On the use of a six-level scale for physical activity.

The 4-level questionnaire to assess leisure-time physical activity (PA) originally described by Saltin and Grimby has been extended to a 6 (or 7)-level questionnaire, especially for the elderly or other persons with a low level of PA, expanded to include household activities. There are currently two main versions, one used in Swedish, Danish, and Norwegian studies, and one with further modifications used in Finnish studies. In this review, predictive validity for mortality and different aspects of physical performance are demonstrated. In a study regarding concurrent validity in one of the Finnish versions, significant correlations with accelerometer-based PA variables are shown. The scale has been used in a number of studies concerning effects of different types of intervention, such as physical training and increased PA, or to describe the PA level in the studied cohort. In presenting and analyzing the data, different combinations of PA levels have been used. As there are major differences between the versions, validity studies cannot easily be transformed between them. Thus, it is suggested that a common consensus be reached with respect to details of the questionnaire.

The "Saltin-Grimby Physical Activity Level Scale" and its application to health research.

The use of a four-level questionnaire to assess leisure time physical activity (PA) and its validation is reviewed in this paper. This questionnaire was first published in 1968 and has then been used by more than 600,000 subjects, especially in different population studies in the Nordic countries. A number of modifications to the questionnaire have been published. These are mostly minor changes, such as adding practical examples of activities to illustrate the levels of PA. Some authors have also added duration requirements that were not included for all levels of PA in the original version. The concurrent validity, with respect to aerobic capacity and movement analysis using objective measurements has been shown to be good, as has the predictive validity with respect to various risk factors for health conditions and for morbidity and mortality.

Pulmonary ventilation measured from body surface movements.

Changes in anteroposterior diameters of the rib cage and abdomen are sensed with magnetometers and summed to give outputs which are very nearly linearly related to changes in lung volume. The volume events of breathing can be measured without recourse to a mouthpiece or face mask, other than for calibration, and with minimal encumbrance to the subject.

Frequency dependence of flow resistance in patients with obstructive lung disease.

Total respiratory, pulmonary, and chest wall flow resistances were determined by means of forced pressure and flow oscillations (3-9 cps) superimposed upon spontaneous breathing in a group of patients with varying degrees of obstructive lung disease. Increased total respiratory and pulmonary resistances were found, whereas the chest wall resistance was normal or subnormal. The total respiratory and pulmonary resistances decreased with increasing frequencies. Static compliance of the lung was measured during interrupted slow expiration, and dynamic compliance was measured during quiet and rapid spontaneous breathing. Compliance was found to be frequency-dependent. The frequency dependence of resistance and compliance are interpreted as effects of uneven distribution of the mechanical properties in the lungs. The practical application of the oscillatory technique to the measurement of flow resistance in patients with lung disease is discussed. Measurements of total respiratory resistance by the forced oscillatory technique at frequencies less than 5 cps appear to be as useful for assessing abnormalities in airway resistance as either the plethysmographic or esophageal pressure techniques.

Cross-diagnostic validity in a generic instrument: an example from the Functional Independence Measure in Scandinavia.

BACKGROUND: To analyse the cross-diagnostic validity of the Functional Independence Measure (FIM) motor items in patients with spinal cord injury, stroke and traumatic brain injury and the comparability of summed scores between these diagnoses. METHODS: Data from 471 patients on FIM motor items at admission (stroke 157, spinal cord injury 157 and traumatic brain injury 157), age range 11-90 years and 70 % male in nine rehabilitation facilities in Scandinavia, were fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM motor items was made prior to testing fit to the model. Categories were re-scored where necessary. Fit to the model was assessed initially within diagnosis and then in the pooled data. Analysis of Differential Item Functioning (DIF) was undertaken in the pooled data for the FIM motor scale. Comparability of sum scores between diagnoses was tested by Test Equating. RESULTS: The present seven category scoring system for the FIM motor items was found to be invalid, necessitating extensive rescoring. Despite rescoring, the item-trait interaction fit statistic was significant and two individual items showed misfit to the model, Eating and Bladder management. DIF was also found for Spinal Cord Injury, compared with the other two diagnoses. After adjustment, it was possible to make appropriate comparisons of sum scores between the three diagnoses. CONCLUSION: The seven-category response function is a problem for the FIM instrument, and a reduction of responses might increase the validity of the instrument. Likewise, the removal of items that do not fit the underlying trait would improve the validity of the scale in these groups. Cross-diagnostic DIF is also a problem but for clinical use sum scores on group data in a generic instrument such as the FIM can be compared with appropriate adjustments. Thus, when planning interventions (group or individual), developing rehabilitation programs or comparing patient achievements in individual items, cross-diagnostic DIF must be taken into account.

Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults.

GH deficiency in adults is associated with reduced muscle mass and muscle strength. The objective of this trial was to follow the effect of 2 yr of GH treatment in GH-deficient adults on muscle performance in relation to a reference population. Knee extensor and flexor strengths for isometric and isokinetic concentric muscle strength were measured using a Kin-Com dynamometer. Hand-grip strength was measured in both hands. The fatigue index was calculated as the percent reduction in peak torque at 50 repeated isokinetic knee extensions. Superimposed, single twitch electrical stimulation was performed. The GH-deficient subjects had lower isometric knee extensor, knee flexor, and hand-grip strength than the reference population. Two years of GH treatment increased and normalized the mean isometric knee extensor and flexor strengths. The concentric knee flexor and extensor strength at an angular velocity of pi rad/s increased, as did the concentric knee flexor strength at an angular velocity of pi/3 rad/s. The increase in muscle strength was more marked in younger patients and in patients with lower initial muscle strength than predicted. Quadriceps endurance decreased, whereas the effect of superimposing single twitches on isometric contraction and hand-grip strength was unaffected by the GH treatment. Two years of GH therapy in GH-deficient adults increased and normalized isokinetic and isometric muscle strength studied in proximal muscle groups. Hand-grip strength and the degree of lack of maximal motor unit activation on voluntary isometric knee extensor force did not change. The dynamic local muscle fatigue index decreased.

GH is needed for the maturation of muscle mass and strength in adolescents.

The postpubertal period and the early years of adulthood may be of importance for continuing tissue maturation of importance in adulthood and aging. An example of this is the peak bone mass. This study has evaluated the importance of GH for lean mass and muscle strength in adolescents and young adults. GH treatment was discontinued in 40 adolescents aged 16-21 yr with GH deficiency of childhood onset. Measurements of isometric and isokinetic knee-extensor and flexor strength, handgrip strength, lean body mass, fat-free mass, and total body nitrogen were performed annually for 2 yr. Two hundred fifty healthy adolescents were randomly selected for prospective measurements of lean mass and handgrip strength between the ages of 17 and 21 yr. In the adolescents with continuing GH deficiency, lean body mass decreased, compared with the patients defined as having sufficient endogenous GH. The isometric strength in knee flexors increased in the sufficient endogenous GH group and was unchanged in the GH deficiency group during the 2 yr off GH treatment (between group, P < 0.05). The mean and peak handgrip strength increased on average by 9-15% in the group with sufficient endogenous GH and was unchanged in those with GH deficiency (P < 0.05). Lean body mass and handgrip strength (both, P < 0.001) increased in both the healthy boys and girls who were followed for 4 yr with a more marked increase in the boys. The mean increase in handgrip between the age of 17 and 21 yr was 7-9%. The increased lean mass and improved muscle performance seen in healthy adolescents did not occur in adolescents with GH deficiency. These findings suggest that GH is of importance for the maturation of lean mass and muscle strength in adolescents and young adults.

Increased muscle dynamic endurance associated with weight reduction on a very-low-calorie diet.

To assess muscle function after a period of negative energy balance, 32 obese women were placed on a 544-kcal/d, high-protein diet for 4 wk. Weight loss was associated with a decrease in the waist-to-hip-circumference ratio (WHR) and significantly higher emptying of abdominal than gluteal fat cells. The low-calorie regimen was associated with a significant increase in isokinetic muscle endurance, a decrease in glycogen concentration, and an increase in glycogen synthase (GS) activity and its fractional velocity (FV). The GS activity and its FV were negatively correlated with the WHR before treatment whereas their subsequent increase was correlated with the decrease in WHR. Dietary treatment produced a decrease in the isokinetic muscle strength, which was correlated with the reduction in lean body mass. The improvement in dynamic endurance observed after energy restriction parallels not only the increase in GS activity in muscle but also the decrease in glycogen stores and glucose oxidation, and most probably depends on the increased utilization of fatty acids.

Lateralization of cutaneous inflammatory responses in patients with unilateral paresis after poliomyelitis.

Unilateral paresis remaining after poliomyelitis may affect the expression of inflammatory diseases by lateralization of the disease manifestations. The purpose of this study was to assess the impact of the unilateral paresis after poliomyelitis on lateralization of neurogenic inflammation and immune responsiveness. The delayed-type hypersensitivity (DTH) reaction to tuberculin was used as an in vivo measure of antigen-specific T lymphocyte reactivity. Assessment of axon reflex vasodilatation was simultaneously employed to test for neurogenic inflammation. Fourteen of the 16 polio patients displayed a positive DTH reaction to tuberculin. All but two showed weaker DTH reaction on the paretic- compared to the contralateral-side (P = 0.001). Magnitude of electrically evoked axon reflexes significantly correlated to asymmetries of DTH responses. We conclude that damage of lower motor neuron leads to ipsilateral down-regulation of T cell-mediated cutaneous inflammation. This lateralization of DTH responses is related to deficiencies in motor and sympathetic innervation of the paretic extremity.

Effects of a sodium-potassium ion-exchanging seaweed preparation in mild hypertension.

A nonpharmacological approach in the treatment of mild hypertension is often advocated. In an attempt to decrease sodium and increase potassium intake, sixty-two middle-aged patients with mild hypertension were given a potassium loaded ion-exchanging sodium-adsorbing potassium-releasing seaweed preparation (seaweed fiber, SF). The mean blood pressure (MBP), evaluated in a double-blind crossover manner with four weeks familiarization and wash-out periods, showed a significant decrease after four weeks on 12 and 24 g/day SF but not on 6 g/day or placebo treatment. Systolic blood pressure during submaximal exercise decreased on all three SF doses. The decrease in MBP appeared to be significantly higher in sodium-sensitive (11.2 mm Hg, P less than .001) than in sodium-insensitive (5.7 mm Hg, P less than .05) patients and was in salt-sensitive patients significantly correlated to the increase in plasma renin activity (PRA). The urinary sodium excretion decreased, the urinary potassium increased and the sodium/potassium urinary excretion ratio decreased, indicating that the decrease of MBP was dependent on the decreased intestinal absorption of sodium and increased absorption of potassium released from the seaweed preparation. A sodium-potassium ion-exchanging seaweed preparation is an effective means of decreasing sodium and increasing potassium intake, and may be used for antihypertensive treatment in mild hypertension.

Muscle performance and structure in the elderly as studied cross-sectionally and longitudinally.

Longitudinal and cross-sectional studies of muscle performance and structure in the elderly are summarized in this article. Muscle strength and muscle mass decrease with age, mainly due to the loss of muscle fibers. In most studies of the vastus lateralis, the mean fiber area decreases only slightly with a larger reduction in the type II fiber area, with the type I fiber area being constant. However, other fiber area patterns have also been recorded, such as the preserved type II fiber area in the biceps brachii muscle, which is larger than the type I fiber area. An increase in fiber areas was recorded in 76- to 80-year-old men who maintained their physical activity level rather well. The muscle enzyme levels of the muscles studied also vary, and show adaptation with training. In particular, oxidative enzymes seem to be well maintained in old age. General conclusions concerning aging effects should not be drawn from measurements in only one muscle, and the impact of the current physical activity level of the subjects should always be taken into account.

Compensatory muscle fiber hypertrophy in elderly men.

Muscle strength and muscle morphology have been studied three times during a period of 11 yr in nine elderly men. On the last occasion the average age was 80.4 (range 79-82) yr. Body cell mass decreased by 6% and muscle strength for knee extension, measured by means of isometric and concentric isokinetic (30-60 degrees/s) recordings, declined by 25-35% over the 11-yr period. Between 76 and 80 yr of age only the isokinetic strength for 30 degrees/s decreased significantly. Muscle fiber composition in the vastus lateralis did not change between 69 and 76 yr of age, but there was a significant reduction in the proportion of type IIb fibers from 76 to 80 yr. The decrease in type II fiber areas was not significant between 69 and 76 yr of age (as in a larger sample from the same population), but a significant increase in both type I and type II fiber areas was recorded from 76 to 80 yr of age and biceps brachii showed similar tendencies. In the same period, the enzymatic activities of myokinase and lactate dehydrogenase subsided in the vastus lateralis, but there was no change for triose phosphate dehydrogenase, 3-hydroxy-CoA-dehydrogenase, and citrate synthase. The muscle fiber hypertrophy in this group of elderly men with maintained physical activity between 76 and 80 yr of age is interpreted as a compensatory adaptation for the loss of motor units. In addition, the adaptation with respect to oxidative capacities seems to be maintained at this age.

Training can improve muscle strength and endurance in 78- to 84-yr-old men.

Nine men, 78-84 yr of age, participated in a dynamometer training program 2-3 times/wk, totaling 25 sessions, using voluntary maximal isometric, concentric, and eccentric right knee-extension actions (30 and 180 degrees/s). Measurements of muscle strength with a Kin-Com dynamometer and simultaneous electromyograms (EMG) were performed of both sides before and after the training period. Muscle biopsies were taken from the right vastus lateralis muscle. The total quadriceps cross-sectional area was measured with computerized tomography. Training led to an increase in maximal torque for concentric (10% at 30 degrees/s) and eccentric (13-19%) actions in the trained leg. The EMG activity increased at maximal eccentric activities. The total cross-sectional quadriceps area of the trained leg increased by 3%, but no changes were recorded in muscle fiber areas in these subjects, who already had large mean fiber areas (5.15 microns 2 x 10(3)). The fatigue index measured from 50 consecutive concentric contractions at 180 degrees/s decreased and the citrate synthase activity increased in all but one subject. The results demonstrate that increased neural activation accompanies an increase in muscle strength at least during eccentric action in already rather active elderly men and that muscle endurance may also be improved with training.

The structure of an instrument for assessing the effects of assistive devices and altered working methods in women with rheumatoid arthritis.

OBJECTIVE: To use Rasch analysis to transform the ordinal score from a newly developed instrument, the Evaluation of Daily Activities Questionnaire (EDAQ), in order to obtain unidimensional linear measures; to analyze whether items change in difficulty with interventions; and to follow changes in subjects' degree of ability. METHODS: Twenty-one women with rheumatoid arthritis rated their perceived difficulty without and with assistive devices or altered working methods using the EDAQ; the EDAQ consists of 102 items of daily activities, divided into 11 dimensions. RESULTS: All items in the EDAQ could be structured into an acceptable model from "hard" to "easy" with the subjects overall measures ranging from "more able" to "less able." Forty-one items showed a significant reduction of difficulty with interventions. For some items results indicated that easier initial difficulty led to greater effect of interventions. In general, difficulty without assistive devices could not predict difficulty with interventions. Twenty women demonstrated a significant increase in activities of daily living (ADL) ability after interventions. CONCLUSION: The EDAQ analyzed with the Rasch model, demonstrated a hierarchical order of difficulty in 102 items showing that it was possible to evaluate the effect of using assistive devices or altered working methods.

Life after cardiac arrest; a retrospective study.

AIM: We decided to evaluate the life situation of the survivors after out-of-hospital cardiopulmonary resuscitation (CPR). METHOD: CPR survivors who were 75 years or younger at the time and who were discharged alive from the hospital were identified consecutively. Average follow-up time was 25.5 months, and at follow-up 24% were deceased and 9% were lost. A questionnaire was completed by 93% and 71% were positive to an interview. RESULTS: Cognitive functions were reduced as well as capacity to perform activities in daily living. This resulted in dependence on other persons for living (nursing homes) and a low return to work. Social isolation was a common complaint. The survivors also reported lower pain awareness than the reference population. As far as other aspects of health-related quality of life, this small group show many similarities with previously evaluated post-infarction patients. CONCLUSION: Lower pain awareness should be taken into consideration when the CPR patients have ischemic heart disease. If possible, try to prevent social isolation.

Quadriceps function and training after knee ligament surgery.

A follow-up study of 30 patients operated on for knee ligament injuries was performed with measurements of maximal isometric and isokinetic (angular velocity 30, 42, 120 degrees/s) torque for knee extension and muscle biopsy from vastus laternalis. The maximal torque values of the operated side were reduced in spite of resumed physical activities and athletic training. Isokinetic training, weight training (10 RM), and self-training were compared. All training groups increased their muscle strength with the largest increase for the isokinetically trained group. Before training, the mean fiber areas were somewhat low, especially for type II fibers and there was a tendency for an increase after training. There was no significant change in ATP, CP, and contractile enzyme activities with training. With the isokinetic training principle, maximal torque can in contrast to weight training be achieved through the whole range of motion, which may explain its larger training effect.

Effects of electrical muscle stimulation combined with voluntary contractions after knee ligament surgery.

The aim of the present study is to compare the effect of electrical muscle stimulation combined with voluntary muscle contractions with a program only with voluntary muscle contractions during immobilization in casts after anterior cruciate ligament surgery. Twenty-three patients, 7 women and 16 men with a mean age of 28 yr, were randomized into two groups: an experimental group (13 patients) and a control group (10 patients). Post-operatively, the patients were immobilized for 3 wk in a full leg cast with the knee flexed at an angle of 20 degrees to 30 degrees and then in a knee cast for another 3 wk. All patients had a standard program with quadriceps muscle contractions. In addition, the experimental group received electrical stimulation of the quadriceps muscle 4 X 10 min, 3 times.wk-1, at a frequency of 30 Hz. During each stimulation, the patients were requested to contract the quadriceps muscle voluntarily as well. When pre-operative measurements were compared with those at the end of the immobilization period (6 wk after the operation), a significantly larger reduction in the knee extension isometric muscle strength was found for the control group than for the experimental group. In comparisons of the data of the male subjects only, this difference was still seen to be significant. The cross-sectional area of the quadriceps muscle measured with computed tomography was significantly less reduced during the immobilization period in the experimental group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphology of the paravertebral muscles in adolescent idiopathic scoliosis.

Histochemical studies of paravertebral muscles in idiopathic scoliosis have shown a consistently higher proportion of type I fibers on the convex side. In this study of the transversospinal muscles in moderate idiopathic scoliosis, we could demonstrate a lower type II B/II A fiber ratio on the convex side, along with an increased proportion of type I fibers. The capillary count was also higher on the convex side, especially around the type I fibers. The few pathologic changes found were predominately seen in the gravest cases of scoliosis. It is concluded that the fiber type distribution, capillary count, and metabolic enzyme activity on the convex side resembles that seen after endurance training. This suggests a secondary adaptive origin of these changes.

Disability in poliomyelitis sequelae.

Patients who have been affected by poliomyelitis may develop new symptoms such as muscle weakness, muscle atrophy, muscle or joint pain, and unexplained fatigue several decades after the onset of their poliomyelitis (post-polio syndrome [PPS]). We report on the results of our study of 59 patients with poliomyelitis using a number of instruments for disability assessment, including a 4- to 5-year follow-up. The main impact of disability for most patients is in mobility-related activities. Dependence in personal activities of daily living is fairly rare, whereas dependence and difficulties in instrumental activities of daily living (eg, cooking, transportation, cleaning, shopping) are more common and also more severe in persons with PPS. Mental health, emotional reactions and social activity, interaction, and isolation are usually less affected, although considerable coping problems may occur, especially in persons with PPS who have new health problems and increasing disabilities. Examples of disabilities, intervention measures, and coping processes are given with case reports. The importance of a broad and interdisciplinary approach is emphasized, in which impairment as well as disability aspects should be considered in treatment and intervention programs.

Isokinetic and isometric muscle strength in patients with rheumatoid arthritis. The relationship to clinical parameters and the influence of corticosteroid.

The isometric and isokinetic muscle strength of the legs in forty-six women with rheumatoid arthritis was measured using a Cybex II dynamometer. Twenty-six of the patients had been treated with corticosteroid - prednisone - some for several years (mean 8 years, range 1-35). Twenty-three healthy age-matched women served as a comparable group (controls). In patients treated with prednisone the mean maximal isokinetic muscle strength of the knee extensors was between 64 +/- 26 Nm (SD) and 43 +/- 18 Nm (SD) at the preset angular velocities 30 degrees/s and 180 degrees/s, respectively, which was a reduction to 54%-55% of that found in controls (p less than 0.001). In patients who had not received prednisone the mean maximal isokinetic strength was between 99 +/- 39 Nm (SD) and 67 +/- 27 Nm (SD) which was a reduction to 84%-86% of that found in controls (p less than 0.05). The force velocity curve showed a parallel decrease in maximal strength with increasing velocity when comparing patients with rheumatoid arthritis to controls. Also on measuring the isokinetic muscle strength of plantar flexors a significantly lower mean maximal torque was found in patients treated with prednisone, (33 +/- 21 Nm (SD) (p less than 0.01] as compared with a control group (50 +/- 28 Nm (SD]. The patients who had not been treated with prednisone showed a lower, but not significantly lower isokinetic strength of the plantar flexors, 46 +/- 22 Nm (SD) at a corresponding angular velocity, 30 degrees/s.(ABSTRACT TRUNCATED AT 250 WORDS)