Effects of different exercise intensity on bone mineral density in adults: a comparative systematic review and meta-analysis.

PURPOSE: The primary objective of the present systematic review and meta-analysis was to determine the effect of differing exercise intensity on (areal) bone mineral density (BMD) at lumbar spine and hip in adults by a comparative meta-analysis. METHODS: A systematic review of the literature according to the PRISMA statement included: (a) exercise trials, (b) with ≥two study arms that compared different exercise intensities, (c) intervention ≥6 months, (d) BMD assessments at lumbar spine (LS) or hip. Five electronic databases were scanned without language restrictions up to July 2021. The present analysis of exercise intensity was conducted as a mixed-effect meta-analysis and applied "type of exercise" and "study duration" as moderator in subgroup analyses. Outcome measures were standardized mean differences (SMD) for BMD changes at the LS, and hip. RESULTS: Eleven exercise studies with 26 study arms were included. Although the effect of high-intensity exercise was more pronounced on LS-BMD (SMD: 0.19, 95%-CI: 0.61 to -0.23) and hip-ROI (0.17, 0.38 to -0.04), we did not observe significant differences between the groups (LS-BMD: p=0.373 and hip-BMD: p=0.109). We observed a substantial level of heterogeneity between the trials for LS- but not for hip-BMD. Applying "type of exercise" and "study duration" as moderators did not significantly modify the differences between low and high exercise intensity on BMD at LS or hip. CONCLUSION: There is insufficient evidence for a superior effect of high-intensity exercise on areal BMD at lumbar spine and hip in people aged 50 years and older. Varying exercise intensity with periods of lower exercise intensity intermitted by higher intensity might be a promising option to address the issue of exercise intensities in intervention studies.

[The S2k guideline: Indications for knee endoprosthesis : Evidence and consent-based indications for total knee arthroplasty]. / S2k-Leitlinie: Indikation Knieendoprothese : Evidenz- und konsensbasierte Indikationsstellung in der Knie-Endoprothetik (EKIT-Knie).

Total knee arthroplasty (TKA) is one of the most frequent surgical procedures in orthopaedic surgery. Until now there have not been any standardized indication criteria, which might contribute to the large geographical differences in the frequency of TKA. This guideline aims to consent minimal requirements (main criteria), additional important aspects (minor criteria), as well as relative and absolute contraindications for TKA. The following main criteria have been consented: knee pain, radiological confirmation of osteoarthritis or osteonecrosis, inadequate response to conservative treatment, adverse impact of knee disease on the patient's quality of life and the burden of suffering due to the knee disease. Relative contraindications have been consented as severe general disease with reduced life expectancy and a BMI ≥40; absolute contraindications are an active infection and if the patient is not able to undergo major surgery.

[The Summer School of the German Society for Orthopaedics and Traumatology - A Success Story]. / Die Summer School der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie ­ eine Erfolgsgeschichte.

Background: It has been known for several years that orthopaedic and trauma clinics suffer from a shortage of young people, due to the substantial loss in attractiveness. The Youth Forum OU has been addressing this problem for many years, by initiating many projects such as the Summer School to counteract this trend. The purpose of this research is to evaluate the success of Summer Schools since 2009. Methods: The Youth Forum OU performed a survey in December 2014 to answer the research question on the basis of an internet-based poll of the student participants in all Summer Schools between 2009 and 2014. Following data cleansing, 121 students and former students were included in the survey. Results: Seventy-two completed questionnaires were collected and included in the evaluation. The survey included 40 % of Summer School participants, with a mean age of 27.3 years (SD ± 2.95); 50 % were female. Participation in the Summer School helped 50 % of the respondents to decide to start advanced study in orthopaedics and/or traumatology (OU). One third of these Summer School participants had already finished a university degree; 100 % are now residents in orthopaedics and/or traumatology. Regardless of prior plans, 87.2 % of participants are now residents in OU. Thirty-three are still students: 78.8 % have already decided to work in OU. The survey also served to identify the factors positively and negatively associated with OU. Unfavourable factors included the reputation of OU, and the difficulty of reconciling family and work. Favourable factors included surgical work and personal experience during university studies. Discussion: The aim of this study was to evaluate whether the efforts of the Youth Forum OU, the German Society for Orthopaedics and Traumatology (DGOU) and the local hospitals lead to increased interest in OU. The answer to this question is positive. This is particularly true for those students who did not plan to become an orthopaedic or trauma surgeon before participating in a Summer School. In conclusion, the efforts to recruit residents for OU by using Summer Schools were successful. Moreover, this research offers approaches to counteract the loss of attractiveness of OU.

[Registries of the German Society for Orthopaedics and Trauma : Overview and perspectives of the DGU and DGOOC registries]. / Die Register der DGOU : Übersicht und Perspektiven der DGU- und DGOOC-Register.

The register network of the German Society for Orthopaedics and Trauma (DGOU) consists of 14 registries that cover the various fields of traumatology and elective orthopedics. In addition to registries that focus on implants and types of diseases without age limitations, there are also registries dealing with special diseases in children and adolescents as well as the special needs of elderly patients with fractures. The registries serve as instruments for outcome research and quality assurance and can be used to develop treatment recommendations on a high level of evidence. The objective of the network is to exchange experience that facilitates the establishment of new registers, to pool expertise and to conserve resources.

[History of conservative spinal therapy]. / Geschichte der konservativen Wirbelsäulentherapie.

Hippocrates was the first to intensively describe and document the principles for the treatment of injuries and diseases of the spine. His principles for abrupt treatment of the "hunchback" were followed by physicians even up to the end of the nineteenth century. The non-operative treatment of scoliosis was improved in the beginning of the sixteenth century by the introduction of mechanical devices that started the development of corsets which are still in use in modern scoliosis treatment. Stretching beds were only in temporary use. With the beginning of the nineteenth century gymnastics and physiotherapy became more and more important. Manual therapy was exercised by physicians until the late Middle Ages. After a long period of time in which bonesetters and other laymen performed manual therapy it was professionalized at the end of the nineteenth century again by the introduction of osteopathy and chiropractic. In Germany the development and introduction of manual treatment started relatively late in the twentieth century, predominantly as manual medicine.

[Inpatient and outpatient rehabilitation in Germany. Current state and further development]. / Stationäre und ambulante Rehabilitation in Deutschland. Aktueller Stand und weitere Entwicklung.

BACKGROUND: The rehabilitation of patients with diseases of the musculoskeletal system and injuries has a high priority in Germany. The costs are essentially borne by the statutory health insurance companies (reha before nursing), pension schemes (reha before pension) and German statutory accident insurance. OBJECTIVES: The necessity for rehabilitation and the derivation of objectives and rehabilitation strategies are based on the international classification of functioning, disability and health (ICF). Medical rehabilitation is increasingly being supplemented by options from medical occupational rehabilitation. DEMOGRAPHIC DEVELOPMENT: Against the background of a predicted reduction in the work force due to the age structure of the population and the associated problem of financing of pensions, people must remain longer in occupations. The increase in the elderly population results in more wear and age-related diseases, such as osteoporosis and arthrosis as well as typical age-related injuries and sequelae. This will place increasing demands on the curative and rehabilitation sectors. CONCLUSION: Maintaining the ability to work and independence results in an increase in the need for rehabilitation; however, this also necessitates an adaptation of processes and structures in order to be able to meet these challenges.

[Rehabilitation in orthopedics and trauma surgery. State of the art]. / Rehabilitation in Orthopädie und Unfallchirurgie. Eine Standortbestimmung.

Diseases and injuries of the musculoskeletal system are the most common reasons for rehabilitation in Germany. The statutory health insurance, pension funds and the German social accident insurance are service providers for rehabilitation. Rehabilitation is based on the international classification of functioning, disability and health (ICF). The extensive possibilities for medical rehabilitation are increasingly being supplemented by options for combined medical and occupational rehabilitation. The demographic changes in Germany are also a challenge for rehabilitation. In a situation of predicted labor deficit, even now it becomes essential to keep employees longer in their jobs. The increasing number of elderly persons causes an increase in frequent age-dependent diseases, such as osteoporosis and osteoarthritis in combination with age-dependent injuries. This will be a burden for the health system in acute care medicine and rehabilitation. Improving activities and participation following diseases and injuries of the musculoskeletal system will end in an increase in utilization of rehabilitation. This needs to be considered and reflected in an adjusted higher budget for costs in rehabilitation.

[Effects of two different types of whole body vibration on neuromuscular performance and body composition in postmenopausal women]. / Effekte unterschiedlicher Ganzkörpervibrationssysteme auf die neuromuskuläre Leistungsfähigkeit und die Körperzusammensetzung postmenopausaler Frauen.

PURPOSE: The effects of different types of whole body vibration (WBV) training on neuromuscular performance and body composition were determined in postmenopausal women. METHODS: In the Erlangen Longitudinal Vibration Study II (ELVIS-II-Study) 108 postmenopausal women between 60 and 75 years of age (average 65.8 ± 3.5 years) were randomly assigned to one of three groups: two WBV training-groups (n = 36 each), each performing an identical program thrice a week for 15 min on two different types of vibration plates for one year: 1. vertical vibrating, 35 Hz, 1.7 mm (VG); 2. rotational vibrating 12.5 Hz, 12 mm (RG). A control group (n = 36) conducted a low intensity gymnastic and relaxation program. Muscular strength and power were assessed, body composition was determined by Dual-energy X-ray absorptiometry (DXA), and pain intensity was assessed by a questionnaire. RESULTS: Maximum leg strength (VG: 24.4 %; RG: 26.6 %; KG: 6.2 %; p < 0.001) and maximum trunk flexion strength (VG: 12.2 %; RG: 11.5 %; KG: -5.5 %; p = 0.01) significantly increased in both vibration groups. No changes were found for body composition parameters (lean body mass, appendicular muscle mass, fat mass). Pain intensity in the big joints (p < 0.05) decreased in both vibration groups, in the lumbar spine region this was not significant. There was no difference between vibration types. No vibration-related side effects were observed. CONCLUSION: The study results suggest that WBV might be an alternative to classic training contents to increase maximum strength and reduce pain.

In healthy elderly postmenopausal women variations in BMD and BMC at various skeletal sites are associated with differences in weight and lean body mass rather than by variations in habitual physical activity, strength or VO2max.

The objective of this study was an integrated cross-sectional investigation for answering the question whether differences in bone mineral density in elderly postmenopausal women are associated with differences in habitual physical activity and unspecific exercise levels. Two hundred and ninety nine elderly women (69-/+3 years), without diseases or medication affecting bone metabolism were investigated. The influence of weight, body composition and physical activity on BMD was measured at multiple sites using different techniques (DXA, QCT, and QUS). Physical activity and exercise level were assessed by questionnaire, maximum strength of the legs and aerobic capacity. Variations in physical activity or habitual exercise had no effect on bone. The only significant univariate relation between strength/VO(2)max and BMD/BMC that remained after adjusting for confounding variables was between arm BMD (DXA) and hand-grip strength. The most important variable for explaining BMD was weight and for cortical BMC of the femur (QCT) lean body mass. Weight and lean body mass emerge as predominant predictors of BMD in normal elderly women, whereas the isolated effect of habitual physical activity, unspecific exercise participation, and muscle strength on bone parameters is negligible. Thus, an increase in the amount of habitual physical activity will probably have no beneficial impact on bone.

[Rehabilitation of younger patients following total joint replacement]. / Rehabilitation bei jüngeren Endoprothesenpatienten.

In the treatment of younger patients following total joint replacement there are different methods for inpatient and outpatient rehabilitation. In principal medical rehabilitation of younger patients does not differ from rehabilitation of older patients. However, the rehabilitation process is not restricted by coexisting diseases. Higher demands on function and performance of the artificial joint have to be considered. Especially in younger patients education and information about use, load and sports following total joint replacement are necessary. In this context occupational rehabilitation concerning restrictions caused by the artificial joint and measures for participation in working life is of special importance.

Structured telephone-based outreach using nonmedical personnel can improve adherence to comprehensive care in families of children with sickle cell disease.

Comprehensive medical care of patients with sickle cell disease decreases morbidity, mortality, and health care resource utilization. Nonadherence to comprehensive care is a barrier to further improvement in the outcomes of these patients. We investigated the feasibility and acceptability of telephone-delivered structured follow-up, support, and education provided by nonmedical personnel and its impact on adherence to comprehensive measures. A semistructured script was designed that included a series of questions relating to the patient's well-being and health-related behaviors and was administered by a graduate student researcher in genetics. Families of all 202 children followed at Children's Hospital of Pittsburgh were attempted to be contacted at 3 monthly intervals from their last contact. A total of 76% [147] of those called were available and willing to talk. Eighteen months after initiation of the study, the number of patients who had not attended comprehensive care clinic for 2 years or more decreased from 46 (19.7%) to 23 patients (9.9%) (P = 0.0019). Similarly, the proportion of eligible patients who had undergone transcranial Doppler screening within the past 12 months increased from 34 to 49% (P = 0.0501). Structured telephone-based follow-up is feasible and well accepted and can lead to improved adherence with comprehensive care measures.

[Physical therapy of osteoarthritis]. / Physikalische Therapie der Arthrose.

Physical therapy is part of guidelines and recommendations in the treatment of osteoarthritis. Different methods of physical therapy are used in osteoarthritis. There is evidence that manual physical therapy and exercise improve function and reduce pain in osteoarthritic joints. Thermal modalities are employed for short-term pain relief and change the intraarticular temperature. Electrotherapy, therapeutic ultrasound and balneotherapy show positive therapeutic effects. Based on studies and clinical experience, physical therapy must be recommended in the therapy of osteoarthritis.

[Evaluation of specific stabilizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation]. / Wertigkeit der muskulären segmentalen Stabilisierung zur Behandlung von Rückenschmerz und Bandscheibenerkrankungen im Rahmen der ambulanten Rehabilitation.

AIM: The aim of the study was to evaluate the outcome of outpatient rehabilitation in patients with low back pain and lumbar disk disease with a specific stabilizing exercise of the M. multifidus and M. transversus abdominis. METHOD: 99 outpatients admitted to a rehabilitation unit were included in a prospective randomized controlled interventional trial. The interventional group consisted of 50 patients (34 male, 16 female; mean age 41.1 +/- 9.1, range; 21 - 54 years), 49 patients (31 male, 18 female; mean age 37.9 +/- 9.5, range; 19 - 55 years) were in the control group. Outcomes were assessed at the beginning and the end of the treatment and at a three month follow-up with the Oswestry Low Back Pain Disability Questionnaire, the Hannover Functional Ability Questionnaire FFbH-R, the pain scale SES and a numeric rating scale. RESULTS: In both groups there was a significant functional improvement as measured with the Oswestry Score and the FFbH-R. The interventional group showed better values at the end of the treatment. Pain as well could be reduced significantly by the treatment, but no differences were noted between the two groups. CONCLUSION: Outpatient rehabilitation improved functional capacity and pain in both groups. Advantages could be seen in the interventional group concerning functional status. The specific stabilizing exercise approach appears to be effective in conservative treatment programs of low back pain and lumbar disk disease.

[Outcome of inpatient rehabilitation following total knee replacement using the HSS-Score]. / Ergebnisevaluation der stationären Rehabilitation nach Knieendoprothetik mit dem HSS-Score.

AIMS: The aim of the study was to evaluate the outcome of inpatient rehabilitation following total knee arthroplasty using the HSS score (Hospital for Special Surgery). Factors influencing the result were analysed. METHOD: 182 patients admitted to a rehabilitation unit after total knee replacement were included. There were 146 female and 36 male patients, with mean age of 72 (+/- 6.1) years (range; 49 to 84 years). RESULTS: At admission, the HSS score was 47.4 (+/- 10.6) and was significantly improved to 69.8 (+/- 8.8) at discharge. The percentage of patients with a poor result was markedly decreased from 86.8 % to 10.4 %. The outcome was independent of sex, age, concomitant diseases or postoperative weight bearing. 34 patients could not be discharged after 3 weeks as usually and stayed for another 8.3 (+/- 2.6) days. These patients had significantly lower scores at admission (41.9 +/- 11.2) than patients who stayed for three weeks (48.6+/- 10.1). At discharge, scores were comparable with 67.7 (+/- 9.4) and 70.2 (+/- 8.6), respectively. CONCLUSION: Inpatient rehabilitation following knee arthroplasty significantly improved the HSS score independent of sex, age, concomitant diseases and weight bearing.

[Inpatient rehabilitation of patients following total hip replacement--a study using the Harris hip score]. / Stationäre Rehabilitation nach Hüftendoprothetik - eine Verlaufsbeobachtung mit dem Harris-Hip-Score.

AIMS: The aim of the study was to evaluate the outcome of inpatient rehabilitation following total hip arthroplasty using the Harris hip score. Factors influencing the result were analysed. METHOD: 338 patients admitted to a rehabilitation unit after total hip replacement were included in a prospective study. There were 252 female and 86 male patients, with a mean age of 69 (+/- 9.7) years (range, 34 to 88 years). RESULTS: At admission the Harris hip score was 63.1 (+/- 10.4) and was improved by almost 25 % to 79.1 (+/- 7.1) at discharge. The percentage of patients with a poor score was decreased from 71.9 % to 8 % after rehabilitation. The result of rehabilitation was independent of sex, age, concomitant diagnoses or weight bearing. 61 patients could not be discharged after three weeks as usual and stayed for another 8.0 (+/- 4.5) days. At admission these patients had significantly lower scores (58.5 +/- 10.8) than the patients who stayed for three weeks (64.1 +/- 10.0). At discharge scores were comparable with 77.0 (+/- 7.2) and 79.6 (+/- 7.0), respectively. CONCLUSION: An inpatient rehabilitation after hip arthroplasty significantly improves the Harris hip score independent of sex, age, concomitant diseases and weight bearing.

[Comparison of Hannover Functional Ability Questionnaire (FFbH) and the SF-36 subscale "Physical Functioning"]. / Der Funktionsfragebogen Hannover (FFbH) und die Subskala "körperliche Funktionsfähigkeit" aus dem SF-36 im Vergleich.

Pretesting of a questionnaire for evaluating day-patient rehabilitation, which included comparison of the "Hannover Functional Ability Questionnaire" (FFbH) and the SF-36 subscale "physical functioning" (SF-36 PF), gave rise to more extensive validity testing of the two instruments. In the framework of an expanded pretest, a questionnaire including FFbH and SF-36 PF was sent out to 520 adult former patients who had undergone inpatient orthopaedic rehabilitation following total hip or knee replacement an average 16 months ago. Return rate was 76%. Checks on plausibility showed no complaints about the Hannover Functional Ability Questionnaire while, on the SF-36 subscale, it was found that 16 of 374 patients (4.3%) had confused positive and negative ratings. Moreover, problems were found concerning the wording of several items (understanding, multidimensionality). In contrast to the FFbH, the SF-36 subscale shows weaknesses in the formulation of its items and particularly its ratings.