas patologías mediante la realización de una revisión sistemática de la literatura. En último lugar, la presente tesis doctoral busca comparar los efectos clínicos y mecánicos, obtenidos a través de escala de valoración del dolor, algometría, miotonometría y ecografía musculo-esquelética, que se producen en el punto gatillo miofascial del músculo trapecio superior en pacientes con cervicalgia mecánica, tras la realización de una sesión de masaje terapéutico usando el instrumento de masaje Richelli’s Painreliever™ o realizado manualmente; además de los efectos en la fuerza de prensión, obtenidos mediante dinamometría, del fisioterapeuta que lleva a cabo dichos procedimientos; todo ello mediante un estudio de control aleatorizado.El ejercicio terapéutico ha demostrado su eficacia como modalidad terapéutica para el alivio del dolor y la mejora de la función en diversas lesiones musculo-esqueléticas crónicas como la cervicalgia, lumbalgia, osteoartritis de rodilla y de cadera, fibromialgia; o incluso en el riesgo de caídas. El entrenamiento de tareas funcionales toma especial interés e importancia como parte de los programas de ejercicio terapéutico, así como de fisioterapia acuática, con beneficios clínicos en cuanto a fuerza, movilidad y funcionalidad. Pero debido a las propiedades únicas del agua, el entrenamiento de las tareas funcionales producirá diferentes respuestas neuromusculares, en función a si se realiza en un medio terrestre o acuático, por lo que estas respuestas deben ser sistemáticamente analizadas. Por otro lado, el masaje terapéutico también tiene un papel muy importante en el tratamiento de estos pacientes con lesiones musculo-esqueléticas. En la actualidad se ha visto incrementada la utilización de diferentes instrumentos de masaje parte de los fisioterapeutas, pero hasta la fecha, la evidencia científica de estas diferentes aplicaciones durante el masaje es poco conocida tanto sobre los pacientes como sobre el fisioterapeuta que realiza dicho procedimiento instrumentado