Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness.

BACKGROUND: Prehabilitation may improve postoperative clinical outcomes among patients undergoing major abdominal surgery. This study evaluated the potential effects of a high-intensity interval training (HIIT) program performed before major abdominal surgery on patients' cardiorespiratory fitness and functional ability (secondary outcomes of pilot trial NCT02953119). METHODS: Patients were included before surgery to engage in a low-volume HIIT program with 3 sessions per week for 3 weeks. Cardiopulmonary exercise and 6-min walk (6MWT) testing were performed pre- and post-prehabilitation. RESULTS: Fourteen patients completed an average of 8.6 ± 2.2 (mean ± SD) sessions during a period of 27.9 ± 6.1 days. After the program, [Formula: see text]O2 peak (+ 2.4 ml min-1 kg-1, 95% CI 0.8-3.9, p = 0.006), maximal aerobic power (+ 16.8 W, 95% CI 8.2-25.3, p = 0.001), [Formula: see text]O2 at anaerobic threshold (+ 1.2 ml min-1 kg-1, 95%CI 0.4-2.1, p = 0.009) and power at anaerobic threshold (+ 12.4 W, 95%CI 4.8-20, p = 0.004) were improved. These changes were not accompanied by improved functional capacity (6MWT: + 2.6 m, 95% CI (- 19.6) to 24.8, p = 0.800). CONCLUSION: A short low-volume HIIT program increases cardiorespiratory fitness but not walking capacity in patients scheduled for major abdominal surgery. These results need to be confirmed by larger studies.

[Plantar fasciitis: update 2021]. / Aponévropathie plantaire : mise au point 2021.

Plantar heel pain affects 4 to 9% of the population and is a common reason for consultation. Plantar fasciitis is the most frequent cause. Its diagnosis is essentially clinical, possibly supported initially by combination of X-ray/ultrasound. Ultrasound is the modality of choice to confirm the diagnosis. The prognosis is favorable, but the evolution can be long. Its management should be structured in a progressive manner, based on therapeutic education and physical measures. These simple measures have the highest level of evidence of effectiveness and should be implemented before proposing, sometimes too early, second-line therapies.

Les talalgies plantaires touchent 4 à 9 % de la population et sont un motif fréquent de consultation en médecine générale et en médecine du sport. L'aponévropathie plantaire en est la cause la plus fréquente. Son diagnostic est essentiellement clinique, éventuellement complété en première intention par le couple radiographie/échographie. Cette dernière est l'examen de choix permettant de confirmer le diagnostic. De pronostic favorable, sa durée d'évolution peut être longue. Sa prise en charge doit être structurée de façon progressive en s'appuyant sur l'éducation thérapeutique et des mesures physiques. Ces mesures simples montrent le niveau de preuve d'efficacité le plus élevé et doivent impérativement être mises en place avant de proposer, parfois trop précocement, des thérapeutiques de seconde intention.

Complex regional pain syndrome of the residual limb in a transtibial lower-limb amputee: diagnosis and treatment.

We present the unusual case of complex regional pain syndrome (CRPS) of the residual limb in a 54-year-old woman with transtibial lower-limb amputation. Intractable pain developed 14 months after amputation, followed by successful rehabilitation. Anamnesis and clinical findings included sensory symptoms, vasomotor symptoms and signs, and oedema. The Budapest criteria for a diagnosis of CRPS were met. After infusions of bisphosphonates during a 5-week inpatient interdisciplinary rehabilitation programme, the pain decreased. Clinicians should suspect CRPS in case of chronic or recurrent residual limb pain. The Budapest criteria seem applicable even if interpretation of symptoms and findings can be complicated in vascular polymorbid lower-limb amputation. Bisphosphonates, proposed as first-line pharmacological treatment, can be useful.

Transcultural adaptation and validation of a French version of the Prosthetic Limb Users Survey of Mobility 12-item Short-Form (PLUS-M/FC-12) in active amputees.

BACKGROUND: The PLUS-M 12-item Short-Form is a self-questionnaire that assesses the perceived capacity of lower limb amputees (LLAs) to perform a number of daily-life activities. Its psychometric properties are excellent (intraclass correlation coefficient [ICC]>0.9, fast administration and scoring, normative data available), and it can be used in clinical practice or for research purposes. OBJECTIVE: We aimed to develop a French version of this questionnaire and to assess its psychometric properties. METHODS: We followed international recommendations for translation and cross-cultural validation of questionnaires. In total, 52 LLAs (age 53±16, 40 males, 28/12/12 transtibial/Gritti-Stokes/transfemoral, 20/28/4 ischemic/traumatic/other) participated. Criterion and construct validities were assessed with the Pearson correlation coefficient (PCC) between the PLUS-M 12-item Short-Form and other constructs (Prosthetic-Profile-of-the-Amputee-Locomotor Capabilities Index, Activities-specific Balance Confidence scale, 2-min walking test and Timed Up and Go test), internal consistency with the Cronbach α and reliability with the ICC in 46 individuals who completed the questionnaire twice in a 7-day interval. RESULTS: The mean (SD) PLUS-M 12-item Short-Form T-score was 56.1 (7.8; range 40.3 to 71.4). Construct and criterion validity, internal consistency and reliability ranged from low to excellent (r=0.43 to 0.84, P<10-2 to 0.002; Cronbach α=0.90, ICC=0.89 [0.81-0.94]). We found no floor or ceiling effect. CONCLUSIONS: The French version of the PLUS-M 12-item Short-Form has good to excellent psychometric properties, comparable to those of the original version. Its use could definitely be proposed for both clinical and research purposes, once its validation is completed by assessing other psychometric qualities, especially sensitivity to change.

[The acute management of muscle injuries in 2018]. / Prise en charge des lésions musculaires aiguës en 2018.

Acute muscle lesions are frequent conditions in sports traumato-logy. Intrinsic traumatic mechanism (excessive stretch) is more prevalent that extrinsic mechanism (direct shock or lacerations). The diagnosis is generally based on the injury mechanism description together with the clinical examination. The ultrasonography is helpful in order to evaluate the severity of the lesion and the time to sports resumption. The initial management is based on the POLICE acronym: Protection, Optimal loading, Ice, Compression, and Elevation. For high grade muscle lesions, patients might benefit from either ultrasound-guided hematoma evacuation or surgical repair. Non-steroid anti-inflammatory drugs should be avoided within the first days. The rehabilitation should begin 48h after the trauma, whatever the severity of the lesion.

Les lésions musculaires sont fréquentes en traumatologie sportive. Le mécanisme traumatique est plus fréquemment intrinsèque (par élongation) qu'extrinsèque (par choc direct ou lacération). Le diagnostic se fait sur la base de la description du mécanisme lésionnel et de l'examen clinique. L'estimation de la gravité et des délais de reprise est aidée par les examens d'imagerie, comme l'échographie. La prise en charge immédiate se base sur le protocole POLICE (Protection, Optimal loading, Ice, Compression, Elevation). Les anti-inflammatoires non stéroïdiens sont à proscrire. Les lésions de haut grade peuvent bénéficier d'une ponction-évacuation d'hématome, voire d'une réparation chirurgicale. Il est recommandé de débuter une rééducation adaptée dès 48 heures après le traumatisme, quelle que soit la sévérité de la lésion initiale.

High-intensity interval training combined with resistance training improves physiological capacities, strength and quality of life in multiple sclerosis patients: a pilot study.

BACKGROUND: Numerous studies have shown that mild-to-moderate intensity or resistance exercise training improves physical capacities such as, peak oxygen consumption, maximal tolerated power and strength in multiple sclerosis patients. However, few studies have evaluated the effects of high-intensity interval training (HIIT) associated to with resistance training. Only few studies have analyzed difference between men and women before and after combined training. Moreover, the evaluation of exercise between ambulatory multiple sclerosis patients without disability (Expanded Disability Status Score [EDSS] 0-3) and patients with disabilities (EDSS 3.5-5) was not largely published. AIM: The main objective of our study was to determine if HIIT combined with resistance training improved aerobic and strength capacities as well as quality of life in multiple sclerosis patients and if gender and disabilities play a role in these changes. DESIGN: This study was an open-label uncontrolled study. SETTING: The study was performed outside from conventional care facilities and including homebased training. POPULATION: Twenty-six multiple sclerosis patients have completed the program (19 women, 7 men; mean age 44.6±7.9 years, EDSS 2 [0-5]). METHODS: We conducted a 12-week program of high-intensity interval training combined with resistance training at body weight. Peak oxygen consumption, maximal tolerated power, lactates, isokinetic strength of quadriceps and hamstrings (at 90°/s, 180°/s, and 240°/s) and quality of life were evaluated before and after the program. RESULTS: Peak oxygen consumption and maximum tolerated power improved by 13.5% and 9.4%, respectively. Isokinetic muscle strength increased in both quadriceps and hamstrings at each speed, with a rebalancing of strength between the two legs in quadriceps. Quality of life was also enhanced in three domains. Women showed better improvements than men in V̇O2peak, maximal tolerated power, lactates at the end of test, and heart rate peak, strength in both quadriceps and hamstrings mostly at low speed, and quality of life. The two EDSS groups increased V̇O2peak and strength. CONCLUSIONS: Our study has shown that HIIT combined with resistance exercise training induced an improvement in physical capacity and quality of life. Moreover, this study allowed patients, irrespective of their sex or EDSS score, to resume exercise autonomously. CLINICAL REHABILITATION IMPACT: The results of the study showed that aerobic training at moderate intensity is not the single type of training tolerated by multiple sclerosis patients. High-intensity interval training is well tolerated too and can be used in clinical rehabilitation with resistance training, in both men and women with and without disabilities.

Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer.

[Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48-0.86) to 0.87 (95% CI, 0.75-0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2-4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from -0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.

Botulinum toxin as a treatment for functional popliteal artery entrapment syndrome.

PURPOSE: Functional popliteal artery entrapment syndrome is responsible for exercise-induced muscle leg pain. This syndrome is caused, in most of the cases, by the excessive size of the gastrocnemius muscles. Currently, its treatment is based only on surgery with variable results. METHODS: We report the case of a young professional soldier in a combat unit with bilateral functional popliteal artery entrapment syndrome that was confirmed by dynamic arteriography, magnetic resonance angiography, and ultrasonography and did not improve after bilateral popliteal arteriolysis without resection of the gastrocnemius medial head. Treatment by injecting botulinum toxin in the proximal part of the gastrocnemius muscles was proposed and carried out. RESULTS: Regular follow-up (from 1 month to 3 yr after botulinum toxin treatment) showed the disappearance of exercise-induced pain and the improvement of the patient's physical and sports performance. Results of follow-up ultrasonography during dynamic maneuvers at 2.5 months and 2 yr after botulinum toxin injection were normal. Neither adverse effects nor motor deficit of the gastrocnemius muscles was reported. CONCLUSIONS: This case report suggests that botulinum toxin treatment could be an alternative to surgery for patients with functional popliteal artery entrapment syndrome. Botulinum toxin could reduce functional compression and, consequently, exercise-induced pain by decreasing the volume of the gastrocnemius muscle.