Development and pilot of equine facilitated physical therapy outcome measure tool for chronic low back pain patients.

Equine Facilitated Physical Therapy (EFPT) lacks consistent documentation due to being an unconventional physical therapy treatment to chronic low back pain patients (LBP) and lacking rehabilitation outcome measure tools for a stable (equestrian) environment. The objectives were to develop an online evaluation tool as well as to define inter- and intra-rater reliability to validate the outcome measurement tool "Evaluation of maintaining sitting position (on a horse) and walking (short distances)" designed for LBP patients in EFPT". A total of 48 movement related functions (n = 48), were derived from the International Classification of Functioning (ICF) and organized to an online evaluation tool. Depending on the state of validation two to six (2-6) raters scored randomized patient (n = 22) video material, recorded during a 12-week EFPT intervention, with the designed tool. Inter-rater agreement level between the experts reached good (α = 87) reliability for the scoring of the items and calculated per patient excellent (α = 100). Intra-rater reliability reached good (α = 87) and per patient good (α = 80) repeatability. For the healthy adults the reliability between raters reached acceptable (α = 72) levels and per rated excellent (α = 100). The developed assessment tool was found satisfactory to fulfil the requirement for the therapeutic practice. With the use of the tool physical therapist may detect postural changes for LBP patients as outcome report in EFPT. The tool may be used to identify treatment progress and to help design home exercises. The created tool will help to collect similar outcome measures from LBP patients in EFPT and to validate the treatment within industry.

Exercise-induced changes in pulmonary function of healthy, elite long-distance runners in cold air and pollen season exercise challenge tests.

Exercise-induced changes in postexercise pulmonary function have not been studied in healthy elite athletes in normal training conditions. Twelve healthy elite runners volunteered. They showed normal resting spirometry and bronchial responsiveness to histamine, and were non-atopic. They performed free running exercise challenge tests (ECT) at subzero temperature and immediately after highest birch pollen season. The mean maximal postexercise changes in FEV(1), PEF, FVC, and FEV(1)/FVC did not differ between the cold air and pollen season ECTs. Compared with pre-exercise values, FEV(1)increased significantly at 10 min (p = 0.028) and 20 min (p = 0.033) postexercise in the cold air ECT, as well as at 10 min (p = 0.024) and 20 min (p = 0.010) postexercise in the pollen season ECT. The mean (SEM) maximal postexercise change in FEV(1) was mostly small + 2.6 (0.6)% in the winter and + 2.7 (0.9)% in the pollen season. In contrast, significant decreases in PEF, compared with baseline, were found at 10 min (p = 0.071) and 20 min (p = 0.0029) postexercise in the cold air ECT, as well as at 10 min (p = 0.060) and 20 min (p = 0.010) postexercise in the pollen season ECT (p = 0.0076). The mean (SEM) maximal postexercise fall in PEF was 5.9 (1.0)% in the winter and 6.0 (1.8)% in the pollen season. Heavy exercise challenge tests in extreme conditions increased FEV(1) post-exercise, while PEF decreased as compared with pre-exercise values. Thus, even small postexercise falls in FEV(1) may be considered as deviate exercise responses in elite athletes.

Occurrence of exercise induced bronchospasm in elite runners: dependence on atopy and exposure to cold air and pollen.

OBJECTIVES: To study factors affecting the occurrence of exercise induced bronchospasm (EIB) in elite runners. METHODS: Fifty eight elite runners, 79% of them belonging to Finnish national teams, volunteered. The athletes answered a questionnaire on respiratory symptoms. Skin prick tests were used to investigate atopy, and spirometry to examine lung function at rest and after an exercise challenge test (ECT) at subzero temperature in the winter and after a similar ECT in the summer at the end of the birch pollen season. RESULTS: Definitive EIB (a post-exercise reduction of 10% or more in forced expiratory volume in one second (FEV1) was observed in five (9%) of the 58 runners. A subgroup consisting of 19 non-atopic symptom-free runners with no family history of asthma was used to establish a normal range for post-exercise reduction in FEV1. When this group's mean exercise induced change in FEV1 minus 2 SDs (a reduction of 6.5% or more in FEV1) was taken as the lower limit of the reference range, 15 (26%) of the runners had probable EIB in either the winter or the pollen season. The occurrence of probable EIB depended on atopy (odds ratio increased with number of positive skin prick test reactions, p < 0.05). Nine (22%) of the 41 runners, challenged in both the winter and the pollen season, had probable EIB only in the winter, and three (7%) had it only in the pollen season. Only one runner (2%) had EIB in both tests. CONCLUSIONS: Mild EIB is common in Finnish elite runners and is strongly associated with atopy. Seasonal variability affects the occurrence of EIB, and thus exercise testing should be performed in both cold winter air and the pollen season to detect EIB in elite runners.

Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors.

BACKGROUND: High prevalence of bronchial hyperresponsiveness and asthma has been found in cross-country skiers. There is limited evidence that asthma and bronchial responsiveness would be common also in athletes with summer events. OBJECTIVES: The objective of this study was to investigate occurrence of and risk factors for increased bronchial responsiveness and asthma in elite athletes with summer events and to compare their results with those of control subjects. METHODS: Forty-nine speed and power athletes (mean age 21.1 years, range 16 to 31), 71 long-distance runners (mean age 26.6 years, range 16 to 39), 42 swimmers (mean age 18.6 years, range 14 to 25), and 45 control subjects (mean age 26.7 years, range 21 to 37) were studied. The subjects answered questionnaires and were given a resting spirometric examination, a skin prick test, and a histamine challenge test. RESULTS: Current asthma (current asthmatic symptoms and increased bronchial responsiveness) was observed in 14% (22 of 162) of the athletes and in 2% (1 of 45) of the control subjects (p = 0.041). Total asthma (current asthmatic symptoms and increased bronchial responsiveness or physician-diagnosed asthma) occurred in 23% (37 of 162) of the athletes and in 4% (2 of 45) of the control subjects (p = 0.0048). Atopy according to skin prick test results was found in 48% (77 of 162) of the athletes and in 36% (16 of 45) of the control subjects (not significant). Clinical pollen allergy (positive skin test reaction to pollen and symptoms of rhinoconjunctivitis) was significantly (p = 0.037) more common in athletes than in control subjects. Atopic athletes showed significantly more often increased bronchial responsiveness, current asthma, and total asthma than nonatopic athletes (p = 0.011, p = 0.0049, and p < 0.0001, respectively), and the odds ratios of increased bronchial responsiveness and asthma increased with the number of positive skin test reactions. After adjustment for confounding factors, the odds ratio for the occurrence of current asthma was 5.49 (95% confidence interval 0.56 to 53.7) in speed and power athletes, 2.88 (0.30 to 27.7) in long-distance runners, and 10.8 (1.10 to 106.0) in swimmers compared with control subjects. The adjusted odds ratios for the occurrence of total asthma were 3.56 (0.62 to 20.5) in speed and power athletes, 6.01 (1.19 to 30.2) in long-distance runners, and 5.89 (1.00 to 34.5) in swimmers. CONCLUSIONS: Asthma is more common in highly trained athletes than in control subjects. Asthma is especially common in elite swimmers, but the risk of asthma is increased also in long-distance runners. Increased bronchial responsiveness and asthma are strongly associated with atopic disposition and its severity in elite athletes.