Effects of Functional Electrical Stimulation Cycling Combined With Arm Cranking Exercise on Cardiorespiratory Fitness in People With Central Nervous System Disorders: A Systematic Review and Meta-analysis.

OBJECTIVE: To examine the evidence regarding the potential of hybrid functional electrical stimulation (FES) cycling for improving cardiorespiratory fitness for people with a mobility disability related to a central nervous system (CNS) disorder. DATA SOURCES: Nine electronic databases: MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo, SPORTDiscus, Pedro, Cochrane, and Scopus, were searched from inception until October 2022. STUDY SELECTION: Search terms included multiple sclerosis, spinal cord injury (SCI), stroke, Parkinson's disease, cerebral palsy, synonyms of FES cycling, arm crank ergometry (ACE) or hybrid exercise, and V̇o2. All experimental studies, including randomized controlled trials that included an outcome measure related to peak or sub-maximal V̇o2 were eligible. DATA EXTRACTION: From a total of 280 articles, 13 were studies included. The Downs and Black Checklist was used to assess study quality. Random effects (Hedges' g) meta-analyses were undertaken to determine whether there were differences in V̇o2peak during acute bouts of hybrid FES cycling vs other modes of exercise and changes resulting from longitudinal training. DATA SYNTHESIS: During acute bouts of exercise, hybrid FES cycling was moderately more effective than ACE (effect size [ES] of 0.59 (95% CI 0.15-1.02, P=.008) in increasing V̇o2peak from rest. There was a large effect on the increase of V̇o2peak from rest for hybrid FES cycling compared with FES cycling (ES of 2.36 [95% CI 0.83-3.40, P=.003]). Longitudinal training with hybrid FES cycling showed a significant improvement in V̇o2peak from pre to post intervention with a large, pooled ES of 0.83 (95% CI 0.24-1.41, P=.006). CONCLUSIONS: Hybrid FES cycling produced higher V̇o2peak compared with ACE or FES cycling during acute bouts of exercise. Hybrid FES cycling can improve cardiorespiratory fitness in people with SCI. Additionally, there is emerging evidence that hybrid FES cycling might increase aerobic fitness in people with mobility disability related to CNS disorders.

Pilot Study of Enhancing Cardiorespiratory Exercise Response in People With Advanced Multiple Sclerosis With Hybrid Functional Electrical Stimulation.

OBJECTIVE: To investigate through a pilot study the acute cardiorespiratory responses during functional electrical stimulation (FES) cycling, arm crank ergometry (ACE), and a combination of ACE and FES cycling (hybrid FES cycling) in people with advanced multiple sclerosis (MS) to provide preliminary guidance for effective aerobic exercise prescription. DESIGN: Acute repeated measures. SETTING: Laboratory setting. PARTICIPANTS: Inclusion criteria was a diagnosis of MS, with Expanded Disability Status Scale (EDSS) 6.0-8.5. Included were 9 participants (N=9; 7 female, age 54.7±8.8y, EDSS 7.2±0.7). INTERVENTIONS: Participants were assessed on 3 different exercise modalities (FES cycling, ACE, hybrid FES cycling) at 40%, 60%, 80%, and 100% of mode-specific peak workload. MAIN OUTCOME MEASURES: Oxygen consumption and heart rate were measured at each workload. RESULTS: Hybrid FES cycling evoked a significantly higher oxygen consumption relative to body weight (V̇o2relative) (mL/kg/min) and heart rate (beats per minute [BPM]) at most workloads compared with ACE or FES cycling. At the 100% workload, heart rate for hybrid FES cycling was 125 BPM (range, 113-148 BPM) and was significantly higher than ACE at 99 BPM (range, 95-119 BPM) (P=.008) and FES cycling at 94 BPM (range, 79-100 BPM) (P=.008). Similarly, at the 100% workload, V̇o2relative for hybrid FES cycling was 11.8 mL/kg/min (range, 7.6-17.6 mL/kg/min) and was significantly higher than ACE at 8.9 mL/kg/min (range, 5.3-12.5 mL/kg/min) (P=.012) and FES cycling at 6.8 mL/kg/min (range, 4.1-9.2 mL/kg/min) (P=.012). CONCLUSIONS: This pilot study showed that hybrid FES cycling can elicit a greater cardiorespiratory response than ACE or FES cycling in people with advanced MS. Thus, hybrid FES cycling might provide a potent enough stimulus to induce clinically relevant changes in cardiorespiratory fitness. Training studies are warranted to document the magnitude and sustainability of aerobic capacity adaptations to hybrid FES cycling and associated health outcomes in advanced MS.

Self-perception and attitude toward physical activity in overweight/obese adolescents: the "martial fitness" study.

This randomized, placebo-exercise controlled trial found that 6-months of Kung Fu training improved enjoyment of physical activity more than the placebo-exercise intervention, while both groups improved perceptions of behavioral conduct and changed strategies for physical activity. Importantly, family support for physical activity declined in subjects who had more visits to health care professionals, which is worrisome, as this represents another risk factor for sedentary behavior in this vulnerable cohort that must be overcome for successful, sustained behavioral change. Programs supporting positive attitudes of both adolescents and their families toward physical activity will be necessary to optimize exercise adoption and adherence as a means to combat the obesity epidemic in childhood and adolescence.

Effects of martial arts on health status: a systematic review.

OBJECTIVE: To systematically summarize the evidence for the effects of martial arts on health and fitness, to show the strengths of different types of martial arts, and to get a more complete picture of the impacts of martial arts on health, and also to provide a basis for future research on martial arts as an exercise prescription in exercise therapy. METHOD: We searched for "martial arts""health" and "random" in eight databases (n= 5432). Randomized controlled trials and controlled clinical trials on the health effects of martial arts were included in the study. RESULTS: The final analysis included 28 papers (one general martial arts, one kung fu, sixteen tai chi, six judo, three karate, and one taekwondo). Among the disciplines of martial arts, tai chi was the most well-studied, followed by judo, karate, and taekwondo. Research topics varied widely, and included health, injuries, competition, morals and psychology, and herbal medicine. Most found positive effects on health. Tai chi is no-contact, low-impact, soft body and mindfulness exercise, which has been widely adopted by elderly people and proven to be a beneficial health promotion exercise. Research on judo, karate, and taekwondo mainly focused on improvements to athletes' competitive abilities, rather than on health effects. We did not find any published randomized controlled trials or controlled clinical trials on aikido, kendo, sumo, kyudo, qi gong, or other disciplines. DISCUSSION AND CONCLUSION: Since martial arts are widely practiced, their effects on physiology, morphology, immunology, and neurology should be further studied in order to help people to select the best discipline or style to accomplish their purposes. This necessitates categorizing and classifying the disciplines and styles according to their effects on different body systems and levels of contact, as well as standardizing evaluation criteria for martial arts. Martial arts as an exercise prescription can then move from an experience-based to an evidence-based treatment.

A randomized controlled trial of Kung Fu training for metabolic health in overweight/obese adolescents: the "martial fitness" study.

Twenty overweight/obese adolescents underwent six months of Kung Fu or placebo (Tai Chi) training, 3x.wk(-1). Outcomes included fasting insulin and insulin resistance, lipids, glucose and HbA(1c), and C-reactive protein (CRP). CRP decreased significantly (p = 0.03) in both groups over time at six months. Although insulin sensitivity did not change, HbA(1c) tended to decrease over time (p = 0.09), again with no group difference (p = 0.60). Reduced CRP was related to increased upper body strength (p = 0.01). Increased lean body mass was related to reductions in HbA(1c), insulin resistance, triglycerides, and total cholesterol. Improvements in lean body mass appear to have a potential role in favorable metabolic outcomes, independent of changes in fat mass. Further research in this area is warranted before definite conclusions can be drawn about the efficacy of martial arts training for metabolic outcomes in this cohort.

Health benefits of Kung Fu: a systematic review.

The Chinese martial arts (Kung Fu) have existed for centuries and are generally accepted as being beneficial for health without much empirical data. The aim of this systematic review was to assess the health effects of "hard" Kung Fu styles by performing electronic and manual searches of the literature. The aspects of health and the Kung Fu style examined varied between most studies; in some cases, the martial art group consisted of practitioners of other martial art styles also. Of 2103 references identified, only nine papers were eligible and reviewed. All were observational studies, observing a range of health aspects possibly related to Kung Fu training or performance. Our findings suggest that there is no evidence that Kung Fu practice is associated with the prevention or treatment of any health condition. However, as a moderate- to high-intensity form of aerobic exercise, it may confer benefits similar to those attributed to other aerobic training modalities. However, this hypothesis remains to be tested in clinical trials. Physiological benefits (e.g., aerobic capacity and bone density) may be associated with long-term Kung Fu practice. Future research in this area should adopt experimental designs, clearly identifying eligibility criteria, testing and training protocols, and include health-related outcomes and documentation of adverse events, to advance knowledge in this field.

Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised double-blind sham-exercise-controlled trial.

BACKGROUND: a large proportion of adults with type 2 diabetes remain sedentary despite evidence of benefits from exercise for type 2 diabetes. Simplified Yang Tai Chi has been shown in one study to have no effect on insulin sensitivity in older adults. However, a modified Tai Chi form, Tai Chi for Diabetes (TCD) has recently been composed, claiming to improve diabetes control. METHODS: subjects were randomised to Tai Chi or sham exercise, twice a week for 16 weeks. Primary outcomes were insulin resistance 72 h post-exercise (HOMA2-IR), and long-term glucose control (HbA(1c)). RESULTS: thirty-eight subjects (65 +/- 7.8 years, 79% women) were enrolled. Baseline BMI was 32.2 +/- 6.3 kg/m(2), 84% had osteoarthritis, 76% hypertension, and 34% cardiac disease. There was one dropout, no adverse events, and median compliance was 100 (0-100)%. There were no effects of time or group assignment on insulin resistance or HbA(1c) ( -0.07 +/- 0.4% Tai Chi versus 0.12 +/- 0.3% Sham; P = 0.13) at 16 weeks. Improvement in HbA(1c) was related to decreased body fat (r = 0.484, P = 0.004) and improvement in insulin resistance was related to decreased body fat (r = 0.37, P = 0.03) and central adiposity (r = 0.38, P = 0.02), as well as increased fat-free mass (r = -0.46, P = 0.005). CONCLUSIONS: TCD did not improve glucose homeostasis or insulin sensitivity measured 72 h after the last bout of exercise. More intense forms of Tai Chi may be required to produce the body composition changes associated with metabolic benefits in type 2 diabetes.

Health benefits of Tai Chi for older patients with type 2 diabetes: the "Move It For Diabetes study"--a randomized controlled trial.

Older adults with type 2 diabetes have mobility impairment and reduced fitness. This study aimed to test the efficacy of the "Tai Chi for Diabetes" form, developed to address health-related problems in diabetes, including mobility and physical function. Thirty-eight older adults with stable type 2 diabetes were randomized to Tai Chi or sham exercise, twice a week for 16 weeks. Outcomes included gait, balance, musculoskeletal and cardiovascular fitness, self-reported activity and quality of life. Static and dynamic balance index (-5.8 +/- 14.2; p = 0.03) and maximal gait speed (6.2 +/- 11.6%; p = 0.005) improved over time, with no significant group effects. There were no changes in other measures. Non-specific effects of exercise testing and/or study participation such as outcome expectation, socialization, the Hawthorne effect, or unmeasured changes in health status or compliance with medical treatment may underlie the modest improvements in gait and balance observed in this sham-exercise-controlled trial. This Tai Chi form, although developed specifically for diabetes, may not have been of sufficient intensity, frequency, or duration to effect positive changes in many aspects of physiology or health status relevant to older people with diabetes.

Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial.

CONTEXT: Respiratory tract infections are prevalent in elderly individuals, resulting in increased morbidity, mortality, and use of health care services. Vitamin E supplementation has been shown to improve immune response in elderly persons. However, the clinical importance of these findings has not been determined. OBJECTIVE: To determine the effect of 1 year of vitamin E supplementation on respiratory tract infections in elderly nursing home residents. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial was conducted from April 1998 to August 2001 at 33 long-term care facilities in the Boston, Mass, area. A total of 617 persons aged at least 65 years and who met the study's eligibility criteria were enrolled; 451 (73%) completed the study. INTERVENTION: Vitamin E (200 IU) or placebo capsule administered daily; all participants received a capsule containing half the recommended daily allowance of essential vitamins and minerals. MAIN OUTCOME MEASURES: Incidence of respiratory tract infections, number of persons and number of days with respiratory tract infections (upper and lower), and number of new antibiotic prescriptions for respiratory tract infections among all participants randomized and those who completed the study. RESULTS: Vitamin E had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, fewer participants receiving vitamin E acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.00; P =.048 for all participants; and 65% vs 74%; RR, 0.88; 95% CI, 0.75-0.99; P =.04 for completing participants), or upper respiratory tract infections (44% vs 52%; RR, 0.84; 95% CI, 0.69-1.00; P =.05 for all participants; and 50% vs 62%; RR, 0.81; 95% CI, 0.66-0.96; P =.01 for completing participants). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83; 95% CI, 0.68-1.01; P =.06 for all participants; and 0.66 vs 0.83 per person-year; RR, 0.80; 95% CI, 0.64-0.98; P =.04 for completing participants) and fewer participants in the vitamin E group acquired 1 or more colds (40% vs 48%; RR, 0.83; 95% CI, 0.67-1.00; P =.05 for all participants; and 46% vs 57%; RR, 0.80; 95% CI, 0.64-0.96; P =.02 for completing participants). Vitamin E had no significant effect on antibiotic use. CONCLUSIONS: Supplementation with 200 IU per day of vitamin E did not have a statistically significant effect on lower respiratory tract infections in elderly nursing home residents. However, we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold, that merits further investigation.

Guidelines for the treatment of postmenopausal osteoporosis for general practitioners.

BACKGROUND: Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis. OBJECTIVE: This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.