Exercise fidelity and progression in a supervised exercise programme for adults with venous leg ulcers.

Despite exercise being included in the recommended advice for patients with venous leg ulcers, there is a fear shared by clinicians and patients that exercise may be either inappropriate or harmful and actually delay rather than promote healing. Therefore, before implementing a larger-scale study exploring the effects of a supervised exercise programme in patients with venous ulcers being treated with compression therapy, it is important to assess exercise safety as well as fidelity and progression in a feasibility study. Eighteen participants randomised in the exercise group were asked to undertake 36 (3 times/week for 12 weeks) 60-min exercise sessions, each comprising moderate-intensity aerobic, resistance, and flexibility exercise components. For the purposes of this paper, we analysed the data collected during the exercise sessions. The overall session attendance rate was 79%, with 13 of 18 participants completing all sessions. No in-session adverse events were reported; 100% aerobic components and 91% of resistance components were completed within the desired moderate-intensity target. Similarly, 81% of aerobic components and 93% of flexibility components were completed within the prescribed duration targets. Our data showed that patients with venous ulcers could safely follow a supervised exercise programme incorporating moderate-intensity aerobic, resistance, and flexibility components.

Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management.

STUDY DESIGN: Clinical Commentary. INTRODUCTION: Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY: The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION: N/A for clinical commentary. CONCLUSIONS: The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE: 5.

Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study.

OBJECTIVES: To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. MAIN OUTCOME MEASURES: Kinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. RESULTS: Two exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10-2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13-6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: -0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). CONCLUSION: This study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT.

Systematic Reductions in Differential Ratings of Perceived Exertion Across a 2-Week Repeated-Sprint-Training Intervention That Improved Soccer Players' High-Speed-Running Abilities.

PURPOSE: To quantify changes in differential ratings of perceived exertion (dRPE) across a 2-wk repeated-sprint-training intervention that improved high-intensity intermittent-running ability and linear speed of semiprofessional soccer players. METHODS: Thirteen players completed 3 (sessions 1-3) or 4 (sessions 4-6) sets of 7 sprints (group 1 [n = 7]: 30-m straight; group 2 [n = 6]: 2 × 10-m shuttle), with 20 s and 4 min of recovery between sprints and sets, respectively. Postset perceptions of breathlessness (RPE-B) and leg-muscle exertion (RPE-L) were rated using the CR100 scale. RESULTS: Overall, RPE-B (mean [SD]: 46 [13] arbitrary units [AU], "hard") was most likely higher than RPE-L (39 [13] AU, "somewhat hard," mean difference: 8 AU; 90% confidence limits [CLs]: ±2). Set-to-set increases in dRPE (in AU; 90% CL: approximately ±2) were large in session 1 (RPE-B: 15; RPE-L: 14), moderate in sessions 2-5 (RPE-B: 7-10; RPE-L: 7-8), and small (RPE-B: 6) to moderate (RPE-L: 7) in session 6. Across the intervention, RPE-B reduced moderately in sets 3 (-13; 90% CL: ±4) and 4 (-12; 90% CL: ±12) and RPE-L reduced by a small magnitude in set 3 (-5; 90% CL: ±6). The set 4 change in RPE-L was unclear (-11; 90% CL: ±13). CONCLUSIONS: The authors observed systematic intrasession and intersession changes in dRPE across a 2-wk repeated-sprint-training intervention, with a fixed prescription of external load that improved semiprofessional soccer players' high-speed-running abilities. These findings could support dRPE as a measure of internal load and highlight its usefulness in evaluating repeated-sprint-training dose-response.

Predictive factors for progression through the difficulty levels of Pilates exercises in patients with low back pain: a secondary analysis of a randomized controlled trial.

BACKGROUND: The progression through the difficulty levels of Pilates exercises is a subjective criterion, that depends on the therapist's experience and ability to identify the best moment to progress to the next level. OBJECTIVE: To identify the factors that interfere in the progression through the difficulty levels of the Pilates exercises in patients with chronic nonspecific low back pain. METHODS: Data from 139 patients with chronic nonspecific low back pain from a randomized controlled trial were used for statistical analysis using binary logistic regression. The dependent variable was the progression through the difficulty levels, and the independent variables were age, gender, educational level, low back pain duration, pain intensity, general disability, kinesiophobia, previous physical activity, and number of absences. RESULTS: The factors that interfered in the progression through the difficulty levels were previous physical inactivity (odds ratio [OR]=5.14, 95% confidence interval [CI]: 1.53-17.31), low educational level (OR=2.62, 95% CI: 1.12-6.10), more advanced age (OR=0.95, 95% CI: 0.92-0.98) and more absences (OR=0.63, 95% CI: 0.50-0.79). These variables explain 41% of the non-progression through the difficulty level of the exercises. CONCLUSION: Physical inactivity, low educational level, more advanced age and greater number of absences can be interfering factors in the progression through the difficulty levels of the Pilates exercises in patients with chronic nonspecific low back pain.

The Effect of Variation of Plyometric Push-Ups on Force-Application Kinetics and Perception of Intensity.

PURPOSE: To examine differences between ground-reaction-force (GRF)-based parameters collected from 5 types of plyometric push-ups. Between-trials reliability and the relationships between parameters were also assessed. METHODS: Thirty-seven highly active commando soldiers performed 3 trials of 5 variations of the plyometric push-up in a counterbalanced order: standard countermovement push-up (SCPu), standard squat push-up (SSPu), kneeling countermovement push-up (KCPu), kneeling squat push-up (KSPu), and drop-fall push-up (DFPu). Vertical GRF was measured during these exercises using a portable Kistler force plate. The GRF applied by the hands in the starting position (initial force supported), peak GRF and rate of force development during takeoff, flight time, impact force, and rate of force development impact on landing were determined. RESULTS: During standard-position exercises (SCPu and SSPu) the initial force supported and impact force were higher (P < .001) than with kneeling exercises (KCPu, KSPu, and DFPu). The peak GRF and rate of force development during takeoff were higher (P < .001) in the countermovement push-up exercises ([CMP] SCPu, KCPu, and DFPu) than squat push-up exercises ([SP] SSPu and KSPu). Furthermore, the flight time was greater (P < .001) during kneeling exercises than during standard-position exercises. A significant relationship (P < .01) between impact force and the rate of force development impact was observed for CMP and SP exercises (r = .83 and r = .62, respectively). The initial force supported was also negatively related (P < .01) to the flight time for both CMP and SP (r = -.74 and r = -.80, respectively). It was revealed that the initial force supported and the peak GRF during takeoff had excellent reliability; however, other parameters had poor absolute reliability. CONCLUSIONS: It is possible to adjust the intensity of plyometric push-up exercises and train athletes' muscle power by correctly interpreting GRF-based parameters. However, caution is required as some parameters had marginal absolute reliability.

Periodization and physical therapy: Bridging the gap between training and rehabilitation.

BACKGROUND: Exercise prescription and training progression for competitive athletes has evolved considerably in recent decades, as strength and conditioning coaches increasingly use periodization models to inform the development and implementation of training programs for their athletes. Similarly, exercise prescription and progression is a fundamental skill for sport physical therapists, and is necessary for balancing the physiological stresses of injury with an athlete's capacity for recovery. OBJECTIVE: This article will provide the sport physical therapist with an overview of periodization models and their application to rehabilitation. SUMMARY: In recent decades models for exercise prescription and progression also have evolved in theory and scope, contributing to improved rehabilitation for countless athletes, when compared to care offered to athletes of previous generations. Nonetheless, despite such advances, such models typically fail to fully bridge the gap between such rehabilitation schemes and the corresponding training models that coaches use to help athletes peak for competition. Greater knowledge of periodization models can help sport physical therapists in their evaluation, clinical reasoning skills, exercise progression, and goal setting for the sustained return of athletes to high level competition.

A theoretical model to describe progressions and regressions for exercise rehabilitation.

This article aims to describe a new theoretical model to simplify and aid visualisation of the clinical reasoning process involved in progressing a single exercise. Exercise prescription is a core skill for physiotherapists but is an area that is lacking in theoretical models to assist clinicians when designing exercise programs to aid rehabilitation from injury. Historical models of periodization and motor learning theories lack any visual aids to assist clinicians. The concept of the proposed model is that new stimuli can be added or exchanged with other stimuli, either intrinsic or extrinsic to the participant, in order to gradually progress an exercise whilst remaining safe and effective. The proposed model maintains the core skills of physiotherapists by assisting clinical reasoning skills, exercise prescription and goal setting. It is not limited to any one pathology or rehabilitation setting and can adapted by any level of skilled clinician.