The Effects of Various Cognitive Tasks Including Working Memory, Visuospatial, and Executive Function on Postural Control in Patients With Anterior Cruciate Ligament Injury.

Anterior cruciate ligament (ACL) rupture can impair balance performance, particularly during cognitive motor dual-tasks. This study aimed to determine the effects of various modalities of cognitive load (working memory, and visuospatial and executive function) on postural control parameters in individuals with ACL injury. Twenty-seven ACL-injured and 27 healthy participants were evaluated doing different cognitive tasks (silent backward counting, Benton's judgment of line orientation, and Stroop color-word test) while standing on a rigid surface or a foam. Each task was repeated three times and then averaged. Center of pressure variables used to measure postural performance included sway area and sway velocity in anterior-posterior and medial-lateral directions. Cognitive performance was also assessed by calculating errors and the score of cognitive tasks. A mixed model analysis of variance for center of pressure parameters indicated that patients had more sways than the healthy group. The interaction of group by postural difficulty by cognitive tasks was statistically significant for cognitive errors (p < .01), and patients with ACL injury indicated more cognitive errors compared to healthy controls while standing on the foam. The main effect of cognitive task was statistically significant for all postural parameters, representing reduced postural sways in both groups with all cognitive tasks. However, ACL-injured patients showed more cognitive errors in difficult postural conditions, suggesting that individuals with ACL injury may prioritize postural control over cognitive task accuracy and adopt the posture-first strategy to maintain balance under dual-task conditions.

Comparing the effects of 30 minutes exergaming versus brisk walking on physiological and psychological measurements of older adults.

BACKGROUND: Active video games can make physical activity more appealing and enjoyable for older people. This study compared the effects of 30 min of Exergaming versus walking on the physiological and psychological measures of asymptomatic older adults. METHODS: Forty eligible participants (mean age = 69.60 ± 4.16 y/o) were randomly divided into two groups of 20 in a crossover design, who either performed Brisk Walking or Exergaming, one week apart. Before each session, each participant's blood pressure was measured, and the subjects were encouraged to play/walk continuously for 30 min using a self-selected intensity. During both sessions, average and peak heart rate, time spent in each of the heart rate zones, blood pressure, and double product were assessed through a Polar H10 heart rate monitor. Participants also filled out the modified Physical Activity Enjoyment Scale (PACES) questionnaire and Rate of Perceived Exertion (RPE) scale. RESULTS: Findings indicated a significantly higher average (P = 0.003) and peak heart rate (P < 0.001) and double product (P = 0.002) during Exergaming compared to Brisk Walking. Also, the RPE score was significantly lower and PACES score was significantly higher (P < 0.001) during the Exergaming session. The analyses of blood pressure showed significant changes in systolic and diastolic blood pressures following each session, while no statistically significant difference was reported between the two exercise modalities (P = 0.012 and P < 0.001, respectively). CONCLUSION: This study showed that Exergaming can be a good alternative to traditional exercises like walking for older adults, providing physiological benefits while being less exhausting and more enjoyable.

Reliability and Fall-Risk Predictability of the Short Form of the Fullerton Advanced Balance Scale in Iranian Older Adults.

Recently, a short form of the Fullerton Advanced Balance (SF-FAB) scale was reported as a good predictor of falls in older adults. However, we found no evidence regarding its reliability in non-American older adults. Therefore, we aimed to analyze the reliability and homogeneity of the SF-FAB scale to measure postural balance in Iranian older adults. Eighty-five community-dwelling older adults (70.75 ± 4.97 years) performed the SF-FAB test on two occasions 1 week apart. In both instances, four raters assessed the performance on the test. The SF-FAB scale (mean total score: 12.46 ± 3.53) revealed acceptable internal consistency (Cronbach's α = .77), excellent intrarater reliability (intraclass correlation coefficient = .94-.99), and excellent interrater reliability (intraclass correlation coefficient = .92-.99). The overall prediction success rate was 83.5% with correctly classifying 95.6% of nonfallers and 35.3% of fallers. The SF-FAB scale can provide a quick screen of balance status in older adults to trigger referral to clinicians for a more comprehensive assessment.

Comparing the Effects of Single-Task versus Dual-Task Balance Training on Gait Smoothness and Functional Balance in Community-Dwelling Older Adults: A Randomized Controlled Trial.

To compare the effects of single- versus dual-task balance training on the gait smoothness and balance of community-dwelling older adults, 69 volunteers were randomized to single-, dual-task training, and control (no intervention) groups. Exercises were received in 18 sessions through 6 weeks. The gait smoothness was measured by the harmonic ratio of trunk accelerations using a triaxial accelerometer. Balance performance was assessed through the Fullerton Advanced Balance scale, Timed Up and Go test, Activities-specific Balance Confidence, and gait speed. After the trial, all variables improved significantly in the training groups. Moreover, differences in the mean change of all variables, except the Timed Up and Go test, were statistically significant between the interventional groups and the control group, but no significant difference was reported between the two training groups. This study suggests that balance training can improve gait smoothness as well as balance status in healthy older adults.

A Comparison between Effects of Neurofeedback and Balance Exercise on Balance of Healthy Older Adults.

BACKGROUND: Balance ability is a crucial component of independent daily activities among the older adultss. Balance impairment is one of the major risk factors for falls and related complications. OBJECTIVE: The present study aims to investigate and compare the effect of neurofeedback training and balance training on balance and fall risk among older adults. MATERIAL AND METHODS: In this randomized controlled trial, a total of 48 older adults aged more than 65 years were recruited and randomly assigned into two groups, neurofeedback group (n=24) and balance exercise group (n=24). Prior to the intervention, the static balance, dynamic balance, and fall risk were measured using Biodex D balance system and Fullerton Advanced Balance scale. Subjects in neurofeedback group received neurofeedback training for 12 sessions of 30-min, every other day. Moreover, subjects in balance exercise group received balance training for four weeks in 12 sessions (45-minute) every other day. After the intervention, balance measurements were repeated in both groups. The significance level was set at p<0.05. RESULTS: Static balance and dynamic balance were shown to significantly improve, after the interventions (p<0.001). Furthermore, fall risk was significantly reduced, after the trial (p<0.001). In addition, the therapeutic effect of neurofeedback training was not less significant than exercises on balance in the older adults (p<0.001). CONCLUSION: The findings suggest that both neurofeedback training and balance training improved balance ability among the older adults. Results also show the therapeutic effect of neurofeedback training on balance in older people. However, further research is required to accurately investigate the long-term effects of these two treatment methods among the older adults.

Cortical Activity During Postural Recovery in Response to Predictable and Unpredictable Perturbations in Healthy Young and Older Adults: A Quantitative EEG Assessment.

INTRODUCTION: To investigate the effects of predictable and unpredictable external perturbations on cortical activity in healthy young and older adults. METHODS: Twenty healthy older and 19 healthy young adults were exposed to predictable and unpredictable external perturbations, and their cortical activity upon postural recovery was measured using a 32-channel quantitative encephalography. The absolute spectral power and coherence z-scores of cortical waves were analyzed through a 3-way mixed ANOVA. RESULTS: During postural recovery from predictable perturbations, older adults exhibited higher frontoparietal beta power and higher alpha and beta coherence during the late-phase recovery than the young individuals. After unpredictable perturbations, the older group showed lower alpha power in the early phase and higher beta power in the late phase as compared to the young group. Results for the group × time and group × location interactions in the older group showed a higher alpha and beta coherence over the late phase, a higher alpha coherence in F3-P3 and F4-P4 regions, and a higher beta coherence in the F4-P4 region compared to the younger group. CONCLUSION: Our results revealed that the cortical activation after external perturbations increases with aging, particularly in frontoparietal areas. A shift from automatic (subcortical level) to attentional (cortical level) processing may reflect the contribution of attentional resources for postural recovery from an external threat in older individuals.

Electromyographic comparison of vastus medialis obliquus facilitatory versus vastus lateralis inhibitory kinesio taping in athletes with patellofemoral pain: A randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP. METHODS: In this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application. RESULTS: Pain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups. CONCLUSIONS: Both VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.

Comparison of postural control in older adults under different dual-task conditions: A cross-sectional study.

BACKGROUND: and purpose: Performing a cognitive task while maintaining postural stability, known as "dual-task" condition, can increase the cognitive demand and reduce the postural control capacity. The inability to allocate attention to postural control under dual-task conditions may lead to balance impairments, particularly in older adults. The present study aimed to compare the effects of different dual-task conditions of backward counting (BC) and visual attention (VA) on older adults' postural balance performance. METHODS: Twenty asymptomatic volunteers (mean age: 70.4 ± 4.1 years) were recruited. Participants stood on a foam surface placed over a force plate, and displacement and sway velocity of their center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions were recorded under three conditions: BC dual-task, VA dual-task (control of center of mass with a laser pointer), and quiet stance as the control task (CT). RESULTS: Repeated measures ANOVA showed a significant difference in AP and ML sway velocities between conditions with p-values of 0.039 and 0.042, respectively. The LSD post-hoc test revealed that the BC task significantly increased AP sway velocity compared to the CT (p = 0.013), and the VA task significantly increased ML sway velocity compared to the CT (p = 0.034) and the BC tasks (p = 0.026). There were no statistically significant differences between conditions for ML (p = 0.058) and AP (p = 0.350) displacements and total sway velocity (p = 0.051). CONCLUSION: Older adults' postural stability can be impaired under dual-task conditions and the present study revealed that various dual tasks increase postural sway in different directions.

A Randomized Controlled Trial on the Effects of 12 Weeks of Aerobic, Resistance, and Combined Exercises Training on the Serum Levels of Nesfatin-1, Irisin-1 and HOMA-IR.

Background/objective: This study aimed to investigate the impacts of a 12-week training of the aerobic exercise (AE), resistance exercise (RE), and combined exercise (CE) on the serum levels of nesfatin-1, irisin-1 and some other metabolic and anthropometric indices in overweight women with metabolic syndrome. Methods: Sixty overweight women with metabolic syndrome were assigned equally into four groups: aerobic exercise (AE, n = 15), resistance exercise (RE, n = 15), combined exercise (CE, n = 15), and control (n = 15). All groups underwent 12 weeks of intervention. The study variables were measured before and 24 h after the intervention period. Results: Twelve weeks of training resulted in an increase of irisin-1 in the AE and CE groups and nesfatin-1 in all the intervention groups. As expected, all the trained groups exhibited a positive alteration in anthropometric indices and lipid profile in comparison with the control group. Besides, compared with the control group, insulin resistance (based on the homeostatic model assessment) in AE (p = 0.022), RE (p = 0.032), and CE (p < 0.001) groups were reduced significantly. According to the observed changes in the measured indices, serum irisin-1 was significantly correlated with body weight, BMI, body fat percentage, fasting insulin, and HOMA-IR. However, with regard to nesfatin-1, only a negative correlation was observed with body fat percentage and LDL-cholesterol. Conclusions: The 12-week systematic training program changed circulating irisin-1 and nesfatin-1. Also, change in the serum irisin-1 and nesfatin-1 were correlated with the change in glycemic and anthropometric indices in addition to LDL-cholesterol. Also, exercise training significantly reduced fasting insulin and HOMA-IR in all the intervention groups. RCT Registration Code: IRCT20180806040721N2.

Normative Data for the Balance Error Scoring System in Iranian Adults.

CONTEXT: The Balance Error Scoring System (BESS), originally designed to diagnose and assess athletes with concussion syndrome, is now widely used to evaluate postural stability. To interpret balance status, a normative database can be a reliable source. However, different anthropometric characteristics and sociocultural backgrounds across populations hinder the application of previously developed databases in different populations. OBJECTIVE: The present study was designed to develop a normative data set for the general population of healthy Iranian adults according to their age groups and to study the correlation between BESS scores and the participants' sex, height, weight, and body mass index. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 1051 community-dwelling adults aged 20-69 years not suffering from balance disorders, dizziness, or other neurological or musculoskeletal diseases were recruited and stratified into 5 different age groups by decade. MAIN OUTCOME MEASURES: The BESS tests were composed of single-leg, double-leg, and tandem stances, each on a rigid surface and a foam pad. The individuals maintained each position for 20 seconds with eyes closed. The assessor recorded the total number of errors as the individuals' BESS score (range: 0-60). RESULTS: Significant but weak correlations were found between BESS score and height (r = -.13, P < .001) and between BESS score and body mass index (r = .11, P < .001), and the difference between sexes in BESS score was statistically significant in the 50- to 59-year-old (P = .021) and 60- to 69-year-old (P < .001) groups. The BESS scores were significantly different between all age groups (P < .05), except between the 20- to 29-year-old and 30- to 39-year-old groups (P = 1.000) and between the 40- to 49-year-old and 50- to 59-year-old groups (P = .086). CONCLUSIONS: This study provided a normative database for different age groups of asymptomatic Iranian adults. The BESS score had weak correlations with height and body mass index and no correlation with weight, and significant differences were found between sexes in 50- to 69-year-old individuals. This study emphasizes the importance of obtaining specific normative data for different populations.

Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome.

CONTEXT: Chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points (MTrPs), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe postneedle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. OBJECTIVE: To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. The authors hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. DESIGN: Single-blind randomized clinical trial. SETTING: Sports medicine physical therapy clinic. PARTICIPANTS: A total of 40 overhead athletes (age = 36 [16] y; 20 females and 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n = 21) and ISP DN (n = 19) groups. INTERVENTION: An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in 3 sessions (2-day interval between each sessions) for each group. MAIN OUTCOME MEASURES: Pain intensity (visual analog scale), pain pressure threshold, and disability in the arm, shoulder, and hand were assessed before and after the interventions. RESULTS: Pain and disability decreased significantly in both groups (P < .001) and pain pressure threshold increased significantly only in the ISP group (P = .02). However, none of the outcome measures showed a significant intergroup difference after treatments (P > .05). CONCLUSIONS: Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

Combined effects of whole body vibration and unstable shoes on balance measures in older adults: A randomized clinical trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of 4 weeks of whole body vibration training on balance in older adults who word two different types of shoes: unstable (unstable group) versus standard shoes (stable group). DESIGN: Randomized, single-blind clinical trial. PARTICIPANTS: Seventy eight eligible older adults were initially enrolled; 59 participants (mean age 69.7±5.3 years) completed the program. INTERVENTION: Participants were randomized 1:1 to an intervention group that received whole body vibration with unstable shoes, and a control group that received whole body vibration with standard shoes. OUTCOME MEASURES: The Fullerton Advanced Balance scale, preferred gait speed, maximum gait speed, and Fall Efficacy Scale were recorded at baseline, after the 4-week intervention, and 1 month after the end of the training program. RESULTS: Both groups showed improvement in all outcome measures at 4 weeks (p < 0.01) with no significant between-group differences. In the unstable group, the gains were maintained at follow-up (p < 0.01) whereas the scores returned to baseline values in the stable group. At follow-up, significant between-group differences were found for Fullerton Advanced Balance scale (p < 0.001), preferred gait speed (p = 0.007) and maximum gait speed (p = 0.007), and all were in favor of the unstable group. CONCLUSION: Combining whole body vibration with unstable shoes can be proposed as a beneficial method with relatively long-term effects to improve balance measures in older people.

Comparing spinal manipulation with and without Kinesio Taping® in the treatment of chronic low back pain.

OBJECTIVES: Chronic non-specific low back pain (CNLBP) is a prevalent problem among athletes that can cause long-lasting disability and time lost from sporting activities. Thus far, a variety of methods have been suggested to address this problem, including spinal manipulation (SM) and Kinesio Tape® (KT). The aim of this study was to investigate whether adding KT to SM can provide any extra effect in athletes with CNLBP or not. METHOD: Forty-two athletes (21males, 21females) with CNLBP were randomized into two groups of SM (n = 21) and SM plus KT (n = 21). Pain intensity, functional disability level and trunk flexor-extensor muscles endurance were assessed by Numerical Rating Scale (NRS), Oswestry pain and disability index (ODI), McQuade test, and unsupported trunk holding test, respectively. The tests were done before and immediately, one day, one week, and one month after the interventions and compared between the two groups. RESULTS: After treatments, pain intensity and disability level decreased and endurance of trunk flexor-extensor muscles increased significantly in both groups. Repeated measures analysis, however, showed that there was no significant difference between the groups in any of the evaluations. CONCLUSIONS: The findings of the present study showed that adding KT to SM does not appear to have a significant extra effect on pain, disability and muscle endurance in athletes with CNLBP. However, more studies are needed to examine the therapeutic effects of KT in treating these patients. CLINICAL TRIAL REGISTRY NUMBER (IRCT.IR): IRCT2016020624149N5.

Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study.

Background: To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility. Methods: Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010. Patients who had sequestrated disc herniation were excluded. All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. Back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline. Results: A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT. Mean changes in ODI in the 5th session and 1 month after treatment also showed significant improvement. The MCIC for NRS and ODI scores in the present study were considered 20 and 6 points, respectively. Therefore, the mentioned improvements were not clinically significant in the 5th session or at 1-month follow-up. Conclusion: Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility. Trial registration: Irct.ir (Identifier: IRCT2017011924149N33), registered 19 February 2017 (retrospectively registered).

Corrigendum: Author's Name and Affiliation Correction. The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women.

This corrects the article on p. 205 in vol. 41, PMID: 28537059.

The immediate effect of talocrural joint manipulation on functional performance of 15-40 years old athletes with chronic ankle instability: A double-blind randomized clinical trial.

OBJECTIVE: To evaluate the immediate effect of talocrural joint manipulation (TCJM) on functional performance of athletes with chronic ankle instability (CAI). PARTICIPANTS: Forty athletes (18males, 22females) with CAI divided into TCJM group (n = 20) and sham manipulation group (n = 20). INTERVENTION: TCJM was performed as a quick thrust on the involved talus, in the posterior direction. Sham manipulation was maintaining the same position, without any thrust. MAIN OUTCOME MEASURES: Functional performance of athletes was assessed with single leg hop; speed and Y balance tests, before and after the interventions. RESULTS: All functional tests evaluated in this study improved significantly after TCJM (p-value<0.05). These findings were not seen in the control group. Between-group comparisons also showed significant changes for all the measurements after the interventions (p < 0.05). CONCLUSIONS: TCJM can significantly increase the functional performance of athletes with CIA and can be an effective supplementary treatment for these subjects. However, this was a pre-post study and future studies with long-term follow-ups may provide more reliable results about the long-term effectiveness of this type of treatment.

Effects of Kinesio Taping® on knee function and pain in athletes with patellofemoral pain syndrome.

OBJECTIVE: To compare the knee performance and pain in athletes with patellofemoral pain syndrome (PFPS) before and after applying Kinesio Tape® (KT) on vastus medialis obliquus (VMO) muscle. PARTICIPANTS: Fifteen participants (10 females, five males) with unilateral PFPS were examined and compared under taped and untaped conditions. INTERVENTION: VMO of the involved leg was taped from origin to insertion, with 75% of KT's maximal length tension. MAIN OUTCOME MEASURES: Maximal eccentric and concentric peak torques of quadriceps were measured at 60 and 180°/s angular velocities by an isokinetic dynamometer. Functional performance and pain were evaluated by functional tests (step-down and bilateral squat) and visual analog scale, respectively. RESULTS: Paired t-test showed statistically significant increase in VMO peak torque and also repetition of step-down test and bilateral squat after using KT. Pain intensity was also decreased significantly following KT application (p < 0.05). CONCLUSIONS: KT application over VMO can decrease pain and improve the functional performance, generally and quadriceps muscle strength, particularly, in athletes with PFPS. However, more research is needed to evaluate the long-term effects of this therapeutic procedure.

The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women.

BACKGROUND: Recent studies have shown that omentin-1 derived from adipokines can affect physiological regulations and some metabolic dis-eases such as type 2 diabetes mellitus (T2DM). METHODS: The purpose of this study was to examine the impact of 12 weeks of aerobic (cycle ergometer), resistance, and combined exercises on omentin-1 level, glucose and insulin resistance indices in overweight middle age women with T2DM. In this study, 60 overweight middle age diabetic women were selected using simple random sampling and they were assigned to three groups of aerobic exercise (n=12), resistant exercise (n=12) and combined exercise (n=13), and one control group (n=15). Exercises were done in a three times per week sessions for a total of 12 weeks. Blood samples were collected before each exercise session and 24 hours after of the last session. RESULTS: Present study showed that fasting blood sugar decreased significantly in all intervention groups, while homeostasis model assessment of insulin resistance (HOMA-IR) decreased only in the aerobic and combined exercises groups. Furthermore, there was a significant increase in the omentin-1 level only in the combined exercise group. CONCLUSION: Compared to aerobic and resistance exercises, 12 weeks of combined exercise was more efficient in improving HOMA-IR and increasing serum omentin-1 among women with T2DM.