Effect of strength training on muscle function in elderly hospitalized patients

Hospitalization is associated with handgrip strength decline in older adults: a longitudinal study

BACKGROUND

Hospitalization episodes in older people are considered critical events because they act in a complex interaction among immobilization effects.

AIM

The purpose of this study was to evaluate the effects of hospitalization on older adults' handgrip strength (HGS) and to identify factors related to its performance on the test.

METHODS

A cohort study was conducted in a hospital in Natal, Brazil, and enrolled all patients aged 60 years and older between January 2014, and April 2015. Cognitive (Leganés Cognitive Test) and functional status (Katz Index, Lawton Scale and Functional limitation Nagi), physical performance (HGS and gait speed) and depressive symptom assessment (GDS-15) were evaluated at admission and discharge time, as well as information about health and functional status prior to hospitalization. Linear Mixed Models were used to create a predictive model for handgrip strength.

RESULTS

A total of 1168 hospitalized older adults were evaluated. A significant decrease in HGS means was observed between admission and discharge time for men (28.12 ± 10.35 and 20.22 ± 14.08 Kgf, p < 0.01) and for women (19.18 ± 7.87 and 14.88 ± 9.79 Kgf, p < 0.01). Undergoing surgery and basal values of the Katz Index were associated with worse HGS performance at discharge.

CONCLUSION

A significant decline in handgrip strength during the hospitalization period was observed, which was more pronounced in men. Performing surgery during hospitalization was an important factor for HGS decline in men and women. This study reinforces the importance of early mobilization and muscle strength loss prevention protocols in hospitalized older patients.

Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability among Older Adults in the Health ABC Study

BACKGROUND

Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with development of hospital-associated ADL disability in older adults in the Health ABC Study.

METHODS

Individuals hospitalized during the first 5 years of follow-up (n=1,724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of pre-hospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability.

RESULTS

Each standard deviation decrement in pre-hospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared to not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death.

CONCLUSIONS

Pre-hospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.

Vitamin D3 supplementation does not enhance the effects of resistance training in older adults

BACKGROUND

Lifestyle therapy with resistance training is a potent measure to counteract age-related loss in muscle strength and mass. Unfortunately, many individuals fail to respond in the expected manner. This phenomenon is particularly common among older adults and those with chronic diseases (e.g. chronic obstructive pulmonary disease, COPD) and may involve endocrine variables such as vitamin D. At present, the effects of vitamin D supplementation on responses to resistance training remain largely unexplored.

METHODS

Ninety-five male and female participants (healthy, n = 71; COPD, n = 24; age 68 ± 5 years) were randomly assigned to receive either vitamin D3 or placebo supplementation for 28 weeks in a double-blinded manner (latitude 61°N, September-May). Seventy-eight participants completed the RCT, which was initiated by 12 weeks of supplementation-only (two weeks with 10 000 IU/day, followed by 2000 IU/day), followed by 13 weeks of combined supplementation (2000 IU/day) and supervised whole-body resistance training (twice weekly), interspersed with testing and measurements. Outcome measures included multiple assessments of muscle strength (nvariables  = 7), endurance performance (n = 6), and muscle mass (n = 3, legs, primary), as well as muscle quality (legs), muscle biology (m. vastus lateralis; muscle fibre characteristics, transcriptome), and health-related variables (e.g. visceral fat mass and blood lipid profile). For main outcome domains such as muscle strength and muscle mass, weighted combined factors were calculated from the range of singular assessments.

RESULTS

Overall, 13 weeks of resistance training increased muscle strength (13% ± 8%), muscle mass (9% ± 8%), and endurance performance (one-legged, 23% ± 15%; whole-body, 8% ± 7%), assessed as weighted combined factors, and were associated with changes in health variables (e.g. visceral fat, -6% ± 21%; [LDL]serum , -4% ± 14%) and muscle tissue characteristics such as fibre type proportions (e.g. IIX, -3% points), myonuclei per fibre (30% ± 65%), total RNA/rRNA abundances (15%/6-19%), and transcriptome profiles (e.g. 312 differentially expressed genes). Vitamin D3 supplementation did not affect training-associated changes for any of the main outcome domains, despite robust increases in [25(OH)D]serum (∆49% vs. placebo). No conditional effects were observed for COPD vs. healthy or pre-RCT [25(OH)D]serum . In secondary analyses, vitamin D3 affected expression of gene sets involved in vascular functions in muscle tissue and strength gains in participants with high fat mass, which advocates further study.

CONCLUSIONS

Vitamin D3 supplementation did not affect muscular responses to resistance training in older adults with or without COPD.

Longitudinal Changes in Muscle Mass, Muscle Strength, and Physical Performance in Acutely Hospitalized Older Adults

OBJECTIVES

Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge.

DESIGN

A prospective observational cohort study was conducted.

SETTING AND PARTICIPANTS

This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge.

METHODS

Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People.

RESULTS

A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (-0.1 kg/m²; P = .03) decreased significantly and muscle strength (-0.5 kg; P = .08) decreased nonsignificantly. The chair stand (+0.7 points; P < .001) and gait speed test (+0.9 points; P < .001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively.

CONCLUSIONS AND IMPLICATIONS

Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization.

Comorbid Conditions in Chronic Obstructive Pulmonary Disease: Potential Therapeutic Targets for Unmet Needs

The management of chronic obstructive pulmonary disease (COPD) has improved significantly due to advances in therapeutic agents, but it has also become apparent that there are issues that remain difficult to solve with the current treatment algorithm. COPD patients face a number of unmet needs concerning symptoms, exacerbations, and physical inactivity. There are various risk factors and triggers for these unmet needs, which can be roughly divided into two categories. One is the usual clinical characteristics for COPD patients, and the other is specific clinical characteristics in patients with comorbid conditions, such as asthma, cardiovascular disease, and bronchiectasis. These comorbidities, which are also associated with the diversity of COPD, can cause unmet needs resistance to usual care. However, treatable conditions that are not recognized as therapeutic targets may be latent in patients with COPD. We again realized that treatable traits should be assessed and treated as early as possible. In this article, we categorize potential therapeutic targets from the viewpoint of pulmonary and systemic comorbid conditions, and address recent data concerning the pathophysiological link with COPD and the impact of intervention on comorbid conditions in order to obtain evidence that could enable us to provide personalized COPD management.

Patients performing lower limb exercises in an orthopedic ward: a best practice implementation project

AIMS

The evidence-based project sought to educate patients on doing lower limb exercises within 24 h of their admissions to the ward. Patients spend most of their time in bed during their hospital stays, which imposes negative outcomes due to inactivity, such as risks of reduced muscle mass and deconditioning, which may further implicate patients' conditions.

METHODS

The project occurred in three phases over a period of 18 months. The project was undertaken in an orthopedic ward of an acute tertiary hospital. A preimplementation and postimplementation audit strategy using the Joanna Briggs Institute's Practical Application of Clinical Evidence System was conducted on a sample of 20 adult patients. The Getting Research into Practice framework was utilized to analyze the barriers and gaps encountered in the clinical ground.

RESULTS

The baseline audit result revealed that only 35% of the patients received education on the exercise program and that there was poor compliance on nursing documentation of the intervention in daily note-free texts. Following the implementation, there was an improvement in nurses' documentation compliance. In follow-up audits one and two, the nurses achieved compliance rates of 60 and 90% in nursing documentation, respectively.

CONCLUSION

Overall, there were improvements in provision of lower limb exercise education to patients. This project has demonstrated that patients were willing to exercise during hospitalization. Nurses play a significant role in providing early education to patients to do simple exercises. The implementation of the evidence-based project may increase the awareness of the importance of exercises to minimize hospital-acquired deconditioning and functional declines among ward nurses and patients.

Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults

BACKGROUND

A classic consequence of short-term bed rest in older adults is the significant loss in skeletal muscle mass and muscle strength that underlies the accelerated physical performance deficits. Structured exercise programmes applied during acute hospitalization can prevent muscle function deterioration.

METHODS

A single-blind randomized clinical trial conducted in an acute care for elders unit in a tertiary public hospital in Navarre (Spain). Three hundred seventy hospitalized patients [56.5% female patients; mean age (standard deviation) 87.3 (4.9) years] were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training programme performed during 5-7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. The main endpoints were change in maximal dynamic strength (i.e. leg-press, chest-press, and knee extension exercises) and maximal isometric knee extensors and hip flexors strength from baseline to discharge. Changes in muscle power output at submaximal and maximal loads were also measured after the intervention.

RESULTS

The physical exercise programme provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 19.6 kg [95% confidence interval (CI), 16.0, 23.2; P < 0.001] on the one-repetition maximum (1RM) in the leg-press exercise, 5.7 kg (95% CI, 4.7, 6.8; P < 0.001) on the 1RM in the chest-press exercise, and 9.4 kg (95% CI, 7.3, 11.5; P < 0.001) on the 1RM in the knee extension exercise over usual-care group. There were improvements in the intervention group also in the isometric maximal knee extension strength [14.8 Newtons (N); 95% CI, 11.2, 18.5 vs. -7.8 N; 95% CI, -11.0, -3.5 in the control group; P < 0.001] and the hip flexion strength (13.6 N; 95% CI, 10.7, 16.5 vs. -7.2 N; 95% CI, -10.1, -4.3; P < 0.001). Significant benefits were also observed in the exercise group for the muscle power output at submaximal loads (i.e. 30% 1RM, 45% 1RM, 60% 1RM, and 75% 1RM; all P < 0.001) over usual-care group.

CONCLUSIONS

An individualized, multicomponent exercise training programme, with special emphasis on muscle power training, proved to be an effective therapy for improving muscle power output of lower limbs at submaximal loads and maximal muscle strength in older patients during acute hospitalization.

Reliability and Validity of the Sit-to-Stand as a Muscular Power Measure in Older Adults

The study aims were to analyze the reliability and validity of the GymAware™ linear position transducer's velocity and power measures during the sit-to-stand, compared with the Dartfish 2D videography analysis, and to assess the relationship of age and handgrip strength with velocity and power in 48 older men and women (77.6 ± 11.1 years). The results showed excellent agreement between GymAware- and Dartfish-derived sit-to-stand velocity (intraclass correlation coefficient2-1 = .94 and power intraclass correlation coefficient2-1 = .98) measures. A moderate and negative relationship was found between age and velocity (r = -.62; p < .001) and age and power (r = -.63; p < .001). A moderate and positive relationship was found between handgrip strength and velocity (r = .43; p = .002) and handgrip strength and power (r = .54; p < .001). The results show the GymAware velocity and power measures during the sit-to-stand in older adults to be reliable and valid.

Exercise prescription for symptoms and quality of life improvements in lung cancer patients: a systematic review

PURPOSE

The purpose of this study was to conduct a systematic review to assess the effect of exercise on symptoms and quality of life in lung cancer patients.

METHODS

We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, Scopus, Web of Science, and SciELO were searched for studies published from January 1998 to January 2019. The review included all randomized controlled trials that evaluated the effect of exercise on symptoms and quality of life of lung cancer patients. Two reviewers independently assessed the quality of all the included studies using the Physiotherapy Evidence Database scale.

RESULTS

In total, ten studies (835 participants) met all inclusion criteria. Three studies investigated the effect of exercise after lung resection, whereas four studies investigated it as a pre-surgery intervention. Two studies investigated the effect of exercise in patients under systemic treatment only, and one study included patients on diverse treatment plans. Exercise protocols consisted of different combinations of strength, aerobic, and inspiratory muscle training. Two trials, including 101 participants, found significant difference in quality of life between groups, favoring the intervention group; and five trials, including 549 participants, found significant inter-group differences in isolated symptoms, also favoring the intervention group.

CONCLUSIONS

Exercise can lead to improvements of symptoms and of quality of life in lung cancer survivors. Providing resistance training combined with high-intensity interval aerobic exercise after lung resection seems to be particularly effective. Further studies are warranted to investigate exercise for patients with poor performance status.

Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions

Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.

An open-label, single-center pilot study to test the effects of an amino acid mixture in older patients admitted to internal medicine wards

OBJECTIVE

Older patients are frequently subjected to prolonged hospitalization and extended bed rest, with a negative effect on physical activity and caloric intake. This results in a consistent loss of muscle mass and function, which is associated with functional decline and high mortality. The aim of this study was to investigate the effect of 1 wk of oral amino acid (AA) supplementation in older patients subjected to low mobility during hospitalization.

METHODS

Hospitalized older patients (69-87) were included in the control group (n = 50) or were administered 25 g of AA mixture (n = 44) twice daily throughout 7 d of low mobility. We collected data related to length of stay as primary outcome measure. In-hospital mortality, 90-d postdischarge mortality, 90-d postdischarge rehospitalization, and falls also were considered. Moreover, variations of anthropometric measures, body composition and muscle architecture/strength, circulating interleukins, and oxidative stress markers between the beginning and the end of the supplementation period were analyzed as secondary outcomes.

RESULTS

Similar values were reported between the two groups regarding age (76.6 ± 6.8 versus 79 ± 7.2 y old), body weight (61.5 ± 14.3 versus 62.1 ± 16.1 kg), and body mass index (28.7 ± 4.15 versus 28.1 ± 3.62 kg/m²). Although no difference in terms of in-hospital, 90-d postdischarge, or overall mortality rate was observed between the two groups, a reduction in length of stay, 90-d postdischarge hospitalization, and falls was observed in the AA supplementation group rather than in controls. Furthermore, the AA mixture limited muscle architecture/strength impairment and circulating oxidative stress, which occurred during hospitalization-related bed rest. The latter data was associated with increased circulating levels of anti-inflammatory cytokines interleukin-4 and -10.

CONCLUSIONS

These results suggest that the AA mixture limits several alterations associated with low mobility in older hospitalized patients, such as length of stay, 90-d postdischarge hospitalization, and falls, preventing the loss of muscle function, as well as the increase of circulating interleukins and oxidative stress markers.

Influence of between-limb asymmetry in muscle mass, strength, and power on functional capacity in healthy older adults

PURPOSE

Numerous daily tasks such as walking and rising from a chair involve bilateral lower limb movements. During such tasks, lower extremity function (LEF) may be compromised among older adults. LEF may be further impaired due to high degrees of between-limb asymmetry. The present study investigated the prevalence of between-limb asymmetry in muscle mass, strength, and power in a cohort of healthy older adults and examined the influence of between-limb asymmetry on LEF.

METHODS

Two hundred and eight healthy older adults (mean age 70.2 ± 3.9 years) were tested for LEF (400 m walking and 30-seconds chair stand). Furthermore, maximal isometric and dynamic knee extensor strength, leg extensor power, and lower limb lean tissue mass (LTM) were obtained unilaterally.

RESULTS

Mean between-limb asymmetry in maximal muscle strength and power ranged between 10% and 13%, whereas LTM asymmetry was 3 ± 2.3%. Asymmetry in dynamic knee extensor strength was larger for women compared with men (15.0 ± 11.8% vs 11.1 ± 9.5%; P = .005) Leg strength and power were positively correlated with LEF (r²  = .43-.46, P < .001). The weakest leg was not a stronger predictor of LEF than the strongest leg. Between-limb asymmetry in LTM and isometric strength was negatively associated with LEF (LTM; r²  = .12, P = .005, isometric peak torque; r²  = 0.40, P = .03.) but dynamic strength and power were not.

CONCLUSION

The present study supports the notion that in order to improve or maintain LEF, healthy older adults should participate in training interventions that increase muscle strength and power, whereas the effects of reducing between-limb asymmetry in these parameters might be of less importance.

Sarcopenia Associated with Chronic Obstructive Pulmonary Disease

Sarcopenia is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD) and cancer. COPD, which is characterized by an irreversible airflow limitation, exacerbates respiratory distress as the disease progresses. The prevalence of sarcopenia in stable COPD was reported to be 15% to 25% in previous foreign studies and 25% in a Korean study. As the amount of activity decreases, muscle mass decreases and eventually oxygen cannot be used effectively, resulting in a vicious cycle of deterioration of exercise capacity. Deconditioning due to decreased activity is a major cause of limb muscle dysfunction in patients with COPD. In these patients, the factors that decrease muscle strength and endurance include chronic inflammation, oxidative stress, inactivity, hypoxemia, hormone abnormality, deficits of nutrients such as protein and vitamin D, and the use of systemic corticosteroid. Therefore, treatment and management should either inhibit this process or should be directed toward supplementing the deficiency, such as with exercise, nutritional support, and medications and supplements. The relationship between sarcopenia and COPD is increasingly being reported, with some overlap in clinical features and treatments. We are fascinated to be able to diagnose 2 diseases through similar physical performance tests and to improve both diseases using the same treatment such as exercise. Therefore, this review summarizes the clinical relevance and integrative management of the 2 diseases.

Early Out-of-Bed Functional Exercise Benefits Elderly Patients Following Hip Fracture: A Retrospective Cohort Study

Hip fracture is a worldwide medical problem with devastating consequences. Older adults are at higher risk for complications and have more mobility limitation. The aim of this study was to assess the impact of delay in out-of-bed functional exercise on one-year mortality and functional outcomes for elderly patients with hip fracture in China. 1,022 cases of patients with hip fracture who were older than 75 were involved in this retrospective cohort study between 2007 and 2017. One-year mortality, follow up Activities of Daily Living (ADL) score, and Harris hip score were collected. Patients with hip fracture experienced an average of 2.9 days of in-bed functional exercise, 41.4% (n = 423) taken out-of-bed functional exercise within 2 days. A Cox proportional regression model showed that after adjustment for age, sex, cardiovascular disease, and urinary disease, delayed out-of-bed functional exercise (> 2 days) associated with higher one-year mortality (OR = 1.38, 95% confidence interval [CI]: 1.09 to 1.69). Ordinary least squares regression showed that delayed out-of-bed functional exercise associated with worsen ADL scores at 1-month (difference of -3.9 points, 95% CI: -6.4 to -1.7), although the long term ADL scores did not have increased. In addition, there were no associations between out-of-bed functional exercise timing and the Harris hip score at 12 months. In conclusion, in elderly patients with hip fracture in China, delayed out-of-bed functional exercise was not associated with improved Harris hip score, but it was associated with worsen ADL capacities at 1-month postoperatively and higher one-year mortality. The present study emphasizes the benefit of early out-of-bed exercise on the majority of elderly patients with hip fracture.

Loss of maximal explosive power of lower limbs after 2 weeks of disuse and incomplete recovery after retraining in older adults

KEY POINTS

Disuse in older adults can critically decrease lower limb muscle power, leading to compromised mobility and overall quality of life. We studied how muscle power and its determinants (muscle mass, single muscle fibre properties and motor control) adapted to 2 weeks of disuse and subsequent 2 weeks of physical training in young and older people. Disuse decreased lower limb muscle power in both groups; however, different adaptations in single muscle fibre properties and co-contraction of leg muscles were observed between young and older individuals. Six physical training sessions performed after disuse promoted the recovery of muscle mass and power. However, they were not sufficient to restore muscle power to pre-disuse values in older individuals, suggesting that further countermeasures are required to counteract the disuse-induced loss of muscle power in older adults.

ABSTRACT

Disuse-induced loss of muscle power can be detrimental in older individuals, seriously impairing functional capacity. In this study, we examined the changes in maximal explosive power (MEP) of lower limbs induced by a 14-day disuse (bed-rest, BR) and a subsequent 14-day retraining, to assess whether the impact of disuse was greater in older than in young men, and to analyse the causes of such adaptations. Sixteen older adults (Old: 55-65 years) and seven Young (18-30 years) individuals participated in this study. In a subgroup of eight Old subjects, countermeasures based on cognitive training and protein supplementation were applied. MEP was measured with an explosive ergometer, muscle mass was determined by magnetic resonance, motor control was studied by EMG, and single muscle fibres were analysed in vastus lateralis biopsy samples. MEP was ∼33% lower in Old than in Young individuals, and remained significantly lower (-19%) when normalized by muscle volume. BR significantly affected MEP in Old (-15%) but not in Young. Retraining tended to increase MEP; however, this intervention was not sufficient to restore pre-BR values in Old. Ankle co-contraction increased after BR in Old only, and remained elevated after retraining (+30%). Significant atrophy occurred in slow fibres in Old, and in fast fibres in Young. After retraining, the recovery of muscle fibre thickness was partial. The proposed countermeasures were not sufficient to affect muscle mass and power. The greater impact of disuse and smaller retraining-induced recovery observed in Old highlight the importance of designing suitable rehabilitation protocols for older individuals.

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

BACKGROUND

Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7).

METHODS

Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.

RESULTS

Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain.

CONCLUSION

Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.

Sarcopaenia in surgical populations: A review

Sarcopaenia, or decreased muscle mass, has been the subject of a large quantity of recent literature in both medical and surgical disciplines. It has been shown, as outlined below, to be of great prognostic importance, and also may be used in certain circumstances to guide treatment. The greatest volume of research into this topic is in oncological surgical populations, in whom the prevalence of sarcopaenia has been shown to be high. However it is being increasingly studied in other patient groups. Interest in using sarcopaenia as an objective and potentially modifiable marker of frailty is increasing, especially with regards to pre-operative risk stratification and amelioration. In this review we consider the current literature regarding the cause and effect of sarcopaenia, the methods by which it may be identified and the potential ways in which it may be treated, in the interest of improving outcomes for surgical patients.

Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer

BACKGROUND

The association between sarcopenia and postoperative outcomes for patients with gastrointestinal malignancies remains controversial. This study aimed to assess the impact of sarcopenia on short- and long-term outcomes after surgery for esophagogastric junction cancer (EGJC) or upper gastric cancer (UGC).

METHODS

The study reviewed 148 patients with EGJC or UGC who underwent surgical resection. The patients were categorized into the sarcopenia group or the non-sarcopenia group according to their skeletal muscle index calculated using abdominal computed tomography images. The study compared clinicopathologic factors, postoperative complications, and prognosis between the two groups.

RESULTS

Sarcopenia was present in 19 patients (32.2%) with EGJC and 23 patients (25.8%) with UGC. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly poorer in the sarcopenia group than in the non-sarcopenia group (OS 85.5 vs 54.8%, P = 0.0010; RFS 78.7 vs 51.7%, P = 0.0054). The development of postoperative complications did not differ significantly between the two groups. Both the uni- and multivariate analyses showed that N stage (P < 0.0001) and sarcopenia (P = 0.0024 and 0.0293, respectively) were independent poor prognostic factors for OS.

CONCLUSIONS

Sarcopenia was strongly associated with a poor long-term prognosis for patients with EGJC or UGC who underwent surgery. The results suggest that special attention might be needed during the development of treatment strategies for patients with sarcopenia who intend to undergo operations for EGJC and UGC.

Supervised progressive cross-continuum strength training compared with usual care in older medical patients: study protocol for a randomized controlled trial (the STAND-Cph trial)

BACKGROUND

Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients.

METHODS

Eighty older medical patients (65 years or older) acutely admitted from their own homes will be included in this randomized, controlled, parallel-group, investigator-blinded, superiority trial. After baseline assessments patients will be randomized to (1) intervention: progressive strength training during hospitalization and after discharge (home-based), or (2) control: usual care. Shortly after discharge, 4 weeks after discharge (primary end point) and 6 months after discharge patients will be assessed in their own homes. The intervention encompasses strength training consisting of two lower extremity exercises (sit-to-stand and heel raise) daily during hospitalization and three times per week for 4 weeks after discharge. Both exercises follow pre-defined models for progression and will be performed for three sets of 8-12 repetitions maximum in each training session. Thereafter, the patient will be asked to consume a protein supplement given orally containing 18 g milk-based protein. The primary outcome will be change in the de Morton Mobility Index score from baseline to 4 weeks after discharge. Secondary outcomes will be 24-h mobility level, isometric knee extension strength, the 30-sec sit-to-stand test, habitual gait speed, hand-grip strength, and Activities of Daily Living.

DISCUSSION

We chose to investigate the effect of a minimal time-consuming treatment approach, i.e. two well-performed strength training exercises combined with protein supplementation, to facilitate implementation in a busy clinical care setting, given a positive trial outcome.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01964482 .

Greater loss in muscle mass and function but smaller metabolic alterations in older compared with younger men following 2 wk of bed rest and recovery

This investigation aimed to compare the response of young and older adult men to bed rest (BR) and subsequent rehabilitation (R). Sixteen older (OM, age 55-65 yr) and seven young (YM, age 18-30 yr) men were exposed to a 14-day period of BR followed by 14 days of R. Quadriceps muscle volume (QVOL), force (QF), and explosive power (QP) of leg extensors; single-fiber isometric force (Fo); peak aerobic power (V̇o2peak); gait stride length; and three metabolic parameters, Matsuda index of insulin sensitivity, postprandial lipid curve, and homocysteine plasma level, were measured before and after BR and after R. Following BR, QVOL was smaller in OM (-8.3%) than in YM (-5.7%,P= 0.031); QF (-13.2%,P= 0.001), QP (-12.3%,P= 0.001), and gait stride length (-9.9%,P= 0.002) were smaller only in OM. Fo was significantly smaller in both YM (-32.0%) and OM (-16.4%) without significant differences between groups. V̇o2peakdecreased more in OM (-15.3%) than in YM (-7.6%,P< 0.001). Instead, the Matsuda index fell to a greater extent in YM than in OM (-46.0% vs. -19.8%, respectively,P= 0.003), whereas increases in postprandial lipid curve (+47.2%,P= 0.013) and homocysteine concentration (+26.3%,P= 0.027) were observed only in YM. Importantly, after R, the recovery of several parameters, among them QVOL, QP, and V̇o2peak, was not complete in OM, whereas Fo did not recover in either age group. The results show that the effect of inactivity on muscle mass and function is greater in OM, whereas metabolic alterations are greater in YM. Furthermore, these findings show that the recovery of preinactivity conditions is slower in OM.

Feasibility of progressive sit-to-stand training among older hospitalized patients

Background. In older patients, hospitalization is associated with a decline in functional performance and loss of muscle strength. Loss of muscle strength and functional performance can be prevented by systematic strength training, but details are lacking regarding the optimal exercise program and dose for older patients. Therefore, our aim was to test the feasibility of a progression model for loaded sit-to-stand training among older hospitalized patients.

Methods. This is a prospective cohort study conducted as a feasibility study prior to a full-scale trial. We included twenty-four older patients (≥65 yrs) acutely admitted from their own home to the medical services of the hospital. We developed an 8-level progression model for loaded sit-to-stands, which we named STAND. We used STAND as a model to describe how to perform the sit-to-stand exercise as a strength training exercise aimed at reaching a relative load of 8–12 repetitions maximum (RM) for 8–12 repetitions. Weight could be added by the use of a weight vest when needed. The ability of the patients to reach the intended relative load (8–12 RM), while performing sit-to-stands following the STAND model, was tested once during hospitalization and once following discharge in their own homes. A structured interview including assessment of possible modifiers (cognitive status by the Short Orientation Memory test and mobility by the De Morton Mobility Index) was administered both on admission to the hospital and in the home setting. The STAND model was considered feasible if: (1) 75% of the assessed patients could perform the exercise at a given level of the model reaching 8–12 repetitions at a relative load of 8–12 RM for one set of exercise in the hospital and two sets of exercise at home; (2) no ceiling or floor effect was seen; (3) no indication of adverse events were observed. The outcomes assessed were: level of STAND attained, the number of sets performed, perceived exertion (the Borg scale), and pain (the Verbal Ranking Scale).

Results. Twenty-four patients consented to participate. Twenty-three of the patients were tested in the hospital and 19 patients were also tested in their home. All three criteria for feasibility were met: (1) in the hospital, 83% could perform the exercise at a given level of STAND, reaching 8–12 repetitions at 8–12 RM for one set, and 79% could do so for two sets in the home setting; (2) for all assessed patients, a possibility of progression or regression was possible—no ceiling or floor effect was observed; (3) no indication of adverse events (pain) was observed. Also, those that scored higher on the De Morton Mobility Index performed the exercise at higher levels of STAND, whereas performance was independent of cognitive status.

Conclusions. We found a simple progression model for loaded sit-to-stands (STAND) feasible in acutely admitted older medical patients (≥65 yrs), based on our pre-specified criteria for feasibility.

Effects of blood-flow-restricted resistance training on muscle function in a 74-year-old male with sporadic inclusion body myositis: a case report

Sporadic inclusion body myositis (sIBM) is a systemic disease that is characterized by substantial skeletal muscle weakness and muscle inflammation, leading to impaired physical function. The objective was to investigate the effect of low-load resistance exercise with concurrent partial blood flow restriction to the working muscles (blood-flow-restricted (BFR) training) in a patient with sIBM. The training consisted of 12 weeks of lower extremity BFR training with low training loads (~25-RM). The patient was tested for mechanical muscle function and functional capacity before and after 6 and 12 weeks of training. Maximal horizontal gait speed increased by 19%, which was accompanied by 38-92% improvements in mechanical muscle function (maximal isometric strength, rate of force development and muscle power). In conclusion, BFR training was well tolerated by the patient with sIBM and led to substantial improvements in mechanical muscle function and gait speed.

Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint

This study investigated the effects of a multicomponent exercise intervention on muscle strength, incidence of falls and functional outcomes in frail elderly patients with dementia after long-term physical restraint, followed by 24 weeks of training cessation. Eighteen frail elderly patients with mild dementia (88.1 ± 5.1 years) performed a multicomponent exercise program, which consisted of 4 weeks of walking, balance and cognitive exercises, followed by 4 weeks of resistance exercise performed twice weekly [8-12 repetitions at 20-50 % of the one-repetition maximum (1RM)], combined with walking, balance and cognitive exercises. Before and after training, as well as after 24 weeks of training cessation, strength outcomes, Barthel Index, balance, gait ability, rise from a chair ability, dual task performance, incidence of falls and Mini-Mental State Examination were assessed. After the first 4 weeks of training, there was a significant improvement only in the balance test, whereas no additional changes were observed. However, after the second part of the training, the participants required significantly less time for the time-up-and-go test (P < 0.05), and improved the isometric hand grip, hip flexion and knee extension strength, as well as the leg press 1RM (P < 0.01). A significant reduction was also observed in the incidence of falls (P < 0.01). After 24 weeks of training cessation, abrupt decreases were observed in nearly all of the physical outcomes (P < 0.05). The exercise intervention improved strength, balance and gait ability in frail elderly patients with dementia after long-term physical restraint, and these benefits were lost after training cessation.

[Review of functional impairment associated with acute illness in the elderly]

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.

In aged men, central vessel transmural pressure is reduced by brief Valsalva manoeuvre during strength exercise

A brief Valsalva manoeuvre, lasting 2-3 s, performed by young healthy men during strength exercise reduces transmural pressure acting on intrathoracic arteries. In this study, we sought to verify this finding in older men. Twenty normotensive, prehypertensive and moderately hypertensive otherwise healthy men 46-69 years old performed knee extensions combined with inspiration or with brief Valsalva manoeuvre performed at 10, 20 and 40 mmHg mouth pressure. Same respiratory manoeuvres were also performed at rest. Non-invasively measured blood pressure, knee angle, respiratory airflow and mouth pressure were continuously registered. In comparison to inspiration, estimated transmural pressure acting on thoracic arteries changed slightly and insignificantly during brief Valsalva manoeuvre at 10 and 20 mmHg mouth pressure. At 40 mmHg mouth pressure, transmural pressure declined at rest (-8·8 ± 11·4 mmHg) and during knee extension (-12·1 ± 11·9 mmHg). This decline ensued, as peak systolic pressure increase caused by this manoeuvre, was distinctly <40 mmHg. Only a main effect of mouth pressure was revealed (P<0·001) and neither exercise nor interaction between these factors, what suggests that transmural pressure decline, depended mainly on intrathoracic pressure developed during brief Valsalva manoeuvre. Resting blood pressure did not influence the effect of brief Valsalva manoeuvre on transmural pressure.

The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol

Background

The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone.

Methods/design

A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed.

Discussion

To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients with an indication for surgery on the time to total hip replacement.

Trial registration

NCT01697241

A qualitative review of balance and strength performance in healthy older adults: impact for testing and training

A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.

Post exercise cardiovascular effects of different resistance exercise protocols for trunk and upper limbs

Objective: to analyze the post exercise cardiovascular effects of different resistance exercise protocols for trunk and upper limbs. Methods: Fifteen males (22.3 ± 0.9 years) underwent three experimental sessions randomly: control session (C), resistance exercise session at 50% of one repetition maximum (1-RM) (E50%), and resistance exercise session at 70% of 1-RM (E70%). Three sets of 12, 9 and 6 repetitions were performed for each exercise. Blood pressure (BP), heart rate (HR) and rate pressure product (RPP) were measured before and during 90 minutes after each session. Results: Systolic BP decreased (P<.05) and diastolic BP increased (P<.05) similarly after C, E50% and E70%. However, HR and RPP decreased after C (P<.01), maintained after E50%, and increased after E70% (P<.01). Conclusions: The resistance exercise intensity did not influence post-exercise BP responses, however, cardiac overload was greater after E70%

Recovery in mechanical muscle strength following resurfacing vs standard total hip arthroplasty - a randomised clinical trial

OBJECTIVES

To evaluate the effect of resurfacing vs standard total hip replacement on post-surgery hip and knee muscle strength recovery in a prospective randomised controlled trial at the Department of Orthopaedics, University Hospital, Odense, Denmark.

METHODS

Forty-three patients were randomised into (A) standard total hip arthroplasty (S-THA) and (B) resurfacing total hip arthroplasty (R-THA). Pre-surgery assessment and follow-up were conducted (8, 26 and 52 wks). Maximal isometric muscle strength (Nm) and between-limb asymmetry for the knee extensors/flexors, hip adductors/abductors, hip extensors/flexors were analysed.

RESULTS

Maximal knee extensor and hip abductor strength were higher in S-THA than R-THA at 52 wks post-surgery (P ≤ 0.05) and hip extensors tended to be higher in S-THA at 52 wks (P = 0.06). All muscle groups showed substantial between-limb strength asymmetry (7-29%) with the affected side being weakest (P ≤ 0.05) and hip flexors being most affected. Asymmetry was present in half of the muscle groups at 26 wks (P ≤ 0.05), and remained present for the hip flexors and hip adductors at 52 wks (P ≤ 0.05).

CONCLUSIONS

R-THA patients showed an attenuated and delayed recovery in maximal lower limb muscle strength (in 2/6 muscle groups) compared to S-THA. Notably, the attenuated strength recovery following R-THA was most markedly manifested in the late phase (1 yr) of post-surgical recovery, and appeared to be due to the detachment of the lower half of the gluteus maximus muscle rather than implant design per se. Thus, the present data failed to support the hypothesis that R-THA would result in an enhanced strength rehabilitation compared to S-THA. Further, between-limb asymmetry remained present for hip flexors and adductors after 52 wks.

TRIAL REGISTRATION

NCT01229293.

Strength training as a countermeasure to aging muscle and chronic disease

Strength training (ST) has long been considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure associated with advanced age but, until recently, the evidence was insufficient to support its role in the prevention or treatment of disease. In recent decades, there has been a long list of quality reviews examining the effects of ST on functional abilities and a few on risk factors for specific diseases, but none have provided a comprehensive assessment of ST as an intervention for a broad range of diseases. This review provides an overview of research addressing the effectiveness of ST as an intervention for the prevention or treatment of the adverse consequences of (i) aging muscle; (ii) the metabolic syndrome (MetS) and its components, i.e. insulin resistance, abdominal obesity, hyperlipidaemia and hypertension; (iii) fibromyalgia; (iv) rheumatoid arthritis; and (v) Alzheimer's disease. Collectively, these studies indicate that ST may serve as an effective countermeasure to some of the adverse consequences of the MetS, fibromyalgia and rheumatoid arthritis. Evidence in support of the hypothesis that ST reduces insulin resistance or improves insulin action comes both from indirect biomarkers, such as glycosylated haemoglobin (HbA(1c)), and insulin responses to oral glucose tolerance tests, as well as from more direct procedures such as hyperglycaemic and hyperinsulinaemic-euglycaemic clamp techniques. The evidence for the use of ST as a countermeasure of abdominal obesity is less convincing. Although some reports show statistically significant reductions in visceral fat, it is unclear if the magnitude of these changes are physiologically meaningful and if they are independent of dietary influences. The efficacy of ST as an intervention for reducing dyslipidaemia is at best inconsistent, particularly when compared with other pharmacological and non-pharmacological interventions, such as aerobic exercise training. However, there is more consistent evidence for the effectiveness of ST in reducing triglyceride levels. This finding could have clinical significance, given that elevated triglyceride is one of the five criterion measures for the diagnosis of the MetS. Small to moderate reductions in resting and exercise blood pressure have been reported with some indication that this effect may be genotype dependent. ST improves or reverses some of the adverse effects of fibromyalgia and rheumatoid arthritis, particularly pain, inflammation, muscle weakness and fatigue. Investigations are needed to determine how these effects compare with those elicited from aerobic exercise training and/or standard treatments. There is no evidence that ST can reverse any of the major biological or behavioural outcomes of Alzheimer's disease, but there is evidence that the prevalence of this disease is inversely associated with muscle mass and strength. Some indicators of cognitive function may also improve with ST. Thus, ST is an effective countermeasure for some of the adverse effects experienced by patients of many chronic diseases, as discussed in this review.

The intensity and effects of strength training in the elderly

BACKGROUND

The elderly need strength training more and more as they grow older to stay mobile for their everyday activities. The goal of training is to reduce the loss of muscle mass and the resulting loss of motor function. The dose-response relationship of training intensity to training effect has not yet been fully elucidated.

METHODS

PubMed was selectively searched for articles that appeared in the past 5 years about the effects and dose-response relationship of strength training in the elderly.

RESULTS

Strength training in the elderly (>60 years) increases muscle strength by increasing muscle mass, and by improving the recruitment of motor units, and increasing their firing rate. Muscle mass can be increased through training at an intensity corresponding to 60% to 85% of the individual maximum voluntary strength. Improving the rate of force development requires training at a higher intensity (above 85%), in the elderly just as in younger persons. It is now recommended that healthy old people should train 3 or 4 times weekly for the best results; persons with poor performance at the outset can achieve improvement even with less frequent training. Side effects are rare.

CONCLUSION

Progressive strength training in the elderly is efficient, even with higher intensities, to reduce sarcopenia, and to retain motor function.

Progressive strength training in older patients after hip fracture: a randomised controlled trial

OBJECTIVE

the aim of this study was to assess the effect of a 3-month strength-training programme on functional performance and self-rated health in a group of home-dwelling older hip fracture patients.

DESIGN

randomised, controlled; single-blind parallel-group trial.

SETTING

intervention at outpatient's clinic.

SUBJECTS

one hundred and fifty patients with surgical fixation for a hip fracture.

METHODS

strength training was integrated into all stages of the programme. The programme comprised four exercises, half of them in a standing position, performed at 80% of maximum. Measurements were taken after the 3-month intervention. The primary outcome measurement was the Berg Balance Scale (BBS). Secondary outcomes were results of the sit-to-stand test, Timed Up-and-Go test, maximal gait speed, 6-min walk test, Nottingham Extended Activities of Daily Living scale and the SF-12 health status questionnaire.

RESULTS

at baseline, there were no significant between-group differences. At follow-up, the intervention group showed highly significant improvements both in the primary endpoint (BBS, mean difference 4.7 points) and in secondary endpoints of tapping strength, mobility and instrumental activities of daily living.

CONCLUSION

home-dwelling hip fracture patients can benefit from an extended supervised strength-training programme in a rehabilitation setting. These patients are capable of high-intensity strength training, which should optimise gains in physical function, strength and balance. Resistance exercise training seems to influence functional performance adaptation.

Effects of aging on muscle mechanical function and muscle fiber morphology during short-term immobilization and subsequent retraining

Very little attention has been given to the combined effects of aging and disuse as separate factors causing deterioration in muscle mechanical function. Thus the purpose of this study was to investigate the effects of 2 wk of immobilization followed by 4 wk of retraining on knee extensor muscle mechanical function (e.g., maximal strength and rapid force capacity) and muscle fiber morphology in 9 old (OM: 67.3 ± 1.3 yr) and 11 young healthy men (YM: 24.4 ± 0.5 yr) with comparable levels of physical activity. Following immobilization, OM demonstrated markedly larger decreases in rapid force capacity (i.e., rate of force development, impulse) than YM (∼ 20-37 vs. ∼ 13-16%; P < 0.05). In contrast, muscle fiber area decreased in YM for type I, IIA, and IIx fibers (∼ 15-30%; P < 0.05), whereas only type IIa area decreased in OM (13.2%; P < 0.05). Subsequent retraining fully restored muscle mechanical function and muscle fiber area in YM, whereas OM showed an attenuated recovery in muscle fiber area and rapid force capacity (tendency). Changes in maximal isometric and dynamic muscle strength were similar between OM and YM. In conclusion, the present data reveal that OM may be more susceptible to the deleterious effects of short-term muscle disuse on muscle fiber size and rapid force capacity than YM. Furthermore, OM seems to require longer time to recover and regain rapid muscle force capacity, which may lead to a larger risk of falling in aged individuals after periods of short-term disuse.

Development of a therapeutic exercise program for patients with osteoarthritis of the hip

BACKGROUND AND PURPOSE

No detailed exercise programs specifically for patients with hip osteoarthritis (OA) have been described in the literature. This lack of data creates a gap between the recommendation that people with OA should exercise and the type and dose of exercises that they should perform. The purpose of this case report is to describe and demonstrate the use of a therapeutic exercise program for a patient with hip OA.

CASE DESCRIPTION

A 58-year-old woman with hip OA completed a 12-week therapeutic exercise program (TEP) with a 6-month follow-up. The patient reported hip pain, joint stiffness, and limited physical function, and she had decreased hip range of motion (ROM) at baseline.

OUTCOMES

The patient performed 19 sessions during the TEP, with a mean of 19.5 exercises per session. She increased the resistance in 3 of 5 strength (force-generating capacity) training exercises and achieved the highest degree of difficulty in all functional exercises. During the TEP and follow-up, the patient reported improvements in pain, joint stiffness, and physical function. Performance improved on the following physical tests: isokinetic peak torque strength (60 degrees /s) in hip extension (40%), hip flexion (27%), knee extension (17%), and knee flexion (42%); hip ROM extension (8 degrees ); and 6-minute walk distance (83 m).

DISCUSSION

The patient experienced less pain and improved physical function and physical test outcomes after intervention and at the 6-month follow-up. The main challenges when prescribing an exercise program for a patient with hip OA are monitoring the exercises to provide improvements without provoking persistent pain and motivating the patient to achieve long-term adherence to exercising. Randomized clinical trials are needed to evaluate the efficacy of this TEP in patients with hip OA.

Electrical impedance myography in the assessment of disuse atrophy

Tarulli AW, Duggal N, Esper GJ, Garmirian LP, Fogerson PM, Lin CH, Rutkove SB. Electrical impedance myography in the assessment of disuse atrophy.

OBJECTIVE

To quantify disuse atrophy using electrical impedance myography (EIM), a noninvasive technique that we have used successfully to study neurogenic and myopathic atrophy.

DESIGN

We performed EIM of the tibialis anterior of subjects with disuse atrophy secondary to cast immobilization and in their contralateral normal leg. Subjects were studied shortly after cast removal and again several weeks to months after the cast was removed and normal mobility was restored.

SETTING

Outpatient neurology and orthopedic practices at a tertiary care medical center.

PARTICIPANTS

Otherwise healthy subjects (N=10) with unilateral leg fracture.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Resistance, reactance, and phase measured at 50kHz.

RESULTS

The main EIM outcome parameter, phase at 50kHz, was lower in the immobilized leg in 9 of 10 cases. Additionally, when normal mobility was restored, the phase of the casted leg increased relative to its initial measurement in all 10 cases, while it increased inconsistently in the contralateral leg.

CONCLUSIONS

EIM may be a powerful tool for the assessment of disuse atrophy.