Development of the International Spinal Cord Injury Activities and Participation Basic Data Set

STUDY DESIGN

Consensus decision-making process.

OBJECTIVES

The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set.

SETTING

International working group.

METHODS

A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed.

RESULTS

Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables.

CONCLUSION

Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardised instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.

Participation and Well-Being Among Older Adults Living with Chronic Conditions

This study explored the unique contribution of participation (daily activities and social roles) in explaining well-being of older adults living with chronic conditions and examined which aspect of participation (accomplishment of participation or satisfaction with participation) was more important in describing their well-being. Two hundred older adults with chronic conditions completed the following assessments: Satisfaction with Life Scale to measure well-being; Assessment of Life Habits to evaluate two aspects of participation: (a) accomplishment of daily activities and social roles and (b) level of satisfaction with participation; Interpersonal Support Evaluation List to assess level of social support and Affect Balance scale to measure level of balance confidence. In addition, participants' level of mobility was assessed using the Timed Up and Go test. Regression analysis was performed. Results indicated that number of chronic conditions, social support and satisfaction with participation had a significant contribution to well-being and altogether explained 31% of its variance whereas accomplishment of participation did not play as significant role in the model. In conclusion, participation has a unique contribution to older adults' well-being where satisfaction with participation rather than the accomplishment of activities is of importance. Additional aspects of participation and level of disability are key factors identified for further inquiry.

Assessment of agonist-antagonist shoulder torque ratios in individuals with paraplegia: a new interpretative approach

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To evaluate isokinetic shoulder flexor-extensor (F/E) and abductor-adductor (Ab/Ad) torque ratios in individuals with paraplegia using a new interpretative approach. We proposed to study torque ratios according to joint angle sections (15 degrees angle subgroups) over a selected range of motion.

SETTING

Pathokinesiology Laboratory, Montreal, Canada.

METHOD

Sixteen individuals with complete motor paraplegia, without shoulder pain or impairment, were included in this study. After a preloading period of 1 s, maximum isokinetic concentric contractions of all muscle groups were completed at 30, 60 and 120 degrees s(-1) over the entire tested ranges of motion (70 to -35 degrees for the flexion-extension and 15 to 60 degrees for the abduction-adduction). After the continuous torque curves were rebuilt, the mean F/E and Ab/Ad torque ratios were calculated and analyzed every 15 degrees.

RESULTS

A significant modification of the F/E (F=66.3; P<0.001) and Ab/Ad (F=100.6; P<0.001) torque ratios was observed according to the 15 degrees angle subgroup evaluated. More precisely, a progressive decline of both the F/E and Ab/Ad ratios was noted as the shoulder flexion or abduction progressed. Angular velocity did not have any influence on torque ratio values.

CONCLUSION

Angle subgroup torque ratio analysis leads to a better estimation of the balance between the agonist and antagonist muscle groups than does traditional peak torque ratio analysis. In individuals with paraplegia, this precise estimation of torque ratios may lead to the development of specific shoulder strengthening programs to prevent muscle imbalance and its consequences.

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

STUDY DESIGN

Three-dimensional kinematic analysis and surface electromyography (EMG) of 10 male adults with complete spinal cord injury (C7 to L2).

OBJECTIVE

To examine movement patterns and muscular demands in individuals with spinal cord injury (SCI) during posterior transfers.

SETTING

Pathokinesiology Laboratory at a Rehabilitation Centre, Montreal, Canada.

METHODS

Kinematic variables that described the positions and angular displacements of the head, trunk, shoulder and elbow were obtained by videotaping markers placed on the subject segments. EMG data were recorded for the biceps, triceps, anterior deltoid, pectoralis major, latissimus dorsi and trapezius muscles of the dominant upper extremity during posterior transfers using surface electrodes. To quantify the muscular demand, the EMG data recorded during the transfers were normalized to values obtained during maximal static contractions (EMGmax). The mean muscular demand was calculated for every muscle during the lift phase of the transfers. The lift phase was determined by pressure-sensitive contacts.

RESULTS

All subjects were able to execute the posterior transfers on an even surface, whereas nine subjects completed at least one of the transfers to the elevated surface. A forward-flexion pattern at the head and trunk was observed when either one or two hands remained on the lower surface, whereas a lift strategy was seen when both hands were placed on the elevated surface. Transferring to the elevated surface with hands on the lower surface required inferior electromyographic muscular utilization ratio (EMUR) than the transfer on the even surface for all muscles. The lowest EMUR were calculated for the transfer to the elevated surface with hands on the lower surface (triceps (18%), pectoralis major (53.8%), trapezius (66%) and latissimus dorsi (24.5%)) while performing the same transfer with hands on the elevated surface generated the highest EMUR (triceps (40.2%), anterior deltoid (73.2%), trapezius (83.6%) and latissimus dorsi (55.3%)).

CONCLUSIONS

Subjects presented different movement characteristics and muscular demands during the posterior transfers. It is suggested that the forward-flexion pattern improves the dynamic trunk stability and reduces the muscular demand required to transfer. High muscular demand developed when hands were positioned on the elevated surface might be due to increased postural control demands on the upper limb and reduced angular momentum.

Predictors of handicap situations following post-stroke rehabilitation

PURPOSE

Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme.

METHODS

At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H).

RESULTS

One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%).

CONCLUSIONS

In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Association between personal and environmental factors and the occurrence of handicap situations following a stroke

BACKGROUND AND PURPOSE

Little is known about the potential role of environmental factors in the handicap creation process following a stroke. The objective of this study was to explore the presence of a relationship between environmental factors and the occurrence of handicap following a stroke, taking into consideration age and the level of impairments and disabilities.

METHODS

This is a cross-sectional study where data were collected 6 months after discharge from an intensive functional rehabilitation unit. A convenience sample of 51 participants was recruited at the time of their admission to the rehabilitation unit for rehabilitation post-stroke. Perceived influence of environmental factors was measured using the Measure of the Quality of the Environment (MQE). Handicap situations were measured with the Assessment of Life Habits (LIFE-H). Impairments and disabilities comprised six domains (cognition, perception. depression, communication, sensorimotor function and comorbidity) assessed using a variety of measuring tools from which a composite score was derived.

RESULTS

Fifty-one participants aged 40-97 years old took part in this study. Perceived obstacles in the environment, together with age and the level of impairments and disabilities, explained 58.9% of the variation in the LIFE-H (handicap level). Taken alone, the perceived obstacles (total score) explained 6.2%. The perceived facilitators (total score) in the environment were not found to be related to the presence of handicap situations.

CONCLUSION

Increased level of impairments and disabilities. advanced age and perceived barriers in the physical and social environment contribute to the handicap creation process following a stroke.

Secondary impairments after spinal cord injury: a population-based study

OBJECTIVE

To determine the prevalence of secondary impairments among individuals with long-standing spinal cord injury in Quebec and the potential relationships between these impairments and several variables.

DESIGN

A review of 2,200 medical files was conducted to determine the target population; 976 patients were selected randomly and mailed questionnaires. The results were based on 482 individuals with spinal cord injury who returned the completed questionnaire. The questionnaire included 14 subsections, such as sociodemographic, medical, psychosocial, and environmental information. The medical section, including the type and level of lesion and the presence of secondary impairments, was analyzed.

RESULTS

Urinary tract infection, spasticity, and hypotension were the most frequently reported secondary impairments, regardless of the severity of injury. Relationships between the prevalence of secondary impairments and the duration of injury, as well as perceived health status, were observed.

CONCLUSIONS

This is the first study to describe secondary impairments after long-standing spinal cord injury in Quebec. Patients with spinal cord injury still present a high prevalence of secondary impairments many years after their rehabilitation, despite preventive education or medical follow-up visits. Further studies are required to determine the specific impact that these impairments have on the patients' social role and their quality-of-life.

Feasibility of an eight-week dance-based exercise program and its effects on locomotor ability of persons with functional class III rheumatoid arthritis

OBJECTIVES

The main objectives of this experimental case series were to evaluate the feasibility of a modified dance-based exercise program with low ground impacts in persons with rheumatoid arthritis (RA) functional class III and to describe its effects on locomotor ability. The relationship between 3 locomotor tests and their responsiveness also were addressed.

METHODS

Ten female subjects participated in an 8-week exercise program. Locomotor ability was measured before and after the program using the 50-foot test of walking time, the 6-minute test of walking distance, and the locomotion biomechanical analysis.

RESULTS

All subjects showed a high compliance (92.5% presence at sessions) over the 8 weeks of exercise without any aggravation in disease status. They were able to train efficiently at moderate intensity up to 25 minutes. Significant improvements were found in locomotor ability, with a higher responsiveness measured by the locomotion biomechanical analysis, followed by the 6-minute gait test and the 50-foot gait test. Inconsistent relationships between tests suggested that different locomotor abilities are required during tests.

CONCLUSION

These results support the feasibility of a modified dance-based exercise program for persons with severe RA. With high levels of responsiveness, the detailed biomechanical analysis and the 6-minute gait test are recommended for the assessment of locomotor ability.

Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations

PURPOSE

Handicap situations in daily life of persons with Spinal Cord Injury (SCI) is rarely evaluated in spite of their impact on long-term health. The purpose of the present study was to identify the occurrence of potential handicap situations in individuals with SCI and to determine the potential associations between the level of social participation and some characteristics of the person.

METHODS

Four hundred and eighty-two individuals completed a mailed questionnaire that comprised the 'assessment of life habits', a tool developed to assess social participation in persons with disabilities.

RESULTS

Significant disruptions were particularly observed in home maintenance, participation in recreational and physical activities as well as in productive activities and the achievement of sexual relations. However, many individuals successfully achieved various social roles despite the presence of disabilities. No indications of a potential impact of premature ageing on the accomplishment of life habits were observed.

CONCLUSIONS

The severity of injury seems to significantly increase the occurrence of handicap situations as the individuals with tetraplegia reported carrying out their life habits with much more difficulty or requiring more assistance than those with a less severe impairment.

Productivity outcomes of individuals with spinal cord injury

STUDY DESIGN

Cross-sectional study by mail survey of participation in productive activities of individuals who sustained a spinal cord injury (SCI) in Quebec from 1970 to 1993.

OBJECTIVES

To determine the level of productivity outcomes of a representative sample and to determine the relationship between the productivity outcomes and some personal and environmental variables.

SETTINGS

Quebec, Canada.

METHODS

Four hundred and eighteen subjects (mean of age=42.1+/-11. 8) were included in this study. Overall productivity was assessed by the participation into five categories of activities (gainful employment, studies, homemaking and family activities, community organizations and leisure activities).

RESULTS

Depending on the severity of injury, 30% to 51% of the variance in productivity outcomes can be explained by a set of ten variables: education, ability to drive a car vehicle, other transportation indices, age related variables and type of locomotion. A discriminant analysis was undertaken to classify the subjects into three levels of productivity (low, moderate and high). The percentage of subjects correctly classified was moderate (54% to 71%) to high (72% to 81%) depending on the productivity levels.

CONCLUSION

The results confirm the significant contribution of education and transportation to explain the productivity outcomes.

SPONSORSHIP

This project was funded by the 'Société d'Assurance Automobile du Québec', the 'Commission de la Santé et de la Sécurité du Travail' and the 'Fondation André Senécal'.

Muscle strength changes as measured by dynamometry following functional rehabilitation in individuals with spinal cord injury

OBJECTIVE

To objectively quantify muscle strength changes over the course of functional rehabilitation and up to 15 months postdischarge in individuals with spinal cord injury (SCI).

METHOD

Hand-held dynamometry was used to evaluate the strength of six muscle groups in 31 individuals after acute SCI (tetraplegia, n = 13, paraplegia, n = 18). Assessment was performed by a single research therapist at admittance and discharge from functional rehabilitation and 3 months and 15 months after discharge.

RESULTS

There were significant increases of mean strength values for all muscle groups between admittance and discharge in individuals with parapalegia (median value between 13% and 22%) and tetraplegia (median value between 33% and 83%). Three months after discharge, only individuals with tetraplegia continued to significantly improve their mean strength for four muscle groups (elbow flexors-extensors and shoulder flexors-extensors). One year later, elbow flexors were significantly improved in both paraplegic and tetraplegic persons, while shoulder extensors showed significant gains only in individuals with paraplegia. Study results showed a large variability in the individual profiles of upper limb strength recovery, particularly in tetraplegic individuals. Although some individuals showed strength gains exceeding 200%, some strength decreases were noted.

CONCLUSION

Recovery of muscle strength in individuals with tetraplegia over individuals with parapalegia continues for a longer period since it depends initially on recovery of muscle innervation. This study quantified strength improvements during rehabilitation and clearly showed that these gains can be maintained or even increased when the person returns to community living.

Profile of handicap situations in children with cerebral palsy

The purposes of this study were to establish a profile of handicap situations in children with cerebral palsy and to identify some variables associated with the occurrence of these situations. Ninety-eight children with a diagnosis of cerebral palsy (mean age +/- 1 SD, 10.5 +/- 3.5 years) were recruited on a voluntary basis. The Life Habits Assessment (LIFE-H, version 1.0) was used to measure the degree of accomplishment in 12 categories of life situations (activities of daily living and social roles). Significant disruptions in the accomplishment of all life habit categories were revealed. The highest disruptions were observed in the following categories: recreation, community, personal care, education, mobility, housing and nutrition. Disruption progressed significantly with increased severity of cerebral palsy. Impairment type, severity, speech and language disorders, and comprehension difficulties explained a high percentage of the total variance (> 60%) in the accomplishment of life habits. The results suggest that life habits related to school and social integration are greatly disturbed.

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

The aim of the project was to compare three methods for measuring muscle strength in individuals with SCI: the manual muscle test (MMT), the hand-held myometry and the isokinetic dynamometry (Cybex). Thirty-eight (38) subjects, 31 men and seven women (age range = 14-63; lesion from C5 to L3) were included in this project. Muscle strength assessment of upper limbs was performed at admittance and discharge using MMT and myometry for the left and right side, and using Cybex dynamometer for the stronger side. The testing sessions were at least a day apart and performed by a single evaluator (trained physiotherapist). Significant and non-significant differences of myometry mean strength values were observed between consecutive levels of MMT. However, the range of myometry scores within each MMT grade led to significant overlaps between two adjacent MMT grades of each muscle group. Variables correlations were observed between the strength values measured by MMT and myometry with paraplegia (0.26 < or = r < or = 0.67) and tetraplegia (0.50 < or = r < or = 0.95). Similar results were observed when compared MMT and Cybex with the stronger side. Moderate to strong correlations were observed between the strength values measured by myometry and Cybex with paraplegia (0.70 < or = r < or = 0.90) and tetraplegia (0.57 < or = r < or = 0.96). These results suggest that the MMT method does not seem to be sufficiently sensitive to assess muscle strength, at least for grade 4 and higher and to detect small or moderate increases of strength over the course of rehabilitation. Since outcome measures is an important issue in rehabilitation, objective measurements of strength should be used in clinical settings. Considering cost and assessment time, the myometry technique seems to be highly valuable.

Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap

OBJECTIVES

To present a conceptual model of disablement adapted from the WHO model and to conduct a pilot study with a measurement tool (LIFE-H) of the concepts of life habits and handicap situations.

DESIGN

Content validity and test-retest reliability study.

SETTING

General community.

PARTICIPANTS

A panel of 12 experts of rehabilitation for the process of content validity and 49 individuals with spinal cord disorders (adults and children) for the reliability study.

OUTCOMES MEASURES

a person's life habits (activities of daily living and social roles).

RESULTS

The LIFE-H questionnaire was designed to assess the handicap situations observed in daily life of individuals with disability. The experts concluded that the LIFE-H items covered most of a person's life habits (ADL and social roles) and that it could be used to determine the appearance of handicap situations. The LIFE-H total score showed a good level of reliability for the children and the adult samples (ICC = 0.73 and 0.74, respectively). Taken individually, a majority of life habit categories have shown a moderate to high reliability level (ICC > or = 0.50) while a few life habit categories such as the interpersonal relationship or nutrition showed a lower reliability level.

CONCLUSION

The development of LIFE-H allows fulfillment of the need to determine the disruptions in life habits of persons with disabilities.

Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy

BACKGROUND AND PURPOSE

"Handicap situation" is defined in the literature as "a disruption in the accomplishment of a person's life habits (activities of daily living and social roles)." The purpose of this study was to determine the strength of association between various types of locomotion and the accomplishment of life habits, which is an indicator of the occurrence of handicap situations in children with cerebral palsy.

SUBJECTS

Ninety-eight children with cerebral palsy, aged 5 to 17.8 years (mean = 10.5, SD = 3.5), were recruited.

METHODS

The Life Habits Assessment was used to evaluate handicap situations in activities of daily living and social roles. Types of locomotion, the Pediatric Functional Independence Measure (locomotion section), and 2 tests representing functional activities (walking speed and stair climbing) were used as characteristics of locomotion.

RESULTS

Locomotion capabilities were associated with the accomplishment of activities of daily living and social roles. Performance in variables related to locomotion, number of associated problems, and type of cerebral palsy explained 17% to 74% of the total variance in accomplishment of life habits in children who walked without technical aids.

CONCLUSION AND DISCUSSION

The results suggest that locomotion might influence the accomplishment of life habits. Other factors, however--such as environmental barriers--should also be examined to determine their impact on the occurrence of handicap situations.

Dance-based exercise program in rheumatoid arthritis. Feasibility in individuals with American College of Rheumatology functional class III disease

Many studies have demonstrated that aerobic exercise training is beneficial to prevent physical deconditioning in persons with rheumatoid arthritis (RA) without inducing adverse effects on individual's joints and general health. After significant results in individuals with RA (Functional Class I and II), the present study was conducted to demonstrate the feasibility of a modified dance-based exercise program to improve the physical fitness and psychological state of persons with RA (Class III). Ten (10) female subjects (mean age, 54 +/- 10 years) participated in an eight-week exercise program (twice weekly). Health status, use of medication, joint pain and swelling, cardiorespiratory fitness, activity of daily living, and psychological state were assessed before and after the training program. A high level of participation has been maintained by the participants (mean = 14.8/16 sessions). Most of them were able to perform a maximal exercise test on treadmill and reached 90% of the predicted heart rate at maximal exercise. No significant gain in aerobic power was observed for the group as a whole, but four subjects showed improvements of between 10% and 20% of their cardiorespiratory fitness. Positive changes in depression, anxiety, fatigue, and tension were observed after the eight-week exercise program. No deleterious effect on the health status was observed. These findings provide some evidences as to the feasibility of submitting individuals with RA to a modified dance-exercise program. Further studies, however, are required to determine the long-term effect of weight-bearing exercise on the health status of individuals with RA.

Spinal cord injury, exercise and quality of life

The ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue. The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency. Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.

Biomechanical analysis of swing-through gait in paraplegic and non-disabled individuals

The purpose of this study was to determine if the deficit of motor function affects the displacement of the lower limbs and increases the physical strain of upper-body musculature in paraplegic individuals performing swing-through gait. A biomechanical model consisting of four linked rigid bodies was developed to analyze this type of gait. Data were obtained on the spatio-temporal characteristics, kinematics and kinetics from a sample of eight non-disabled and nine paraplegic individuals performing swing-through gait. Net muscle moments acting on the segments and mechanical powers at three joints (shoulder, elbow, hip) were estimated during a complete gait cycle from basic force equations and moments of force acting on a rigid body. Results show that the two groups selected a similar comfortable speed suggesting that the type of gait per se is an important factor in the selection of speed. Paraplegic individuals had a longer crutch stance phase duration than the non-disabled due to inadequate hip muscle activations as confirmed by the moment of force and power analyses. Moreover, a higher moment of force at the shoulder was observed in the paraplegics individuals, mostly during the crutch stance phase. Consequently, the loss of motor function of the lower limbs in paraplegic individuals modifies the biomechanical pattern of swing-through gait compared to non-disabled individuals, and seems to increase the physiological demand on the upper limbs during the stance and swing phases of the gait cycle.

Effects of a modified dance-based exercise on cardiorespiratory fitness, psychological state and health status of persons with rheumatoid arthritis

Cardiorespiratory function and exercise tolerance appear very limited in persons with rheumatoid arthritis (RA). Many studies have demonstrated that aerobic exercise training is beneficial to prevent physical deconditioning without inducing adverse effects on an individual's joints and general health. The present study was conducted to demonstrate that a dance-based exercise program is a safe and efficient activity to improve physical fitness and psychological state in persons with RA. A group of 19 persons (mean age, 49.3 +/- 13 yr) participated in a 12-wk exercise program (twice weekly), whereas 10 persons (mean age, 49.4 +/- 12 yr) served as controls. Health status, use of medication, joint pain and swelling, physical fitness, activity of daily living and psychological state were assessed at baseline, after the 12-wk training program and 6 mo after the end of the program. Exercise training induced a mean improvement of 13% in aerobic power, with the highest values reaching 40%. No significant changes were observed in joint status, even though the count of painful joints tended to decrease in the exercise group. Positive changes in depression, anxiety, fatigue and tension were observed after the 12-wk exercise program. These findings provide some evidences in favor of aerobic exercise in individuals with RA. Furthermore, it is of primary interest to note that a weight-bearing activity with limited ground impacts do not provoke short-term adverse effects on joint status. Further studies, however, are required to determine the long-term effect of weight-bearing exercise on the health status of individuals with RA.

Guarding against pitfalls in multivariate analysis. An illustration from fitness testing of the spinally-injured

Potential pitfalls in the multivariate analysis of data, and methods of overcoming such problems, are illustrated by reference to recent research that has examined relationships between fitness variables and overall productivity in a population of young male paraplegics. Particular attention is directed to the need for residual analysis, tests of multiple collinearity, and a cautious approach to interpreting the theoretical meaning of individual coefficients in multiple regression equations.

Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury

Associations between a physically active leisure, physical fitness, impairment and disability have been tested in 123 volunteers (73 with paraplegia and 50 with quadriplegia). Active physical leisure was assessed by the questionnaire of Godin and Shephard (Canadian Journal of Sports Sciences 10, 141-6 1985). Fitness measures included body mass index, peak oxygen intake on a wheelchair ergometer, and tests of muscle strength and endurance (peak isokinetic torque, average muscle power and total muscle work for shoulder flexion, shoulder adduction and elbow flexion at movement speeds of 60 degrees and 180 degrees s-1). Primary impairment was assessed by the ISMGF scale, and secondary impairment was judged from reported pressure scores, spasticity, and urinary infections over the previous 12 months. Scores for self-care and mobility were obtained using a modified Barthel Index. Physically active leisure and fitness were unrelated to secondary impairment. However, functional ability for a given primary impairment was significantly correlated with peak oxygen intake and the three indices of muscle strength, particularly in individuals with high level lesions. Associations between physical activity and functional ability were weaker, but tended in the same direction. Although longitudinal studies are needed to prove the causality of these relationships, the findings point towards a significant influence of fitness status upon functional ability. Rehabilitation teams should thus give a stronger emphasis to systematic exercise conditioning programmes when planning overall treatment following SCI.

Prediction of maximal aerobic power from a submaximal exercise test performed by paraplegics on a wheelchair ergometer

The aim of the present study was to verify the basic principles underlying the prediction of VO2 peak from a submaximal exercise test performed by paraplegics on a wheelchair ergometer and thus to propose regression equations of VO2 peak prediction. Forty-six paraplegic subjects (mean age = 33.2 +/- 8.7 years) with a traumatic lesion (T1-L3) performed a graded exercise test on a wheelchair ergometer until exhaustion. The test started with an initial workload of 0 watts, with an increment of 6 watts per 2 minutes. Measurements included power output (W), heart rate (HR) and oxygen consumption (VO2) throughout the test. Linear relationships were observed between VO2 and W (VO2 = 0.79 + 0.02 W, r = 0.80, SEE = 0.22 l min-1) as well as between %VO2 max and % maximal heart rate (% VO2 max = 8.7 + 0.83 %HR, r = 0.83 SEE = 10.5%). Combination of the two equations for estimating VO2 peak led to a linear relationship between the estimated and measured VO2 peak. Nonetheless, the strength and accuracy of the prediction were low (r = 0.49, SEE = 0.29 l min-1). Participation in aerobic exercise, body mass and lean body mass, introduced as correction factors in the regression equation, significantly improved the strength and the accuracy of the prediction (r = 0.85, SEE = 0.29 l min-1).(ABSTRACT TRUNCATED AT 250 WORDS)

[Maximal physiological response during exertion in quadriplegic subjects]

Devices used for the assessment of physical working capacity in quadriplegics may be determinant in terms of efficiency during maximal exercise testing. The aim of this study was to compare the physiological responses of a group of quadriplegics during graded exercise tests on arm cranking ergometer (ACE) and wheelchair ergometer (WE). Fifty subjects, age 34.1 (+/- 9.5) years, participated in the study. Measurements comprised heart rate, ventilation, oxygen consumption, and power output. Unlike other studies suggesting a higher physical working capacity on ACE compared with WE, no significant differences were observed in physiological measurements between the two ergometers. However, power output on ACE was 65% higher than that of WE (p < or = 0.001). These results suggest that power output of quadriplegics on ACE is higher due to differences in mechanical patterns required to induce movements of propelling (arm cranking vs. rolling movements). The need to link the assessment results to the type of locomotion used by the spinal cord injured persons may suggest the use of WE for testing and training in such individuals.

Return to work after spinal cord injury: the potential contribution of physical fitness

The history, physical characteristics and fitness status of 60 persons who had sustained a spinal cord injury at least 3 years previously were considered in relation to current occupation. All subjects had completed their education, 39 being gainfully employed and 21 unemployed. The general characteristics of the sample, mainly beneficiaries of the Quebec Automobile Insurance Plan, were typical of spinal cord injured individuals in North America. The working group had a significantly higher current level of education than those who were unemployed (p less than .01). In terms of physical fitness, the workers were lighter, with a lower body mass index and a higher aerobic power (p less than .05). Isokinetic testing suggested a trend toward a higher peak torque in the workers. The total work performed (Nm.kg-1) during an isokinetic endurance test (25 biphasic contraction at 180 degrees.sec-1) was significantly higher in the workers, suggesting that such muscular endurance might be even more useful than greater peak isokinetic strength during vocational activities. However, the likelihood of employment was unrelated to habitual patterns of either aerobic exercise or overall physical activity. No significant differences of physical fitness or physical activity habits were found between workers holding sedentary versus physically demanding jobs. The results verified the positive relationship between physical fitness (body composition, aerobic power, muscular endurance) and the gainful employment of paraplegics, but failed to show any significant relationship between physical fitness and the acceptance of physically demanding work by such individuals.

Effects on plasma lipoproteins and endogenous sex hormones of substituting lean white fish for other animal-protein sources in diets of postmenopausal women

A crossover 8-wk study was conducted to compare the effects on plasma lipoproteins and endogenous sex hormones of lean white fish (LWF) and of beef, pork, egg, and milk (BPEM) within a prudent diet in postmenopausal women. Diets provided 8050 kJ as 19% proteins, 52% carbohydrates, 29% lipids (P/M/S (proportion of polyunsaturated, monounsaturated, and saturated fatty acids, 1.1:1:1) and approximately 210 mg cholesterol/d. The LWF diet compared with the BPEM diet significantly induced higher concentrations of plasma cholesterol, LDL-apo B, HDL-C, and HDL3-C, indicating that incorporation of LWF as a substitute for BPEM in a low-fat, high-P:S diet offers little benefit with regard to plasma cholesterol and LDL-apoB in postmenopausal women. Moreover, the LWF diet significantly increased plasma SHBG, suggesting that the divergent effects of substituting LWF for other animal-protein sources on plasma cholesterol and lipoproteins may be partly mediated by variations in plasma sex-hormone status.

Physiological responses to maximal exercise on arm cranking and wheelchair ergometer with paraplegics

This study describes the responses of 20 paraplegic athletes (mean age: 26.8 +/- 1.6 years) to a continuous incremental workload test until exhaustion on an arm cranking ergometer (ACE) and on a wheelchair ergometer (WCE). Both ergometers used the same electromagnetic braking device allowing a fair comparison between results. Tests were conducted at a 24 hour interval at the same time of the day. Oxygen uptake (VO2), heart rate (HR), workload (W), blood pressure (BP), Borg index, and mechanical efficiency (ME) were measured at every minute during the effort and the cool down periods of both tests. The purpose of this study was to analyse the different responses obtained on ACE and on WCE during maximal effort by paraplegics, and also to determine which ergometer permits the higher ME. Results indicate that paraplegics reached the same max HR on ACE and on WCE (97% of the predicted max HR). The lack of significant difference (p less than 0.05) between ACE and WCE in terms of maximal values of VO2, VE and HR suggests that the subjects reached their maximal capacity on each test regardless of the type of ergometer. Nevertheless, W max (in Watts) was 26% higher on ACE than on WCE. Maximal ME values were respectively 16% and 11.6% on ACE and WCE. Results suggest that ergometers and protocol used in this study are appropriate to measure physiological responses of paraplegic athletes during arm cranking and wheelchair exercise without excessive or early arm fatigue.

[Aging and technology: physical condition in a post-industrial society]

Compulsory retirement, normally set at 65, may be considered discriminatory by people who wish to continue in their current employment to a greater age. The aging process sometimes limits the performance of daily work, particularly in occupations that demand a high rate of energy expenditure. However, this is not a general rule; there are many individuals older than 65 years (particularly those who have remained physically active) who can still carry out moderate physical tasks without fatigue. This article reviews various aspects of occupation, including the evaluation of work performance, and the beneficial effects of programs designed to increase functional capacity in the context of compulsory retirement. Biological age seems a useful criterion in deciding upon the appropriateness of mandatory retirement when reviewing individual cases. The authors recommend adopting a form of health hazard appraisal and measures of physical condition (including aerobic power, muscular strength and reaction time) as a part of such an evaluation, while recognizing the need for more precise methods of identifying those who can remain in gainful employment beyond the age of 65 years.

[Exercise test before prosthesis fitting in amputees with vascular insufficiency]

93 subjects (age = 65 +/- 10 years) with lower limb amputation ensuing from peripheral vascular disease performed a graded exercise test on arm cranking ergometer with an electromagnetic braking to assess their physical fitness and cardiac condition before starting a prosthetic training programme. The protocol was continuous with a workload increment of 10 watts every two minutes. Heart rate, blood pressure and ECG were recorded at each stage. Reasons to stop the test were 1) arm muscle fatigue, 2) reaching of target heart rate, 3) cardiovascular abnormalities. At the end of the test, the mean percentage of maximum heart rate was 53%, 92%, and 66% for each of these reasons, respectively (p less than .0001). Results showed that subjects who received a prosthesis had a higher exercise capacity than those who did not get a prosthesis (39.0 watts vs 18.5 watts, p less than 0.001). Furthermore, maximal oxygen uptake (4.4 METs vs 3.0 METs, p less than 0.001) and reached maximal heart rate (131 vs 110 bpm, p less than .005) were both higher in subjects of prosthesis group. Results suggest that a graded exercise test at the beginning of prosthetic training allows a rehabilitation team 1) to predict the success of the prosthetic process and 2) to identify subjects for which this process could increase the risks of health problems.

Body mass index as a discriminant function among health-related variables and risk factors

A group of 206 subjects (30-55 years) were studied with the objective of quantifying the relationships between fitness indicators (relative body weight (BMI), aerobic power, muscular endurance), health indicators and risk factors, (appraised age, cost of health services consumed, blood pressure (SBP and DBP), blood lipids (CHO and HDL), cigarette smoking). BMI was significantly correlated with the risk indicators in the male sample (.302 less than or equal to r less than or equal to .364) and in the female sample (.217 less than or equal to r less than or equal to .521). All coefficients were in the direction of the established biological assumption as concerns hazards to health. The discriminant analysis revealed that in the total group of men, 77% (p less than or equal to .001) of the subjects could be classified either in high or low BMI (greater than Q75 or less than or equal to Q25) on the basis of the scores in SBP, HDL, HDL/CHO. In the subgroup of women greater than or equal to 40 years, statistically significant classification occurred in 100% of the cases (p less than or equal to .001) on the basis of DBP, CHO, HDL/CHO, NCIG. The results indicate that BMI is a fitness determinant which is valid, convenient and easy to use in the detection of unfavorable health indices and when clinical intervention is justified.

[Ventricular function in the normal subject and the coronary patient following exercise]

The effect of acute exercise stress on cardiac function varies between individuals. This variation can be attributed to differences in the degree of physical fitness, quality of coronary circulation and myocardial oxygenation and contractility. Extended long term physical training regimes can induce chronic modifications of cardiac function in both healthy individuals and subjects with coronary artery disease. These modifications are evident at rest and during submaximal and maximal work levels. It is not yet clear however, that exercise training induces a hypertrophic response of the ventricular walls in either healthy subjects or coronary patients although it is generally accepted that the functional capacity of the myocardial tissue is improved in both cases. The present report reviews recent data regarding the modifications of cardiac function in both normal healthy subjects and cardiac patients following exercise training.