High Intensity Interval Training or Moderate Intensity Continuous Exercise in Patients with Myocardial Infarction?

Objectives: To determine the effects of high intensity interval training (HIIT) or moderate intensity continuous exercise (MICE) in patients with myocardial infarction (MI). Background: Cardiovascular diseases are the leading cause of mortality and morbidity globally causing a significant reduction in the quality of life of these patients. Participation of these patients in rehabilitation programs which involve a significant component of exercise seems to help by improving functional capacity and quality of life (QoL). Despite the beneficial effect of exercise, the type of exercise that yields the best results is yet to be determined.Methods: Three databases (MEDLINE, CINHAL and SportDirect) were searched in May-June 2017 for original articles regarding the effect of two types of exercise in patients with myocardial infarction. Randomized control trial studies which enrolled patients with myocardial infarction and studied the effects of HIIT and/or MICE, were included in this review. Data were extracted and summarised and all studies were assessed for bias.Results: Both forms of exercise seem to improve the relevant outcome measures such as functional capacity, QoL, walking distance, fatigue and function of the left heart. However HIIT seemed to be better in comparison with MICE in improving these outcomes. Several limitations and risk of bias have been identified and reported.Conclusion: Both HIIT and MICE are recommended for patients with MI. Further research is required to conclusively support the superiority of HIIT over other types of exercise

Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life

Objectives Restless legs syndrome (RLS) symptoms are common in Multiple Sclerosis (MS) patients. The aim of the current study was to examine for the first time whether RLS could affect the functional capacity and various contributing parameters related to quality of life and fatigue in MS patients. Methods According to their RLS status, 50 relapsing-remitting MS patients were divided into the RLS (n = 10) and non-RLS groups (n = 40). Specific questionnaires were used in order to assess the health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, and depression symptoms of the patients. Functional capacity was examined using a battery of functional tests. Total body and visceral fat levels were assessed via bioelectrical impedance analyzers. Results Sleep quality, depression, fatigue, and HRQoL levels were found to be significantly worse in the patients with RLS compared to their free-RLS counterparts (P < 0.05). In addition, patients with RLS were found to exhibit further impairments in their performance in various functional tests related mainly with strength levels of lower extremities (P < 0.05). Finally, the patients with RLS were found to have significantly higher both total and trunk fat levels compared to patients without RLS (P < 0.05). A strong correlation was observed between the severity of RLS symptoms, sleep quality, fatigue, and QoL levels. Discussion It seems that RLS contributes even further to impairments on sleep quality, fatigue, functional capacity, and therefore HRQoL levels in relapsing-remitting MS patients, whilst for the first time a link between high fat levels has been revealed

Biomechanics of intervertebral disc pain

'Background: Back pain is strongly (but variably) associated with degeneration of intervertebral discs. Mechanical loading has long been considered one of the causes of disc pathology and pain, but its precise role is poorly understood. In particular the spatial relation between load distribution inside the disc, the disc matrix changes as a result of load and their relationship with pain has not been researched. Methods: Distribution of compressive stress inside intervertebral discs from all regions of the spine was studied using stress profilometry in cadaveric motion segments. Matrix pathological changes were studied using simple histology and light microscopy in two groups of surgically removed discs: 'painful' discs from patients undergoing surgery for suspected discogenic pain, and 'control' discs from patients undergoing surgery for scoliosis or spondylolisthesis reduction. Ingrowth of nerves and blood vessels into the annulus was studied by immunohistochemistry with an endothelial and a general neuronal marker. Stress reduction inside annulus fissures were investigated using stress profilometry. Proteoglycan reduction within annulus fissures was studied by means of a novel, semi-quantitative method involving simple histology and image analysis. Although semi-quantitative, the technique had great spatial resolution and allowed integration with the results from the mechanical experiments. Results: High stress concentrations were localised in the middle annulus and increased with disc degeneration. Associated stress gradients appeared early in the degeneration process and were not diminished in late stage degeneration when substantial compressive loading is transferred to the neural arch. Nerve and blood vessel ingrowth increased with degeneration, but were confined to the outermost 4mm of the annulus. Other cellular changes such as apoptosis, cellular infiltration and proliferation were mostly confined to the annulus. Annulus fissures were found to represent focal regions of low proteoglycan content, and also of low compressive stress, especially when the nucleus was also decompressed. Conclusions: Results suggest that high stress gradients play an important role in progressive annulus disruption, and that annulus fissures provide a microenvironment that is mechanically and chemically conducive to the ingrowth of nerves and blood vessels. Co-localisation of nerves, blood vessels and stress concentrations in the middle-outer annulus suggest that this is the most likely site of discogenic pain. Pain is associated with annulus disruption and the attempted healing rather than age-related degenerative changes in the nucleus.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Mechanical Influences in Progressive Intervertebral Disc Degeneration

Study Design. Mechanical study on cadaver motion segments. Objective. To determine whether high gradients of compressive stress within the intervertebral disc are associated with progressive disc degeneration. Summary of Background Data. Mechanical loading can initiate disc degeneration but may be unimportant in disease progression, because degenerative changes cause the disc to be increasingly “stress-shielded” by the neural arch. However, the most typical feature of advanced disc degeneration (delamination and collapse of the annulus) may not depend on absolute values of compressive stress but on gradients of compressive stress that act to shear annulus lamellae. Methods. A total of 191 motion segments (T7–T8 to L5–S1) were dissected from 42 cadavers aged 19 to 92 years. Each was subjected to approximately 1 kN compression, while intradiscal stresses were measured by pulling a pressure transducer along the disc's midsagittal diameter. “Stress gradients” in the annulus were quantified as the average rate of increase in compressive stress (MPa/mm) between the nucleus and the region of maximum stress in the anterior or posterior annulus. Measurements were repeated before and after creep loading and in simulated flexed and erect postures. Disc degeneration was assessed macroscopically on a scale of 1 to 4. Results. As grade of disc degeneration increased from 2 to 4, nucleus pressure decreased by an average 68%, and maximum compressive stress in the annulus decreased by 48% to 64%, depending on location and posture. In contrast, stress gradients in the annulus increased by an average 75% in the anterior annulus (in flexed posture) and by 108% in the posterior annulus (in erect posture). Spearman rank correlation showed that these increases were statistically significant. Conclusion. Despite stress-shielding by the neural arch, gradients of compressive stress increase with increasing grade of disc degeneration. Stress gradients act to shear adjacent lamellae and can explain progressive annulus delamination and collapse. Level of Evidence: N/

A systematic review evaluating the clinimetric properties of the Victorian Institute of Sport Assessment (VISA) questionnaires for lower limb tendinopathy shows moderate to high-quality evidence for sufficient reliability, validity and responsiveness—part II

Purpose The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon—VISA-A, greater trochanteric pain syndrome—VISA-G, proximal hamstring tendinopathy—VISA-H, patellar tendon—VISA-P). Methods A systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis. Results There is moderate-quality evidence for sufficient VISA-A, VISA-G, and VISA-P reliability. There is moderate-quality evidence for sufficient VISA-G and VISA-P measurement error, and high-quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high-quality evidence exists with regard to VISA-A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions. Conclusions Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA-A which displayed insufficient measurement error. Level of evidence IV. Registration details Prospero (CRD42018107671); PROSPERO reference—CRD42019126595.Other Information Published in: Knee Surgery, Sports Traumatology, Arthroscopy License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s00167-021-06557-0</p

Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity—part I

Purpose The Victorian Institute of Sport Assessment (Achilles tendon—VISA-A, greater trochanteric pain syndrome—VISA-G, proximal hamstring tendinopathy—VISA-H, patellar tendon—VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized. Methods The systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross-cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross-cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis. Results The VISA-A presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA-G displayed moderate-quality evidence for sufficient comprehensibility and very-low-quality evidence of sufficient relevance and comprehensiveness. The VISA-P presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA-H presented very-low evidence of insufficient content validity. VISA-A displayed low-quality evidence for structural validity concerning unidimensionality and internal structure, while VISA-H presented low-quality evidence of insufficient unidimensionality. The structural validity of VISA-G and VISA-P were indeterminate and inconsistent, respectively. Internal consistency for VISA-G, VISA-H, and VISA-P was indeterminate. No studies evaluated cross-cultural validity, while measurement invariance across sexes was assessed in one study. Conclusions Only very-low-quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies. Level of evidence IV. Registration PROSPERO reference—CRD42019126595.Other Information Published in: Knee Surgery, Sports Traumatology, Arthroscopy License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s00167-021-06598-5</p

The effects of specific Omega-3 and Omega-6 polyunsaturated fatty acids and antioxidant vitamins gait and functional capacity parameters in patients with relapsing-remitting multiple sclerosis

Patients with multiple sclerosis (MS) are characterized by, among other symptoms, impaired functional capacity and walking difficulties. Polyunsaturated fatty acids (PUFAs) have been found to improve MS patients' clinical outcomes; however, their effect on other parameters associated with daily living activities need further investigation. The current study aimed to examine the effect of a 24-month supplementation with a cocktail dietary supplement formula, the NeuroaspisTM PLP10, containing specific omega-3 and omega-6 PUFAs and specific antioxidant vitamins on gait and functional capacity parameters of patients with MS. Fifty-one relapsing-remitting MS (RRMS) patients with low disability scores (age: 38.4 ± 7.1 years; 30 female) were randomized 1:1 to receive either a 20 mL daily dose of the dietary formula containing a mixture of omega-3 and omega-6 PUFAs (12,150 mg), vitamin A (0.6 mg), vitamin E (22 mg), and γ-tocopherol (760 mg), the OMEGA group (n = 27; age: 39 ± 8.3 years), or 20 mL placebo containing virgin olive oil, the placebo group (n = 24; age: 37.8 ± 5.3 years). The mean ± SD (standard deviation) Expanded Disability Status Scale (EDSS) score for the placebo group was 2.36 and for the OMEGA group 2.22. All enrolled patients in the study were on Interferon-β treatment. Spatiotemporal gait parameters and gait deviation index (GDI) were assessed using a motion capture system. Functional capacity was examined using various functional tests such as the six-minute walk test (6MWT), two sit-to-stand tests (STS-5 and STS-60), and the Timed Up and Go test (TUG). Isometric handgrip strength was assessed by a dynamometer. Leg strength was assessed using an isokinetic dynamometer. All assessments were performed at baseline and at 12 and 24 months of supplementation. A total of 36 patients completed the study (18 from each group). Six patients from the placebo group and 9 patients from the OMEGA group dropped out from the study or were lost to follow-up. The dietary supplement significantly improved the single support time and the step and stride time (p &lt; 0.05), both spatiotemporal gait parameters. In addition, while GDI of the placebo group decreased by about 10% at 24 months, it increased by about 4% in the OMEGA group (p &lt; 0.05). Moreover, performance in the STS-60 test improved in the OMEGA group (p &lt; 0.05) and there was a tendency for improvement in the 6MWT and TUG tests. Long-term supplementation with high dosages of omega-3 and omega-6 PUFAs (compared to previous published clinical studies using PUFAs) and specific antioxidant vitamins improved some functional capacity and gait parameters in RRMS patients