In vivo assessment of the passive stretching response of the bicompartmental human semitendinosus muscle using shear-wave elastography.

The semitendinosus muscle contains distinct proximal and distal compartments arranged anatomically in series but separated by a tendinous inscription, with each compartment innervated by separate nerve branches. Although extensively investigated in other mammals, compartment-specific mechanical properties within the human semitendinosus have scarcely been assessed in vivo. Experimental data obtained during muscle-tendon unit stretching (e.g., slack angle) can also be used to validate and/or improve musculoskeletal model estimates of semitendinosus muscle force. The purpose of this study was to investigate the passive stretching response of proximal and distal human semitendinosus compartments to distal (knee) joint extension. Using two-dimensional shear-wave elastography, we bilaterally obtained shear moduli of both semitendinosus compartments from 14 prone-positioned individuals at 10 knee flexion angles [from 90° to 0° (full extension) at 10° intervals]. Passive muscle mechanical characteristics (slack angle, slack shear modulus, and the slope of the increase in shear modulus) were determined for each semitendinosus compartment by fitting a piecewise exponential model to the shear modulus-joint angle data. We found no differences between compartments or legs for slack angle, slack shear modulus, or the slope of the increase in shear modulus. We also found that the experimentally determined slack angle occurred at ∼15°-80° higher knee flexion angles compared with estimates from two commonly used musculoskeletal models, depending on participant and model used. Overall, these findings demonstrate that passive shear modulus-joint angle curves do not differ between proximal and distal human semitendinosus compartments and provide experimental data to improve semitendinosus force estimates derived from musculoskeletal models.NEW & NOTEWORTHY We conducted an elastography-based investigation of the passive stretching response of the proximal and distal compartments of the human semitendinosus muscle and found no difference in shear modulus-joint angle curves between compartments. We also found that common musculoskeletal models tend to misestimate semitendinosus slack angle, most likely due to typical model assumptions. These results provide an important step toward a better understanding of semitendinosus passive muscle mechanics and improving computational estimates of muscle force.

The Effect of Static and Dynamic Stretching during Warm-Up on Running Economy and Perception of Effort in Recreational Endurance Runners.

This randomized crossover counterbalanced study investigated, in recreational runners, the acute effects of pre-exercise stretching on physiological and metabolic responses, endurance performance, and perception of effort. Eight male endurance runners (age 36 ± 11 years) performed three running-until-exhaustion tests, preceded by three warm-ups, including the following different stretching protocols: static (SS), dynamic (DS), and no-stretching (NS). During the SS and DS sessions, the warm-up consisted of 10 min of running plus 5 min of SS or DS, respectively, while during the NS session, the warm-up consisted of 15 min of running. Physiological and metabolic responses, and endurance running performance parameters, were evaluated. The perception of effort was derived from the rating of perceived exertion (RPE). Running economy significantly improved after SS (p < 0.05) and DS (p < 0.01), and RPE values were significantly lower in SS (p < 0.05) and DS (p < 0.01), compared to NS. No differences in physiological and metabolic responses among the sessions were found. This study showed that including SS and DS within the warm-up ameliorated running economy and decreased the perception of effort during a running-until-exhaustion test, highlighting the benefits of stretching on endurance performance. These results should encourage recreational runners to insert stretching during warm-up, to optimize the running energy costs, reducing the perception of effort and making the training sessions more enjoyable.

Assessment of the Maximal Range of Motion from Initial Sensation of Stretching to the Limits of Tolerance.

The aim of this study was to determine whether the first sensation of stretching (ROMFSS) may predict the maximum range of motion (ROMMAX) in male (N = 37) and female (N = 32) volunteer subjects, and to assess the reliability of the ROM perceived by subjects in relation to a pre-determined ROM (ROM50%). Subjects attempted three experimental sessions with 48 hours between sessions 1 and 2 and 28 days between sessions 1 and 3. Within each session, five trials were performed with isokinetic equipment to assess posterior thigh muscle flexibility. The results revealed a strong and significant correlation between ROMMAX and ROMFSS for both sexes, females (r = 0.96, p < 0.001, R2 = 0.92) and males (r = 0.91, p < 0.001; R2 = 0.82). The accuracy of the model verified by the standard error of estimate (SEE) was high in the equations proposed for both female (SEE = 4.53%) and male (SEE = 5.45%). Our results revealed that ROMFSS may predict the ROMMAX for both male and female subjects. The ROMFSS may contribute to the development of evaluation methods that do not subject the individuals to conditions that may include unnecessary risk of injury and is well suited to monitor the training process of stretching exercises with submaximal loads.

Associations of Exercise Types with All-Cause Mortality among U.S. Adults.

PURPOSE: Exercising benefits physical and mental health as well as longevity. However, the extent to which different types of exercise are differentially associated with the risk of mortality is less clear. This study examined whether 15 different types of exercise were uniquely associated with all-cause mortality in a nationally representative sample of noninstitutionalized American adults between 18 and 84 yr old. METHODS: A total of 26,727 American adults in the National Health Interview Survey who reported their exercise type(s) in 1998 were prospectively followed for all-cause mortality through the end of 2015. We applied a series of discrete time logistic models to estimate odds ratios (OR) and 95% confidence intervals (CI) for all-cause mortality. RESULTS: During 17 yr of follow-up, 4955 deaths occurred. After adjusting for total volume of other exercises and confounders (demographic factors, socioeconomic status, and health behaviors and status), walking, aerobics, stretching, weight lifting, and stair climbing were related to lower risks of mortality (OR ranged from 0.78 to 0.93). When adjusting for engagement in all exercise types and confounders, stretching (OR = 0.90, 95% CI = 0.83-0.97) and playing volleyball (OR = 0.53, 95% CI = 0.31-0.93) were uniquely associated with lower risks of mortality. CONCLUSION: These findings suggest that some types of exercise have unique benefits for longevity, but most are indistinguishable in relation to longevity. Future studies should further investigate the unique contribution of specific exercises and the joint contribution of multiple exercises and how to promote greater exercise participation.

Bend Don't Break: Stretching Improves Scores on a Battery of Fall Assessment Tools in Older Adults.

CONTEXT: Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk. OBJECTIVE: This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults. PARTICIPANTS: Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions. RESULTS: The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = -5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = -.308, P = .03). CONCLUSION: Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults.

Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE).

OBJECTIVE: To evaluate the cost-effectiveness of deep tissue massage ('massage'), strengthening and stretching exercises ('exercises') or a combination of both ('combined therapy') in comparison with advice to stay active ('advice') for subacute and persistent neck pain, from a societal perspective. METHODS: We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of 619 participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years (QALYs) in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated. RESULTS: In the cost-consequence analysis, in comparison with advice, exercises resulted in higher QALY gains, and massage and the combined therapy were more costly and less beneficial. Exercises may be a cost-effective treatment compared with advice to stay active if society is willing to pay 17 640 EUR per QALY. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.88, exercises: 0.89, combined therapy: 0.88 and, advice: 0.88. CONCLUSIONS: Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 640 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. While exercise appeared to have the best cost/benefit profile, even this treatment had only a modest benefit and treatment innovation is needed. Advice to stay active remains as a good therapeutic alternative from an economical perspective.

Body Temperature and Energy Expenditure During and After Yoga Breathing Practices Traditionally Described as Cooling.

BACKGROUND In traditional yoga texts, sheetali and sitkari pranayamas are described as cooling. The present study was aimed at recording the surface body temperature, oxygen consumed, and carbon dioxide eliminated before, during, and after performance of sheetali and sitkari pranayamas. MATERIAL AND METHODS Seventeen healthy male volunteers with ages between 19 to 25 years (average age 20.7±1.8 years) were assessed in 4 sessions, viz. sheetali pranayama, sitkari pranayama, breath awareness and quiet lying, on 4 separate days, in random sequence. The axillary surface body temperature (TRUSCOPE II, Schiller, China) and metabolic variables (Quark CPET, COSMED, Italy) were recorded in 3 periods: before (5 minutes), during (18 minutes), and after (5 minutes), in each of the 4 sessions. The heat index was calculated in the before and after periods, based on recordings of ambient temperature and humidity. Data were analyzed using SPSS (Version 24.0). RESULTS Body temperature increased significantly during sheetali and sitkari (p<0.05, p<0.01; respectively) while it decreased after breath awareness and quiet lying down (p<0.01, p<0.001; respectively) when compared with respective post-exercise states. Oxygen consumption increased by 9.0% during sheetali (p<0.05) and by 7.6% during sitkari (p<0.01) while it decreased significantly during (p<0.05) and after (p<0.01) quiet lying down compared to respective pre-exercise states. CONCLUSIONS The results do not support the description of these yoga breathing practices as cooling. These yoga breathing practices may be used to induce a mild hypermetabolic state.

Effectiveness of stretching and bracing for the treatment of osteoarthritis-associated joint contractures prior to joint replacement: a systematic review protocol.

INTRODUCTION: Many patients with osteoarthritis (OA) develop restrictions in passive range of motion (ROM) of their affected joints (called contractures), leading to increased pain and reduced function. Effective treatment to reverse OA-associated contractures is lacking. Our aim is to evaluate the effectiveness of stretching and bracing on native (non-operated) joint contractures in people with radiographically diagnosed OA. METHODS AND ANALYSIS: We will search the following databases without time restriction: Cochrane Library (CENTRAL, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database), MEDLINE, Embase, CINAHL, SCI-EXPANDED (ISI Web of Knowledge) and PEDro. Other sources will include WHO International Clinical Trials Registry Platform, reference lists of included studies, relevant systematic reviews and textbooks. We will include randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies, cohort studies and case-control studies that include participants ≥18 years of age with radiographic evidence of OA. Participants with inflammatory arthropathies or those that have undergone joint arthroplasty will be excluded. Interventions will include therapist-administered or patient-administered stretching, use of an orthosis (static or dynamic), use of serial casting and/or adjunctive modalities. Outcomes will include joint ROM (active and passive), pain (rest and/or activity related), stiffness, activity limitations, participation restrictions, quality of life and adverse events. Studies will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study inclusion, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed using appropriate tools for each study design. Data synthesis will be performed using Cochrane Review Manager software. If sufficient data are available, meta-analysis will be conducted. We will summarise the quality of evidence using Grading of Recommendations Assessment, and the effect size of interventions for RCT and non-RCT studies. ETHICS AND DISSEMINATION: Ethics approval not required because individual patient data are not included. Findings will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019127244.

Designing and psychometric evaluation of Stretching Exercise Influencing Scale (SEIS).

OBJECTIVE: The lack of reliable and valid tools for assessing the factors that influence stretching exercises (SEs) among Iranian office employees is obvious. This study aimed to design and evaluate psychometric properties of this instrument. DESIGN: Cross-sectional study of psychometric properties. SETTING: Data were gathered from May to September 2017. PARTICIPANTS: Participants were 420 office employees who were working in 10 health centres affiliated to the Shahid Beheshti University of Medical Sciences in Tehran, Iran. PRIMARY OUTCOME MEASURES: The instrument was designed on the basis of the constructs of the health promotion model (HPM) and extant literature. Exploratory factor analysis (EFA), Cronbach's α and intraclass correlation coefficient (ICC) were employed to check the scale's psychometric properties. RESULTS: In total, 420 questionnaires were completed. The mean age of the office employees was 37.1±8.03 years. Among the 86 items, 77 items had significant item-to-total correlations (p<0.05). The results showed good internal consistency and reliability for the whole questionnaire and each domain. EFA results confirmed 53.32% of the total variance of the items yielded in 11 subscales. The ICC was acceptable (0.78, 95% CI 0.70 to 0.88). CONCLUSIONS: The Stretching Exercise Influencing Scale (SEIS) can be a reliable and valid instrument for measuring the factors that influence SEs among office employees. TRIAL REGISTRATION: IRCT20160824295512N1.

Weekly assessment of number of yoga classes and amount of yoga home practice: Agreement with daily diaries.

OBJECTIVE: To evaluate a weekly yoga practice assessment instrument designed to assess number of classes attended in the previous week, number of times engaged in formal home yoga practice, total number of minutes engaged in formal home yoga practice in the past week, and number of times engaged in informal home yoga practice. "Informal" practice was defined as "in the middle of other activities, you spent a few moments engaged in asanas/postures, focus on breath, body awareness, or very brief meditation, for less than 5 min at a time." We assessed agreement between this weekly assessment and a daily home practice log. DESIGN AND SETTING: Seventy-two community yoga practitioners completed online daily yoga logs for 28 days as well as the weekly yoga practice assessment four times over the 28 day period. RESULTS: We examined agreement between the two methods on the four indices of amount of weekly yoga practice. We found acceptable agreement between the two methods for number of classes, number of times engaged in formal home practice, and total number of minutes engaged in formal home practice. Agreement was lower for number of times engaged in informal practice. CONCLUSIONS: These data provide support for use of a weekly yoga practice assessment to assess number of classes attended and amount of formal but not informal home practice.

Avaliação da flexibilidade de crianças com paralisia cerebral espástica após intervenção fisioterapêutica / Assessment of the flexibility of children with spastic cerebral palsy after physiotherapeutic intervention

Introdução: A fisioterapia favorece a flexibilidade e diminue a espasticidade de crianças com paralisia cerebral (PC). Objetivos: avaliar os benefícios da fisioterapia convencional para a flexibilidade a curto e longo prazo de crianças com PC espástica. Métodos: participaram seis pacientes com PC espástica, idade de seis a 14 anos, ambos os gêneros. Foram realizadas 16 sessões de fisioterapia convencional com alongamentos passivos. Para avaliação da flexibilidade, aplicou-se o Teste de Sentar e Alcançar utilizando o Banco de Wells antes e após cada sessão. Para a análise estatística foi utilizado o Software Sigma-Stat® versão 3.5 com significância estatística (p<0,05). Resultados: houve aumento significativo da flexibilidade da cadeia muscular posterior comparando pré e pós individualmente (p<0,05) e da média pré e pós sessões (p<0,0001). Conclusão: fisioterapia convencial por meio de exercícios de alongamentos passivos melhora a flexibilidade da cadeia muscular posterior de crianças com PC espástica a curto ou a longo prazo.

Introduction: Physiotherapy favors flexibility and reduce the spasticity of children with spastic cerebral palsy. Objectives: To evaluate the benefits of conventional physiotherapy to improve the flexibility of the posterior muscle chain in the short and long term of children with spastic cerebral palsy. Methods: participated six patients with a diagnosis of Cerebral Palsy, age of six to 14 years, both genders. There were 16 sessions of conventional physiotherapy with passive stretching. For the assessment of flexibility, the sit and reach test was applied using the Wells's box before and after each session. For statistical analysis, Sigma-Stat® Software version 3.5 was used with statistical significance (p <0.05). Results: There was a significant increase in the flexibility of the posterior muscular chain of the children when comparing pre and post individually (p <0.05) and the mean before and after the sessions (P <0.0001). Conclusion: Conventional physiotherapy through passive stretching exercises improves the flexibility of the posterior muscular chain of children with spastic Cerebral Palsy in the short or long term.

Delivering occupational therapy hand assessment and treatment sessions via telehealth.

Introduction Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction. Methods Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%. Results Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high. Discussion Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.

Reliability of Sonographic Assessment of Biceps Femoris Distal Tendon Strain during Passive Stretching.

The purpose of this study was to determine the intra-rater, inter-examiner and inter-observer reliability of biceps femoris long head (BFlh) tendon strain using ultrasound imaging. Nineteen patients (age: 20.4 ± 0.35 y) were tested twice with a 1-wk interval. Each session included passive stretching from three different hip positions. Tests were performed independently by two examiners while BFlh tendon displacement (mm) and strain (%) were manually extracted from ultrasound video footages by two observers. Intra-rater comparisons revealed an intra-class correlation coefficient (ICC2,1) range of 0.87 to 0.98 and a variability less than 4.74%. Inter-examiner comparisons revealed an ICC2,1 range of 0.83 to 0.99 and less than 4.69% variability. Inter-observer ICCs ranged from 0.93 to 0.97 with variability less than 4.89%. Using a well-defined scanning protocol, two experienced examiners attained high levels of intra-rater agreement, with similarly excellent results for inter-rater and inter-observer reliability for BFlh tendon displacement and strain.

Hand exercises for patients with rheumatoid arthritis: an extended follow-up of the SARAH randomised controlled trial.

OBJECTIVES: The Stretching And strengthening for Rheumatoid Arthritis of the Hand (SARAH) randomised controlled trial evaluated the effectiveness of a hand exercise programme and demonstrated it was clinically effective and cost-effective at 12 months. The aim of this extended follow-up was to evaluate the effects of the SARAH programme beyond 12 months. METHODS: Using postal questionnaires, we collected the Michigan Hand Questionnaire hand function (primary outcome), activities of daily living and work subscales, pain troublesomeness, self-efficacy and health-related quality of life. All participants were asked how often they performed hand exercises for their rheumatoid arthritis. Mean difference in hand function scores were analysed by a linear model, adjusted for baseline score. RESULTS: Two-thirds (n=328/490, 67%) of the original cohort provided data for the extended follow-up. The mean follow-up time was 26 months (range 19-40 months).There was no difference in change in hand function scores between the two groups at extended follow-up (mean difference (95% CI) 1.52 (-1.71 to 4.76)). However, exercise group participants were still significantly improved compared with baseline (p=0.0014) unlike the best practice usual care group (p=0.1122). Self-reported performance of hand exercises had reduced substantially. CONCLUSIONS: Participants undertaking the SARAH exercise programme had improved hand function compared with baseline >2 years after randomisation. This was not the case for the control group. However, scores were no longer statistically different between the groups indicating the effect of the programme had diminished over time. This reduction in hand function compared with earlier follow-up points coincided with a reduction in self-reported performance of hand exercises. Further intervention to promote long-term adherence may be warranted. TRIAL REGISTRATION NUMBER: ISRCTN89936343; Results.

Pre- and Post-Activity Stretching Practices of Collegiate Athletic Trainers in the United States.

Popp, JK, Bellar, DM, Hoover, DL, Craig, BW, Leitzelar, BN, Wanless, EA, and Judge, LW. Pre- and post-activity stretching practices of collegiate athletic trainers in the United States. J Strength Cond Res 31(9): 2347-2354, 2017-The aim of the study was to investigate the knowledge and practices of collegiate-certified athletic trainers (ATs) in the United States. Participants (n = 521) were provided an overview of the study and a hyperlink to a web-based survey. The "pre- and post-activity practices in athletic training questionnaire" consisted of demographic items and elements to measure knowledge and practices related to pre- and post-activity stretching routines. In previous studies, the survey demonstrated construct validity, α = 0.722. Pearson chi-square test was used to evaluate goodness of fit, and kappa was calculated to measure agreement between items. Only 32.2% of ATs recommended dynamic stretching (DS) to be performed pre-activity, whereas a larger percentage (42.2%) recommended a combination of static stretching (SS) and DS. Athletic trainers reported that only 28.0% of athletes are performing DS before activity. Conversely, 60.6% of collegiate ATs recommended SS postexercise, and 61.0% of athletes agree and perform after workout SS (κ = 0.761, p < 0.001). Collegiate ATs seem to underuse the current research evidence, which indicates that DS is more beneficial than SS when used pre-activity, and ATs continue to regularly incorporate SS in their pre-activity routines. However, there is evidence that collegiate ATs in the United States emphasize SS postactivity in a manner consistent with current research.

The cost-effectiveness of TheraBite® as treatment for acute myogenic temporomandibular disorder.

OBJECTIVE: Temporomandibular disorder (TMD) is a very common and costly pain problem concerning the temporomandibular joint. A previous study has shown that for the treatment of acute myogenic TMD, TheraBite® (TB) offers a faster and greater effect than usual care consisting of physical therapy (PT). This study estimates the cost-effectiveness of TB compared to PT. METHODS: Differences in costs and quality-adjusted life-years (QALYs) between TB and PT are analyzed using a decision model. RESULTS: The point estimate for the incremental cost-effectiveness ratio is -28,068 EUR (-30,191 USD) per QALY (dominant) for TB versus PT. At the willingness-to-pay ratio of 20,000 EUR (21,513 USD) per QALY, TB has a 97% probability of being cost-effective compared to PT. CONCLUSION: TB is expected to be cost-effective compared to PT for the treatment of acute myogenic TMD, offering faster recovery of quality of life for patients, at a lower cost to society.

Long Term Home-Based Exercise is Effective to Reduce Blood Pressure in Low Income Brazilian Hypertensive Patients: A Controlled Trial.

INTRODUCTION: Home-based exercise programs may increase adherence to physical activity among groups with poor access to exercise facilities. However, their effectiveness to lower blood pressure of hypertensive patients remains undefined. AIMS: This controlled clinical trial investigated the influence of a home-based exercise program upon blood pressure, blood metabolic profile, and physical fitness in a Brazilian cohort of low income patients diagnosed with hypertension. METHODS: Twenty-nine patients (22 women, age: 53 ± 11 years) underwent 16 months of home-based exercise, including 30 min of moderate intensity walking and stretching exercises. Fourteen patients (9 women, age: 48 ± 5 years) composed a non-exercise control group. Primary outcomes were assessed each two months. RESULTS: Body mass (3.6 ± 0.2 kg; P = 0.03) and sum of skinfolds (3.0 ± 1.2 cm; P = 0.04) increased in controls vs. baseline. Mean compliance to home-based exercise was 83 ± 7 %, which induced significant improvements from baseline vs. controls in body mass (-5.4 ± 2.0 kg; P = 0.04), body fat (-4.7 ± 0.3 %; P = 0.03), waist circumference (-6.1 ± 1.2 cm; P = 0.03), sum of skinfolds (-14.8 ± 3.7; P = 0.02); aerobic efficiency reflected by slopes of relationships between heart rate and workload (-0.05 ± 0.01; P = 0.05), trunk flexibility (7.8 ± 1.7 cm; P = 0.02), HDL (1.8 ± 0.9 mg/dL; P = 0.04), triglycerides (-12.3 ± 1.0 mg/dL; P = 0.03), and glucose (-6.9 ± 2.9 mg/dL; P = 0.05). Systolic and diastolic BP decreased until the sixth month of intervention vs. baseline and controls, remaining stable at lower levels thereafter (systolic blood pressure: -4.5 ± 0.3 mmHg; P = 0.03; diastolic blood pressure: -2.5 ± 0.6 mmHg; P = 0.05). CONCLUSIONS: Low income hypertensive patients complied with a long-term home-based exercise program, which was effective for improving their functional capacity, blood metabolic profile, and blood pressure.

Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality?

OBJECTIVE: To determine whether the behavioral participation in muscle-strengthening activity (MSA) or the strength outcome produces the largest reduction in all-cause mortality risk. PATIENTS AND METHODS: The 1999-2002 National Health and Nutritional Examination Survey was used, with follow-up of up to 12.6 years (mean, 9.9 years) (N=2773 adults aged ≥50 years). Participants were placed into 4 groups based on 2 dichotomously categorized variables: lower-extremity strength (LES) of the knee extensors (top quartile) and adherence to MSA guidelines (≥2 MSA sessions per week). Approximately 21% of the population died during follow-up. RESULTS: Compared with individuals not meeting MSA guidelines and not in top quartile for LES, the adjusted hazard ratios (HRs) and 95% CIs were as follows: (1) meets MSA guidelines but not in top quartile for LES (HR=0.96; 95% CI, 0.63-1.45; P=.84), (2) in top quartile for LES but does not meet MSA guidelines (HR=0.54; 95% CI, 0.42-0.71; P<.001), and (3) in top quartile for LES and meets MSA guidelines (HR=0.28; 95% CI, 0.12-0.66; P=.005). Further analyses revealed that individuals in the top quartile for LES who also met MSA and moderate to vigorous physical activity guidelines were at even further reduced risk for premature all-cause mortality (HR=0.23; 95% CI, 0.08-0.61; P=.005). CONCLUSION: These results demonstrate that muscle strength seems to be more important than the behavioral participation in MSA for reducing the risk of premature all-cause mortality.

If you've seen one construction worksite stretch and flex program you've seen one construction worksite stretch and flex program.

BACKGROUND: Work-related Musculoskeletal Disorders (WMSD) account for approximately one-third of all injuries in the U.S. construction industry. Many companies have implemented stretch and flex (s/f) programs to reduce WMSD despite a lack of evidence showing effectiveness. METHODS: We conducted a mixed-methods study to understand (a) why employers continue devoting resources to s/f programs; (b) how programs vary; and (c) any actual or perceived benefits. RESULTS: Nineteen safety and health professionals were interviewed and 133 more (13.3% response rate) completed an on-line survey. Fifty-six percent had implemented an s/f program with the primary goal of reducing WMSDs; though most did not review data to determine goal achievement. Program structure varied in terms of duration, frequency, and type of stretches. There was strong agreement about mandating attendance but not participation, due primarily to liability issues. Cost was a factor when deciding to implement a program but not for sustaining one. The majority had not implemented other ergonomic prevention activities, but many had started conducting daily safety huddles for task and safety planning. Those reporting a reduction in WMSDs agreed that it was not due to the s/f program alone and that other benefits included increased worker camaraderie, communication, and collaboration. CONCLUSION: Although there is little to no scientific evidence showing that they work as intended, construction companies continue to implement s/f programs with the goal of reducing WMSDs. Bringing work crews together for s/f activities has prompted employers to also begin conducting daily safety huddles. Although employers may not be able to link reduced WMDS to an s/f program, the ancillary benefits may warrant the time and resources. PRACTICAL APPLICATIONS: S/f programs should be only one component of a more comprehensive ergonomics prevention program. Conducting daily safety huddles at the same time also may enhance worker communication, camaraderie, collaboration and improve safety outcomes.

Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011.

INTRODUCTION: Exercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease. METHODS: We used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses. RESULTS: Tai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. Results from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered. CONCLUSION: Tai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation.