Isokinetics strength relation with fear of fall, falls and physical activity level in elderly women

Introduction: Low levels of physical activity (PA) in elderly has been related with the decline in physical and psychological functions, affecting the ability in the performance of activities of daily living (ADLs) and contributing to the occurrence of walking-related fall (Metz, Lee, Sui, Powell, Blair, 2010). The purpose of this study was to relate strength levels with fear of fall (FF), falls occurrence as well as with PA level on elderly women. Methods: One hundred not institutionalized post-menopausal women (aged 66.17 ± 8.21 years) volunteered to participate on this research. The peak torque (PT) at 60º.s-1 ( 3 rep) and 180º.s-1 (20 rep) angular speeds in knee extension and flexion concentric actions were measured using an isokinetic dynamometer (Biodex System 3). Muscular fatigue was also estimated at 180º.s-1. To achieve the occurrence of falls during last year as well FF score, we applied a standardized Questionnaire that included socio-demographic, health and falls parameters. PA level was accessed by interview with Yale Physical Activity Questionnaire. Descriptive statistics was performed using means and standard deviations. The Spearman correlation coefficient was used to investigate associations among quantitative independent variables. Results: PT at 60º.s-1 in knee extension and flexion and PT at 180º.s-1 in knee flexion showed a positive association with vigorous index (r=,205 p=,041; r=,249 p=,013; r=,218 p=,029 respectively). Standing index presented also a positive correlation with PT at 60º.s-1 and PT 180º.s-1 in knee extension (r=,205 p=,041 and r=,314 p=,004). FF registered a positive association with body mass (BM) and body mass index (BMI) (r=,205 p=,041 and r=,201 p=,045), and a negative association with PT in extension action on both angular velocities (r=-,241 p=,016 and r=-,203 p=,043). Muscular fatigue showed a positive correlation with the number of falls during the last year (r=,201 p=,036). Conclusions: Decreases of strength on lower limb is an important factor that contributes to falls occurrence once we registered a negative relation between PT on extension action and the FF. Our data related higher values of BM and BMI with higher fear of falling confirming that overweight are common associated to disturb on gait function and mobility that represents also a risk factor for falls. Present results suggest that more time of PA is needed to increase lower limb strength in the elderly

Effects of 8-Month Aquatic Training on Bone Mass Density In Post Menopausal Women With Fibromyalgia

Objective: To evaluate the effect of an aquatic training program on bone mass density (BMD) in post- menopausal women with fibromyalgia (FM). Design: Randomised controlled trial (ISRCTN53367487). Settings: Faculty of Sport Science Subjects: Twenty-four postmenopausal women with FM (mean age, 56, SD, 7 years) were randomised to intervention (n=12) or control group (n=12). Interventions: The experimental group received a supervised 8-month aquatic training consisted of three 1-hour sessions per week that included aerobic and strength exercises. Outcome Measures: The BMD of the hip area and lumbar spine was assessed by dual-energy X-ray absorptiometry technique. HRQOL was assessed using EQ-5D and the Fibromyalgia Impact Questionnaire (FIQ). Data were analysed using analysis of variance adjusted for weight and age. Results: The exercise group improved their scores for EQ-5D time trade-off utility (86%, p=.007; effect size= 0.70) and FIQ (18%, p=.005; effect size= 0.61) while the control did not. The BMD of both groups remained statistically and clinically unchanged (p> .05; effect size < 0.2). Conclusions: The aquatic training was highly effective in improving HRQOL with no adverse effects on the BMD in women with FM. The trend of bone loss was similar to that reported in non-FM untrained women. This type of rehabilitation should be complemented with exercises with higher impact on bone mass like Whole Body Vibration

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Methods Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. Results The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001). Conclusions The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool

High Levels of Physical Activity May Promote a Reduction in Bone Mineral Density in Peritoneal Dialysis

Background and objectives: Peritoneal dialysis (PD) patients are expected to present lower levels of physical activity, unhealthy changes at the body composition level, and low levels of strength. Firstly, this study aimed to report the sex differences in physical activity, body composition and muscle strength and the relations among these variables. Secondly, we analyze the relationship between physical activity and biochemical parameters. Materials and Methods: Thirty-four patients (13 women and 21 men) participated in this study. Body composition was assessed by bioimpedance and dual-energy X-ray absorptiometry (DXA), and maximum isokinetic unilateral strength, analytical parameters and physical activity levels were evaluated. Results: The men showed higher values for weight, height, lean body mass, bone mineral content, bone mineral density (BMD) and total body water, while women showed higher values for the percentage of fat mass and hydration of lean body mass (p < 0.05). No differences between the sexes were found in different levels of physical activity; however, males registered significantly higher values for isokinetic strength variables except for knee extensor strength. BMD was positively related to sedentary activity and negatively related to moderate and vigorous activity (r = 0.383 and r = −0.404, respectively). Light physical activity was negatively correlated with albumin (r = −0.393) and total protein (r = −0.410) levels, while moderate/vigorous activity was positively correlated with urea distribution volume (r = 0.446) and creatinine clearance (r = 0.359) and negatively correlated with the triglyceride level (r = −0.455). Conclusions: PD patients with higher levels of physical activity present better results in terms of body composition and biochemical parameters. Additional studies should be conducted to clarify the relation between physical activity level and BMD

Rotator cuff isokinetic strength of young group aged swimmers in a competitive training program

Introduction: In any given sports activity, muscular or movement instability is pointed out as having a high influence for the maintenance of correct joint functionality. In swimming, due to the repetitive use of shoulder muscles, there is a higher tendency to promote injuries at the shoulder joint, especially when instability between the internal (IR) and external (ER) shoulder rotators is present. The aims of this study were to evaluate the rotator cuff isokinetic strength in order to determine any possible muscular over compensation or imbalance, and to assess differences between the dominant and non-dominant side, of young group aged swimmers. Methods: Forty young aged swimmers in a competitive training program were evaluated, and divided in two groups. Only subjects without any previous history of strength training were included. Group 1 (n=19), age 15 to 16 (years); height [mean (SD)] 168.6 (6.5) (centimeters); weight 59.6 (6.0) (kilograms), training/week 113.7 (12.6) (minutes); experience 5.3 (1.6) (years) and Group 2 (n=21); age 13 to 14; height 160.5 (12.2); weight 50.4 (10.8); training/week 88.6 (17.7); experience 4.1 (2.2) (years). The maximal unilateral isokinetic strength was measured (Biodex System 3) on the shoulder IR and ER during concentric action at 60°/second, bilaterally. Data was examined by the application of appropriate statistical tests for the analysis of variance. Results: Statistical differences were found on peak torque (Nm) at the agonist/antagonist ratio measured unilaterally [Group 1: right shoulder 35.8 (7.9) (IR) and 25.8 (4.7) (ER) (p=0.001) and left shoulder 32.7 (6.7) (IR) and 23.9 (5.1) (ER) (p=0.001) / Group 2: right shoulder 23.4 (6.5) (IR) and 19.0 (5.4) (ER) (p=0.048) and left shoulder 22.4 (5.4) (IR) and 16.8 (6.1) (ER) (p=0.027)]. However, no statistical differences were found between the maximal rotation strength measured bilaterally [Group 1: ER (p=0.280) and IR (p=0.246) / Group 2: ER (p=0.186) and IR (p=0.522)]. Conclusion: Young swimmers involved in a competitive training program can suffer from unilateral over compensation at shoulder IR or ER. This compensation seems to increase with the number of training years. To enable a higher stability between the internal and external shoulder rotators it is recommended that shoulder muscle strengthening should be considered in young aged swimmers training programs

Effects of shoulder compensatory strength training program in rotator cuff strength of young swimmers

INTRODUCTION The purpose of this study was to evaluate de effects of 16 week compensatory strength training program in shoulder strength and respective conventional ratios (concentric ER/IR). METHODS A total of 40 national level male swimmers were assessed and randomly divided in two groups – experimental group (N=20)-(age:14.65±0.67 years old, height:173.48±6.87 cm, body mass:63.15±5.68 kg) and control group (N=20)-(age:14.60±0.60 years old, height: 170.79±6.48 cm, body mass:61.73±4.68 kg). Experimental subjects participated in a 16 week shoulder strength program with Thera-Band® elastic bands (3 times a week). The peak-torque of shoulder internal (IR) and external rotators (ER) was measured in both groups at baseline and after 16 weeks. Concentric action at 60º/s (3 rep) and 180º/s (20 rep) were measured, in a seated position, with the shoulder at 90º of abduction and the elbow flexed to 90º, using an isokinetic dynamometer (Biodex System 3 – Biodex Corp., Shirley, USA). Anova with repeated measures was used to determine significant main effects in shoulder rotators strength and unilateral ER/IR ratios. The level of significance was set at 0.05. RESULTS Significant differences were found in all variables that measure the ER shoulder strength at 60º/s in dominant(DT) (P=0.031) and non-dominant(NDT) shoulder (P=0.001). Meanwhile concentric action at 180º/s, only showed significant differences on DT shoulder (P=0.032). In respect of ER/IR ratio, a compensatory strength training programme induces significant differences in both shoulders at 60º/s (DT: P=0.001; NDT: P=0.001). At 180º/s we just found significant effects on the DT ER/IR ratio (P=0.002). DISCUSSION The results of this study support earlier research [1] that showed that the unilateral shoulder strength ratios increases substantially after a period of a strength training program. Since the ratios describe the quality of muscular balance/imbalance [1], we can conclude that a 16 week compensatory shoulder strength training program using Thera-Band® elastic bands, reduces muscular imbalances in rotator cuff of competitive young swimmers. These results highlight the useful of this kind of compensatory program to prevent shoulder injuries

Jumping into the deep-end: results from a pilot impact evaluation of a community-based aquatic exercise program

This multi-center quasi-experimental pilot study aimed to evaluate changes in pain, joint stiffness, physical function, and quality of life over 12 weeks in adults with musculoskeletal conditions attending ‘Waves’ aquatic exercise classes. A total of 109 adults (mean age, 65.2 years; range, 24–93 years) with musculoskeletal conditions were recruited across 18 Australian community aquatic centers. The intervention is a peer-led, 45 min, weekly aquatic exercise class including aerobic, strength, flexibility, and balance exercises (n = 67). The study also included a control group of people not participating in Waves or other formal exercise (n = 42). Outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQoL five dimensions survey (EQ-5D) at baseline and 12 weeks. Satisfaction with Waves classes was also measured at 12 weeks. Eighty two participants (43 Waves and 39 control) completed the study protocol and were included in the analysis. High levels of satisfaction with classes were reported by Waves participants. Over 90 % of participants reported Waves classes were enjoyable and would recommend classes to others. Waves participants demonstrated improvements in WOMAC and EQ-5D scores however between-group differences did not reach statistical significance. Peer-led aquatic exercise classes appear to improve pain, joint stiffness, physical function and quality of life for people with musculoskeletal conditions. The diverse study sample is likely to have limited the power to detect significant changes in outcomes. Larger studies with an adequate follow-up period are needed to confirm effects

Fitness efficacy of vibratory exercise compared to walking in postmenopausal women

In this study, we compared the efficacy of 8 months of low-frequency vibration and a walk-based program in health-related fitness. Twenty-seven postmenopausal women were randomly assigned into two groups: whole-body vibration (WBV) group (n = 18) performed three times/week a static exercise on a vibration platform (6 sets of 1-min with 1 min of rest, with a 12.6 Hz of frequency and an amplitude of 3 mm); walk-based program (WP) group (n = 18) performed three times/week a 60-min of walk activity at 70-75% of maximal heart rate. A health-related battery of tests was applied. Maximal unilateral concentric and eccentric isokinetic torque of the knee extensors was recorded by an isokinetic dynamometer. Physical fitness was measured using the following tests: vertical jump test, chair rise test and maximal walking speed test over 4 m. Maximal unilateral isokinetic strength was measured in the knee extensors in concentric actions at 60 and 300 degrees /s, and eccentric action at 60 degrees /s. After 8 months, the WP improved the time spent to walk 4 m (20%) and to perform the chair rise test (12%) compared to the WBV group (P = 0.006, 0.002, respectively). In contrast, the comparison of the changes in vertical jump showed the higher effectiveness of the vibratory exercise in 7% (P = 0.025). None of exercise programs showed change on isokinetic measurements. These results indicate that both programs differed in the main achievements and could be complementary to prevent lower limbs muscle strength decrease as we age [ISRCTN76235671]

The placebo effect and its determinants in fibromyalgia: meta-analysis of randomized controlled trials

The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition