Spinal Cord Stimulation Research in the Restoration of Motor, Sensory, and Autonomic Function for Individuals Living With Spinal Cord Injuries: A Scoping Review.

OBJECTIVE: To describe the status of spinal cord stimulation (SCS) research for the improvement of motor, sensory, and autonomic function for individuals living with a spinal cord injury (SCI). DATA SOURCES: This scoping review identified original research published before March 31, 2021, via literature searches using MEDLINE, Embase, PubMed, Science Direct, Cumulative Index to Nursing and Allied Health, Sport Discus, and Web of Science, as well as a targeted search for well-known principal investigators. Search terms included permutations of "spinal cord stimulation," "epidural spinal cord stimulation," "transcutaneous spinal cord stimulation," "magnetic spinal cord stimulation," and "neuromodulation." STUDY SELECTION: Studies were included if they (1) were in English, (2) presented original research on humans living with a SCI, and (3) investigated at least 1 of the 3 forms of SCS. DATA EXTRACTION: Extracted data included authors, publication year, participant characteristics, purpose, study design, stimulation (device, location, parameters), primary outcomes, and adverse events. DATA SYNTHESIS: As a scoping review the extracted data were tabulated and presented descriptively. Themes and gaps in the literature were identified and reported. Of the 5754 articles screened, 103 articles were included (55 epidural, 36 transcutaneous, 12 magnetic). The primary research design was a case study or series with only a single randomized controlled trial. Motor recovery was the most common primary outcome for epidural and transcutaneous SCS studies, whereas bowel and bladder outcomes were most common for magnetic SCS studies. Seventy percent of the studies included 10 or fewer participants, and 18 articles documented at least 1 adverse event. Incomplete stimulation parameter descriptions were noted across many studies. No articles mentioned direct engagement of consumers or advocacy groups. CONCLUSIONS: This review identified a need for more robust study designs, larger sample sizes, comparative studies, improved reporting of stimulation parameters, adverse event data, and alignment of outcomes with the priorities of the community with SCI.

Acute physiological comparison of sub-maximal exercise on a novel adapted rowing machine and arm crank ergometry in people with a spinal cord injury.

STUDY DESIGN: Non-randomized crossover trial. OBJECTIVES: The objective of this study was to assess the oxygen uptake during exercise using the Adapted ROWing machine (AROW) compared to the more commonly used Arm Crank Ergometry (ACE) for people with spinal cord injury/disease (SCI/D) with or without trunk stability. SETTING: Canada, Vancouver. METHODS: Participants were from a convenience sample of 14 adults with SCI/D (age 21-63 y) which include those with lumbar to low cervical impairments currently exercising at least once per week using cardiovascular exercise equipment at our Physical Activity Research Centre. The interventions were non-randomized steady-state exercise bouts at self-selected low and moderate workloads on the AROW and ACE for 5 min each. Our primary outcomes were the rate of oxygen consumption (mL/kg/min) and the Borg 0-10 Rating Scale of Perceived Exertion (RPE). RESULTS: A repeated measures two-way ANOVA (p < 0.05) indicated that exercising on the AROW resulted significantly greater oxygen consumption and perceived exertion than ACE at similar sub-maximal workloads which may be explained by the differences in efficiency between the devices (Partial eta squared = 0.84, F stat = 48.25; Partial eta squared = 0.86, F stat = 53.54). CONCLUSIONS: We have demonstrated that this form of upper extremity exercise had a greater RPE and VO2 on the ACE at a given workload. Thus, the AROW could provide a functional upper extremity workout that can be used for daily exercise for those with varying levels of SCI.

Should I stay or should I go? An exploratory study comparing wheelchair-adapted rowing at home vs. in community gyms.

PURPOSE: Wheelchair users experience many barriers to physical activity as affordable and accessible exercise equipment options are limited. Thus, the home-based adapted rower (aROW) and gym-based aROW were developed. The objectives were to determine: 1) wheelchair users' preferences, perspectives, facilitators, and barriers to using the home-based versus the gym-based aROW, 2) perceived usability of the home and gym aROWs, and 3) recommendations to adapt the aROW further for home and community use. MATERIALS AND METHODS: In this two-phase exploratory mixed-methods study, participants completed one month of using a home aROW, followed by one month of using a community gym aROW. After each phase, participants completed a semi-structured interview and the System Usability Scale (SUS) questionnaire. Interview data were analyzed using conventional content analysis and effect size comparing SUS data was calculated. RESULTS AND CONCLUSIONS: Four categories were identified: what worked well, barriers to using the aROWs, what could be improved and important considerations. There was a large effect size in perceived usability between the aROWs with participants preferring the home aROW. Overall, rowing was enjoyable, and participants achieved positive physical outcomes. As preferences are individual, the home aROW provides wheelchair users with a potential choice between home or gym exercise.

Rowing is an enjoyable and effective form of aerobic exercise for wheelchair usersWheelchair users experience social, environment and financial barriers to engaging in exerciseThe home aROW provides a low-cost and accessible option for wheelchair-adapted aerobic exercise.

Implementing Lived Experience Workshops in Regional Areas of British Columbia to Enhance Clinicians' Confidence in Spinal Cord Injury Care: An Evaluation.

In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1-14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11-14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians' knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians' understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC.

Preliminary Study: Short-term Beneficial Effects of Thai Tok Sen Massage on Pain, Pressure Pain Threshold, and Upper Trapezius Muscle Thickness Among People with Shoulder Pain.

Background: Shoulder muscle pain and spasm is the most common problem in people after prolonged working, similar to that resulting from office syndrome. Various medicinal treatments with analgesic drugs, hot packs, therapeutic ultrasound, or deep friction techniques can be clinically applied. Alternatively, traditional Thai massage (TM) with deep compression gentle technique also can help to release that problem. In addition, an traditional Thai treatment with Tok Sen (TS) massage has been generally performed in the Northern part of Thailand without any scientific evidence support. Thus, the aim of this preliminary study was to reveal the scientific value of Tok Sen massage on shoulder muscle pain and upper trapezius muscle thickness among people with shoulder pain. Materials & Methods: Twenty participants (6 males and 14 females) who suffered from shoulder pain were randomized into TS (n =10, aged 34.2 ± 7.34 yrs) or TM (n=10, aged 32.8 ± 7.24 yrs). Each group received two times 5-10 minutes of treatment, one week apart. At the baseline and after completing two times of each intervention, pain score, pain pressure threshold (PPT), and specific trapezius muscle thickness were evaluated. Results: Before both TM and TS interventions, pain score, PPT, and muscle thickness were not statistically different between groups. After two times of intervention, pain scores significantly reduced in TM (3.1 ± 0.56; p = .02, 2.3 ± 0.48; p < .001), as same as in TS (2.3 ± 0.67; p = .01, 1.3 ± 0.45; p < .001) when compared to baseline. This was the same as the results of PPT in TM (4.02 ± 0.34; p = .012, 4.55 ± 0.42; p = .001) and TS (5.67 ± 0.56; p = .001, 6.8 ± 0.72; p < .001). However, the trapezius muscle thickness reduced significantly after two interventions by TS (10.42 ± 1.04; p = 0.002 & 9.73 ± 0.94 mm, p < .001), but did not change in TM (p > .05). Moreover, when compared between intereventions at the first and second periods, TS showed a significant difference in pain score (p = .01 & p <.001), muscle thickness (p = .008 & p = .001) as well as PPT (p < .001 & p < .001) when compared to TM. Conclusion: Tok Sen massage improves upper trapezius thickness from muscle spasms and reduces pain perception and increases the pressure threshold pain among participants who suffer from shoulder pain similar to that of office syndrome.

Sweet-type star fruit supplementation controls oxidative stress status and enhances the community walking capacity among elderly Thai.

BACKGROUND: Sweet-type Star fruit (SF) (Averrhoa carambola L.) is seasonal and more available for purchase in many markets in Thailand, when compared to the sour-type. But, its antioxidant activity results and potentially more modified supplement for elderly health during regular exercise in the community are unclear. OBJECTIVE: This study aimed to evaluate the antioxidant activity and physical capacity from supplementation of sweet-type SF among elderly people performing home walking exercise. METHODS: Mixing SF juice with honey industrially prepared the SF product. Its effects on oxidative stress status and physical capacity were studied in four groups; a supplement with walking exercise (n = 11, 67.00 ± 4.17 years), control (n = 12, aged 67.50 ± 5.58 years), supplementation (n = 11, aged 69.63 ± 7.14 years), and walking exercise (n = 12, aged 67.91 ± 4.33 years). Twenty grams or two teaspoons of supplement in warm water (150 mL) was the guideline for consumption twice daily for 4 weeks. In contrast, the walking exercise was prescribed with moderate intensity for 30 min, 3 days per week. Before and after the 4-week period, the oxidative stress status; glutathione (GSH), ascorbic acid (Vit C), total antioxidant capacity (TAC), and malondialdehyde (MDA), and 6-minute walking distance (6MWD) were evaluated. RESULTS: Results after the 4-week period, showed that Vit C and TAC increased and the MDA decreased significantly in the supplementation group, except the GSH and 6MWD results. The GSH and Vit C slightly decreased in the walking exercise group, whereas, its TAC, MDA and 6MWD increased significantly. Finally, The GSH and Vit C did not decrease and MDA slightly decreased in the combined group, but, their TAC and 6MWD increased significantly. CONCLUSION: Supplementation of the SF product during walking exercise possibly controls oxidative stress status and may enhance walking capacity.

Short-Term Effects of Lower-Extremity Heavy Resistance versus High-Impact Plyometric Training on Neuromuscular Functional Performance of Professional Soccer Players.

BACKGROUND: To compare the effects of short-term 8 week heavy-resistance or plyometric training protocols (HRT or PLY) incorporated into regular soccer practice on measures of neuromuscular functional performance in professional soccer players, a single-blind randomized controlled trial was conducted. METHODS: Forty-seven participants aged 22.3 ± 3.52 years were assigned to three groups: HRT (n = 15), PLY (n = 15), and control (CON; n = 17). The HRT group performed 3 sets and 10 repetitions twice a week using 80% of their baseline 1-RM (weeks 1-3), followed by 8 repetitions at 85% 1-RM (weeks 4-6), and 6 repetitions at 90% 1-RM (weeks 7-8) of 6 lower-body strength exercises with a 1 min rest period between sets. The PLY protocol involved a preparatory phase (weeks 1-2), followed by two 3-week progressive periods (weeks 3-5 and weeks 6-8). The plyometric sessions consisted of four jump exercises/drills with progressively increasing number of sets and total number of foot contacts. The rest intervals between repetitions and sets were 15 and 90 s, respectively. Outcome measures included tests assessing 10 and 30 m speed (t10m and t30m), one-repetition maximum half-back squat (1-RM squat), isokinetic peak torques for the quadriceps and hamstring muscles (Qcon and Hcon), countermovement jump (CMJ), and squat jump (SJ). RESULTS: Two-way ANOVA detected main effects of time and group×time interactions for all examined variables, except t30m, 1-RM, and relative 1-RM. Post hoc analyses revealed significant increases in the HRT group (t10m: 6.3%, t30m: 7.1%; absolute 1-RM: 29.6%; relative 1-RM: 30.3%, Qcon: 24.5%; Hcon: 14.4%; CMJ: 5.9%; SJ: 7.2%, all p < 0.001) and the PLY group (t10m: 3.1%; t30m: 4.1%; absolute 1-RM:19.1%; relative 1-RM: 20.3%; Qcon: 12.6%; Hcon: 8.7%; CMJ: 3.3%; SJ: 3.5%, all p < 0.001). HRT was superior compared to PLY in relative 1-RM, Qcon and Hcon (all p < 0.001). In addition, we found knee muscular strength imbalance in 70.5% of participants from the total sample (H/Q ratio < 60%). The HRT and PLY protocols resulted in improved neuromuscular functional performance compared to the regular soccer regime. CONCLUSIONS: This study showed that during the pre-competitive season, additional HRT and PLY drills/exercises as a substitute for standard soccer training as part of a regular 90 min practice twice a week for 8 weeks, can produce acute physical performance-enhancing effects in professional soccer players.

Effects of two low-volume high-intensity interval training protocols in professional soccer: sprint interval training versus small-sided games.

BACKGROUND: The programming of training protocols within a high-intensity interval training (HIIT) framework with appropriate analysis of total training load could deliver optimal training adaptations. This study aims to compare the efficiency of two low-volume HIIT protocols integrated with the regular training regime in professional soccer players. METHODS: Twenty-five participants aged 18.4-29.7 years were randomly assigned to one of two interventions involving straight-line sprint interval training (SIT, N.=13) or small-sided games (SSG, N.=12). Periodization was divided into two 3-week phases concluded by a 7-day taper. SIT first involved two-session·week-1 of one set of 10·45-s sprints (at maximal intensity) and then three-session·week-1 of two sets of 10·30-s sprints with a 0.75:1 and 1:1 recovery interval (slow running and stretching exercises), respectively. SSG in the first phase involved 5·3-min games of 4 vs. 4 and in the second phase 4·4-min games of 2 vs. 2 with 3-min recovery (practice drills at 60-70% HRmax). Training load was controlled via session-RPE and HR-based methods. Pre- and postintervention testing included: countermovement jump height, 5-m and 30-m sprints performance, anaerobic power by the 10-s Wingate Anaerobic Test, maximal oxygen uptake (V̇O2max) and blood lactate concentration (BLa-) determined by incremental exhaustive running test. RESULTS: Two-way ANOVA showed group×time interaction effects for the 30-m sprint time (F(1,23)=3.023; P=0.049; η2 P=0.116), BLa- (F(1,23)=5.250; P=0.031; η2 P=0.185), and V̇O2max (F(1,23)=4.648, P=0.044; η2 P=0.157). SIT elicited greater enhancements in anaerobic performance (30-m sprint time and BLa-), while SSG induced larger improvements in V̇O2max. CONCLUSIONS: Comparable effects of SIT and SSG protocols were noted, however the aerobic capacity benefits provided by SSG warrant this HIIT protocol as a highly recommended training modality in the professional soccer.

Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury.

OBJECTIVE: The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury. METHODS: This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed. RESULTS: At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers. CONCLUSION: The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community. IMPACT: The discharge SWAT is useful to optimize discharge planning.

Acute Cardiorespiratory and Metabolic Responses to Incremental Cycling Exercise in Endurance- and Strength-Trained Athletes.

The purpose of this study was to examine the acute effects of a progressive submaximal cycling exercise on selected cardiorespiratory and metabolic variables in endurance and strength trained athletes. The sample comprised 32 participants aged 22.0 ± 0.54 years who were assigned into three groups: an endurance trained group (END, triathletes, n = 10), a strength trained group (STR, bodybuilders, n = 10), and a control group (CON, recreationally active students, n = 12). The incremental cycling exercise was performed using a progressive protocol starting with a 3 min resting measurement and then a 50 W workload with subsequent constant increments of 50 W every 3 min until 200 W. The following cardiometabolic variables were evaluated: heart rate (HR), oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), systolic and diastolic blood pressure (SBP and DBP), and blood lactate (BLa−). We found the between-group differences in metabolic variables (the average RER and BLa−) were statistically significant (Tukey's HSD test: CON vs. STR, p < 0.01 and p < 0.05, respectively; CON vs. END, p < 0.001; END vs. STR, p < 0.001). RER and BLa− differences in all groups depended on the workload level (G-G-epsilon = 0.438; p < 0.004 and G-G-epsilon = 0.400; p < 0.001, respectively). There were no significant differences in cardiorespiratory variables between endurance- and strength-trained groups. In conclusion, this study demonstrated that acute cardiorespiratory responses at each of the four submaximal workloads were comparable in endurance- compared to strength-trained athletes, but significantly different compared to recreationally active men. However, there were significant differences in the metabolic responses of RER and BLa−. Based on our findings we recommend that endurance-trained athletes follow a concurrent training program, combined strength and endurance training, to improve neuromuscular parameters and thus optimize their economy of movement and endurance-specific muscle power capacity.

Exploring exercise participation and the usability of the adaptive rower and arm crank ergometer through wheelchair users' perspectives.

PURPOSE: Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE). METHODS: This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (n = 14) with spinal cord injury/disease (SCI/D) completed the System Usability Scale (SUS), and a semi-structured interview. Participants were asked about the use of both exercise modalities, and general exercise participation. SUS data were analyzed using a paired sample t-test and qualitative data were analyzed through conventional content analysis. RESULTS: Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise. CONCLUSIONS: The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives.Implications for rehabilitationWheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health.The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers.The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise.More available equipment may increase community participation and promote inclusion for wheelchair users.

Benefits of Thai Yoga on physical mobility and lower limb muscle strength in overweight/obese older women: A randomized controlled pilot trial.

BACKGROUND AND PURPOSE: Although Thai Yoga (TY) is reported to improve health-related fitness for the elderly, no study has yet carried out the effect of TY Program on physical mobility and lower-limb muscle strength in overweight/obese older women. MATERIALS AND METHODS: In a randomized controlled pilot design, twenty-two sedentary women with a BMI ≥ 23 kg/m2, aged 62 ± 1 years were randomly assigned to either a TY group for 60 min, 3 times a week or to a "no exercise" control (CON) group. Sit and reach (SRT), functional reach (FRT) and 30-s chair stand (CST-30), 8-foot up and go (8UGT), 6-min walk (6MWT)) and lower-limb muscle strength were measured at the beginning, 4, and 8 weeks. RESULTS: At week 4, a significant between groups was obtained in CST-30, 8UGT, and 6MWT. At week 8, FRT, 8UGT, 6MWT and knee flexor and extensor muscle strength were improved in the TY over the CON. Significant improvement was found in all variables within the TY, but no change was observed in the CON. CONCLUSION: An 8-week TY program appears to provide beneficial improvements in physical mobility in overweight/obese older women.

Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain.

Motor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.

Effect of increased relative stiffness of the lumbar spine on hamstring muscle stretching in individuals with a history of low back pain suspected to have a clinical lumbar instability: A randomized crossover design.

BACKGROUND: Theoretically, lumbopelvic stabilization techniques during hamstring muscle stretching could increase lumbar stiffness relative to hamstring muscle in individuals with a history of low back pain and suspected clinical lumbar instability. However, evidence to support this theory is limited. This study aimed to 1) determine changes in lumbopelvic, lumbar, and hip motions, and hamstring muscle length after stretching exercises with lumbopelvic stiffening or relaxing techniques, and 2) compare those changes between techniques. METHODS: This study used a randomized crossover design. Thirty-two participants with a history of low back pain and bilateral hamstring muscle tightness were recruited. The order of the first technique was randomly assigned. After a 2-day washout, participants were crossed over to the second technique. Motion data during active forward trunk bending and bilateral hamstring muscle length during passive knee extension were collected pre- and post-intervention. FINDINGS: Significant increases (P < 0.05) were found in bilateral hamstring muscle length for both techniques. However, stiffening technique demonstrated a significant decrease in lumbar motion (P < 0.05) and increase in hip motion (P < 0.05), while relaxing technique demonstrated trends showing increases in lumbar and hip motions (P = 0.134 and 0.115, respectively). The findings showed significantly greater improvement (P < 0.05) in lumbar and hip motions with stiffening technique. INTERPRETATION: The findings suggest increased relative stiffness of the lumbar spine during hamstring muscle stretching can specifically lengthen bilateral hamstring muscle and decrease excessive lumbar motion. This stiffening technique may prevent excessive movement of the lumbar spine, thereby reducing the risk of recurrent low back pain.

The effects of a 6-month moderate-intensity Hatha yoga-based training program on health-related fitness in middle-aged sedentary women: a randomized controlled study.

BACKGROUND: There is paucity of data examining the effectiveness of long-term Hatha yoga-based (HY) programs focused on the health-related fitness (H-RF) of asymptomatic, sedentary women. The purpose of this study was to examine the effects of a 6-month HY-based training program on H-RF components in sedentary middle-aged women. METHODS: Eighty sedentary women were randomly assigned into either the HY group (HYG) (N.=42) or the control group (CG) (N.=38). The 6-month HYG program involved a progressive series of Vinyasa Flow poses performed 3 times/week for 60 minutes (40 minutes within the exercise zone of 60-75% HRmax). The CG participants did not undergo any physical training or education. Health-related fitness parameters included measures of pre- and post-training: body composition, muscular strength and maximal voluntary isometric torques of elbow flexors and knee extensors, cardio-respiratory fitness, lower back and hamstring flexibility and a static-dynamic balance. RESULTS: Two-way mixed design ANOVA revealed significant main effects for all the indicators of H-RF. Tukey post-hoc tests confirmed that the HYG demonstrated significant improvements in every variable tested. Examples of the benefits achieved include (all P<.001): an average loss of 1.03 kg and a 4.82% decrease in body fat, 14.6% and 13.1% gains in isometric strength of the knee extensors and elbow flexors respectively, an increase in relative VO2max of 6.1% (33.12±5.30 to 35.14±4.82 mL/kg/min), a 4-cm or 10.4% increase in their MSAR, and an average improved Balance Index of 5.6 mm/s. Reversely, the CG showed non-significant changes in H-RF variables (all P>0.05; percent range from -1.4% to 1.1%). CONCLUSIONS: By participating in a moderate-intensity 6-month HY-based training program, middle-aged women can significantly improve their HR-F status. The application of progressive target heart rate goals facilitated greater than expected improvements in cardio-respiratory fitness and improvements in body composition.

Consumption of star fruit juice on pro-inflammatory markers and walking distance in the community dwelling elderly.

PURPOSE: This study aimed to evaluate the effect of star fruit juice supplementation on tumor necrosis factor-alpha (TNF-α), interleukin-23 (IL-23) and interleukin-2 (IL-2), nitric oxide (NO), and 6 min walking distance (6MWD) in a group of elderly individuals. METHODS: Twenty-nine individuals (20 males, 9 females) with a mean age of 72.4±8.3 years completed this study. A two-week control period was followed by four weeks of 100g fresh star fruit juice consumption twice per day after meals. RESULTS: Plasma TNF-α, IL-23, IL-2, NO and the 6MWD were evaluated twice during the control period (weeks 0 and 2) and once after the star fruit juice consumption (week 6). RESULTS: The results showed that all parameters in the blood did not change significantly during the control period. After 4 weeks of star fruit juice consumption, a significant reduction in NO, TNF-α and IL-23 was found; however, there was no change in IL-2. Moreover, the 6MWD increased significantly at week 6, when compared to that at week 0 and 2. Furthermore, the results also showed a significantly positive and negative correlation of NO and TNF-α to the 6MWD, but no correlation of IL-23 and IL-2. CONCLUSION: This preliminary study concluded that consumption of star fruit juice at 100g twice daily for one month can significantly depress the pro-inflammation cytokines: TNF-α, IL-23, and NO, while increasing walking distance. Low TNF-α and high NO also present a significant correlation to walking capacity in elderly individuals.

A preliminary study on the effects of star fruit consumption on antioxidant and lipid status in elderly Thai individuals.

OBJECTIVE: The aims of this preliminary study were to evaluate the antioxidant and lipid status before and after star fruit juice consumption in healthy elderly subjects, and the vitamins in star fruit extracts. METHODS: A preliminary designated protocol was performed in 27 elderly individuals with a mean (±SD) age of 69.5±5.3 years, by planning a 2-week control period before 4 weeks of consumption of star fruit twice daily. Oxidative stress parameters such as total antioxidant capacity, glutathione, malondialdehyde, protein hydroperoxide, multivitamins such as l-ascorbic acid (Vit C), retinoic acid (Vit A), and tocopherol (Vit E), and the lipid profile parameters such as cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were analyzed. Moreover, Vit C, Vit A, and Vit E levels were evaluated in the star fruit extracts during the 4-week period. RESULTS: In the 2-week control period, all parameters showed no statistically significant difference; after 4 weeks of consumption, significant improvement in the antioxidant status was observed with increased total antioxidant capacity and reduced malondialdehyde and protein hydroperoxide levels, as well as significantly increased levels of Vit C and Vit A, when compared to the two-time evaluation during the baseline periods. However, glutathione and Vit E showed no statistical difference. In addition, the HDL-C level was higher and the LDL-C level was significantly lower when compared to both baseline periods. But the levels of triglyceride and cholesterol showed no difference. Vit C and Vit A were identified in small quantities in the star fruit extract. CONCLUSION: This preliminary study suggested that consumption of star fruit juice twice daily for 1 month improved the elderly people's antioxidant status and vitamins, as well as improved the lipoproteins related to Vit C and Vit A in the star fruit extract.

Aerobic, anaerobic, and skill performance with regard to classification in wheelchair rugby athletes.

The purpose of the study was to examine the sport-specific performance of wheelchair rugby players with regard to their classification. A group of 30 male athletes from the Polish Wheelchair Rugby League participated in the study. The seven International Wheelchair Rugby Federation classes were collapsed into four groups. Standardized measures of aerobic, anaerobic, and skill performance were examined to identify performance differences among the four groups. Major findings were that most differences were between Group I players and all others and that anaerobic performance was the most sensitive to classification differences. Another important finding was that for all other groups, with one exception, adjacent groups did not differ in anaerobic, aerobic, and sport-specific skill performance. The results of this study demonstrate the need to investigate other performance measures that will help in evaluating the current wheelchair rugby classification system.

Comparison of lateral abdominal muscle thickness between weightlifters and matched controls.

OBJECTIVE: To compare lateral abdominal muscle thickness between weightlifters and matched controls. DESIGN: A case control study design. SETTING: University laboratory. SUBJECTS: 16 female Thai national weightlifters and 16 matched controls participated in this study. MAIN OUTCOME MEASURES: Ultrasound imaging with a 12-MHz linear array was used to measure the resting thickness of transversus abdominis (TrA), internal oblique (IO) and total thickness (Total) of lateral abdominal muscle (LAM) on the right side of abdominal wall. The absolute muscle thickness and the relative contribution of each muscle to the total thickness were determined. RESULTS: Weightlifters had significantly thicker absolute TrA and IO muscles than matched controls (p < 0.01). Further, the relative thickness of the IO was significantly greater in weightlifters than matched controls (p < 0.05). CONCLUSIONS: The findings of this study suggest that routine Olympic style weight training among female weightlifters appears to result in preferential hypertrophy or adaptation of the IO muscle.

Relationship between functional classification levels and anaerobic performance of wheelchair basketball athletes.

Wheelchair basketball athletes are classified using the International Wheelchair Basketball Federation (IWBF) functional classification system. The purpose of this study was to evaluate the relationship between upper extremity anaerobic performance (AnP) and all functional classification levels in wheelchair basketball. Ninety-seven male athletes from the Polish and Lithuanian national wheelchair basketball leagues took part in this study. The Wingate Anaerobic Test was used to assess four AnP indexes with an arm crank ergometer The level of AnP in wheelchair basketball athletes depends to some degree on classification level. No significant differences were found for the AnP indexes across levels 1.0-2.5 and 3.0-4.5. However the AnP level for those in classes 1.0-2.5 was significantly lower than those in classes 3. 0-4.5. The findings from this study provided some evidence that the IWBF functional classification system should be reexamined and that a consolidation of the current eight levels might be in order.