Basic principles regarding strength, flexibility, and stability exercises

Fusing CNNs and attention-mechanisms to improve real-time indoor Human Activity Recognition for classifying home-based physical rehabilitation exercises

Physical rehabilitation plays a critical role in enhancing health outcomes globally. However, the shortage of physiotherapists, particularly in developing countries where the ratio is approximately ten physiotherapists per million people, poses a significant challenge to effective rehabilitation services. The existing literature on rehabilitation often falls short in data representation and the employment of diverse modalities, limiting the potential for advanced therapeutic interventions. To address this gap, This study integrates Computer Vision and Human Activity Recognition (HAR) technologies to support home-based rehabilitation. The study mitigates this gap by exploring various modalities and proposing a framework for data representation. We introduce a novel framework that leverages both Continuous Wavelet Transform (CWT) and Mel-Frequency Cepstral Coefficients (MFCC) for skeletal data representation. CWT is particularly valuable for capturing the time-frequency characteristics of dynamic movements involved in rehabilitation exercises, enabling a comprehensive depiction of both temporal and spectral features. This dual capability is crucial for accurately modelling the complex and variable nature of rehabilitation exercises. In our analysis, we evaluate 20 CNN-based models and one Vision Transformer (ViT) model. Additionally, we propose 12 hybrid architectures that combine CNN-based models with ViT in bi-model and tri-model configurations. These models are rigorously tested on the UI-PRMD and KIMORE benchmark datasets using key evaluation metrics, including accuracy, precision, recall, and F1-score, with 5-fold cross-validation. Our evaluation also considers real-time performance, model size, and efficiency on low-power devices, emphasising practical applicability. The proposed fused tri-model architectures outperform both single-architectures and bi-model configurations, demonstrating robust performance across both datasets and making the fused models the preferred choice for rehabilitation tasks. Our proposed hybrid model, DenMobVit, consistently surpasses state-of-the-art methods, achieving accuracy improvements of 2.9% and 1.97% on the UI-PRMD and KIMORE datasets, respectively. These findings highlight the effectiveness of our approach in advancing rehabilitation technologies and bridging the gap in physiotherapy services.

Optimizing young tennis players' development: Exploring the impact of emerging technologies on training effectiveness and technical skills acquisition

The research analyzed the effect of weekly training plans, physical training frequency, AI-powered coaching systems, virtual reality (VR) training environments, wearable sensors on developing technical tennis skills, with and personalized learning as a mediator. It adopted a quantitative survey method, using primary data from 374 young tennis players. The model fitness was evaluated using confirmatory factor analysis (CFA), while the hypotheses were evaluated using structural equation modeling (SEM). The model fitness was confirmed through CFA, demonstrating high fit indices: CFI = 0.924, TLI = 0.913, IFI = 0.924, RMSEA = 0.057, and SRMR = 0.041, indicating a robust model fit. Hypotheses testing revealed that physical training frequency (β = 0.198, p = 0.000), AI-powered coaching systems (β = 0.349, p = 0.000), virtual reality training environments (β = 0.476, p = 0.000), and wearable sensors (β = 0.171, p = 0.000) significantly influenced technical skills acquisition. In contrast, the weekly training plan (β = 0.024, p = 0.834) and personalized learning (β = -0.045, p = 0.81) did not have a significant effect. Mediation analysis revealed that personalized learning was not a significant mediator between training methods/technologies and acquiring technical abilities. The results revealed that physical training frequency, AI-powered coaching systems, virtual reality training environments, and wearable sensors significantly influenced technical skills acquisition. However, personalized learning did not have a significant mediation effect. The study recommended that young tennis players' organizations and stakeholders consider investing in emerging technologies and training methods. Effective training should be given to coaches on effectively integrating emerging technologies into coaching regimens and practices.

Personalizing Injury Management and Recovery: A Cross-Sectional Investigation of Musculoskeletal Injuries and Quality of Life in Athletes

Purpose

The study explores the impact of Musculoskeletal Injuries on the quality of life in youth athletes, aiming to understand the extent of these injuries' effects on their physical and mental wellbeing.

Patients and Methods

This cross-sectional study included 130 youth athletes, using questionnaires to collect data on demographics, training exposures (averaging 11±3.8 hours/week), overuse symptoms (using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire), acute injury history, and overall wellbeing (assessed by the RAND 36-item Short Form Health Survey).

Results

Findings indicated that 55.4% of participants had suffered an acute injury in the past 6 months, leading to an average of 4 weeks of time loss. The mean score for OSTRC-O Scores was 16.8±6.4, with knee overuse averaging 21.3± 8.8. In terms of wellbeing, physical and mental health scores were 82.4±15.3 and 81.7±14.1 respectively. There were significant correlations between higher overuse scores and poorer physical functioning (r=-0.42), bodily pain (r=-0.38), vitality (r=-0.32), and mental health (r=-0.31). Acute injuries were linked with worse physical functioning and role limitations. Regression analysis showed that both overuse and acute injuries predicted poorer physical health.

Conclusion

The study underscores the significant prevalence of musculoskeletal injuries among youth athletes and delineates their profound impact on the quality of life, encompassing both the physical and mental health realms. These findings advocate for the critical integration of preventive measures and personalized training protocols, spotlighting the pivotal role of comprehensive biopsychosocial strategies in nurturing athletes' overall wellbeing. By prioritizing the quality of life as a key outcome, this research advocates for a more nuanced approach to injury management and recovery.

Effects of Adjuvant Exercise and Nutrition Therapy on Muscle Fibre Biomechanics in Gastrointestinal Cancer Patients

Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on the biomechanical function of muscle. A promising prevention strategy was found in the form of a multi-modal therapy combining mild resistance exercise (e.g., whole-body electro-myostimulation, WB-EMS) and a protein-rich diet. In a previous study of ours, this was effective in counteracting the loss of muscle mass, yet a systematic and comprehensive assessment of active and passive single muscle fibre functions was so far absent. This pilot study investigated the biomechanical function of single muscle fibres (rectus abdominis) from the biopsies of conventionally treated (pre-)cachectic cancer ((pre-)CC) patients (m = 9), those receiving the multi-modal therapy comprising WB-EMS training and protein-rich nutrition (m = 3), and a control group (m = 5). Our findings not only align with previous findings showing the absolute force loss in CC that is accelerated by atrophy but also speak in favour of a different, potentially energy- and Ca2+-homeostasis-related effect that compromises muscle contraction (F ~0.9 mN vs. F ~0.6 mN in control patients). However, myofibrillar Ca2+ sensitivity and the quality of contraction were unaltered (pCa50: 5.6-5.8). Single fibres from the (pre-)CC patients receiving WB-EMS training and protein supplementation were significantly more compliant (p < 0.001 at ≥130% of resting length L0). Those fibres displayed a similar softness to the ones from the control patients (axial compliance ~15 m/N at ≥130% L0), while single fibres from the patients with (developing) cachexia were significantly stiffer (axial compliance ~7 m/N, p < 0.001 at ≥130% L0). Adjuvant multi-modal therapy (WB-EMS training and nutritional support) contributes to maintaining the axial compliance of single fibres and potentially improves the quality of life for patients at risk of developing CC.

Health profile with body mass index and physical fitness in Swedish adolescents: a cross-sectional study

OBJECTIVES

Physical inactivity and poor physical fitness in children and adolescents are growing public health problems globally. This study aimed to investigate the correlation between Body Mass Index (BMI) and three physical fitness components, including overall fitness, according to the Swedish Physical power, Mental harmony and Social capacity profile (FMS profile). Another aim was to investigate the test-retest reliability of the FMS questionnaire and fitness tests.

METHODS

A total of 3,692 male and female adolescents in Sweden, between year 2004 and 2013, aged from 16 to 18 years old, were included. Height and weight data were collected to calculate the Body mass index (BMI). The participants performed physical fitness tests, which measure cardio-respiratory fitness, muscular strength and flexibility. The test-retest study included 18 adolescents, aged 16. They answered the FMS questionnaire and participated in the fitness tests with one-week interval.

RESULTS

A weak inverse relationship between BMI and physical fitness was found: r=-0.06 to -0.07 (p<0.05) for flexibility, r=-0.13 to 0.10 (p<0.001) for strength, r=-0.14 to -0.33 (p<0.001) for cardiorespiratory fitness, and r=-0.15 to -0.27 (p<0.001) for overall fitness. In the test-retest study, the ICC's for strength, flexibility and balance were 0.94, 0.96 and 0.89, respectively. The ICC's for the questions regarding lifestyle ranged from 0.75 to 1.00 and for diet, physical activity and drugs were 0.56, 0.44 and 0.58, respectively. The correlation was stronger in overweight/obese individuals compared to normal weight individuals.

CONCLUSION

Overweight and obese individuals scored lower in the fitness tests compared to their normal weight counterparts. The test-retest study revealed that the FMS questionnaire and fitness tests are reliable tools.

The UP150: A Multifactorial Environmental Intervention to Promote Employee Physical and Mental Well-Being

Physical activity (PA) is a major health factor and studies suggest workplaces could promote PA by modifying office design, motivational strategies and technology. The present study aims to evaluate the efficiency of UP150, a multifactorial workplace intervention for the improvement and maintenance of the level of physical fitness (PF) and wellbeing. Forty-five employees were randomly divided into the experimental (EG) and control (CG) groups. The PF was assessed pre-post intervention using the cubo fitness test (CFT), the amount of PA was evaluated using the IPAQ questionnaire and accelerometers while the workload was assessed using the NASA-TLX questionnaire and psycho-physical health by using the SF-12 questionnaire. The EG worked in UP150 offices while the CG worked in their usual offices for 8 weeks. The EG and CG came back 4 weeks after the intervention for CFT retention. The EG improved CFT motor efficiency and the amount of moderate PA, while it reduced mental load. The EG retained reached motor efficiency levels 4 weeks after the intervention. No differences were found in IPAQ. The UP150 demonstrated to be a proactive environment and to be efficient in the promotion of PA, improving PF and mental health while decreasing mental load.

Effect of acute static stretching on the passive mechanical properties of the Achilles tendon: a systematic review and meta-analysis

Background/Aims

Little is known about the effectiveness of static stretching on the tendinous structures. The aim of this study was to verify the effect of acute static stretching on the passive mechanical properties of the Achilles tendon.

Methods

Databases were searched with the descriptors ‘muscle stretching exercises,’ ‘adult’ and ‘Achilles tendon’ with a sample consisting of physically active young adults. Two blind reviewers performed the review.

Results

A total of four studies were selected. After the meta-analysis, no significant difference was observed for range of motion (−0.73; 95% confidence interval −2.18–0.71; I2=0%), muscle-tendon unit (−0.02; 95% confidence interval −0.23–0.19; I2= 83%), muscle (−0.43; 95% confidence interval −0.92–0.06; I2= 0%) and tendon stiffness (3.70; 95% confidence interval 1.57–5,83; I2=0%; P=0.0007) and passive torque (−1.35; 95% confidence interval −4.75–2.05; I2= 0%). Maximum voluntary isometric contraction showed an alteration with a longer stretching time (1215 seconds).

Conclusions

Passive static stretching (60–1215 seconds) does not significantly alter the analysed variables.

Examining the Impact of a Mobile Health App on Functional Movement and Physical Fitness: Pilot Pragmatic Randomized Controlled Trial

Background

Numerous mobile apps available for download are geared toward health and fitness; however, limited research has evaluated the real-world effectiveness of such apps. The movr app is a mobile health app designed to enhance physical functioning by prescribing functional movement training based on individualized movement assessments. The influence of the movr app on functional movement and physical fitness (flexibility, strength, and cardiovascular fitness) has not yet been established empirically.

Objective

This study aims to examine the real-world impact of the movr app on functional movement, flexibility, strength, and cardiovascular fitness.

Methods

A total of 48 healthy adults (24 women and 24 men; mean age 24, SD 5 years) completed an 8-week pilot pragmatic randomized controlled trial in which they were randomly assigned to either 8-week use of the movr app (n=24) or 8-week waitlist control (n=24). Measures of functional movement (Functional Movement Screen [FMS]), strength (push-ups, handgrip strength, and countermovement jump), flexibility (shoulder flexibility, sit and reach, active straight leg raise [ASLR], and half-kneeling dorsiflexion), and cardiovascular fitness (maximal oxygen uptake []) were collected at baseline and the 8-week follow-up.

Results

Repeated measures analyses of variance revealed significant group-by-time interactions for the 100-point FMS (P<.001), shoulder flexibility (P=.01), ASLR (P=.001), half-kneeling dorsiflexion (P<.001), and push-up tests (P=.03). Pairwise comparisons showed that FMS scores increased from pre- to postintervention for those in the movr group (P<.001) and significantly decreased for those in the control group (P=.04). For shoulder flexibility, ASLR, half-kneeling dorsiflexion, and push-up tests, improvements from pre- to postintervention were found in the movr group (all values of P<.05) but not in the control group (all values of P>.05). There were no changes in the sit and reach or handgrip strength test scores for either group (all values of P>.05). A significant main effect of time was found for the countermovement jump (P=.02), such that scores decreased from pre- to postintervention in the control group (P=.02) but not in the movr group (P=.38). Finally, a significant group-by-time interaction was found for (P=.001), revealing that scores decreased pre- to postintervention in the control group (P<.001), but not in the movr group (P=.54).

Conclusions

The findings revealed that movr improved indices of functional movement (FMS), flexibility (shoulder, ASLR, and dorsiflexion), and muscular endurance (push-ups) over an 8-week period compared with the control group while maintaining handgrip strength, lower body power (countermovement jump), and cardiovascular fitness (). Thus, this study provides initial evidence of the effectiveness of the movr app for enhancing functional movement and physical fitness among healthy adults.

Trial Registration

ClinicalTrials.gov NCT04865666; https://clinicaltrials.gov/ct2/show/NCT04865666

The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

BACKGROUND

Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate.

METHODS

Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions.

RESULTS

The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups.

CONCLUSION

Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).

Physical activity and exercise: Strategies to manage frailty

Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.

Skeletal Muscle Aging Atrophy: Assessment and Exercise-Based Treatment

In the ordinary course of aging, individuals change their body composition, mainly reducing their skeletal muscle mass and increasing their fat mass. In association, muscle strength and functionality also decrease. The geriatric assessment allows knowing the baseline situation of the patients, determines the impact of diseases, and defines specific treatments. There are various tools to evaluate the health condition of older people. These tools include the assessment scales of necessary Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), physical and functional assessment scales, and instruments that assess the cognitive state of the person. There are several strategies that have been proposed to combat skeletal muscle atrophy due to aging, such as physical exercise, nutritional supplements, or drugs. Some researchers have highlighted the efficacy of the combination of the mentioned strategies. In this chapter, we will focus only on physical exercise as a strategy to reduce skeletal muscle loss during aging.

The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis

BACKGROUND

Despite many benefits of the physical activity on physical and mental health of patients with Multiple Sclerosis (MS), the activity level in these patients is still very limited, and they continue to suffer from impairment in functioning ability. The main aim of this study is thus to closely examine exercise's effect on fatigue of patients with MS worldwide, with particular interest on Iran based on a comprehensive systematic review and meta-analysis.

METHODS

The studies used in this systematic review were selected from the articles published from 1996 to 2019, in national and international databases including SID, Magiran, Iranmedex, Irandoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (ISI). These databases were thoroughly searched, and the relevant ones were selected based on some plausible keywords to the aim of this study. Heterogeneity index between studies was determined using Cochran's test and I2. Due to heterogeneity in studies, the random effects model was used to estimate standardized mean difference.

RESULTS

From the systematic review, a meta-analysis was performed on 31 articles which were fulfilled the inclusion criteria. The sample including of 714 subjects was selected from the intervention group, and almost the same sample size of 720 individuals were selected in the control group. Based on the results derived from this meta-analysis, the standardized mean difference between the intervention group before and after the intervention was respectively estimated to be 23.8 ± 6.2 and 16.9 ± 3.2, which indicates that the physical exercise reduces fatigue in patients with MS.

CONCLUSION

The results of this study extracted from a detailed meta-analysis reveal and confirm that physical exercise significantly reduces fatigue in patients with MS. As a results, a regular exercise program is strongly recommended to be part of a rehabilitation program for these patients.

Therapeutic Exercise

Physicians often overlook exercise as a treatment or prophylactic measure for many common diseases and ailments. It can be used to treat comorbidities including obesity, cardiovascular disease, chronic obstructive pulmonary disease, diabetes mellitus, osteoporosis, osteoarthritis, cancer, and low back pain. Education on the general physical activity guidelines as well as easy exercise prescription methods can improve the ability of physicians to prescribe exercise as a therapeutic option. In addition, identifying barriers to compliance with exercise and ways to overcome these barriers is also necessary in order to use therapeutic exercise effectively.

Muscle strength and functional capacity of elderly people engaged in two types of strength training

Abstract Introduction: Regular physical activity is one of the main ways of avoiding compromised functional capacity and gaining muscle mass. Objective: investigate the differences in muscle strength and functional capacity of elderly people engaged in two types of strength exercises. Method: a cross-sectional study of 80 seniors of both sexes, 40 of whom engaged in weight training and 40 from the Fitness Zone in the city of Maringá, Paraná, state. A sociodemographic questionnaire, the sitting-rising and elbow flexion tests, and the functional capacity tests of the Latin American Development Maturity Group (GDLAM) were applied. The data were analyzed using the Shapiro-Wilk, Mann-Whitney “U” and Spearman’s correlation tests (p<0.05). Results: Most seniors who performed well in the sitting and rising test, rising from a chair and moving around the house and rising from the dorsal decubitus position engaged in weight training (p=0.001). Those engaged in weight training exhibited better upper limb strength and functional capacity in all the tests performed (p <0.05). Muscle strength is inversely related to functional capacity, that is, the better the result in the upper and lower limb muscle strength tests, the better the functional capacity of the elderly engaged in weight training. Conclusion: According to the results obtained, older people who engage in weight training display better upper limb strength and functional capacity than seniors from the Fitness Zone.

Rehabilitation Management of Rotator Cuff Injuries in the Master Athlete

Rotator cuff (RTC) injuries are common in master athletes, especially overhead athletes. Risk factors include aging and degeneration as nonmodifiable and volume of activity, muscle weakness, and loss of motion as modifiable. The clinical presentation involves limited range of motion (ROM), pain at rest and at night. Injury classification into traumatic versus nontraumatic and tendinopathy, partial or full-thickness tears helps to establish a treatment plan. RTC injury rehabilitation protocols are criteria-based, multimodal, and divided into four phases. The acute phase addresses pain, inflammation, ROM, and RTC protection. The recovery phase addresses kinetic chain abnormalities, flexibility, and strength, and the functional phase involves exercises directed toward specific sport activities. Return to sports is based on clinical recovery, kinetic chain principles, and adequate sports technique. Nonsurgical management is recommended in most cases, and surgical management is considered if symptoms progress, especially for full-thickness tears.

Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review

OBJECTIVES

The objectives of this scoping review were to identify (1) study designs and participant populations, (2) types of specific methodology and (3) common results, conclusions and recommendations from the body of evidence regarding our research question; is there a relationship between sleep posture and spinal symptoms.

DESIGN

Scoping review.

DATA SOURCES

PEDro, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Medline, ProQuest, PsycINFO, SportDISCUS and grey literature from inception to 10 April 2018.

DATA SELECTION

Using a modified Arksey and O'Malley framework, all English language studies in humans that met eligibility criteria using key search terms associated with sleep posture and spinal symptoms were included.

DATA EXTRACTION

Data were independently extracted by two reviewers and mapped to describe the current state of the literature. Articles meeting the search criteria were critically appraised using the Downs and Black checklist.

RESULTS

From 4186 articles, four articles were identified, of which three were epidemiological and one interventional. All studies examined three or more sleep postures, all measured sleep posture using self-report and one study also used infrared cameras. Two studies examined symptoms arising from the lumbar spine, one the cervical spine and one the whole spine. Waking pain and stiffness were the most common symptoms explored and side lying was generally protective against spinal symptoms.

CONCLUSIONS

This scoping review highlights the importance of evaluating sleep posture with respect to waking symptoms and has provided preliminary information regarding relationships between sleep posture and spinal symptoms. However, there were not enough high-quality studies to adequately answer our research question. It is recommended future research consider group sizes and population characteristics to achieve research goals, that a validated measure be used to assess sleep posture, that characteristics and location of spinal symptoms are clearly defined and that the side lying posture is subclassified.

Effect of corporal suspension and pendulum exercises on neuromuscular properties and functionality in patients with medullar thoracic injury

BACKGROUND

Traumatic spinal cord injury (TSCI) is one of the most devastating injuries that has a physical impact on patients. The CHORDATA® method involves suspension and pendulous exercises and has been clinically used to treat patients with TSCI. Although empirically used to treat neurological patients, there is no scientific evidence of the efficacy of this method.

PURPOSE

To evaluate the chronic effects of CHORDATA® method on torque, muscle activation, muscle thickness, and functionality in patients with traumatic spinal cord injury.

METHODS

Twenty-six male patients with medullar thoracic injury were randomly categorised into two groups: intervention group (n = 14) and control group (n = 12). Rehabilitation program comprised of 16 sessions of body suspension and pendulum exercises (twice/week). The maximal voluntary isometric trunk flexion and extension torques, muscle activation and thickness (external and internal oblique, rectus and transversus abdominis, longissimus, and multifidus muscles), and functionality (adapted reach test) were evaluated before and after of rehabilitation program.

FINDINGS

A significant increase was observed in maximal voluntary isometric torque (flexion, 58%; extension, 76%), muscle activation of the rectus abdominis muscle, and muscle thickness of all intervention group muscles, without changes in the control group. Compared to the pre-intervention period, the intervention group also showed improvement in functionality at post-intervention, but no such differences were noted in the control group.

INTERPRETATION

The corporal suspension and pendulum exercises training improved rectus abdominis muscle activation, trunk muscles structure and strength, and reaching capacity in medullar thoracic injury patients.

Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers

OBJECTIVES

Investigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP).

SETTING

Regional Australian council training facility.

PARTICIPANTS

Consecutive participants recruited during 39 back education classes (8-26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18-64 years, 67.1% male.

METHODS

Cross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) 'toilet squat'; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times.

INTERVENTIONS

Nil.

RESULTS

For the group 'no-some', 94.3% completed 4-5 test exercises, while for group 'With', 95.7% completed 0-1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ²₍₁₀₎=300.61, p<0.001). Furthermore, multinomial logistic regression predicting LBP (0=no, 1=some, 2=most) from the number of exercises completed, substantially improved the model fit (initial-2LL=348.246, final-2LL=73.620, χ²₍₂₎=274.626, p<0.001). As the number of exercises performed increased, the odds of reporting 'some LBP' or 'most LBP' dropped substantially (ORs of 0.34 and 0.17, respectively).

CONCLUSION

The ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.

Benefits of Exercise in the Older Population

Older adults 65 years of age and older compose a great portion of the US population. Physiologic changes of aging that limit function and general quality of life occur at a faster rate as we get older. There is high-quality evidence that exercise activity has many favorable benefits for older adults. The ideal exercise program in older adults should include aerobic, resistance, flexibility, and balance training. The exercise recommendations should be individually tailored to the abilities, precautions, and goals of each person. They also should be of sufficient intensity, volume, and duration in order to achieve maximal benefits.

Effects of chair yoga therapy on physical fitness in patients with psychiatric disorders: A 12-week single-blind randomized controlled trial

INTRODUCTION

Since falls may lead to fractures and have serious, potentially fatal outcomes, prevention of falls is an urgent public health issue. We examined the effects of chair yoga therapy on physical fitness among psychiatric patients in order to reduce the risk of falls, which has not been previously reported in the literature.

METHODS

In this 12-week single-blind randomized controlled trial with a 6-week follow-up, inpatients with mixed psychiatric diagnoses were randomly assigned to either chair yoga therapy in addition to ongoing treatment, or treatment-as-usual. Chair yoga therapy was conducted as twice-weekly 20-min sessions over 12 weeks. Assessments included anteflexion in sitting, degree of muscle strength, and Modified Falls Efficacy Scale (MFES) as well as QOL, psychopathology and functioning.

RESULTS

Fifty-six inpatients participated in this study (36 men; mean ± SD age, 55.3 ± 13.7 years; schizophrenia 87.5%). In the chair yoga group, significant improvements were observed in flexibility, hand-grip, lower limb muscle endurance, and MFES at week 12 (mean ± SD: 55.1 ± 16.6 to 67.2 ± 14.0 cm, 23.6 ± 10.6 to 26.8 ± 9.7 kg, 4.9 ± 4.0 to 7.0 ± 3.9 kg, and 114.9 ± 29.2 to 134.1 ± 11.6, respectively). Additionally, these improvements were observable six weeks after the intervention was over. The QOL-VAS improved in the intervention group while no differences were noted in psychopathology and functioning between the groups. The intervention appeared to be highly tolerable without any notable adverse effects.

CONCLUSIONS

The results indicated sustainable effects of 20-min, 12-week, 24-session chair yoga therapy on physical fitness. Chair yoga therapy may contribute to reduce the risk of falls and their unwanted consequences in psychiatric patients.

Postural sway and flexibility in patients with schizophrenia-spectrum disorders: A cross-sectional study

Coordinated bodily balance is necessary to prevent falls, where postural sway and/or body inflexibility should be relevant. We aimed to assess postural sway and flexibility in patients with schizophrenia and identify clinical characteristics. Postural sway (length and range of trunk motion, and Romberg ratio) and flexibility (anteflexion in sitting) were measured in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) and the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) were used for the assessment of psychopathology and extrapyramidal symptoms, respectively. Characteristics associated with postural sway and flexibility were examined with regression analysis. A total of 100 patients (68 men, mean ± S.D. age: 49.3 ± 13.8 years, PANSS score: 83.4 ± 15.1, DIEPSS score: 2.2 ± 2.2) participated in this study. The anteflexion in sitting was not significantly correlated with length of trunk motion, range of trunk motion, or Romberg ratio. Postural instability was associated with higher DIEPSS overall severity score and PANSS positive symptoms. A significant correlation was also found between less flexibility and increased PANSS negative symptoms. In conclusion, flexibility and postural stability might be regarded as separate elements of physical fitness in schizophrenia. Prospective exercise intervention would be worthy of investigation to enhance postural stability and flexibility in an effort to prevent falls.

Effects of a pilates school program on hamstrings flexibility of adolescents

INTRODUCTION: Low levels of hamstring flexibility may trigger certain acute and chronic pathologies and injuries. Poor flexibility is observed among teenagers and several authors have recommended the use of specific programs in this population to improve flexibility levels. The Pilates Method (PM) may be an appropriate intervention to achieve this purpose and has rarely been used with this population. Objective: Study was to assess changes in the flexibility of hamstrings after running a didactic PM unit for high-school students.METHODS: This research was developed through a quasi-experimental design. The sample consisted of 66 high-school students divided into experimental group (EG=39) and control group (CG=27). The intervention was carried out 2 times a week for six weeks. Each session lasted 55 minutes divided into three parts: warm-up, main part and cool down. Hamstring flexibility was assessed using the toe-touch test. Paired Student t-test and t-test for independent samples were applied. The size of the effect (d) was determined.RESULTS: The EG showed significant provident in hamstring flexibility (+3.54±3.9cm). The effect size was low (d>d>0,2<0,53), which means that a small proportion of participants improved their results. The control group did not have significant changes after the intervention. In the experimental group, both boys (+3.38± 3.7cm) and girls (+3.85 ± 4.2cm) showed significant improvements. The effect size was low for boys (d>d>0.2<0.53), which means that a small proportion of participants improved their results, and high for girls (d>1.15) which means that a large proportion of participants improved their results.CONCLUSION: This study showed that six-weeks of Pilates training in Physical Education classes has significantly improved the hamstrings flexibility among adolescents.

The role of physiatry in regenerative medicine: the past, the present, and future challenges

Historically, the foundation of physical medicine and rehabilitation training has provided the capabilities to optimize nonoperative treatments of a variety of musculoskeletal conditions, including acute and chronic muscle, tendon, ligament, and cartilage disorders. Such treatments include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic modalities (eg, thermal and manual therapies), and corticosteroid injections in conjunction with specific rehabilitation exercises. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to worse long-term outcomes by potentially interfering with tissue healing. Regenerative interventions, including platelet-rich plasma and mesenchymal stem cells, recently have been used to treat refractory painful conditions such as chronic tendinopathies because of the potential of these interventions to facilitate tissue healing. The future development of these regenerative techniques will require a variety of conditions to be met, including determining the most appropriate procedures based on the disease being treated; establishing the optimal preparations of these regenerative techniques; and providing clinicians, patients, and regulatory agencies with high-quality evidence demonstrating the safety, effectiveness, and long-term results of these treatments. Clarification of current regulatory uncertainty, improved access for all patients, proper training for clinicians who incorporate these techniques into their practice, and determination of the most appropriate postinjection protocols will allow physical medicine and rehabilitation specialists to play a unique role in the long-term management of patients with musculoskeletal and sports injuries. This article will also address the role physiatrists should have in the inevitable growth of regenerative medicine applications.

Prevalence and consequences of positive blood alcohol levels among patients injured at work

Aims:

The aim of this study was to characterize positive blood alcohol among patients injured at work, and to compare the severity of injury and outcome of blood alcohol concentration (BAC) positive and negative patients.

Settings and Design:

A retrospective cohort study was performed at a Level 1 academic trauma center. Patients injured at work between 01/01/07 and 01/01/12 and admitted with positive (BAC+) vs negative (BAC−) blood alcohol were compared using bivariate analysis.

Results:

Out of 823, 319 subjects were tested for BAC (38.8%), of whom 37 were BAC+ (mean 0.151 g/dL, range 0.015-0.371 g/dL). Age (41 years), sex (97.2% men), race, intensive care unit (ICU) and hospital length of stay (LOS), and mortality were similar between groups. Nearly half of BAC+ cases were farming injuries (18, 48.6%): Eight involved livestock, five involved all-terrain vehicles (ATVs), three involved heavy equipment, one fell, and one had a firearm injury. Eight (21.6%) were construction site injuries involving falls from a roof or scaffolding, five (13.5%) were semi-truck collisions, four (10.8%) involved falls from a vehicle in various settings, and two (5.4%) were crush injuries at an oilfield. BAC+ subjects were less likely to be injured in construction sites and oilfields, including vehicle-related falls (2.3 vs 33.9%, P < 0.0001). Over half of BAC+ (n = 20, 54%) subjects were alcohol dependent; three (8.1%) also tested positive for cocaine on admission. No BAC+ subjects were admitted to rehabilitation compared to 33 (11.7%) of BAC− subjects. Workers’ compensation covered a significantly smaller proportion of BAC+ patients (16.2 vs 61.0%, P < 0.0001).

Conclusions:

Alcohol use in the workplace is more prevalent than commonly suspected, especially in farming and other less regulated industries. BAC+ is associated with less insurance coverage, which probably affects resources available for post-discharge rehabilitation and hospital reimbursement.

Comparing the Effects of a Novel and a Traditional Proprioceptive Balance Training Program on Activity Adherence and Balance Control in a Healthy University Population: A Preliminary Study

OBJECTIVE

This study explored balance performance and participant adherence to either the Wii Fit™ (Nintendo of America, Redmond, WA) or a proprioceptive BOSU(®) (Ashland, OH) ball balance program.

MATERIALS AND METHODS

Twenty university-aged participants were randomly allocated to either a Wii Fit or BOSU ball balance training program. Participants engaged in one of the two training regimens for 20 minutes, three times a week, for 4 weeks. Adherence was measured by recording attendance and time spent at each session. Motivational factors associated with adherence were assessed using the Physical Activity Enjoyment Scale. Balance was measured using a stabilometer.

RESULTS

No significant difference in participant adherence was found between the groups. Significantly higher levels of activity enjoyment were reported from participants assigned to the Wii Fit intervention, and a positive correlation was found between physical activity enjoyment and adherence. A significant main effect for time demonstrating improved balance scores for both groups was found. No significant interaction between program type and time was found.

DISCUSSION

Although both interventions led to balance improvements, Wii Fit participants reported significantly higher levels of activity enjoyment. Although these higher levels of enjoyment did not lead to a statistically significant difference between the groups with regard to the number of sessions attended, participants assigned to the Wii Fit group spent more time engaged in the balance training activities than those allocated to the BOSU group. Although this study is preliminary and has the limitations of being statistically underpowered and dissimilar from the unsupervised home-based programs often prescribed by health professionals, results suggest that exergaming-based balance training may be an important adjunct to traditional training programs.