Pain Relief in Older Adults Following Static Contractions is not Task-Dependent

Pain complaints increase with age. Exercise is frequently utilized for pain relief but the optimal exercise prescription to relieve pain is not clear. Following static contractions, young adults experience the greatest pain relief with low intensity, long duration contractions. The pain response to static contractions in older adults however is unknown. PURPOSE : To compare pain reports in healthy older adults before and after static contractions of varying intensity and duration. METHODS: Pain perception was assessed in 23 healthy older adults (11 men, 12 women; 72.0 ± 6.3 yrs) using a pressure pain device consisting of a 10 N force applied to the right index finger through a Lucite edge (8 x 1.5mm) for two minutes. Subjects pushed a timing device when they first felt pain (i.e., pain threshold) and rated their pain intensity every 20 seconds using a 0-10 numerical rating scale. Pain threshold and pain ratings were measured before and immediately after static contractions of the left elbow flexors at the following three doses: 1) three brief maximal voluntary contractions (MVC); 2) 25% MVC sustained for 2 minutes; and 3) 25% MVC sustained until task failure. Experimental sessions were randomized and separated by one week. RESULTS : Time to task failure for the 25% MVC contraction was 11.8 ± 5.1 minutes. A reduction in pain was found following all three tasks with no difference between tasks (trial x task effect: p \u3e 0.05), despite the duration of the 2 minute low-intensity contraction being ~17% of the contraction held to task failure. Pain thresholds for all doses increased 20% from 51 ± 33 to 61 ± 37 seconds and pain ratings averaged over the six time points decreased 20% from 3.3 ± 2.8 to 2.6 ± 2.5 following static contractions (trial effect: p \u3c 0.001 and p \u3c 0.001, respectively). CONCLUSION : Low and high intensity static contractions of both long and short duration produce similar levels of pain reduction in older adults. These preliminary data suggest that several different types of static contractions can induce significant pain relief in older adults. Age-related changes in the pain response to static contractions must be taken into account when prescribing static exercise for the management of pain

Pain Relief in Older Adults Following Static Contractions is not Task-Dependent

Pain complaints increase with age. Exercise is frequently utilized for pain relief but the optimal exercise prescription to relieve pain is not clear. Following static contractions, young adults experience the greatest pain relief with low intensity, long duration contractions. The pain response to static contractions in older adults however is unknown. PURPOSE : To compare pain reports in healthy older adults before and after static contractions of varying intensity and duration. METHODS: Pain perception was assessed in 23 healthy older adults (11 men, 12 women; 72.0 ± 6.3 yrs) using a pressure pain device consisting of a 10 N force applied to the right index finger through a Lucite edge (8 x 1.5mm) for two minutes. Subjects pushed a timing device when they first felt pain (i.e., pain threshold) and rated their pain intensity every 20 seconds using a 0-10 numerical rating scale. Pain threshold and pain ratings were measured before and immediately after static contractions of the left elbow flexors at the following three doses: 1) three brief maximal voluntary contractions (MVC); 2) 25% MVC sustained for 2 minutes; and 3) 25% MVC sustained until task failure. Experimental sessions were randomized and separated by one week. RESULTS : Time to task failure for the 25% MVC contraction was 11.8 ± 5.1 minutes. A reduction in pain was found following all three tasks with no difference between tasks (trial x task effect: p \u3e 0.05), despite the duration of the 2 minute low-intensity contraction being ~17% of the contraction held to task failure. Pain thresholds for all doses increased 20% from 51 ± 33 to 61 ± 37 seconds and pain ratings averaged over the six time points decreased 20% from 3.3 ± 2.8 to 2.6 ± 2.5 following static contractions (trial effect: p \u3c 0.001 and p \u3c 0.001, respectively). CONCLUSION : Low and high intensity static contractions of both long and short duration produce similar levels of pain reduction in older adults. These preliminary data suggest that several different types of static contractions can induce significant pain relief in older adults. Age-related changes in the pain response to static contractions must be taken into account when prescribing static exercise for the management of pain

Toward Consistent Fiduciary Duties for Publicly Traded Entities

After the 2008 recession, it is difficult to imagine that the public is investing billions of dollars in publicly traded entities with little regulation of board conflicts and no fiduciary duty protections. Yet, that is precisely the case for more than $284 billion of investments. Investors have flocked to publicly traded limited partnerships (LPs) and limited liability companies (LLCs), collectively known as master limited partnerships (MLPs), because many are high-performing energy companies with a tax preference. MLP market capitalization, while only$14 billion in 2000, topped $284 billion as of February 2016, and more initial public offerings are on the horizon. Dazzled by the possibility of high yields, individual investors are likely unaware that they do not enjoy the same fiduciary duty protections that apply to stockholders of publicly traded corporations. Delaware corporate law offers significant investor protections largely flowing from an unwaivable duty of loyalty. In contrast, Delaware’s alternative entity scheme permits the waiver of all fiduciary duties in LP and LLC agreements. Publicly traded LPs are also exempt from listing rules that normally require independent board members. Even where special committees vet conflicted transactions, committee members may have affiliations with the MLP’s corporate sponsor and owe conflicting duties to the sponsor and the limited partners. Scholars suggest that “uncorporate” substitutes could theoretically mitigate the absence of fiduciary duties, but empirical research shows that publicly traded MLPs rarely adopt such substitutes. The realities of the MLP marketplace leave investors with only the implied covenant of good faith and fair dealing, which is not a substitute for traditional fiduciary duties. This Article exposes the many obstacles investors have faced in obtaining remedies under MLP agreements. It argues that Contractarian theories or legal diversification constructs do not justify the under-regulation of publicly traded MLPs. This Article recommends reinstating the duty of loyalty for MLPs and ending the LP exception from board independence requirements

Impact of primary breast cancer therapy on energetic capacity and body composition

PURPOSE: This observational study was designed to measure baseline energy parameters and body composition in early-stage breast cancer patients, and to follow changes during and after various modalities of treatment. This will provide information to aid in the development of individualized physical activity intervention strategies. METHODS: Patients with newly diagnosed stage 0-III breast cancer were enrolled into three cohorts: A (local therapy alone), B (endocrine therapy), or C (chemotherapy with or without endocrine therapy). At baseline, 6 months, and 12 months, subjects underwent a stationary bicycle protocol to assess power generation and DEXA to assess body composition. RESULTS: Eighty-three patients enrolled. Patients had low and variable levels of power generation at baseline (mean power per kilogram lean mass 1.55 W/kg, SD 0.88). Power normalized to lean body mass (W/kg) decreased significantly, and similarly, by 6 months in cohorts B (1.42-1.04 W/kg, p = 0.008) and C (1.53-1.18 W/kg, p < 0.001). In all cohorts, there was no recovery of power generation by 12 months. Cohort C lost lean body mass (- 1.5 kg, p = 0.007), while cohort B maintained lean body mass (- 0.2 kg, p = 0.68), despite a similar trajectory in loss of power. Seven patients developed sarcopenia during the study period, including four patients who did not receive any chemotherapy (cohort B). CONCLUSIONS: The stationary bike protocol was feasible, easy, and acceptable to patients as a way to measure energetic capacity in a clinical setting. Early-stage breast cancer patients had low and variable levels of power generation, which worsened following primary therapy and did not show evidence of 'spontaneous recovery' by 12 months. Effective physical activity interventions will need to be personalized, accounting for both baseline ability and the effect of treatment