Showing papers in "The Physician and Sportsmedicine in 2011"

Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review

Abstract: Objective: To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to de...

Integrative Training for Children and Adolescents: Techniques and Practices for Reducing Sports-Related Injuries and Enhancing Athletic Performance

Abstract: As more children and adolescents participate in sports and conditioning activities (sometimes without consideration for cumulative workload), it is important to establish age-appropriate training guidelines that may reduce the risk of sports-related injury and enhance athletic performance. The purpose of this article is to review the scientific evidence on youth strength and conditioning and to provide age-appropriate recommendations for integrating different strength and conditioning activities into a well-designed program that is safe, effective, and enjoyable. Integrative training is defined as a program or plan that incorporates general and specific strength and conditioning activities that enhance both health- and skill-related components of physical fitness. The cornerstone of integrative training is age-appropriate education and instruction by qualified professionals who understand the physical and psychosocial uniqueness of children and adolescents.

The 6-minute walk test as a predictor of objectively measured aerobic fitness in healthy working-aged adults.

Abstract: There is a paucity of research examining the 6-minute walk test (6MWT) in young to middle-aged healthy individuals, and little is known about the utility of the 6MWT for predicting aerobic fitness. Purpose: 1) To characterize the aerobic demand of the 6MWT in a group of healthy working-aged adults; 2) to examine the ability of the 6MWT to objectively differentiate the fitness level between participants; and 3) to create prediction equations for 6MWT distance and maximal oxygen consumption (VO2 max) using the 6MWT results in combination with easily measured anthropometric and demographic variables. Methods: Participants (N = 44; men, 23; women, 21) completed the 6MWT, VO2 max, and a battery of simple fitness measures. Results: The aerobic demand of the 6MWT was 28.7 ± 5.7 mL·kg-1·min-1 (72.7% ± 11.6% of VO2 max). Rank order correlation revealed a moderate strength association between 6MWT distance and VO2 max (r = 0.49; P = 0.001). Using stepwise multiple linear regression, we were able to account ...

Chronic Exercise Preserves Lean Muscle Mass in Masters Athletes

Abstract: Aging is commonly associated with a loss of muscle mass and strength, resulting in falls, functional decline, and the subjective feeling of weakness. Exercise modulates the morbidities of muscle aging. Most studies, however, have examined muscle-loss changes in sedentary aging adults. This leaves the question of whether the changes that are commonly associated with muscle aging reflect the true physiology of muscle aging or whether they reflect disuse atrophy. This study evaluated whether high levels of chronic exercise prevents the loss of lean muscle mass and strength experienced in sedentary aging adults. A cross-section of 40 high-level recreational athletes ("masters athletes") who were aged 40 to 81 years and trained 4 to 5 times per week underwent tests of health/activity, body composition, quadriceps peak torque (PT), and magnetic resonance imaging of bilateral quadriceps. Mid-thigh muscle area, quadriceps area (QA), subcutaneous adipose tissue, and intramuscular adipose tissue were quantified in magnetic resonance imaging using medical image processing, analysis, and visualization software. One-way analysis of variance was used to examine age group differences. Relationships were evaluated using Spearman correlations. Mid-thigh muscle area (P = 0.31) and lean mass (P = 0.15) did not increase with age and were significantly related to retention of mid-thigh muscle area (P < 0.0001). This occurred despite an increase in total body fat percentage (P = 0.003) with age. Mid-thigh muscle area (P = 0.12), QA (P = 0.17), and quadriceps PT did not decline with age. Specific strength (strength per QA) did not decline significantly with age (P = 0.06). As muscle area increased, PT increased significantly (P = 0.008). There was not a significant relationship between intramuscular adipose tissue (P = 0.71) or lean mass (P = 0.4) and PT. This study contradicts the common observation that muscle mass and strength decline as a function of aging alone. Instead, these declines may signal the effect of chronic disuse rather than muscle aging. Evaluation of masters athletes removes disuse as a confounding variable in the study of lower-extremity function and loss of lean muscle mass. This maintenance of muscle mass and strength may decrease or eliminate the falls, functional decline, and loss of independence that are commonly seen in aging adults.

Dimethyl Sulfoxide: An Effective Penetration Enhancer for Topical Administration of NSAIDs

Abstract: Dimethyl sulfoxide (DMSO) is a molecule with a long history in pharmaceutics and is now well established as a penetration enhancer in topical pharmaceutical formulations It is currently used for this purpose in diclofenac sodium topical solution (approved in the United States to treat signs and symptoms of osteoarthritis) and idoxuridine topical solution (approved in Europe for the treatment of herpes zoster) This article reviews the mechanism of action of DMSO as a pharmaceutical penetration enhancer, the characteristics of the molecule that facilitate transdermal drug delivery, and studies of efficacy and safety The clinical use of pharmaceutical-grade DMSO as a penetration enhancer is supported by the robust data that have accumulated over the past 3 decades demonstrating the favorable safety and tolerability profile Dimethyl sulfoxide is a safe and effective mechanism for facilitating the transdermal delivery of both hydrophilic and lipophilic medications to provide localized drug delivery

Exercise and diet, independent of weight loss, improve cardiometabolic risk profile in overweight and obese individuals.

Abstract: Diet and/or exercise are routinely advised as methods for weight loss in overweight/obese individuals, particularly those who are at high risk for cardiovascular disease and type 2 diabetes mellitus However, physical activity and structured exercise programs rarely result in significant loss of body weight or body fat, and weight-loss diets have extraordinarily high recidivism rates Despite only modest effects on body weight, exercise and ad libitum nutrient-dense diets for overweight/obese individuals have many health benefits, including skeletal muscle adaptations that improve fat and glucose metabolism, and insulin action; enhance endothelial function; have favorable changes in blood lipids, lipoproteins, and hemostatic factors; and reduce blood pressure, postprandial lipemia and glycemia, and proinflammatory markers These lifestyle-induced adaptations occur independently of changes in body weight or body fat Thus, overweight/obese men and women who are at increased risk for cardiovascular disease and type 2 diabetes as a result of sedentary lifestyle, poor diet, and excess body weight should be encouraged to engage in regular physical activity and improve their diet, regardless of whether the healthier lifestyle leads to weight loss

Is Quadriceps Muscle Weakness a Risk Factor for Incident or Progressive Knee Osteoarthritis

Abstract: The role of the quadriceps muscle in mediating risk for knee osteoarthritis (OA) is a common subject of investigation. The quadriceps muscle is a principal contributor to knee joint stability and provides shock absorption for the knee during ambulation. Clinically, weakness of the quadriceps muscle is consistently found in patients with knee OA. Research has shown that higher quadriceps muscle strength is associated with a reduced risk for incident symptomatic knee OA. However, there is limited evidence to suggest that quadriceps muscle plays a significant role in the incidence of radiographic knee OA. In addition, greater quadriceps muscle strength is associated with a lower risk for progression of tibiofemoral joint space narrowing and cartilage loss in women. This article summarizes knowledge of the relationship between quadriceps muscle strength and risk for knee OA.

2011 recommendations for the diagnosis and management of gout and hyperuricemia

Abstract: Gout is a major health problem in the United States; it affects 8.3 million people, which is approximately 4% of the adult population. Gout is most often diagnosed and managed in primary care practices; thus, primary care physicians have a significant opportunity to improve patient outcomes. Following publication of the 2006 European League Against Rheumatism (EULAR) gout guidelines, significant new evidence has accumulated, and new treatments for patients with gout have become available. It is the objective of these 2011 recommendations to update the 2006 EULAR guidelines, paying special attention to the needs of primary care physicians. The revised 2011 recommendations are based on the Grading of Recommendations Assessment, Development, and Evaluation approach as an evidence-based strategy for rating quality of evidence and grading the strength of recommendation formulated for use in clinical practice. A total of 26 key recommendations, 10 for diagnosis and 16 for management, of patients with gout were evaluated, resulting in important updates for patient care. The presence of monosodium urate crystals and/or tophus and response to colchicine have the highest clinical diagnostic value. The key aspect of effective management of an acute gout attack is initiation of treatment within hours of symptom onset. Low-dose colchicine is better tolerated and is as effective as a high dose. When urate-lowering therapy (ULT) is indicated, the xanthine oxidase inhibitors allopurinol and febuxostat are the options of choice. Febuxostat can be prescribed at unchanged doses for patients with mild-to-moderate renal or hepatic impairment. The target of ULT should be a serum uric acid level that is ≤ 6 mg/dL. For patients with refractory and tophaceous gout, intravenous pegloticase is a new treatment option. This article is a summary of the 2011 clinical guidelines published in Postgraduate Medicine. This article provides a streamlined, accessible overview intended for quick review by primary care physicians, with the full guidelines being a resource for those seeking additional background information and expanded discussion.

Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency.

Abstract: A crossover second toe is a commonly seen forefoot problem, usually occurring in women aged > 50 years, and often in association with a bunion deformity. The plantar plate is the principal static stabilizer of the second metatarsophalangeal (MTP) joint. Different authors have proposed classifications to define instability of the second MTP joint, but only describe clinical progression of the deformity. Once a plantar plate tear has developed, conservative treatment can eliminate the symptoms and prevent progression of the deformity but cannot achieve correction or realignment of the deformity. The proposed clinical staging and anatomic grading classification combines clinical findings and anatomic aspects of the plantar plate tears. The surgical treatment described herein reconstructs the anatomic structures that lead to the instability of the second MTP joint. A plantar plate tear repair and lateral soft tissue reefing can restore the normal alignment of the joint with an anatomic repair.

Platelet-Rich Plasma Therapy: A Systematic Literature Review and Evidence for Clinical Use

Abstract: Platelet-rich plasma (PRP) is an autologous blood-derived product with an increased concentration of platelets in plasma, which are used to deliver supraphysiological levels of growth factors. Platelet-rich plasma has been used in many fields, including oral, maxillofacial, and plastic surgery. Its use in sports medicine has been increasing after recent evidence and media publicity suggest that it may augment the treatment of muscle strains, as well as tendon and ligament healing. Basic science and animal studies show promising results, but high-level clinical trials have yet to prove its efficacy. With increasing media coverage on the use of PRP in athletes, it is paramount that orthopedic surgeons and sports medicine physicians understand the various methods of preparation and administration, potential clinical applications, and available clinical results to best counsel patients on its advantages and disadvantages.

The Advanced Throwers Ten Exercise Program: A New Exercise Series for Enhanced Dynamic Shoulder Control in the Overhead Throwing Athlete

Abstract: The overhead throwing motion is a high-velocity, extremely stressful athletic movement. Its repetitive nature places tremendous demands on the entire body, frequently resulting in injury to the throwing shoulder. Such injuries, whether managed nonoperatively or surgically, require a multiphased approach beginning with exercises to restore muscular strength and proprioception, and advancing to more demanding exercises to improve power, endurance, and dynamic control. This article presents a new and innovative approach to the rehabilitation of the overhead throwing athlete, The Advanced Throwers Ten Exercise Program. This expanded program incorporates throwing motion-specific exercises and movement patterns performed in a discrete series, utilizing principles of coactivation, high-level neuromuscular control, dynamic stabilization, muscular facilitation, strength, endurance, and coordination, which all serve to restore muscle balance and symmetry in the overhead throwing athlete. This program is a continuation of the Throwers Ten Exercise Program, which has been utilized with excellent results in clinical practice and in athletic performance training. This unique combination of advanced exercise techniques bridges the gap between rehabilitation and training, facilitating a kinetic linking of the upper and lower extremities and providing a higher level of humeral head control necessary for the overhead throwing athlete's symptom-free return to sports.

Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review.

Abstract: Objective: To investigate the clinical efficacy of ultrasound when compared with anatomic standard injection using palpation/anatomic landmarks. Methods: PubMed, Ovid Medline/Cochrane Reviews, BIOSIS Previews®, and SPORTDiscus™ databases were searched to January 2011. To narrow the search, the following key search terms were used: ultrasound, guided, injection, joint, shoulder, elbow, wrist, hip, knee, and ankle. Fifteen articles were determined to be relevant, and an additional 2 articles were added after bibliography sections of the 15 articles were reviewed, resulting in a total of 17 articles meeting inclusion and exclusion criteria. Results: Accuracy was greater in the ultrasound-guided group, independent of anatomic site. An improvement in time to symptom onset in the short term (< 6 weeks) was greatest with the use of ultrasound-guided intra-articular injection. Long-term outcomes are not proven to be different between intra-articular injection with ultrasound or anatomic guidance. The grea...

Bone Health and the Female Athlete Triad in Adolescent Athletes

Abstract: Peak bone mass (PBM) is a negative predictor of osteoporosis and lifelong fracture risk Because osteoporosis is such a prevalent disease with life-threatening consequences, it is important to try to maximize PBM Adolescence is a critical period for bone acquisition This article discusses some of the differences in male and female skeletal development and modifiable factors that enhance bone accrual in this age group, particularly in athletes Hormonal influences, effects of physical activity, and nutritional contributions are included, with a focus on the adolescent athlete Emphasis is placed on the importance of appropriate energy availability in this age group We also review prevention and treatment strategies for the female athlete triad (ie, the inter-relationship of decreased energy availability, menstrual irregularity, and low bone density) in adolescents and athletic women Recommendations for maximizing bone density in both male and female adolescents are discussed

Athletic Performance after ACL Reconstruction in the Women's National Basketball Association

Abstract: Purpose: Females are at greater risk than males for sustaining an anterior cruciate ligament (ACL) tear. Performance outcomes and attrition rates associated with ACL injury and reconstruction in Women's National Basketball Association (WNBA) athletes are unclear. The purpose of this study was to compare athletes who underwent ACL reconstruction with pre-injury and matched controls to determine differences in performance and return to play. Methods: A retrospective review of 18 WNBA players who underwent ACL reconstruction between 1998 and 2008 was conducted. Performance data for 2 full seasons before and after the index surgery were collected. Data were obtained from 36 matched controls. Within-group and between-group comparisons were performed to assess significance of changes in athletic performance between the pre- and post-index seasons, and the odds ratios of return to play following surgery. Results: Fourteen (78%) of 18 WNBA athletes who underwent ACL reconstruction returned to play in the ...

The intrinsic risk factors for ACL ruptures: an evidence-based review.

Abstract: This article aims to assess the evidence related to the intrinsic risk factors for anterior cruciate ligament (ACL) ruptures. The level of evidence (according to evidence-based guidelines) for each study and the level of certainty for each risk factor were determined. After a review of the evidence, femoral notch geometry was the only risk factor that was found to be associated with risk of ACL rupture with high certainty. This review concludes that more research, particularly high-quality, prospective studies, are required to provide accurate measures of risk. These data should be used to establish multifactorial risk factor models designed to identify individuals at high risk of sustaining an ACL injury.

Three-Dimensional Motion Analysis Validation of a Clinic-Based Nomogram Designed to Identify High ACL Injury Risk in Female Athletes

Abstract: Aims: Prospective measures of high knee abduction moment (KAM) during landing identify female athletes at increased risk for anterior cruciate ligament (ACL) injury. Laboratory-driven measurements predict high KAM with 90% accuracy. This study aimed to validate the clinic-based variables against 3-dimensional motion analysis measurements. Methods: Twenty female basketball, soccer, and volleyball players (age, 15.9 ± 1.3 years; height, 163.6 ± 9.9 cm; body mass, 57.0 ± 12.1 kg) were tested using 3-dimensional motion analysis and clinic-based techniques simultaneously. Multiple logistic regression models have been developed to predict high KAM (a surrogate for ACL injury risk) using both measurement techniques. Clinic-based measurements were validated against 3-dimensional motion analysis measures, which were recorded simultaneously, using within- and between-method reliability as well as sensitivity and specificity comparisons. Results: The within-variable analysis showed excellent inter-rater reli...

Exercise and osteoporosis-related fractures: perspectives and recommendations of the sports and exercise scientist.

Abstract: Osteoporosis-related fractures represent a major health concern, particularly in elderly populations. Direct and indirect costs (amounting to nearly $17 billion in 2005), increased morbidity, and loss of independence place substantial burden on the health care system. Observational studies have shown that a physically active lifestyle is associated with a 30% to 50% decrease in vertebral or hip fractures, and a recent meta-analysis that determined the effects of exercise on fracture incidence further confirmed these results. However, because no randomized controlled exercise trials have selected fractures as a primary endpoint, causality between a sedentary lifestyle and fractures may be potentially confounded by participants' poor health status. With regard to fall reduction and bone strength as the main surrogates for fracture risk, many randomized controlled trials and corresponding meta-analyses have reported significant positive outcomes. Interestingly, no study that has assessed fall-related injuries has focused specifically on interventions that aimed to reduce fall impact. There is ongoing debate as to which factor, osteoporosis or falls, is more important for fracture prevention. This may be dependent on the region prone to fracture and the subjects' health status. In randomized controlled trials on exercise, the type, mode, and composition of exercise parameters are predictors of study outcome. Unfortunately, many exercise trials on fall prevention have not adequately described the exercise protocol used, which makes it difficult to determine which fall prevention protocol was most effective. A recent meta-analysis recommended Tai Chi and/or a mix of balance and resistance exercises for fall prevention. More sophisticated protocols are required to impact bone strength. Corresponding state-of-the-art protocols have focused on periodized high-impact/high-intensity resistance protocols performed at least twice per week. In the frail elderly, high-frequency/high-cycle number exercise programs with low-to-moderate strain intensity may also positively affect bone strength.

Clinical Management of the Physically Active Patient with Type 1 Diabetes

Abstract: The prevalence and incidence of type 1 diabetes continues to increase worldwide. Most patients with type 1 diabetes are young at the time of diagnosis and wish to continue leading a physically active life. Although regular exercise, insulin therapy, and proper nutrition are the cornerstone of treatment, there are considerable challenges in managing the active individual with type 1 diabetes. The current recommendation for diabetes management is intensive glycemic control for all patients when possible to help prevent secondary complications. Both insulin pump therapy and multiple daily injections are beneficial treatment options to lower average glucose levels; however, without continuous glucose monitoring, these treatment options typically increase the risk of hypoglycemia. In active patients with type 1 diabetes, the challenges of maintaining good glycemia are complicated by the inability to regulate insulin concentrations during and after exercise. Physiological and psychosocial factors during growth and maturation also provide additional challenges. This article highlights challenges and key strategies for diabetes management in the active individual with type 1 diabetes, including the application of the most recent diabetes technologies.

High Tibial Osteotomy for the Treatment of Unicompartmental Knee Osteoarthritis: A Review of the Literature, Indications, and Technique

Abstract: In the past decades, there has been varying support for high tibial osteotomy. This surgical procedure was originally popularized by Mark B. Coventry, MD in the 1960s, but fell out of favor with orthopedic surgeons as knee arthroplasty became more commonplace. In the past 10 years, osteotomy has been rediscovered as an important adjunct to cartilage repair procedures that rely on a normalized biomechanical environment. Furthermore, there has been an increase in the number of patients presenting with unicompartmental disease (eg, after prior meniscectomy) who are at an age and functional level that is not ideally suited for joint arthroplasty. High tibial osteotomy allows 70% to 85% of patients to delay arthroplasty for ≥ 5 to 10 years and 50% to 60% for ≥ 15 years. This article provides an overview of the indications, technique, complications, and outcomes of high tibial osteotomy, specifically the more commonly used opening wedge technique.

Platelet-rich plasma products in sports medicine.

Abstract: Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is considerable interest in using these PRP products for the treatment of musculoskeletal disorders, particularly athletic injuries. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. Platelet-rich plasma has been used to treat conditions such as lateral epicondylitis, ligament and muscle strains, and tears of the rotator cuff, anterior cruciate ligament, and Achilles tendon. Platelet-rich plasma can be applied at the site of injury either during surgery or through an injection performed in the physician's office. The benefits of PRP therapy appear to be promising, and many investigators are exploring the ways in which this therapy can be used in the clinical setting. However, there is little published clinical evidence that proves its efficacy in treating the multitude of injuries/disorders that are thought to benefit from PRP. The purpose of this article is to review the current evidence on PRP therapy.

The Classification Systems of Stress Fractures: A Systematic Review

Abstract: Background: Stress fractures of the upper and lower extremity are troublesome overuse injuries in athletes and nonathletes alike. These injuries have a broad spectrum of severity and prognosis. We performed a systematic search of the literature, which revealed multiple classification systems; however, we did not uncover a general system that offered both validated radiographic and clinical parameters. Methods: A literature search was conducted using Ovid/Medline, Embase, and the Cochrane Library, with publication dates ranging from 1960 to December 2009. Inclusion criteria included all studies and review articles regarding stress or fatigue fractures and their classification. Results: Forty-three studies and/or articles were identified for this review. Of these articles, 27 classification systems were referenced. Sixteen of the systems were applicable to any injury location, and 1 applied to specific bones (femoral neck, tibia, tarsal navicular, pars interarticularis, and fifth metatarsal). Four c...

Meniscal injuries in the young, athletically active patient.

Abstract: Meniscal injuries are common in young physically active individuals, particularly those who are involved in contact level 1 sports that involve frequent pivoting, such as soccer and American football. This is a unique population because of their high physical activity at a young age, and it is important that correct diagnosis and appropriate treatment are provided, as the medial and lateral menisci are essential for normal knee function. In this article, we review the anatomy and function of the meniscus, the epidemiology of meniscal tears, and mechanism(s) of injury. Important concomitant injuries are also discussed. When making a diagnosis, relevant patient history, physical examination, and appropriate imaging studies are required. Nonoperative treatment is rarely successful for treating meniscal tears in young athletes, and therefore repair of the torn menisci is often required. We also discuss partial resection (which should only be performed when repair is not possible), as well as rehabilitation protocols after repair has been performed. All of these factors associated with meniscal injuries are important for a physician when diagnosing and treating these often complex injuries.

Acromioclavicular Joint Injuries: Anatomy, Diagnosis, and Treatment

Abstract: Acromioclavicular (AC) joint injuries are common in athletic populations and account for 40% to 50% of shoulder injuries in many contact sports, including lacrosse, hockey, rugby and football. The AC joint is stabilized by static and dynamic restraints, including the coracoclavicular (CC) ligaments. Knowledge of these supporting structures is important when identifying injury and directing treatment. Management of AC injuries should be guided by severity of injury, duration of injury and symptoms, and individual patient factors. These help determine how best to guide management, and whether patients should be treated surgically or nonsurgically. Treatment options for AC injuries continue to expand, and include arthroscopic-assisted anatomic reconstruction of the CC ligaments. The purpose of this article is to review the anatomy, diagnostic methods, and treatment options for AC joint injuries. In addition, the authors' preferred reconstruction technique and outcomes are presented.

Effects of 1,3-dimethylamylamine and caffeine alone or in combination on heart rate and blood pressure in healthy men and women.

Abstract: Background: The use of 1, 3-dimethylamylamine (geranamine), alone and in combination with caffeine, is becoming widespread within the dietary supplement industry. To our knowledge, no data are available concerning the effects of oral geranamine intake on heart rate (HR) and blood pressure in individuals. Methods: Ten young healthy men and women ingested 1 of 5 conditions on different days using a double-blind, randomized, crossover design. The following were ingested after a 10-hour overnight fast: 250 mg caffeine (C), 50 mg geranamine (G 50 mg), 75 mg geranamine (G 75 mg), 250 mg caffeine + 50 mg geranamine (C + G 50 mg), and 250 mg caffeine + 75 mg geranamine (C + G 75 mg). Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were measured pre-ingestion and at 30, 60, 90, and 120 minutes post-ingestion. Plasma norepinephrine (NE) and epinephrine (EPI) were measured pre-ingestion and at 60 and 120 minutes post-ingestion. Results: Heart rate wa...

A carbohydrate-restricted diet during resistance training promotes more favorable changes in body composition and markers of health in obese women with and without insulin resistance.

Abstract: Objective: To determine whether sedentary obese women with elevated levels of homeostatic model assessment (HOMA) insulin resistance (ie, > 3.5) experience greater benefits from an exercise + higher-carbohydrate (HC) or carbohydrate-restricted weight loss program than women with lower HOMA levels. Methods: 221 women (age, 46.5 ± 12 years; body weight, 90.3 ± 16 kg; body mass index, 33.8 ± 5 kg/m2) participated in a 10-week supervised exercise and weight loss program. The fitness program involved 30 minutes of circuit-style resistance training 3 days per week. Subjects were prescribed low-fat (30%) isoenergetic diets that consisted of 1200 kcals per day for 1 week (phase 1) and 1600 kcals per day for 9 weeks (phase 2) with HC or higher protein (HP). Fasting blood samples, body composition, anthropometry, resting energy expenditure, and fitness measurements were obtained at 0 and 10 weeks. Subjects were retrospectively stratified into lower (LH) or higher (HH) than 3.5 HOMA groups. Data were analyze...

Acute effects of passive leg cycling on upper extremity tremor and bradykinesia in Parkinson's disease.

Abstract: Background: Previous studies have shown that single bouts of high-rate active cycling (> 80 rpm) improve upper extremity motor function in individuals with Parkinson's disease (PD). It is unknown if passive leg cycling produces a similar effect on upper extremity function. This article examines whether passive leg cycling can promote immediate changes in upper tremor and bradykinesia in PD and if pedaling rates have variable effects. Methods: Twenty individuals with mild-to-moderate idiopathic PD completed 4 sessions, with each session taking place 1 week apart. In the second to fourth sessions, a motorized bicycle was set to passively rotate the subjects' legs at rates of 60, 70, or 80 rpm for 30 minutes. Quantitative upper extremity motor assessments were completed immediately before and after each session. Results: Passive leg cycling was shown to reduce tremor and bradykinesia in PD. However, the rate of passive cycling did not affect the degree of improvement in bradykinesia or tremor. Conclu...

Exercise as a Nonpharmacologic Intervention in Patients with Heart Failure

Abstract: For patients with heart failure (HF), dyspnea and fatigue resulting in diminished exercise tolerance are among the main factors that contribute to decreased social and physical functioning and quality of life There has long been evidence to suggest that measures of cardiac function, such as ejection fraction and cardiac output, only poorly correlate with a patient's exercise capacity, indicating the involvement of factors other than those impacting central circulation The lack of a close correlation between central hemodynamics and exercise tolerance has led to investigations into alterations in the periphery, such as abnormalities in vascular endothelial function, hyperactivation of the sympathetic nervous system, and changes in structure and oxidative capacity of skeletal muscle, which are commonly seen in patients with HF Over the past 2 decades, numerous clinical trials have demonstrated the beneficial impact of exercise training on skeletal muscle energy metabolism, vascular function, and ventilatory capacity, which correlate with improvements in exercise tolerance, hospitalization rates, and quality of life of patients with HF In accordance with recent guidelines established by the leading cardiology societies in the United States and Europe, physicians are urged to emphasize exercise training for all clinically stable patients with HF using individualized protocols that feature early mobilization after acute exacerbations of the disease and gradual increases in intensity

Anthropometric and training variables related to half-marathon running performance in recreational female runners.

Abstract: The relationship between skin-fold thickness and running has been investigated in distances ranging from 100 m to the marathon distance (42.195 km), with the exclusion of the half-marathon distance (21.0975 km). We investigated the association between anthropometric variables, prerace experience, and training variables with race time in 42 recreational, nonprofessional, female half-marathon runners using bi- and multivariate analysis. Body weight (r, 0.60); body mass index (r, 0.48); body fat percentage (r, 0.56); pectoral (r, 0.61), mid-axilla (r, 0.69), triceps (r, 0.49), subscapular (r, 0.61), abdominal (r, 0.59), suprailiac (r, 0.55), and medial calf (r, 0.53) skin-fold thickness; mean speed of the training sessions (r, -0.68); and personal best time in a half-marathon (r, 0.69) correlated with race time after bivariate analysis. Body weight (P = 0.0054), pectoral skin-fold thickness (P = 0.0068), and mean speed of the training sessions (P = 0.0041) remained significant after multivariate analysis. Mean running speed during training was related to mid-axilla (r, -0.31), subscapular (r, -0.38), abdominal (r, -0.44), and suprailiac (r, -0.41) skin-fold thickness, the sum of 8 skin-fold thicknesses (r, -0.36); and percent body fat (r, -0.31). It was determined that variables of both anthropometry and training were related to half-marathon race time, and that skin-fold thicknesses were associated with running speed during training. For practical applications, high running speed during training (as opposed to extensive training) may both reduce upper-body skin-fold thicknesses and improve race performance in recreational female half-marathon runners.

Exercise in the management of type 2 diabetes mellitus: what are the benefits and how does it work?

Abstract: In this article, we examine the results from meta-analyses of studies that have focused on the effects of supervised exercise in patients with established type 2 diabetes mellitus. Exercise has been clearly demonstrated to have benefits on blood glucose control (average reduction of glycated hemoglobin, 0.6%) and cardiovascular risk factors. These benefits are observed independently of any change in body mass index and fat mass, and are also seen in older populations. Multiple mechanisms are involved, and the improved insulin-sensitizing effect of exercise training is not restricted to muscle but extends to hepatic and adipose tissue. However, while the benefits of exercise in type 2 diabetes management are undisputable, it is not as easy to draw correlations between clinical benefit and the amount of physical activity included in daily life. Recent studies have shown encouraging results with moderate increases in physical activity, which are feasible for most patients and are sufficient to induce sustained positive changes for 2 years. Thus, the benefits of structured and supervised exercise in patients with type 2 diabetes have been consistently demonstrated. Currently, the primary challenge is to determine how long-term increased physical activity can be durably implemented in a patient's daily life.

The NSAID Dilemma: Managing Osteoarthritis in High-Risk Patients

Abstract: For decades, evidence-based data and reported experience have warned that the common chronic oral nonsteroidal anti-inflammatory drug (NSAID) therapy for osteoarthritis (OA) in elderly patients is ultimately dangerous. Elderly patients with OA are at heightened risk for developing serious gastrointestional and cardiovascular adverse events, including gastrointestinal bleeding, myocardial infarction, and stroke. Prescribing NSAIDs, especially in an elderly population, continues to be discouraged because of these significant risks. A dilemma exists for individuals who need the established efficacy associated with oral NSAIDs but who are at increased risk for serious adverse events associated with these agents. The goal of this clinical review was to evaluate the risks versus benefits of current options in the treatment of OA. This review found that topical NSAIDs seem to be the safest choice among all options to mitigate gastrointestinal and cardiovascular risks and should be considered prior to the initiation of oral nonselective or cyclooxygenase (COX)-2-selective NSAIDs for individuals presenting with a localized expression of OA. Further research is needed to evaluate and compare these therapies in treating both pain and inflammation effectively while mitigating safety risks in high-risk populations.