Increased physical fitness among patients following endurance training during haemodialysis.

OBJECTIVE: The study aimed to investigate the effect of 6 months of endurance training of moderate intensity on physical performance and the risk of falling in haemodialysis patients. MATERIAL AND METHODS: This was a prospective interventional study in which 21 of 35 eligible patients accepted to participate. The 6-minute walk test (6MWT), timed up and go (TUG), timed stand test and Romberg's test were used to evaluate physical fitness. The Borg scale was used to control the workload. The patients bicycled for 12-40 min with increasing workload according to their capabilities. Wilcoxon signed ranks and McNemar's tests were used for analysis. RESULTS: Of the 21 participants, 12 completed 3 months of training. Their median (range) age was 69 (37-88) years, duration of dialysis was 2.5 (1-11) years and body mass index was 25.0 (20.0-31.9). Romberg's test was positive in four participants at the beginning but in three after 3 months. Nine participants completed 6 months of training; none had a positive Romberg's test at that time. Walking distance increased significantly after 3 and 6 months of training (p = 0.002 and p = 0.012, respectively), and time for the TUG decreased significantly (p = 0.041 and p = 0.044), as did time for the timed stand test (p = 0.015 and 0.018), compared with baseline values. The TUG test was in excess of 14 s in four patients at baseline but only one at the end of training. CONCLUSION: Endurance training of moderate intensity during dialysis results in significantly increased physical performance in haemodialysis patients.

Rib cage motion in ankylosing spondylitis patients: a pilot study.

BACKGROUND: Assessment of chest expansion is one of the measures of rib cage mobility recommended as "core set for assessing Ankylosing Spondylitis" (AS). A recently developed instrument for measuring respiratory movements is introduced. PURPOSE: To compare chest and abdominal wall movements in AS patients with those of controls using a newly developed instrument. STUDY DESIGN: A comparative study. PATIENT SAMPLE: Fourteen male AS patients were invited to the study. All subjects answered a standardized questionnaire concerning general health. OUTCOME MEASURES: Body height and weight and respiratory movements. METHODS: Upper and lower chest wall and abdominal motion was measured bilaterally for a period of 1 minute during deep breathing by using a new instrument based on a laser technique, The Respiratory Movement Measuring Instrument (ReMo, Reykjavík, Iceland). Results were compared to healthy controls matched for age, gender, and body mass index. RESULTS: The patients' mean age was 47+/-9.5 years, and they had a history of AS for 13+/-6 years. Their mean BMI was 27+/-3.6. The respiratory movements of the upper thoracic level were significantly lower than in the reference group (right p=.01, left p=.05). They had, however, a normal range of lower thoracic and abdominal movement and their respiratory movement patterns were symmetrical. CONCLUSION: The AS patients had reduced upper thoracic movements but normal lower thoracic and abdominal wall movements.

Posterior-anterior(PA) pressure Puffin for measuring and treating spinal stiffness: Mechanism and repeatability.

BACKGROUND: Posterior-anterior (PA) pressure technique is widely used for assessing and treating spinal segments. PA pressure is manually applied and stiffness is subjectively assessed. The method has been deemed unreliable and is associated with occupational strain. OBJECTIVES: To introduce a new ergonomically designed hand-held device measuring spinal stiffness, and to assess its repeatability. DESIGN: Quasi experimental study. METHOD: A convenience sample of 30 university students, 20-30 years old was used. The participants were tested two consecutive days by two physical therapy students using the new device; the PA pressure Puffin. The spinal segments under study were L1, Th12, Th7 and Th6 which all were tested three times with 9 kg force by both testers, both days. Intra-class correlation coefficients (ICC3,k) were used to assess intra- and inter-tester repeatability and analysis of variance with alpha-level at 0.05 was used to assess differences in joint mobility at the four segments measured. Linear regression analyses were used to assess repeatability. RESULTS: Inter-tester and intra-tester coefficients (ICCs) ranged from 0.88 to 0.97 and from 0.83 to 0.97, respectively. There was no significant difference in displacement between Th6 and Th7 but all other joints were significantly different from each other. Displacement was always significantly greater the second day compared with day one (p < 0.05). CONCLUSIONS: This close to final prototype of the PA pressure Puffin measures segmental spinal stiffness and its ergonomically designed handle provides a promising tool for physical therapists applying PA pressure. Further research is needed for validation and reliability assessments.

[Pelvic floor muscle training with and without functional electrical stimulation as treatment for stress urinary incontinence]. / Samanburdur á grindarbotnsthjálfun med og án raförvunar sem medferd vid áreynsluthvagleka.

BACKGROUND: Twelve to 55% of women experience stress urinary incontinence at some time during their lifetime. OBJECTIVE: To compare the effectiveness of pelvic floor muscle training with and without electrical stimulation in treatment of stress urinary incontinence. MATERIAL AND METHODS: Participants were 24 women, 27-73 years of age, diagnosed with stress urinary incontinence. Exclusion criteria were pregnancy and urge urinary incontinence. These participants were randomly divided into group 1 and 2. Both groups trained 15 min. twice a day for 9 weeks. Group 2 used simultaneously intermittent electrical stimulation. The pelvic floor muscles were evaluated using the Oxford scale, vaginal palpation, and by electromyogram, (Myomed 930, Enraf Nonius). The quantity and frequency of urinary incontinence episodes was evaluated using a questionnaire and a VAS scale before and after the treatment. RESULTS: The groups were demographically similar, except group 2 was significantly younger. Both groups had significantly increased pelvic floor muscle strength (p=0.007; p=0.005 respectively) after the treatment and 70% of all the women had reduced or no stress urinary incontinence. Group 2 had significantly (p=0.013) better relaxation post treatment. CONCLUSION: Pelvic floor muscle training is an effective treatment for stress urinary incontinence, but electrical stimulation gave no additional effect for this patient group. The significantly lower relaxation threshold in group 2 indicates that electrical stimulation could be a possible treatment for symptoms caused by hypertensive pelvic floor muscles.

Breathing movements and breathing patterns among healthy men and women 20-69 years of age. Reference values.

BACKGROUND: Measurements in absolute terms of the whole respiratory movement pattern (range, type, symmetry, rhythm and frequency of breathing movements) of healthy individuals are valuable for reference, when assessing patients with conditions affecting respiration. OBJECTIVE: To establish reference data for breathing movements and patterns for healthy men and women. METHODS: Fifty men (mean age 47.8 years) and 50 women (mean age 43.4 years) aged between 20 and 69 years participated in the study. Anterior-posterior breathing movements of the upper and lower thorax and abdomen were measured bilaterally during quiet breathing and deep breathing using the respiratory movement measuring instrument. Descriptive statistics, paired-sample statistics and Kendall's correlation test were used for analysis. RESULTS: Breathing movements were symmetrical and did not change significantly with increasing age. The average breathing type for men and women was abdominal during quiet breathing. During deep breathing the abdominal movements were significantly less amongst the women than the men (p < 0.05). The average respiratory rate was 14 during quiet and 7.4 during deep breathing for both sexes. The rhythm (inspiration/expiration ratio) was 1:1.21 for men and 1:1.14 for women during quiet breathing and 1:1.23 for men and 1:1.40 for women during deep breathing. CONCLUSIONS: As men and women have similar breathing movements during quiet breathing their reference values can be combined. On the other hand, separate reference values are needed for men and women for deep breathing.

Chest wall motion and pulmonary function are more diminished following cardiac surgery when the internal mammary artery retractor is used.

OBJECTIVES: Pulmonary complications following cardiac surgery through sternotomy have been widely studied. The duration of these complications, however, has been less studied and the proposed alterations in chest wall mechanism even less. The purpose of this study was to investigate changes in chest wall motion and pulmonary function of cardiac surgery patients, where both the median and the internal mammary artery retractor was used (IMA group) and cardiac surgery patients, where only the median retractor was used (Median group). DESIGN: Subjects were 20 cardiac surgery patients with mean age 65 years (12 in the IMA group and 8 in the Median group). Bilateral respiratory movements (RMs) using the Respiratory Movement Measuring Instrument, lung volumes including vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume (FEV1) using the Vitalograph Alpha were measured and pulmonary radiographs analyzed before, 3 and 12 months after the operation. ANALYSIS: Descriptive statistics, t-tests, Mann-Whitney and Wilcoxon Signed Rank tests were used for analyses, p < or = 0.05. RESULTS: RMs were symmetrical in both groups prior to the operation and the differences in RMs and lung volumes between the groups were not significant. Three and 12 months postoperatively bilateral abdominal respiratory movements (ARM) were significantly less in the IMA group than in the Median group. Average left ARM were significantly less than the average right ARM in the IMA group 3 months postoperatively, while symmetrical in the Median group. Average FVC and FEV1 were significantly less in the IMA group than in the Median group 3 months postoperatively and FVC was still significantly less in the IMA group 12 months after the operation. CONCLUSION: The significantly more reduced ARM and lung volumes 3 months postoperatively in the IMA group than in the Median group suggests that the IMA retractor causes greater injury to the rib cage and the diaphragm.

Respiratory movements are altered three months and one year following cardiac surgery.

OBJECTIVE: Pulmonary complications following cardiac surgery through sternotomy are well known, but little is known about the proposed alterations of the chest wall mechanism. The purpose of this study was to examine changes in chest wall motion and pulmonary function after cardiac surgery. DESIGN: The subjects were 20 cardiac surgery patients, 13 men and 7 women, mean age 65 years. MEASUREMENTS: Bilateral respiratory movements were measured using the Respiratory Movement Measuring Instrument before, 3 and 12 months after the operation. Vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume (FEV1) were measured with the Pulminet III (Gold Godart Ltd Vitalograph Alpha Ltd. Maids Morton, Buckingham, England) preoperatively, 3 and 12 months postoperatively, and radiographs were taken at the same points in time. ANALYSIS: Descriptive statistics, paired sample t-tests, Mann-Whitney and Wilcoxon Signed Rank tests were used for analyses, p < or = 0.05. RESULTS: Average abdominal movements 3 months postoperatively were significantly decreased and the difference between right and left side in upper thoracic and abdominal movements was significant. All pulmonary function measurements except the FEV1/FVC showed a significant decrease and a restrictive pattern compared with preoperative values. Twelve months after the operation the upper thoracic movements were significantly increased. Five patients had an abnormal chest x-ray before the operation, eight 3 months and three 12 months after the operation. CONCLUSION: The motor system of the respiratory organs suffers considerable injury from cardiac surgery, which in part at least can explain the restrictive breathing 3 months postoperatively.

Short-term changes in pulmonary function and respiratory movements after cardiac surgery via median sternotomy.

OBJECTIVE: To study the changes in bilateral respiratory motion and pulmonary function following sternotomy and the relationships between the changes in respiratory movements, spirometry, radiographic analyses, and several intra-operative surgical characteristics. DESIGN: Respiratory motion during deep breathing and lung volumes were measured in 20 patients (mean age 65 years, SD 16) before and after median sternotomy. Chest x-rays were analyzed pre- and postoperatively and a variety of perioperative variables were measured. RESULTS: Average abdominal motion decreased to 57% of preoperative values bilaterally 1 week postoperatively, the average lower thoracic motion decreased to 72%, and the average upper thoracic motion decreased to 87%, whereas the right upper thoracic motion increased 3% compared with preoperative values. Lung volumes decreased to around 60% of preoperative values (p<0.05). Significant correlations were found between the decrease in pulmonary function and the mean respiratory movements. Abnormal chest radiographs were found in all patients. CONCLUSION: The breathing pattern before sternotomy is predominantly abdominal but moves to a thoracic and upper thoracic pattern postoperatively and is associated with reduced pulmonary function. Therapeutic interventions aimed at correcting the less effective upper thoracic breathing pattern should likely be implemented.