Effects of different core exercises on respiratory parameters and abdominal strength

The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss.

DESIGN

We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks.

RESULTS

In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total.

CONCLUSIONS

Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.

Effects of hypopressive exercises on pelvic floor and abdominal muscles in adult women: A systematic review of randomized clinical trials

INTRODUCTION

Hypopressive exercises (HE) are postural and breathing exercises that activate deep muscles in the abdomen and pelvic floor. Despite this, there is still no consensus in the literature on its real effectiveness. The objective was to analyze the effects of HE on the abdominal and pelvic floor muscles in women with or without dysfunctions in these regions.

METHODS

This is a systematic review of randomized clinical trials found in the PEDro, PubMed, Cochrane, LILACS, and Embase databases. We include studies that evaluate the effects of HE (with or without other techniques) on the pelvic floor and abdominal region for 8 weeks or more, in women over 18 years old, with or without dysfunction in these regions, with the presence of a control group (active or passive).

RESULTS

HE were effective in improving strength, tone, and reducing symptoms of pelvic floor dysfunctions, in magnitude less than (in two studies) or equal (in one study) to the pelvic floor muscle training (PFMT). When HE were performed with PFMT in the same group, no additional benefits were found. Only one study evaluated abdominal muscles activation, where HE were effective in improving postural control and activation of the transversus abdominis muscle.

CONCLUSIONS

The HE presented positive results to the evaluated parameters. However, the information is still preliminary and scarce. There are methodological divergences regarding the execution, follow-up and standardization of the method, which could affect the results. According to the existing information, HE cannot yet be reliably indicated for the treatment of the pelvic floor, despite pointing out relevant results in some studies. More randomized clinical trials and long-term studies are needed to analyze the effects of HE not only for pelvic floor, but also for other regions, such as abdominal muscles and related dysfunctions.

Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial

INTRODUCTION

Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease.

METHODS

A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures.

RESULTS

The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53).

CONCLUSIONS

No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively. NCT02622737.

Effect of the Dynamic Neuromuscular Stabilization Technique on Functional Capacity in Overweight and Obese Individuals: A Randomized Controlled Trial

Background Individuals with overweight and obesity (OW/OB) have poor performance in weight-bearing exercises, resulting in low functional capacity. The dynamic neuromuscular stabilization (DNS) technique was created to engage the core-postural chain in conjunction with the core muscles, generating enough intra-abdominal pressure to dynamically support the spine through muscular activity. DNS is a strategy that emphasizes the activation of the spine's intrinsic stabilizers, as well as proper breathing patterns, before any intended functional movement. The aim and objective of this study was to determine the effectiveness of the DNS technique on functional capacity in OW/OB individuals and to compare the effectiveness of the DNS and conventional approach. Methods The study recruited 100 individuals, who were separated into an experimental group (DNS technique) and a control group (conventional exercises), each with 50 participants. Outcome measures, including a six-minute walk test (SMW test) and body mass index (BMI), were taken pre-treatment and post-treatment. Results and discussion Based on the inclusion criteria of this study, the age group included was 20 to 25 years old. Pre- and post-treatment statistically significant changes were observed in the experimental and control groups in the BMI and SMW test. However, the BMI (kg/m2) was not statistically significant in the experimental group (t-value=-0.15, p=0.87) and control group (t-value=-0.22, p=0.82). Moreover, in the SMW test (meter), no statistical significance was found in the experimental group (t-value=-0.15, p=0.87) and control group (t-value=- 0.22, p=0.82). Conclusions Both groups are effective in increasing the functional capacity of obese and overweight individuals. The study indicates a strong need for further research into its long-term effectiveness in the OW/OB population.

Muscle Activity and Aerodynamic Voice Changes at Different Body Postures: A Pilot Study

OBJECTIVE

Body posture is a commonly discussed component of voice training and therapy. However, body postures, postural changes, related posturing muscle monitoring, and the potential changes in voice production (eg, glottal aerodynamic changes, acoustic differences) have been inconsistently described in the literature, leaving room for free interpretation and possible misunderstandings. The primary purpose of this pilot study was to compare the magnitude of electromyographical activation of muscles involved in phonation-breathing functions and their changes due to four standardized body postures in experienced singers. Secondly, to identify which body posture produces greater changes in aerodynamic parameters, vocal pitch, and loudness.

METHODS

Eight healthy adults with experience in singing voice performed a vocal task during different body postures commonly used in both voice training and therapy. A 3D-capture system was used to control and quantify the alignment of each posture. During the performances, surface electromyography (sEMG) was used to measure the muscular activity involved in the breathing/phonation and posture processes. A nonparametric Kruskal-Wallis test was used to compare the sEMG activity of phonatory muscles and aerodynamic voice variables between postures.

RESULTS

Our study did not reveal significant differences in sEMG activity, aerodynamic parameters, vocal pitch, and loudness among body postures during vocal task productions. However, the vocal pitch (in semitones) revealed significant differences in the unstable surface when compared to the upright posture, modified upright, and leaning postures.

CONCLUSION

The body postures selected did not generate voice aerodynamic modifications of the voice nor in the levels of activation of muscles involved in the phonation-breathing process in individuals with experience in singing voice. Modifications of body posture as a tool for voice therapy should be further investigated, considering the population with voice problems and no voice training experience.

Women's Respiratory Movements during Spontaneous Breathing and Physical Fitness: A Cross-Sectional, Correlational Study

BACKGROUND

Abdominal/diaphragmatic breathing exercises are popular worldwide and have been proven to be beneficial for physical performance. Is abdominal motion (AM) during spontaneous breathing correlated with physical fitness? The present study aimed to answer this question.

METHODS

434 women (aged 20-59) were enrolled and participated in respiration tests using two respiration belts (one was tied at the height of the xiphoid and another at the navel) to detect AM and thoracic motion (TM). They also performed physical fitness tests to measure body size, muscular strength, muscular power, muscular endurance, balance, flexibility, reaction time, and cardiorespiratory endurance.

RESULTS

All the correlation coefficients between respiratory movements (AM, TM, AM + TM, AM/(AM + TM)) and physical fitness outcomes were less than 0.4/-0.4. Only AM and muscular power (countermovement jump height) had a weak correlation, with a correlation coefficient close to 0.4 in the 20-29-year age group (r_s = 0.398, p = 0.011, n = 40).

CONCLUSIONS

Women's respiratory movements during spontaneous breathing were not correlated with physical fitness. Future studies may focus on the relationship between AM and countermovement jump height in young women with a larger sample size and using ultrasound to directly test the excursion of the diaphragm.

Integrated Nutritional Supports for Diabetic Patients During COVID-19 Infection: A Comprehensive Review

BACKGROUND

Diabetes mellitus is an endocrine metabolic disorder, which affects the major organs in human and comorbid with others. Besides, diabetic patients are more prone to various infectious diseases as well as COVID-19 sporadic infection which is a high risk for patients with diabetes mellitus. To combat these infections and comorbid situations, an integrated balanced nutritional supportive could help in maintaining sound health and increase immunity for prevention and management of such type of viral infections.

OBJECTIVES

While information regarding nutritional supports in COVID-19 pandemic in diabetic patients is not available, this review aimed to accumulate the evidence from previous publications where studied about nutrition-based supports or interventions for viral diseases with special emphasis on respiratory infections.

METHODS

For reviewing, searches are done for getting journal articles into Google Scholar, Pub Med/Medline, Database of Open Access Journal and Science Direct for relevant data and information.

RESULTS

Integrated nutritional supports of both macronutrients and micronutrients guidelines, including home-based physical exercise schedule, is summarized in this comprehensive review for possible prevention and management of diabetic patients in COVID-19 infections. The immuneboosting benefits of some vitamins, trace elements, nutraceuticals and probiotics in viral infections of diabetic patients are also included.

CONCLUSION

There is an urgent need for a healthy diet and integrated nutritional supports with home-based physical activities for diabetic patients during the self-isolation period of COVID-19 Infection.

Physical Therapy for Muscle Tension Dysphonia with Cervicalgia

OBJECTIVES

This study investigated the effectiveness of a specialized manual physical therapy (PT) program at improving voice among patients diagnosed with concomitant muscle tension dysphonia (MTD) and cervicalgia at a tertiary care voice center.

MATERIALS AND METHODS

Cervicalgia was determined by palpation of the anterior neck. Both voice therapy (VT) and PT was recommended for all patients diagnosed with MTD and cervicalgia. PT included full-body manual physical therapy with myofascial release. Patients underwent: 1) VT alone, 2) concurrent PT and VT (PT with VT), 3) PT alone, 4) VT, but did not have PT ordered by treating clinician (VT without PT order) or 5) VT followed by PT (VT then PT). The pairwise difference in post-Voice Handicap Index-10 (VHI-10) controlling for baseline variables was calculated with a linear regression model.

RESULTS

178 patients met criteria. All groups showed improvement with treatment. The covariate-adjusted differences in mean post-VHI-10 improvement comparing the VT alone group as a reference were as follows: PT with VT 9.95 (95% confidence interval 7.70, 12.20); PT alone 8.31 (6.16, 10.45); VT without PT order 8.51 (5.55, 11.47); VT then PT 5.47 (2.51, 8.42).

CONCLUSION

Among patients diagnosed with MTD with cervicalgia, treatment with a specialized PT program was associated with improvement in VHI-10 scores regardless of whether they had VT. While VT is the standard of care for MTD, PT may also offer benefit for MTD patients with cervicalgia.

Effects of core stability training program on trunk muscle endurance in deaf children: A preliminary study

INTRODUCTION

Sport participation is an important for deaf children as participants experience physical, psychological and social benefits; however, the beneficial effect of core stability training on core muscle endurance is unclear. The present study aimed to examine the effects of an 8-week core stability exercise training program on endurance of trunk muscles in deaf children.

METHODS

Twenty male deaf students (age, 16.5 ± 0.65 y; body mass, 62.08 ± 5.39 kg; BMI, 22.33 ± 2.24 kg/m²) volunteered to participate in this study and were randomly assigned to experimental (EXP, n = 10) and control (CON, n = 10) groups. The subjects in the EXP group performed 3 times a week for 8 weeks period of core stability training program and tested trunk muscle endurance including prone bridge, supine bridge and flexor endurance tests at pre and post 8 weeks intervention.

RESULTS

The CON group did not show any significant change after training period (p > 0.05). The EXP group showed significantly changes in core stability muscle endurance tests following the 8-week core stability training program (p < 0.05). In addition, the EXP group indicated statistically significant changes than the CON group in truck muscle endurance (p < 0.05).

CONCLUSIONS

The results indicated that core stability training program improved trunk muscle endurance. Therefore, this training approach can be recommended in deaf rehabilitation programs to improve trunk muscle endurance.

NEUROMUSCULAR MECHANISMS AND EFFECTS OF CORE STABILIZATIONS ON TRUNK AND HIP MUSCLE ACTIVITY DURING LIFTING MOVEMENT

While the presence of lumbopelvic-hip stabilization has been provided as an importance component of the intra-abdominal pressure and dynamic spinal stabilization prior to movement, no previous study has investigated the effects in nonsymptomatic adults. This study investigated neuromuscular mechanisms and effects by comparing the natural core stabilization (NCS), abdominal bracing stabilization (ABS), and coordinated core stabilization (CCS) techniques in nonsymptomatic adults during lifting movement. A convenience sample of 40 nonsymptomatic adults (mean [Formula: see text] standard deviation, [Formula: see text]; 27 males, 13 females) were randomized into the NCS, ABS, and CCS techniques during lifting movement. The clinical outcomes included the deep and local (transverse abdominis (TrA), internal oblique (IO), and gluteus maximus (Gmax)) and superficial and global muscle (thoracic erector spinae (TES), lumbar erector spinae (LES), and external oblique (EO)) activation and balance ratios (IO/LES and Gmax/LES) and onset time co-activation ratios (IO/LES and Gmax/LES). One-way repeated-measures analysis of variance (ANOVA) and Bonferroni correction revealed that the IO/LES and Gmax/LES balance and activation ratios were greater in CCS than in NCS and ABS. The onset time co-activation ratio was improved in CCS as compared with NCS and ABS, and ABS dropped equally inversely to NCS. Our results provide novel therapeutic evidence that CCS-based lifting movement is more balanced or coordinated in terms of neuromuscular control than the other techniques and may be used as an alternative exercise for core stabilization.

Effects of a Randomized Home-Based Quality of Movement Protocol on Function, Posture and Strength in Outpatients with Obesity

The aim of this study was to determine the effects of two different home-based training interventions on functional parameters and body composition in obese patients. Sixty-four obese patients were recruited at the IRCCS Istituto Auxologico Italiano and randomly assigned into a movement quality group (MQ) and a conventional training group (CT). In the MQ, the training protocol combined various stimuli based on whole-body movement patterns, mobility, motor control and diaphragmatic breathing. The CT included traditional bodyweight resistance-training exercises. All patients were tested for movement efficiency (Functional Movement Screen, FMS), postural control (Modified Balance Error Scoring System, M-BESS), breathing pattern (Total Faulty Breathing Scale, TFBS), muscular strength (Handgrip Strength Test, HST and Five Repetition Sit to Stand, FRSTS) and body composition (Waist Circumference, WC, Body Mass Index, BMI, Body fat mass percentage, Fat Mass) before and after a 6-week period of training. Significant interactions and main effects of time (p < 0.0001) were found in MQ compared to CT in the FMS, M-BESS and TFBS parameters, while muscular strength (HST, FRSTS) and body composition parameters improved similarly in both groups with a main effect of time (p < 0.05). These findings suggest that a 6-week movement quality training is effective in ameliorating postural control and movement efficiency with similar improvements in muscular strength and body composition compared with a mere traditional home-based training. Fitness coaches and practitioners might consider the MQ intervention as a valuable alternative to conventional training when treating obesity.

Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019

Supplemental Digital Content is available in the text.

OBJECTIVES:

Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019.

DESIGN:

Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways.

SETTING:

ICU Recovery Clinic in an academic medical center.

PATIENTS:

Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019.

INTERVENTIONS:

Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training.

MEASUREMENTS AND MAIN RESULTS:

Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life.

CONCLUSIONS:

A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report

OBJECTIVE

The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome.

METHODS (CASE DESCRIPTION)

A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD).

RESULTS

The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction.

CONCLUSION

This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes.

IMPACT

This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.

Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial

BACKGROUND

It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP.

METHODS

The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention.

RESULTS

Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher's exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005).

CONCLUSIONS

Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP.

TRIAL REGISTRATION

The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on September 10, 2020 as IRCT20090228001719N8 .

The relationships between isometric muscle strength and respiratory functions of the Turkish National Paralympic Goalball Team

Goalball is a unique sport for only blind and visually disabled people to prevent physical inactivity and its harmful consequences. Determining the profile of physical fitness parameters and their relationship is crucial for all sports discipline. The purpose of the study is to determine the characteristics and the relationship between isometric muscle strength and respiratory functions. A total of 14 (10 female, four male athletes) goalball athletes were included in the study. Upper-extremity, lower-extremity and trunk isometric muscle strength and pulmonary function tests measurements were performed to the athletes on two different days. The relationship between parameters was evaluated by Spearman correlation test. Strength and pulmonary function parameters were higher in male athletes (P<0.05). A medium/strong/very strong correlation was found between respiratory function and upper extremity isometric muscle strength (r=0.529–0.917, P<0.05). A moderate/strong correlation was found between lower extremity isometric muscle strength and respiratory function (r=0.534–0.867, P<0.05). A moderate correlation was found between trunk isometric muscle strength and respiratory function (r=0.538–0.640, P<0.05). It was seen that respiratory functions were associated with upper-lower extremity and trunk muscle strength. With this result, the idea arises that strength exercises can affect the improvement of respiratory function in individuals with disabilities, which is very important for both overall health and sports performance.

The Motor Impact of the Static Balance in the Up Plank Position on Three Different Balls in Physical Activities of Physical Education Students

The present study aimed to assess the capacity of stability and motor impact in the development of the balance of student athletes by reducing the support surface on the ball in the up plank position, by using three categories of balls of equal size, but with different elasticity and weight. In this study, the second aim was to investigate the differences in maintaining static balance, on different balls, between those who are practicing individual sports or team sports. The total study sample include 48 students, active athletes (45.8% of individual sports and 54.2% of team sports), age X ± SD 18.74 ± 1.94 years. The research included two test sessions (initial and final) applied in two stages. The static balance tests were performed by measuring the time maintaining the up plank position with two and three points of support on the three balls, with different characteristics of elasticity and ranges of deformation: medical ball, handball ball and fitness ball. The results of the study showed that the superior initial and final results were recorded on the fitness ball, and the inferior results on the medicine ball. The upper difference was recorded at the up plank position with two support points (arms, legs) on the fitness ball, at 4980 s, and the lowest in the same test on the medical ball, at 3420 s. The largest difference was recorded at the up plank position with three support points on the handball ball, at 7.082 s, and the lowest in the same test on the medical ball, at 3.093 s. The subjects of the study perceived that the most difficult position to execute was the up plank position on the medical ball with two support points, with 43.8%, and the easiest stability was registered in the up plank position on the fitness ball with three points of support, of 37.5%. The relevance of the research results from the possibility of using different balls in conditions of positioning and body posture with a diminished support base in order to improve physical fitness.

Effects of lumbar segmental stabilization exercise and respiratory exercise on the vital capacity in patients with chronic back pain

BACKGROUND

Trunk stabilization contributes to the efficient control of body movements in daily life, and it plays an important role in maintaining the proper alignment of the body and preventing low back pain.

OBJECTIVE

This study aimed to identify the effectiveness of breathing exercises and lumbar segmental exercises on the vital capacity of lumbar instability patients.

METHOD

Fifty-nine patients suffering from chronic low back pain participated in this study. They were randomly divided into three groups: experiment group 1 performed breathing and segmental stabilization exercises (n= 20), experiment group 2 performed segmental stabilization exercises (n= 20), and the control group performed the modality treatment (n= 19). The measurements were assessed on vital capacity.

RESULTS

The difference in the forced vital capacity, maximal expiratory pressure, and maximal inspiratory pressure at pre- and post-intervention was significant in the RE+LSSE and LSSE groups (p< 0.05) and among all groups (p< 0.05). The difference in the forced expiratory volume at one second of each group was significant (p< 0.05) but was not significant among groups (p> 0.05).

CONCLUSION

In conclusion, the lumbar segmental stabilization exercise activates the deep muscle and improves the respiratory function and respiratory pressure, when used for chronic low back pain patients with segmental instability.

Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.

Lung Function and Respiratory Muscle Adaptations of Endurance- and Strength-Trained Males

Diverse exercise-induced adaptations following aerobic endurance compared to strength-training programs is well documented, however, there is paucity of research specifically focused on adaptations in the respiratory system. The aim of the study was to examine whether differences in lung function and respiratory muscle strength exist between trainers predominately engaged in endurance compared to strength-related exercise. A secondary aim was to investigate if lung function and respiratory muscle strength were associated with one-repetition maximum (1RM) in the strength trainers, and with VO2 max and fat-free mass in each respective group. Forty-six males participated in this study, consisting of 24 strength-trained (26.2 ± 6.4 years) and 22 endurance-trained (29.9 ± 7.6 years) participants. Testing involved measures of lung function, respiratory muscle strength, VO2 max, 1RM, and body composition. The endurance-trained compared to strength-trained participants had greater maximal voluntary ventilation (MVV) (11.3%, p = 0.02). The strength-trained compared to endurance-trained participants generated greater maximal inspiratory pressure (MIP) (14.3%, p = 0.02) and maximal expiratory pressure (MEP) (12.4%, p = 0.02). Moderate-strong relationships were found between strength-trained respiratory muscle strength (MIP and MEP) and squat and deadlift 1RM (r = 0.48-0.55, p ≤ 0.017). For the strength-trained participants, a strong relationship was found between MVV and VO2 max (mL·kg-1·min-1) (r = 0.63, p = 0.003) and a moderate relationship between MIP and fat-free mass (r = 0.42, p = 0.04). It appears that endurance compared to strength trainers have greater muscle endurance, while the latter group exhibits greater respiratory muscle strength. Differences in respiratory muscle strength in resistance trainers may be influenced by lower body strength.

Prospective observational study of abdominal wall reconstruction with THT technique in primary midline defects with diastasis recti: clinical and functional outcomes in 110 consecutive patients

INTRODUCTION

Surgical treatment of diastasis recti is still a matter of debate. Open approaches such as abdominoplasty, which offer the possibility to combine reparation of the diastasis with abdominal cosmetic surgery, are challenged by the emerging less-invasive laparoscopic or robotic techniques that offer shorter recovery for patients. However, evidence in favour of one of the two approaches concerning both short- and long-term complications and functional results is still lacking. In this paper, we analysed clinical and functional results of a new endo-laparoscopic technique for midline reconstruction (THT technique) in patients with primary abdominal wall defects associated with diastasis recti.

METHODS

Prospective observational study on 110 consecutive patients was submitted to endo-laparoscopic reconstruction of the abdominal wall with linear staplers. Morbidity and relapse rates with clinical and radiological follow-up were recorded at 1, 6, 12, and 24 months after the operation. Data regarding the impact of surgery on patients' quality of life (EuraHSQol) on chronic low back pain (Oswestry Disability Index, ODI) and urinary stress incontinence (Incontinence Severity Index, ISI) were gathered.

RESULTS

After a mean follow-up of 14 months, the morbidity rate was 9.1% and no recurrences were recorded. 6-month follow-up ultrasound showed a rectus muscles mean distance of 6.7 mm; EuraHSQol, ODI, and ISI scores significantly improved in 93%, 77%, and 63% of the cases, respectively.

CONCLUSIONS

The THT technique proved to be a feasible, safe, and effective alternative for corrective surgery of primary midline hernias associated with diastasis recti. Short- and mid-term results are encouraging but need to be confirmed by further studies with longer follow-up. The achieved midline reconstruction offers a significant improvement of patients' perceived quality of life through reduction of abdominal wall pain, bulging, low back pain, and urinary stress incontinence.

Dynamics of ventilation parameters at different load intensities and the options to influence it by a breathing exercise

BACKGROUND

Minimizing the energy required for breathing muscles is based on the adaptation of the respiratory muscles which is reflected in the reduction of breathing frequency (BF) and tidal volume (V<inf>T</inf>) increase. This may be influenced through a targeted BE and the quality of breathing may be linked to endurance performance. Aim of this study was assess dynamic ventilation parameters at different load intensities and their changes due to the systematic breathing exercise (BE).

METHODS

Study recruit 36 runners of both sexes with a mean age 16.8±1.6 years. A random distribution was performed. The intervention program consisted of a set of BE aimed at the activation of the diaphragm. We monitored the dynamics of ventilation parameters at intensities 2, 3, 4 W/kg during a stepped test on a bicycle ergometer.

RESULTS

The BE was focused on the activation of the diaphragm for a 12.2±3.6 minutes per day, sixteen weeks. After eight weeks, there were significant changes in V<inf>T</inf> and BF (P<0.05). After sixteen weeks there was a significant increase in V<inf>T</inf> of 5.7-18.3% (P<0.01), depending on the load level, BF values decreased significantly by 5.4-14.4% (P<0.01). V<inf>E</inf> and VO<inf>2</inf> values were without changes. There were no significant changes in the control group.

CONCLUSIONS

It was confirmed that the two-month BE intervention focused on the activation of the diaphragm is sufficient and resulted in a significant change in the values of dynamic ventilation parameters. After four months of intervention, the changes are significantly greater compared with values found after a two-month intervention period.

Analysis of Phonatory and Respiratory Functions in Physical Fitness Instructors in Comparison to Controls

OBJECTIVE

Professional voice users form an increasing part of our population. Physical fitness instructors listed as professional voice users are at risk for voice problem as they perform vigorous exercises, instruct at the same time and compete vocally with loud background music. Hence, there is a dire need to study the voice problems in this population. The current study was aimed at investigating the phonatory and respiratory functions in physical fitness instructors in comparison to a control group.

STUDY DESIGN

Cross-sectional study design MATERIALS AND METHODS: Fifty physical fitness instructors (48 males and two females) and 50 controls (45 males and five females) with the age range of 18-40 years were initially enrolled in the study. The phonatory function measures (perceptual, physiological, and acoustic) and respiratory function measures (aerodynamics) were obtained.

RESULTS

Following the data analysis only for male participants, the majority of the perceptual parameters such as grade, roughness, breathiness, and strain showed significant increase in the clinical group compared to controls (P < 0.05). Similarly, few acoustic parameters such as fundamental frequency (F₀) related parameters such as average F₀, mean F₀, highest fundamental frequency (Fhi) and lowest fundamental frequency (Flo) showed significant decrease in clinical group compared to controls (P < 0.05).

CONCLUSIONS

Few perceptual and acoustic parameters are sensitive in differentiating the voice problems in physical fitness instructors from the controls. The significant perceptual and acoustic parameters implied that they are at risk for developing voice problems. Hence, early identification and prevention of voice problems in this population is warranted.

Effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder: Randomized controlled trial

BACKGROUND

Adolescent substance abuse is a serious and growing problem worldwide. The aim of this study was to investigate the effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder (SUD).

METHODS

This was a prospective randomized controlled trial. A total of 49 adolescent male patients with SUD were randomly assigned to either the exercise group (n = 25; mean age 16.6 years) or the control group (n = 24; mean age 16.7 years), for 6 weeks. All participants underwent a medical and behavioral therapy program 5 days a week for 6 weeks. The exercise group received five core stabilization exercises combined with deep breathing as a group training for 45 to 60 minutes, twice a week for 6 weeks, and the control group received recreational activities in addition to the usual care for 45 to 60 minutes, twice a week for 6 weeks. Spirometry, maximal inspiratory and expiratory pressures, and the 6-minute walk test were performed and measured at baseline and after training.

RESULTS

There were significant improvements in maximal inspiratory pressure (24.16 cm H₂ O; P < 0.0001), maximal expiratory pressure (30.28 cm H₂ O; P < 0.0001), forced vital capacity (5.80% predicted, P < 0.0001), forced expiratory volume in 1 second (7.34% predicted; P = 0.002), peak expiratory flow (13.32% predicted; P = 0.0003), forced expiratory flow 25%-75% (11.84% predicted; P = 0.027), and the 6-minute walking distance (65.84 m; P < 0.0001) in the exercise group compared with the control group.

CONCLUSIONS

Core stabilization exercise can improve pulmonary function, respiratory muscle strength, and functional capacity in adolescents with SUD.

Effects of 8-week core training on core endurance and running economy

The purpose of this study was to examine the effects of 8-week core training on core endurance and running economy in college athletes. Twenty-one male college athletes were randomly divided into 2 groups: a control group (CON) (n = 10) and a core training group (CT) (n = 11). Both groups maintained their regular training, whereas CT attended 3 extra core training sessions per week for 8 weeks. The participants were assessed before and after the training program using sensory organization test (SOT), sport-specific endurance plank test (SEPT) and 4-stage treadmill incremental running test (TIRT). Compared with the pre-test, significant improvements were observed in post-test SOT (78.8 ± 4.8 vs. 85.3 ± 4.8, p = 0.012) and SEPT (193.5 ± 71.9 s vs. 241.5 ± 98.9 s, p = 0.001) performances only in CT. In the TIRT, the post-test heart rate values were lower than the pre-test values in CT in the first 3 stages. In stage 4, the post-test oxygen consumption (VO2) was lower than that in pre-test in CT (VO2: 52.4 ± 3.5 vs. 50.0 ± 2.9 ml/kg/min, p = 0.019). These results reveal that 8-week core training may improve static balance, core endurance, and running economy in college athletes.

The Role of the Pelvic Floor in Respiration: A Multidisciplinary Literature Review

OBJECTIVE

To conduct an interdisciplinary literature review on the function of the pelvic floor musculature during respiration and its role in phonation, particularly singing.

STUDY DESIGN

This is a literature review.

METHODS

A literature review was conducted using three electronic databases: PubMed, Scopus, and Google Scholar. An index search was also performed for the NATS Journal/Journal of Singing utilizing the keywords from the original search, as these articles did not appear in the original search. Peer-reviewed articles from 1985 to 2017 were gathered on the respiratory musculature and/or support mechanisms for phonation (anatomy and physiology). Articles that pertained to the muscular function of the respiratory system in breathing and/or phonation were utilized in the review. Eighty-five articles were included in this review.

RESULTS

Breathing and support strategies were variable and nonspecific in much of the singing voice literature. The voice science literature was a rich source of articles written about breathing and support for singing. Multiple studies looked at musculature utilized in respiration and breath support and subglottal pressure generation for muscular support. However, little or no mention was made specifically of the pelvic floor. The physical medicine literature includes the pelvic floor musculature as having an important role in respiration, as a key player in the generation of intra-abdominal pressure, and as a primary expiratory muscle.

CONCLUSIONS

The information gleaned from this literature review suggests that a cross-pollination between areas of science is needed, because quite obviously, the pelvic floor is a topic in physical medicine, but it is not (so much) in the voice literature. Reaching a consensus on how we describe the function of the respiratory musculature and specifically including the role of the pelvic floor in respiration and phonation deserves future attention. Further research looking specifically at the role of the pelvic floor in phonation is also warranted.

Individualized dry-land intervention program for an elite Paralympic swimmer

The aim of this retrospective case study is the longitudinal description of the physical and functional parameters of a top-level Paralympic swimmer class S9-SB8-SM9 during four swimming seasons of training, from the Paralympic games in London 2012 to the Paralympic games in Rio 2016. A 22-year-old male swimmer underwent a specific preventive dry-land training based on diaphragmatic breathing, postural alignment, and slow-velocity resistance training aimed to improve his muscle strength. He was tested by using the Functional Movement Screen™, photographic postural assessment and vertical jump. The swimmer improved his functional, postural and strength parameters indicating a better functional movement and muscular power. These results show that a four-year specific dry-land intervention could be capable of enhancing the functional and physical requirements of a top-level Paralympic swimmer. This approach might be a suitable novel alternative for coaches and athletic trainers to integrate their training protocols for athletes with similar impairments.