A pilot study of a single intermittent arm cycling exercise programme on people affected by Facioscapulohumeral dystrophy (FSHD).

For patients affected by Facioscapulohumeral dystrophy (FSHD), alternate methods for increasing physical activity engagement that may benefit shoulder function and wider health are needed. Arm cycling has been proposed as a potential method for achieving this although dosage parameters and evidence is limited. The aim of this study was to conduct a pilot study evaluating the effect of a single intermittent arm cycling exercise programme on people affected by FSHD. People with confirmed genetic diagnosis of FSHD between the ages 18-60 years were recruited to attend a single session for the exercise intervention (5 exercise efforts lasting 2 minutes each with 30 seconds of rest between each effort). Prior to exercise, measures of shoulder function (Oxford shoulder score), strength and range of movement were recorded. During the exercise participants were video recorded to quantify range of movement and extract movement profile features. Participants comments were recorded and followed up four days later to check for adverse events. Fifteen participants, (6F:9M) were recruited with median (IQR) Oxford Shoulder Scores of 25 (18 to 39). All participants successfully completed the exercise intervention with only transient symptoms consistent with exercise being reported and achieving a median (IQR) rate of perceived exertion scores of 13 (12 to 13). Movement profile data was available for 12 out of 15 participants and suggests that exercise intensity did not compromise movement. An association between strength and shoulder function (R2 = 0.5147), Rate of perceived exertion (RPE) of the final effort against shoulder function and strength (R2 = 0.2344 and 0.1743 respectively) was identified. Participant comments were positive regarding the exercise intervention. Our study demonstrates that an intermittent arm cycling programme is feasible for people affected by FSHD. Further work is needed to evaluate physiological responses to exercise across variations in programme variables and equipment set up in a larger sample of people affected by FSHD.

The Relationship between Postural Control and Muscle Quality in Older Adults.

This study aimed to determine relationships between muscle quality, the ratio of muscle strength to muscle mass, and postural control and compare postural control of older adults with higher and lower muscle quality. Twenty-five older adults had leg muscle quality and postural control with eyes open and closed measured. Linear and non-linear postural control variables were calculated from center of pressure movements. There was a significant canonical correlation between muscle quality and sway complexity, but no relationship between muscle quality and sway magnitude. Higher muscle quality older adults had greater medio-lateral sway complexity than lower muscle quality older adults. These findings suggest that higher muscle quality relates to greater sway complexity in older adults, suggesting maintenance of muscle quality should be considered important to attenuate postural control declines.

The effect of walking and stationary work on the acute back pain, muscle activation, posture and postural control of older women.

Back pain is associated with activity such as walking or assembly line work that involves upper-body movement. However, no single study has explored the effect of these tasks on back pain, spinal angles and balance in an older adult female population. This study investigated changes in back pain, postural sway, upper-, lower- and full-spine angle and EMG activation of trunk muscles following 30 minutes of walking and a modified quiet standing task. Fourteen older adult females (62 ± 11yrs) with low to moderate chronic back pain were recruited as participants. Findings demonstrated that following these activities, increased acute back pain and upper-spine flexion occur although acute back pain was not clinically significant; postural control and muscle activation remained unchanged. This suggests that walking and modified quiet standing can lead to subtle acute back pain in older females that could be due to an increased upper spinal flexion rather than muscle fatigue. Practitioner summary: Back pain and postural problems are common in older adults. Older adult female participants experienced increased back pain and greater upper-spine flexion following 30-minute walking and standing with trunk rotation, but the practical importance was less clear. However, balance was unaffected, suggesting no increase in fall risk. Abbreviations: CBP: chronic back pain; MQS: modified quiet standing; QS: quiet standing; RPE: rating of perceived exertion; TD: trapezius descendens; TT: trapezius transversalis; TA: trapezius ascendens; ESL: erector spinae longissimus; C7: seventh cervical vertebrae; T7: seventh thoracic vertebrae; T10: tenth thoracic vertebrae; T12: twelfth thoracic vertebrae; L2: second lumbar vertebrae; S2: second sacral vertebrae; AP: anterior-posterior; ML: medial-lateral; SWAYtot: total postural sway; M: mean.

Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study.

BACKGROUND: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. OBJECTIVE: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. METHODS: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. RESULTS: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. CONCLUSIONS: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/16846.

Stable and Unstable Load Carriage Effects on the Postural Control of Older Adults.

The aim of this study was to investigate the effects of backpack load carriage on quiet standing postural control and limits of stability (LOS) of older adults. Fourteen older adults (65 [6] y) performed quiet standing and a forward, right, and left LOS test in 3 conditions, unloaded, stable, and unstable backpack loads while activity of 4 leg muscles was recorded. Stable and unstable loads decreased postural sway (main effect ηp2=.84, stable P < .001, unstable P < .001), mediolateral (main effect ηp2=.49, stable P = .002, unstable P = .018) and anterior-posterior (main effect ηp2=.64, stable P < .001, unstable P = .001) fractal dimension, and LOS distance (main effect ηp2=.18, stable P = .011, unstable P = .046) compared with unloaded. Rectus femoris (main effect ηp2=.39, stable P = .001, unstable P = .010) and gastrocnemius (main effect ηp2=.30, unstable P = .027) activity increased in loaded conditions during LOS and quiet standing. Gastrocnemius-tibialis anterior coactivation was greater in unstable load than stable loaded quiet standing (main effect ηp2=.24, P = .040). These findings suggest older adults adopt conservative postural control strategies minimizing the need for postural corrections in loaded conditions. Reduced LOS may also increase fall risk when carrying a load. However, there was no difference between unstable and stable loads for postural control variables.

Effect of stable and unstable load carriage on walking gait variability, dynamic stability and muscle activity of older adults.

Load carriage perturbs the neuromuscular system, which can be impaired due to ageing. The ability to counteract perturbations is an indicator of neuromuscular function but if the response is insufficient the risk of falls will increase. However, it is unknown how load carriage affects older adults. Fourteen older adults (65 ±â€¯6 years) attended a single visit during which they performed 4 min of walking in 3 conditions, unloaded, stable backpack load and unstable backpack load. During each walking trial, 3-dimensional kinematics of the lower limb and trunk movements and electromyographic activity of 6 lower limb muscles were recorded. The local dynamic stability (local divergence exponents), joint angle variability and spatio-temporal variability were determined along with muscle activation magnitudes. Medio-lateral dynamic stability was lower (p = 0.018) and step width (p = 0.019) and step width variability (p = 0.015) were greater in unstable load walking and step width variability was greater in stable load walking (p = 0.009) compared to unloaded walking. However, there was no effect on joint angle variability. Unstable load carriage increased activity of the Rectus Femoris (p = 0.001) and Soleus (p = 0.043) and stable load carriage increased Rectus Femoris activity (p = 0.006). These results suggest that loaded walking alters the gait of older adults and that unstable load carriage reduces dynamic stability compared to unloaded walking. This can potentially increase the risk of falls, but also offers the potential to use unstable loads as part of fall prevention programmes.

The effect of prolonged level and uphill walking on the postural control of older adults.

Prolonged walking could alter postural control leading to an increased risk of falls in older adults. The aim of this study was to determine the effect of level and uphill prolonged walking on the postural control of older adults. Sixteen participants (64 ±â€¯5 years) attended 3 visits. Postural control was assessed during quiet standing and the limits of stability immediately pre, post and post 15 min rest a period of 30 min walking on level and uphill (5.25%) gradients on separate visits. Each 30 min walk was divided into 3 10 min blocks, the limits of stability were measured between each block. Postural sway elliptical area (PRE: 1.38 ±â€¯0.22 cm2, POST: 2.35 ±â€¯0.50 cm2, p = .01), medio-lateral (PRE: 1.33 ±â€¯0.03, POST: 1.40 ±â€¯0.03, p = .01) and anterio-posterior detrended fluctuation analysis alpha exponent (PRE: 1.43 ±â€¯0.02, POST: 1.46 ±â€¯0.02, p = .04) increased following walking. Medio-lateral alpha exponent decreased between post and post 15 min' rest (POST: 1.40 ±â€¯0.03, POST15: 1.36 ±â€¯0.03, p = .03). Forward limits of stability decreased between the second walking interval and post 15 min' rest (Interval 2: 28.1 ±â€¯1.6%, POST15: 25.6 ±â€¯1.6%, p = .01) and left limits of stability increased from pre-post 15 min' rest (PRE: 27.7 ±â€¯1.2%, POST15: 29.4 ±â€¯1.1%, p = .01). The neuromuscular alterations caused by prolonged walking decreased the anti-persistence of postural sway and altered the limits of stability in older adults. However, 15 min' rest was insufficient to return postural control to pre-exercise levels.

Correction to: Effectiveness of Exercise Interventions to Improve Postural Control in Older Adults: A Systematic Review and Meta-Analyses of Centre of Pressure Measurements.

Page 103, Table 1: The cell entry in the 'Terms used' column which previously read: "Centre of pressure OR center of pressure OR COP OR postural sway OR postural stability OR postural control OR balance OR force plat*".

The acute effects of integrated myofascial techniques on lumbar paraspinal blood flow compared with kinesio-taping: A pilot study.

BACKGROUND: Myofascial techniques and Kinesio Taping are therapeutic interventions used to treat low back pain. However, limited research has been conducted into the underlying physiological effects of these types of treatments. OBJECTIVES: The purpose of this study was to compare the acute effects of integrated myofascial techniques (IMT) and Kinesio Tape (KT) on blood flow at the lumbar paraspinal musculature. METHODS: Forty-four healthy participants (18 male and 26 female) (age, 26 ± SD 7) volunteered for this study and were randomly assigned to one of three interventions, IMT, KT or a control group (Sham TENS). Paraspinal blood flow was measured at the L3 vertebral level, using Near Infrared Spectroscopy (NIRS), before and after a 30-min treatment. Pain Pressure Threshold (PPT) was also measured before and after treatments. RESULTS: A one-way ANOVA indicated a significant difference between groups for O2Hb [F (2-41) = 41.6, P < 0.001], HHb [F (2-41) = 14.6, P < 0.001] and tHb [F (2-41) = 42.2, P < 0.001]. Post hoc tests indicated that IMT was significantly greater, from the KT and the control treatments (P < 0.001), for changes in O2Hb, HHb, and tHb. There were no significant differences for PPT [F (2-41) = 2.69, p = 0.08], between groups. CONCLUSIONS: This study demonstrated that IMT increases peripheral blood flow at the paraspinal muscles in healthy participants compared to KT and sham TENS. The change in blood flow had no impact on pain perception in the asymptomatic population group.

Effectiveness of Exercise Interventions to Improve Postural Control in Older Adults: A Systematic Review and Meta-Analyses of Centre of Pressure Measurements.

BACKGROUND: Previous reviews have shown balance in older adults to be improved with exercise. However, it is currently unclear whether postural control, indicated by centre of pressure (COP) measurement, can be improved in older adults and thus whether postural control could be a mechanism to improve balance. OBJECTIVES: The purpose of this systematic review was to assess the effectiveness of force platform COP variables to identify changes in postural control following exercise interventions in older adults. In addition, a secondary purpose was to determine whether the exercise types (balance, resistance or multi-component exercise interventions) are equally effective to improve postural control. METHODS: Randomised controlled trials were identified using searches of databases and reference lists (PROSPERO registration number CRD42014010617). Trials performing exercise interventions, reporting force platform COP measurements, in participants with a mean age of ≥60 years were included. Risk of bias assessments were performed following the Cochrane guidelines. Data were pooled in meta-analyses, and standardised mean differences (SMDs) with 95 % confidence intervals (CIs) were calculated. RESULTS: Twenty-three trials met the inclusion criteria for the systematic review. Twenty-two trials could be defined as either utilising a balance, resistance or multi-component exercise intervention. These 22 trials were used in the meta-analyses. All trials reported measurements of double leg stance; eight trials reported additional stance conditions. The meta-analyses of double leg stance showed that balance exercise interventions significantly decreased total sway path length/velocity [SMD -1.13, 95 % CI -1.75 to -0.51 (eyes open); SMD -0.79, 95 % CI -1.33 to -0.26 (eyes closed)] and anterior-posterior sway path length/velocity [SMD -1.02, 95 % CI -2.01 to -0.02 (eyes open); SMD -0.82, 95 % CI -1.46 to -0.17 (eyes closed)] in both eyes open and eyes closed conditions. Balance exercise interventions also decreased sway area in eyes closed conditions (SMD -0.57, 95 % CI -1.01 to -0.13) and medio-lateral sway path length/velocity in eyes open conditions (SMD -0.8, 95 % CI -1.48 to -0.12). In contrast, neither resistance nor multi-component exercise interventions affected any of the included COP measurements. CONCLUSIONS: Postural control is improved by balance exercise interventions. In contrast, strength or multi-component exercise interventions did not influence postural control measurements in older adults. In addition, a lack of standardisation in collection protocol and COP variables calculated across trials was identified.

The Effect of Cycling Intensity on Cycling Economy During Seated and Standing Cycling.

BACKGROUND: Previous research has shown that cycling in a standing position reduces cycling economy compared with seated cycling. It is unknown whether the cycling intensity moderates the reduction in cycling economy while standing. PURPOSE: The aim was to determine whether the negative effect of standing on cycling economy would be decreased at a higher intensity. METHODS: Ten cyclists cycled in 8 different conditions. Each condition was either at an intensity of 50% or 70% of maximal aerobic power at a gradient of 4% or 8% and in the seated or standing cycling position. Cycling economy and muscle activation level of 8 leg muscles were recorded. RESULTS: There was an interaction between cycling intensity and position for cycling economy (P = .03), the overall activation of the leg muscles (P = .02), and the activation of the lower leg muscles (P = .05). The interaction showed decreased cycling economy when standing compared with seated cycling, but the difference was reduced at higher intensity. The overall activation of the leg muscles and the lower leg muscles, respectively, increased and decreased, but the differences between standing and seated cycling were reduced at higher intensity. CONCLUSIONS: Cycling economy was lower during standing cycling than seated cycling, but the difference in economy diminishes when cycling intensity increases. Activation of the lower leg muscles did not explain the lower cycling economy while standing. The increased overall activation, therefore, suggests that increased activation of the upper leg muscles explains part of the lower cycling economy while standing.

Effect of gradient on cycling gross efficiency and technique.

PURPOSE: The purpose of this study was to determine the effect of gradient on cycling gross efficiency and pedaling technique. METHODS: Eighteen trained cyclists were tested for efficiency, index of pedal force effectiveness (IFE), distribution of power production during the pedal revolution (dead center size [DC]), and timing and level of muscle activity of eight leg muscles. Cycling was performed on a treadmill at gradients of 0% (level), 4%, and 8%, each at three different cadences (60, 75, and 90 rev·min). RESULTS: Efficiency was significantly decreased at a gradient of 8% compared with both 0% and 4% (P < 0.05). The relationship between cadence and efficiency was not changed by gradient (P > 0.05). At a gradient of 8%, there was a larger IFE between 45° and 225° and larger DC, compared with 0% and 4% (P < 0.05). The onset of muscle activity for vastus lateralis, vastus medialis, gastrocnemius lateralis, and gastrocnemius medialis occurred earlier with increasing gradient (all P < 0.05), whereas none of the muscles showed a change in offset (P > 0.05). Uphill cycling increased the overall muscle activity level (P < 0.05), mainly induced by increased calf muscle activity. CONCLUSIONS: These results suggest that uphill cycling decreases cycling gross efficiency and is associated with changes in pedaling technique.