Use of an elliptical machine for improving functional walking capacity in individuals with chronic stroke: a case series

Renal Function Recovery Strategies Following Marathon in Amateur Runners

Long distance races have a physiological impact on runners. Up to now, studies analyzing these physiological repercussions have been mainly focused on muscle and cardiac damage, as well as on its recovery. Therefore, a limited number of studies have been done to explore acute kidney failure and recovery after performing extreme exercises. Here, we monitored renal function in 76 marathon finishers (14 females) from the day before participating in a marathon until 192 h after crossing the finish line (FL). Renal function was evaluated by measuring serum creatinine (sCr) and the glomerular filtration rate (GFR). We randomly grouped our cohort into three intervention groups to compare three different strategies for marathon recovery: total rest (REST), continuous running at their ventilatory threshold 1 (VT1) intensity (RUN), and elliptical workout at their VT1 intensity (ELLIPTICAL). Interventions in the RUN and ELLIPTICAL groups were performed at 48, 96, and 144 h after marathon running. Seven blood samples (at the day before the marathon, at the FL, and at 24, 48, 96, 144, and 192 h post-marathon) and three urine samples (at the day before the marathon, at the finish line, and at 48 h post-marathon) were collected per participant. Both heart rate monitors and triaxial accelerometers were used to control the intensity effort during both the marathon race and the recovery period. Contrary to our expectations, the use of elliptical machines for marathon recovery delays renal function recovery. Specifically, the ELLIPTICAL group showed a significantly lower ∆GFR compared to both the RUN group (p = 4.5 × 10−4) and the REST group (p = 0.003). Hence, we encourage runners to carry out an active recovery based on light-intensity continuous running from 48 h after finishing the marathon. In addition, full resting seems to be a better strategy than performing elliptical workouts.

Variations in plantar pressure variables across elliptical trainers in older adults

BACKGROUND

Ellipticals are used to address walking and cardiorespiratory training goals of older adults, some of whom are at risk for foot injuries. Variations in joint kinematics and muscle demands when using different ellipticals could lead to plantar pressure differences. This study explored plantar pressure variables during gait and use of four ellipticals.

METHODS

Plantar pressures were recorded while 10 adults [68.1 (4.5) years] walked and used the True, Octane, Life Fitness, and SportsArt ellipticals. Repeated-measures ANOVAs (5 × 1) identified forefoot and heel differences across conditions.

FINDINGS

Maximum forefoot forces and peak pressures were significantly lower than walking for each elliptical condition with one exception (Life Fitness peak pressure). However, sustained elliptical pedal contact time contributed to forefoot pressure-time integrals and dosages (i.e., cumulative pressure during one minute of activity) not varying significantly amongst elliptical and walking conditions. Heel maximum forces and peak pressures were significantly lower than walking during all elliptical conditions except SportsArt. Heel contact time on SportsArt and Octane exceeded walking, and SportsArt heel contact time exceeded Life Fitness. Heel pressure-time integral was greater on SportsArt compared to walking, Life Fitness, and True. Sports Art heel dosage exceeded Life Fitness and True.

INTERPRETATION

While elliptical training's sustained double limb support diminished maximal forces and peak pressures under the forefoot and heel compared to walking, each ellipticals' pressure-time integral and dosage were not significantly lower than walking. These findings point to the importance of carefully initiating elliptical training programs to minimize tissue injury, particularly if sensory neuropathy is present.

Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial

Background: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.

Persons with multiple sclerosis show altered joint kinetics during walking after participating in elliptical exercise

Patients with multiple sclerosis (MS) experience abnormal gait patterns and reduced physical activity. The purpose of this study was to determine if an elliptical exercise intervention for patients with MS would change joint kinetics during gait toward healthy control values. Gait analysis was performed on patients with MS (n = 24) before and after completion of 15 sessions of supervised exercise. Joint torques and powers were calculated, while also using walking velocity as a covariate, to determine the effects of elliptical exercise on lower extremity joint kinetics during gait. Results show that elliptical exercise significantly altered joint torques at the ankle and hip and joint powers at the ankle during stance. The change in joint power at the ankle indicates that, after training, patients with MS employed a walking strategy that is more similar to that of healthy young adults. These results support the use of elliptical exercise as a gait training tool for patients with MS.