Preoperative quadriceps muscle strength deficit severity predicts knee function one year after anterior cruciate ligament reconstruction.

Quadriceps strength is critical for patients with anterior cruciate ligament (ACL) reconstruction; however, little is known about the relationship between preoperative quadriceps strength deficit and postoperative subjective knee functions. The study aimed to investigate the relationship between preoperative quadriceps strength and postoperative knee function in patients after ACL reconstruction. Seventy-five male patients with primary ACL reconstruction surgery with hamstring autografts between 2014 and 2017 were included. An isokinetic dynamometer assessed quadriceps strength while self-reported knee functions were measured by the International Knee Documentation Committee (IKDC) and Lysholm scores at baseline and 1 year after surgery. The three identified groups (Q1-Q3) were classified according to the preoperative quadriceps muscle strength deficit. Q1 were patients with < 25% quadriceps muscle strength deficit, Q2 showed a 25-45% deficit, and Q3 included those with a deficit > 45%. We compared knee functions between the three groups and examined the associations between preoperative variables and functional knee outcomes. The preoperative quadriceps muscle strength deficit had a negative association with the knee functional scores at 1 year follow-up including the IKDC score (rs = - 0.397, p = 0.005) and the Lysholm score (rs = - 0.454, p < 0.001), but not other factors. Furthermore, only the Q1 group, with < 25% deficit in preoperative quadriceps muscle strength, showed a significant correlation in postoperative IKDC score (r = - 0.462, p = 0.030), and Lysholm score (r = - 0.446, p = 0.038). Preoperative quadriceps muscle strength deficit had a significant negative relationship with postoperative function at 1 year following ACL reconstruction.

The effects of pre-transplantation center-based cardiac rehabilitation on the postoperative quality of life and adherence to exercise in patients undergoing heart transplantation.

BACKGROUND: Heart transplantation (HTx) is the final treatment option for patients with chronic heart failure. Several studies have reported that exercise therapy, which is a component of cardiac rehabilitation, improves exercise capacity and the quality of life (QOL) in patients with heart failure. METHODS: Three patients, referred to an inpatient cardiac rehabilitation before HTx, participated in center-based cardiac rehabilitation (CBCR) during the hospitalization period. The CBCR, including aerobic exercises and resistance training, was conducted 3-4 days/week under cardiac rehabilitation team. Clinical outcomes included QOL using short form (SF)-36 questionnaire and the level of physical activity using international physical activity questionnaire (IPAQ) were evaluated before and after following the CBCR. RESULTS: These patients showed an improved QOL in physical components with mean 32% and in mental components with mean 43%. The adherence to exercise confirmed by level of physical activity also increased as much as mean 1275 MET-minutes at 3 months after transplantation. CONCLUSIONS: The findings in case report show the safety and effectiveness of CBCR in patients waiting for HTx during hopitalization. This is the first case report showing the effect of CBCR in admission period in Korean patients undergoing HTx.

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review.

BACKGROUND: Exercise intensity in exercise training programs is an important determinant of program efficacy, such as improvement in exercise capacity and quality of life (QOL). It is not well known whether differently applied exercise intensities are efficacious when used in exercise-based cardiac rehabilitation programs for patients with pulmonary arterial hypertension (PAH). METHODS: Three databases (PubMed, EMBASE, and CINAHL) were searched with the following inclusion criteria: comparative study of exercise interventions for patients with pulmonary arterial hypertension. Three clinical specialists (a physician, nurse, and exercise physiologist) selected the included articles using the process of systematic review. Included articles were grouped according to aerobic exercise intensity: low, moderate-to-vigorous, and vigorous. The level of evidence for each study was rated using Sackett's levels of evidence. RESULTS: Of 1,452 studies reviewed, 8 were included according to the inclusion criteria (3 randomized controlled trials (RCTs), 3 prospective studies, and 2 case series). Exercise capacity for a six-minute walk distance (mean: 57.7 m) and QOL improved in the above moderate intensity group, while the low intensity group did not show improvement after intervention. For termination criteria, data obtained from the reviewed articles were not sufficient to suggest any exercise intensity recommendations for patients with pulmonary arterial hypertension. DISCUSSION: The findings in this study suggest that at least moderate aerobic exercise intensity is needed to significantly improve six-minute walk distance and QOL in individuals diagnosed with World Health Organization Group 1 of pulmonary arterial hypertension. There is a need for prospective RCTs comparing different exercise intensities in this patient population.

Effects of Aerobic and Resistance Exercise Training on Carotid Intima-Media Thickness in Abdominal Obese Women.

Aims: The purpose of this study was to investigate the effects of a 12-week aerobic and resistance training program on waist circumference (WC) and carotid intima-media thickness (CIMT) in abdominal obese middle-aged women. Methods: Subjects were 40 middle-aged women with abdominal obesity (WC >85 cm) but no specific diseases. Subjects were divided into a combined exercise group (aerobic and resistance exercise) and a control group that did not participate in any lifestyle modification. Carotid variables were measured using B-mode ultrasound. A treadmill exercise test was conducted to directly assess the peak oxygen uptake (VO2peak). Differences in the carotid variables and relative changes between baseline and after 12 weeks were evaluated. Results: After 12 weeks, body weight (70.6 ± 7.8 to 65.6 ± 6.3 kg, P < 0.05), WC (88.8 ± 3.6 to 85.6 ± 3.1 cm, P < 0.01), total cholesterol (215.5 ± 38.4 to 188.2 ± 25.8 mmHg, P < 0.05), low-density lipoprotein cholesterol (150.5 ± 30.6 to 131.6 ± 22.3 mmHg, P < 0.05), triglycerides (164.5 ± 82.3 to 119.9 ± 60.6 mmHg, P < 0.01), VO2peak (24.2 ± 6.2 to 28.7 ± 4.4 mL/kg/min, P < 0.01), and CIMT (0.61 ± 0.13 to 0.58 ± 0.12 mm, P < 0.05) were significantly improved in the combined exercise group but not in the control group; changes in CIMT were associated with changes in WC decrease (r = 0.41, P < 0.01) and VO2peak (r = -0.53, P < 0.01). Conclusions: Combined exercise training in abdominal obese women decreased CIMT; these changes were also associated with reduced WC and improved VO2peak.

Association of Vitamin D Status with Lower Limb Muscle Strength in Professional Basketball Players: A Cross-Sectional Study.

Vitamin D deficiency in athletes may play a role in influencing fracture risk and athletic performance. This study aimed to examine the vitamin D status of basketball players and determine its correlation with muscle strength. We included 36 male professional basketball players (mean age, 22.6 ± 3.2 years) categorized by vitamin D status. We examined the muscle strength of knee extension/flexion and ankle dorsiflexion/plantarflexion using an isokinetic dynamometer. Eleven (30.5%), fifteen (41.7%), and ten (27.8%) players had deficient (<20 ng/mL), insufficient (20-32 ng/mL), and sufficient vitamin D levels (>32 ng/mL), respectively. In the dominant side, there were no significant correlations of vitamin D level with knee extension/flexion strength (r = 0.134, p = 0.436; r = -0.017, p = 0.922, respectively), or with plantarflexion/dorsiflexion ankle strength (r = -0.143, p = 0.404; r = 1.109, p = 0.527, respectively). Moreover, the isokinetic lower limb strengths were not significantly different between the three groups in all settings (all p > 0.05). In conclusion, professional basketball players had a high prevalence of vitamin D insufficiency. Though it may not be associated with muscle strength, maintaining adequate vitamin D levels by micronutrients monitoring, regular dietician consultation, and supplementation is still a critically considerable strategy to enhance young athletes' health.

Isokinetic Performance of Shoulder External and Internal Rotators of Professional Volleyball Athletes by Different Positions.

This study aimed to exam the isokinetic shoulder rotator strength of professional volleyball athletes, by playing positions. This cross-sectional study included a total of 49 healthy male professional volleyball players. We measured the isokinetic strength of the external rotator (ER) and internal rotator (IR) muscles and compared the dominant and non-dominant shoulders at angular speeds of 60°/s and 180°/s. In ER, all positions of players had similar strength between the dominant shoulder and non-dominant shoulders. Conversely, all playing positions except libero had stronger strength in dominant shoulder than that in the non-dominant shoulder. The ER/IR ratio in the dominant shoulder was significantly lower only for the attacker (outside hitter and opposite) at 60°/s and 180°/s (P < 0.0001; P = 0.0028 respectively) and blocker at 60°/s (P = 0.0273) when compared with non-dominant shoulder. Furthermore, the attacker had a lower ER/IR ratio in the dominant shoulder than setter and libero at 60°/s and 180°/s. For elite volleyball players without injury, the dominant shoulder had a higher strength of internal rotation, causing the relative muscle imbalance than the non-dominant shoulder, especially for the attacker and blocker positions. Training program should be individualized for each playing position to improve the imbalanced shoulder.

Preoperative Rotator Muscle Strength Ratio Predicts Shoulder Function in Patients After Rotator Cuff Repair.

BACKGROUND: Shoulder function after rotator cuff repair is associated with patient satisfaction after surgery. Several studies have demonstrated that the muscle strength ratio (external rotators/internal rotators) is an important factor to evaluate shoulder function, but little is known about the relationship between the preoperative muscle strength ratio and postoperative shoulder function. PURPOSE: To evaluate the effect of the preoperative muscle strength ratio of the shoulder rotators on function after rotator cuff repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study participants were patients with small- to medium-sized rotator cuff tears diagnosed by magnetic resonance imaging; 77 patients were included in the analysis. Preoperative muscle strength was assessed through use of isokinetic equipment. Patients were classified into 2 groups (normal and abnormal) according to a normal strength ratio range of 55% to 75%, with "abnormal" meaning a deviation of more than 15% from the normal range. The American Shoulder and Elbow Surgeons (ASES) score and the Constant score were used to evaluate shoulder function preoperatively and postoperatively at 6 months, 1 year, and 2 years. RESULTS: There were 30 patients in the normal group and 47 in the abnormal group, with a preoperative muscle strength ratio of 63.5% ± 5.5% and 42.6% ± 6.1%, respectively. The ASES score was 88.6 ± 9.1 in the normal group and 77.5 ± 13.6 in the abnormal group at 2 years postoperatively, and the Constant score was 82.7 ± 8.4 in the normal group and 69.5 ± 13.4 in the abnormal group at 2 years postoperatively. A significant difference was found in postoperative shoulder function between the normal and abnormal groups. CONCLUSION: This study demonstrated that the preoperative muscle strength ratio was associated with postoperative shoulder function. The preoperative muscle strength ratio should be considered an important predictor of shoulder function after rotator cuff repair.

Is Scapular Stabilization Exercise Effective for Managing Nonspecific Chronic Neck Pain?: A Systematic Review.

Scapular stabilization is thought to have an important role in improving pain and dysfunction around the neck and shoulders, but evidence of this is lacking. We aim to systematically review the effect of a scapular stabilization exercise (SSE) on pain and dysfunction in patients with nonspecific chronic neck pain (NP). We searched the PubMed, EMBASE, CINAHL, and Cochrane Library databases using the terms (NP [MeSH] OR NP OR cervical pain OR neck ache OR cervicalgia) AND (scapular exercise OR periscapular exercise OR SSEs). We included suitable studies that met the study's inclusion criteria. Among the 227 studies identified by our search strategy, a total of four (three randomized controlled studies and one prospective study) met the inclusion criteria. The SSE was intense. It included three sets of 10 repetitions. In most of the studies, the exercises were conducted 3 times per week. Most studies reported that the SSE improved pain and dysfunction in patients with nonspecific chronic NP; however, the reviewed articles did not use the same variables for measurement. Additionally, the sample size was small. Although several studies show that SSE might improve NP and dysfunction, the effects of SSE on pain and dysfunction in the neck region remain unclear because the number of studies was small. Further high-quality studies are necessary to identify the detailed effects of SSE in patients with NP.

The Relationship between Vitamin D Status and Rotator Cuff Muscle Strength in Professional Volleyball Athletes.

This study aimed to examine the vitamin D status of professional volleyball athletes and to determine its correlation with shoulder muscle strength. We included 52 healthy male professional volleyball players (23.2 ± 4.5 years), who were categorized by vitamin D status (<20 ng/mL: deficiency, 20-30 ng/mL: insufficiency, and >30 ng/mL: sufficiency). We examined the strength of the internal rotator (IR) and external rotator (ER) muscles of the shoulder by using an isokinetic dynamometer. Fourteen players (26.9%) had vitamin D deficiency, 24 players (46.2%) were vitamin D-insufficient, and 14 players (26.9%) were vitamin D-sufficient. There was no significant correlation between vitamin D level and shoulder muscle strength at 60°/s (IR, r = 0.159, p = 0.26; ER, r = 0.245, p = 0.08) and at 180°/s (IR, r = -0.093, p = 0.51; ER, r = -0.037, p = 0.79). Moreover, the isokinetic shoulder strengths were not significantly different across the three groups in all settings. In conclusion, vitamin D insufficiency was common in elite volleyball players. Though not being associated with isokinetic muscle weakness, vitamin D levels should be regularly monitored, and vitamin D should be supplied to young elite athletes, considering its importance for musculoskeletal health.

Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up.

In Korea, the first patient with a left ventricular assist device (LVAD) for destination therapy had successful implantation of a continuous-flow model in 2012. We investigated the safety and efficacy of exercise therapy with LVAD implantation 15 Korean patients. We retrospectively reviewed 15 patients (mean age, 67.4±11.6 years; 10 males, 5 female, left ventricular ejection fraction 23.6%±7.1%), including 4 with implanted continuous-flow and 11 an axial-flow LVAD. The New York Heart Association functional classification, ejection fraction, and quality of life were obtained. Survival rate, adverse events, admission rates, and enrollment rates in cardiac rehabilitation were investigated. Survival at 6 and 12 months was 100% and 89%, respectively. The New York Heart Association functional classification improved from 3.4±0.5 to 2.3±0.05 at 12 months postoperatively (P<0.0001). The ejection fraction significantly increased from 23.6%±7.2% on the preoperative day to 35.4%±14.2% at 1 year (P<0.0018). The quality of life was also improved at 1 year (P<0.0001). The most common adverse events were bleeding (56%) and dyspnea (44%). The number of admissions was 3.2 per patient-year. LVAD therapy is a safe and effective treatment option with exercise intervention for Korean patients waiting for heart transplantation or those who were ineligible for heart transplantation. A larger study with longer follow-up is needed to determine details clinical outcomes after LVAD.

What Is the Optimal Exercise Prescription for Patients With Dilated Cardiomyopathy in Cardiac Rehabilitation? A SYSTEMATIC REVIEW.

PURPOSE: Dilated cardiomyopathy (DCM) is 1 of the major causes of advanced heart failure. However, relatively little is known about the effects of exercise specifically in patients with DCM. This purpose of this literature review was to identify optimal exercise training programming for patients with DCM. METHODS: A systematic review was conducted by 3 clinical specialists and the level of evidence of each study was rated using Sackett's levels of evidence. Multiple databases (PubMed Central, EMBASE, and EBSCO) were searched with the inclusion criteria of articles published in English. RESULTS: A total of 4544 studies were identified using the search strategy, of which 4 were included in our systematic review. The exercise frequency of the reviewed studies ranged from 3 to 5 times/wk, and exercise intensity was prescribed within a range from 50% to 80% of oxygen uptake reserve. Exercise time was as high as 45 min by the final month of the exercise prescription. Exercise type was mainly aerobic exercise and resistance training. The average improvement of exercise capacity was 19.5% in reviewed articles. Quality of life also improved after intervention. CONCLUSIONS: According to this systematic review of the literature, data related to exercise therapy specifically for patients with DCM are scarce and exercise interventions in articles reviewed were prescribed differently using the FITT (frequency, intensity, time, and type) principle. Exercise intensity tailored to individual exercise capacity should be used for optimal exercise prescriptions that are safe and efficacious in patients with DCM.

Patients older than 50 years had similar results of knee strength and anteroposterior stability after ACL reconstruction compared to younger patients.

PURPOSE: To evaluate knee strength, ligament stability, and functional outcomes in patients older than 50 years who underwent anterior cruciate ligament (ACL) reconstruction, and to compare these results with those obtained from a younger patient group (< 40 years). METHODS: Forty patients older than 50 years and 50 patients younger than 40 years who underwent ACL reconstruction were retrospectively studied. Isokinetic extensor and flexor muscle strength were evaluated. The peak torque was determined at speeds of 60°/s and 180°/s. The highest peak torque at each velocity was compared with that on the uninjured side. Patients were also evaluated for knee anteroposterior (AP) laxity and functional outcomes, which were measured by the Lysholm and International Knee Documentation Committee (IKDC) scores. All tests were evaluated at baseline and 1 year postoperatively. RESULTS: The groups were comparable at the baseline. Both groups had significant improvements in all parameters, including isokinetic muscle strength, AP laxity, and functional scores, at 1 year postoperatively (all p < 0.05). Compared with younger patients, older patients had similar results for extensor and flexor strength, AP laxity, and Lysholm score (n.s.). However, younger patients had better IKDC scores than did older patients [median 81.1; 95% confidence interval (CI) 95% CI 78.9-88.7 vs. median 75.6; 95% CI 70.1-79.3, p = 0.007]. CONCLUSIONS: Though with lower IKDC scores, older patients with ACL reconstruction had comparable results of knee strength and ligament laxity to younger patients. ACL reconstruction is recommended for treating patients older than 50 years with ACL insufficiency, especially for those with high functional demand. LEVEL OF EVIDENCE: Retrospective cohort study, III.

The Relationship Between Cardiorespiratory Fitness and Arterial Stiffness in Middle-Aged Men with Abdominal Obesity.

BACKGROUND: Abdominal obesity increases rapidly after middle age in Korean men, and there is an associated trend toward increasing levels of cardiovascular disease (CVD). The purpose of this study was to examine the effect of cardiorespiratory fitness (CRF) on arterial stiffness in men with abdominal obesity. METHODS: A total of 387 middle-aged men (ages 42-59 years) with abdominal obesity participated in this cross-sectional study. Abdominal obesity was defined as a waist circumference ≥90 cm. Arterial stiffness was derived from brachial/ankle pulse wave velocity (baPWV). A treadmill exercise test was conducted to directly assess CRF using the peak oxygen uptake. Blood glucose, blood pressure, lipids, C-related protein (CRP), and baPWV were measured at rest. RESULTS: CRF was inversely associated with baPWV (r = -0.340, P = 0.014) and CRP level (r = -0.325, P = 0.026). In addition, high CRF was associated with a lower triglyceride level (r = -0.219, P = 0.030) and a higher high-density lipoprotein cholesterol level (r = 0.317, P = 0.019). CONCLUSIONS: These results demonstrated that high CRF was inversely associated with arterial stiffness in men with abdominal obesity. These results suggest that maintaining a high level of CRF can help middle-aged men with abdominal obesity to improve blood factors related to CVD.

Lumbar Extensor Muscle Size and Isometric Muscle Strength in Women with Symptomatic Lumbar Degenerative Diseases.

STUDY DESIGN: A cross-sectional design. PURPOSE: To determine the characteristics of lumbar extensor muscle (LEM) size and isometric muscle strength and examine their correlations in women with lumbar degenerative diseases (LDDs). OVERVIEW OF LITERATURE: Many studies have evaluated the relationship between muscle size and strength, but the results have been controversial. METHODS: Seventy-four female patients (mean age, 66 years) who consecutively underwent posterior lumbar interbody fusion (L1-S1) were recruited. The cross-sectional area (CSA) of the back extensor muscles was measured between L1-2 to L5-S1, and the total sum of the CSAs at each disc level was calculated. Back extensor muscle strength was evaluated using a MedX lumbar extension machine. The Oswestry Disability Index (ODI, 0-100) and Visual Analog Scale (VAS, 0-10) of lower back pain were determined. RESULTS: The mean CSAs of the LEM at each level (L1/2-L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. The mean isometric strength at each angle (range, 0°-72°) was 32.5, 50.1, 72.0, 88.7, 100.7, 112.2, and 126.2 ft-lb, respectively. The mean ODI and VAS scores were 54.6 and 6.6, and the mean body weight and body mass index (BMI) were 59.9 kg and 24.9 kg/m2, respectively. The CSAs of the upper lumbar level (L1-4) and the total sum of the CSAs were associated with isometric strength, which was negatively correlated with patients' age and ODI and positively associated with body weight and BMI, mainly at higher lumbar flexion angles (48°-72°). CONCLUSIONS: In women with LDD, LEM sizes of the upper lumbar levels (L1-4) were larger than those of the lower levels (L4-S1) and were positively associated with muscle strength. The upper lumbar levels in patients with LDDs appear to play a compensatory role when degenerative lesions are present in the lower lumbar levels.

Comparison of Knee Stability, Strength Deficits, and Functional Score in Primary and Revision Anterior Cruciate Ligament Reconstructed Knees.

Comparing to primary surgery, revision ACL reconstruction is more technically demanding and has a higher failure rate. Theoretically, rehabilitation can improve knee function after ACL reconstruction surgery. This study aimed to compare knee stability, strength, and function between primary and revision ACL reconstructed knees. 40 primary and 40 revision ACL reconstruction surgeries were included between April 2013 and May 2016. Patients with revision surgery had a higher anteroposterior translation comparing those with primary reconstruction (median laxity, 2.0 mm vs. 3.0 mm, p = 0.0022). No differences were noted in knee extensor at 60°/sec or 180°/sec (p = 0.308, p = 0.931, respectively) or in flexor muscle strength at 60°/sec or 180°/sec between primary and revision ACL reconstruction knees (p = 0.091, p = 0.343, respectively). There were also no significant differences between functional scores including IKDC score and Lysholm score in primary versus revision surgeries at 12th months after index operation (p = 0.154, p = 0.324, respectively). In conclusion, despite having higher anteroposterior instability, patients with revision ACL reconstruction can have non-inferior outcomes in isokinetic knee strength and function compared to those with primary ACL reconstruction after proper rehabilitation.

The Effect of Preoperative Cognitive Behavior and Exercise Therapy for a Patient With an Implanted Left Ventricular Assist Device in Korea.

Left ventricular assist devices (LVADs) are used in patients with progressive heart failure symptoms to provide circulatory support. Patients with LVADs are referred to inpatient cardiac rehabilitation to prevent postoperative complications and improve aerobic capacity and quality of life. Preoperative exercise therapy for cardiac patients is an emerging treatment modality, and several studies have reported that it improves postoperative outcomes, such as length of hospital stay and postoperative complications. This case report describes the benefits of preoperative cognitive behavioral and exercise therapy in a Korean patient undergoing LVAD implantation. LEVEL OF EVIDENCE: V.

Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey.

Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period.

How does back muscle strength change after posterior lumbar interbody fusion?

OBJECTIVE There is a lack of evidence of how back muscle strength changes after lumbar fusion surgery and how exercise influences these changes. The aim of this study was to evaluate changes in back muscle strength after posterior lumbar interbody fusion (PLIF) and to measure the effects of a postoperative exercise program on muscle strength and physical and mental health outcomes. METHODS This prospective study enrolled 59 women (mean age 58 years) who underwent PLIF at 1 or 2 spinal levels. To assess the effects of a supervised lumbar stabilization exercise (LSE), the authors allocated the patients to an LSE (n = 26) or a control (n = 33) group. The patients in the LSE group performed the LSEs between 3 and 6 months postoperatively. Back extensor strength, visual analog scale (VAS) scores in back pain, and physical component summary (PCS) and mental component summary (MCS) scores on the 36-Item Short Form Health Survey were determined for the both groups. RESULTS Mean strength of the back muscles tended to slightly decrease by 7.5% from preoperatively to 3 months after PLIF (p = 0.145), but it significantly increased thereafter and was sustained until the last follow-up (38.1%, p < 0.001). The mean back muscle strength was similar in the LSE and control groups preoperatively, but it increased significantly more in the LSE group (64.2%) than in the control group (21.7%) at the last follow-up 12 months after PLIF (p = 0.012). At the last follow-up, decreases in back pain VAS scores were more significant among LSE group patients, who had a pain reduction on average of 58.2%, than among control group patients (reduction of 26.1%) (p = 0.013). The patients in the LSE group also had greater improvement in both PCS (39.9% improvement) and MCS (20.7% improvement) scores than the patients in the control group (improvement of 18.0% and 1.1%, p = 0.042 and p = 0.035, respectively). CONCLUSIONS After PLIF, strength in back muscles decreased until 3 months postoperatively but significantly increased after that period. The patients who regularly underwent postoperative LSE had significantly improved back strength, less pain, and less functional disability at 12 months postoperatively.

Fitness, Body Habitus, and the Risk of Incident Type 2 Diabetes Mellitus in Korean Men.

The relative contributions of cardiorespiratory fitness (CRF) and body habitus to predict incident type 2 diabetes mellitus (T2DM) remain unclear. We prospectively investigated the relation of CRF and body habitus on the risk of developing T2DM in men. Participants included 3,770 apparently healthy men who initially presented without baseline evidence of diabetes, cardiovascular disease, and hypertension. Participants were divided into 3 groups as normal weight (18.5 to 24.9 kg/m(2)), obese I (25.0 to 29.9 kg/m(2)), and obese II (≥30.0 kg/m(2)). CRF was directly measured by peak oxygen uptake (VO2peak) and categorized into unfit and fit cohorts based on the median value of age-specific VO2peak. Diabetes was defined as a glycated hemoglobin >6.5% and/or a fasting glucose >126 mg/dl at baseline and follow-up examinations. During a median follow-up of 5 years, 170 men (4.5%) developed diabetes. After adjusting for age and fasting glucose, the relative risk and 95% confidence interval (CI) for incident T2DM were 1.52 (95% CI 1.11 to 2.07) for obese I and 3.11 (95% CI 1.35 to 7.16) for obese II versus normal weight and 0.69 (95% CI 0.51 to 0.95) for fit versus unfit. However, these associations were no longer statistically significant after adjusting for potential confounders with VO2peak (1.32; 95% CI 0.96 to 1.83 for obese I and 1.61, 95% CI 0.64 to 4.06 for obese II vs normal weight) or body mass index (0.75, 95% CI 0.54 to 1.05 for fit vs unfit). In the joint analysis, obese-unfit men had 1.81 times (95% CI 1.22 to 2.69) greater risk of incident T2DM, but obese-fit men were not at increased risk of incident T2DM (0.95, 95% CI 0.57 to 1.58) compared with fit-normal weight men. In conclusion, these results suggest that both CRF and obesity predict the incidence of T2DM independent of potential confounders; however, CRF appears to attenuate the risk of developing diabetes in obese men.

Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction.

[Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.