Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study.

INTRODUCTION: Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders. AIM: This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH. METHODS: Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up. RESULTS: A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP. CONCLUSION: The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.

The Validity and Reliability of Knee Proprioception Measurement Performed With Inclinometer in Different Positions.

CONTEXT: Proprioception is the basic element of the spontaneous control of movement, balance and joint stability. Therefore, it is necessary for the execution of walking and daily and sport activities. Loss of proprioception of the knee, which may cause a new injury, is important to evaluate the position sense of the joint during the rehabilitation period. However, the evaluation methods that are used are very expensive, complicated and non-portable, or the measuring method is difficult to implement. OBJECTIVE: We demonstrated the validity and reliability of knee proprioception measurements performed in the open kinetic chain position and closed kinetic chain position with a dual inclinometer. DESIGN: We assessed the validity and intra-tester reliability of a digital inclinometer for measuring the knee joint position sense in different positions. SETTING: Clinical laboratory. PARTICIPANTS: We enrolled 22 participants (age = 21.8 ± 0.95 years, height = 172 ± 9.1 cm, weight = 64.9 ± 14 kg) into the study. INTERVENTION: The same investigator used an inclinometer to take knee proprioception measurements in open and closed kinetic chain positions. MAIN OUTCOME MEASURES: The relative angular error was calculated by taking the arithmetic average of the difference between the target angle and reproduced angle and was the main outcome measure. RESULTS: We found that the dynamometer-inclinometer had a moderate ICC value (ICC = 0.594, SEM = 1.60, p = 0.005), whereas inclinometer t1 vs inclinometer t2 (ICC = 0.778, SEM = 0.62, p < 0.001) and closed kinetic chain position t1 and closed kinetic chain position t2 (ICC = 0.888, SEM = 0.63, p < 0.001) had high ICC values. CONCLUSION: Knee proprioception measurements performed with a dual inclinometer were reliable in the closed kinetic chain position in healthy, sedentary individuals and were valid and reliable in the open kinetic chain position.

Recovery levels after eccentric and concentric loading in maximal force.

[Purpose] The aim of this study was to compare the differences in recovery periods after maximal concentric and eccentric exercises. [Subjects and Methods] Twenty-two participants voluntarily participated and were divided into two groups: the athlete and sedentary groups. An incremental treadmill running test was performed until exhaustion. During the subsequent passive recovery session, heart rate and venous blood lactate level were determined every 3 minutes until the venous blood lactate level reached 2 mmol/l. The same test protocol was implemented 15 days later. [Results] Both groups showed significantly shorter running durations in concentric exercise, while significant differences were found between the athlete and sedentary groups in terms of venous blood lactate level responses. In addition, there were significant differences between the athlete and sedentary groups in terms of running duration and heart rate in concentric and eccentric exercises. [Conclusion] The present study revealed no difference between the athlete and sedentary groups in terms of recovery durations after eccentric and concentric loadings, although the athletes demonstrated faster recovery in terms of HR compared with the sedentary group. It was thought that concentric exercises cause greater physiological responses.

The Effect of Attention Focus Instructions on Strength and Balance in Subjects With Generalized Joint Hypermobility.

This study aims to examine the effects of different attention focuses on muscle strength and balance performance in individuals with Generalized Joint Hypermobility (GJH). This randomized crossover trial included 32 individuals with GJH whose Beighton score was greater than 5. Subjects performed each task under external attentional focus, internal attentional focus, and neutral attentional focus condition. Knee extensor muscle strength was measured using the Isokinetic Dynamometer. Postural stability was evaluated using the Biodex Balance System, while dynamic balance was assessed using the Y Balance Test. The main effects of attentional focus on the outcomes were analyzed using repeated measures ANOVA and post-hoc corrections with a 95% confidence interval. Subjects produced significantly higher quadriceps peak torque during external focus instruction and internal focus instruction compared to neutral condition (p = .006). Postural stability performance were found to be better during external attention focus compared to the internal focus of attention and the neutral group (p = .008). In addition, an increase in Y balance composite score was observed during external condition compared to internal condition and neutral condition (p < .001). Whether internal or external, the use of attentional focus may be beneficial for optimal force production during training in individuals with GJH. External attention focus enabled better postural stability and dynamic balance performances.

Comparison of posture and muscle stiffness between adolescent boys with haemophilia and age-matched healthy peers: An observational comparative study.

BACKGROUND: Haemophilic arthropathy is likely to influence posture and muscle stiffness in adolescent male haemophilia patients (HP). OBJECTIVE: This study aimed to investigate the possible change in upright standing posture and stiffness of the superficial postural muscles in HP. METHODS: Twenty-two HP aged between 12 and 19 years and twenty-two healthy peers were included in the study. The photogrammetry was used to assess the upright standing posture from sagittal and frontal planes. Also, stiffness of the superficial postural muscles was evaluated using the myotonometry. RESULTS: A significant difference was found in the craniovertebral, lumbar lordosis, knee flexion-valgus, and ankle plantar flexion angles between the groups (p< 0.05). Craniovertebral, knee flexion, and knee valgus angles were lower; whereas lumbar lordosis and ankle plantar flexion angles were higher in HP compared to the healthy peers. Stiffness of the rectus femoris muscle was lower in HP (p< 0.001). CONCLUSION: This study revealed that the ankle, knee, lumbar, and craniovertebral segments' posture angles were changed and the stiffness of the rectus femoris muscle decreased in HP. Postural alterations and reduced rectus femoris stiffness should be considered in management of the musculoskeletal complications of haemophilia.

A Novel Method to Measure Dual Task Capacity in Young Football Players: A Preliminary Study.

CONTEXT: When deciding to return to sport, literature usually uses evaluations based on physical abilities. But, current literature urges us to use more than physical performance evaluations. Classical dual-task testing methods do not simulate in-game loads and cannot sufficiently measure football players' dual-task capacity. OBJECTIVE: The purpose of our study was to create a dual-task test that would simulate football players' in- game situations and measure their capacity. DESIGN: Cross-sectional study. SETTING: Football Pitch. PARTICIPANTS: Twenty-two football players (aged 17.37±0.52 years) who played in a professional club (U19, elite league) were recruited for our study. INTERVENTIONS: Novel dual task test with questions containing scenarios from a football game to cognitively load players, while they are performing modified t-test. MAIN OUTCOME MEASURES: After the warm-up period, participants attended four tests in random order: juggling (foot) test, speed dribbling test, long passing test, and 'novel dual-task test'. RESULTS: There was no significant relationship between physical performance parameters and dual task parameters (all ps>0.05). There was a significant increase in the completion time of modified t-test when performed under dual task condition (Z=-7.568, p<0.001). The increase in completion time was found as 2.14±1.29 seconds. This duration difference was calculated as 22.79±14.58%, as dual task cost. CONCLUSIONS: Our test provides a new method to measure athletes' dual task capacity, which is not related to physical performance and cannot be measured with current tests. This test also showed players with lower dual task ability could not keep up their performance under dual task conditions, such as passing a ball to a team-mate when being pressed by an opponent. Players with good dual task ability could maintain 1 their performance (got affected only up to 10%); players with poor dual task ability could not maintain their performance and got affected by up to 50% (with a mean of 22.79%).

Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability.

BACKGROUND: Patients with Multiple Sclerosis (PwMS) often experience sensory, balance, and gait problems. Impairment in any sensation may increase imbalance and gait disorder in PwMS. This study aimed to (1) compare foot plantar sensations, knee position sense, balance, and gait in PwMS compared to Healthy Individuals (HI) and (2) examine the relationship between plantar sensations, knee position sense, balance, and gait in PwMS. METHODS: Thirty PwMS with mild disability and 10 HI participated in this study. Light touch threshold, two-point discrimination, vibration duration, and knee position sense were examined on the Dominant Side (DS) and Non-Dominant Side (NDS). Balance and spatio-temporal gait analysis were evaluated in all participants. RESULTS: PwMS had higher postural sway with eyes closed on the foam surface, longer swing phase of DS, longer single support phase of NDS, and shorter double support phase of DS compared to HI (p < 0.05). The results of regression analysis showed that the light touch thresholds of the 1st and 5th toes of the DS were associated with postural sway in different sensory conditions (p < 0.05). In contrast, the light touch thresholds of the 1st and 5th toes, two-point discrimination of the heel, vibration duration of the 1st metatarsal head and knee position sense of the NDS, and light touch threshold in the medial arch of both sides were associated with the gait parameters (p < 0.05). CONCLUSION: PwMS, even with mild disabilities needs neurorehabilitation to improve plantar sensation and knee position sense.

Does total knee arthroplasty affect pelvic movements? A prospective comparative study.

OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., "gait velocity," "cadence," and "stride length") were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery.

"Long-term callisthenic exercise-related changes in blood lipids, homocysteine, nitric oxide levels and body composition in middle-aged healthy sedentary women".

"Regular physical exercise plays an important role in reducing obesity, preventing hyperglycemia, lowering blood lipids and reducing systemic blood pressure. But the question about the nature of the relationship between homocysteine, nitric oxide and physical activity remains unanswered. The aim of this study was to investigate the effects of callisthenic exercises on plasma lipids, homocysteine (Hcy), total nitric oxide (NOx) and body composition in middle-aged healthy sedentary women. Forty-two middle-aged women (ages: 28-49; mean: 41.40 ± 7.3 years) were asked to perform a callisthenic exercise 50 min per session, 3 times per week for 12 weeks in a sports hall. Before and after the exercise, plasma lipids (total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride), Hcy and NO were determined. Body composition, including body mass index, fat percentage, fat free mass, resting systolic and diastolic blood pressures and heart rates were measured. After a 12-week callisthenic exercise program, plasma NOx and Hcy levels were found to be significantly increased (P < 0.05). Body composition parameters, lipid profile, resting systolic and diastolic blood pressures and heart rate significantly decreased (P < 0.05). Aerobic callisthenic exercises characterized by 50 min/day and 3 days/week resulted in positive changes in important health parameters like reducing obesity, lowering blood lipids and increasing plasma NOx. Cardiovascular improvements might be dependent on the increase of NOx values. But callisthenic exercise in such intensity did not lower the plasma Hcy level. Moreover, Hcy level increased significantly. The result shows that if the Hcy is in the normal levels in healthy subjects, long-term callisthenic exercise do not decrease the Hcy levels despite some beneficial effects on health. On the contrary, the Hcy levels are increased by long-term callisthenic exercises."

Lung age and respiratory muscle strength in female volleyball players.

OBJECTIVE: Lung age estimation is a useful approach to determine pulmonary pathologies. In literature, no studies have evaluated and compared lung age in athletes with healthy volunteers. This study aims to compare lung age and respiratory muscle strength in female volleyball players and age-matched healthy volunteers. METHODS: A total of 18 female volleyball players (22.39±4.97 years) and 20 female healthy volunteers (24.85±3.33 years) were included. Pulmonary functions and respiratory muscle strength were assessed using a spirometer and mouth pressure device, respectively. The lung age was calculated using reference equations associated with gender, height, and forced expiratory volume in 1 second. RESULTS: Lung age was significantly lower, and forced expiratory volume in 1 L, forced vital capacity, and maximal inspiratory and expiratory pressure (cmH2O, %) were higher in female volleyball players compared with healthy volunteers (p≤0.05). CONCLUSION: The lung age and respiratory muscle strength of female volleyball players were better than healthy volunteers. Regular training in female volleyball players may improve respiratory functions and lung age.

Relationship between body composition and lung function in elderly men and women.

INTRODUCTION: The purpose of this study was to evaluate the relationship between body composition parameters and lung functions including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), FEV(1):VC ratio, and FEV(1):FVC ratio in elderly men and women. METHODS: The study was a cross-sectional evaluation of 99 healthy men and women (aged 60-88 years). Anthropometric and body composition parameters (including fat mass [FM], fat-free mass [FFM] and percentage body fat [%BF]) were evaluated using the skinfold method, and lung function was examined using spirometry. RESULTS: Data analysis showed %BF, body FM and body mass index (BMI) of women to be significantly higher than men. Also, their body FFM was significantly less than men (P<0.05). Lung volume (P<0.01) and lung capacity values (P<0.05) (VC, FVC, FEV(1), FEV(1):VC, FEV(1):FVC) of women were significantly less than men. There was a positive significant relationship between the FFM versus FVC and FEV(1) values of women and men. A negative significant relationship was demonstrated between body FM, BMI and FVC of all subjects. CONCLUSION: This investigation showed that women aged between 60 and 88 years had a lower lung capacity compared to men of the same age. Older women were found to have a higher body fat ratio than men, and it was found that increasing %BF and BMI had a negative effect on lung functions in both sexes.

Does total knee arthroplasty affect pelvic movements? A prospective comparative study

SUMMARY OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., "gait velocity," "cadence," and "stride length") were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery.

Effects of different resistance exercise protocols on nitric oxide, lipid peroxidation and creatine kinase activity in sedentary males.

The purpose of this study was to determine the changes of oxidative response and exercise-induced muscle damage after two different resistance exercise protocols. Whether training with low or high intensity resistance programs cause alterations in the activities of lipid peroxidation, nitric oxide (NOx), and creatine kinase (CK) activity in human plasma was investigated. Twenty untrained males participated into this study. Ten of the subjects performed high intensity resistance (HR) exercise circuit and the rest of them performed low intensity resistance (LR) exercise circuit of 4 different exercises as a single bout. Venous blood samples were drawn pre-exercise, immediately after the exercise, and at the 6(th), 24(th), 48(th) and the72(nd) hours of post-exercise. Samples were analyzed for markers of muscle damage (CK), lipid peroxidation (MDA) and NOx. NOx production increased in HR group (p < 0.05). The MDA response to the two different resistance exercise protocol in this study caused a significant increase between pre and post-exercise values in both groups (p < 0.05). Also, there was a significant difference in the MDA level between the two groups in post-exercise values (p < 0.05) and higher values were observed in HR group. CK activities showed a significant increase in all post exercise values (p < 0.05) of both groups but there were no difference between HR and LR groups. These findings support that high intensity resistance exercise induces free radical production more than low intensity resistance exercise program. Key pointsHigh intensity resistance exercise caused increases in NOx, MDA and CK levels.Light intensity resistance exercises increased MDA and CK levels but did not affect NOx levels.Damage arose during resistance exercises may be related to the level of resistance applied.

Lung age and respiratory muscle strength in female volleyball players

SUMMARY OBJECTIVE: Lung age estimation is a useful approach to determine pulmonary pathologies. In literature, no studies have evaluated and compared lung age in athletes with healthy volunteers. This study aims to compare lung age and respiratory muscle strength in female volleyball players and age-matched healthy volunteers. METHODS: A total of 18 female volleyball players (22.39±4.97 years) and 20 female healthy volunteers (24.85±3.33 years) were included. Pulmonary functions and respiratory muscle strength were assessed using a spirometer and mouth pressure device, respectively. The lung age was calculated using reference equations associated with gender, height, and forced expiratory volume in 1 second. RESULTS: Lung age was significantly lower, and forced expiratory volume in 1 L, forced vital capacity, and maximal inspiratory and expiratory pressure (cmH2O, %) were higher in female volleyball players compared with healthy volunteers (p≤0.05). CONCLUSION: The lung age and respiratory muscle strength of female volleyball players were better than healthy volunteers. Regular training in female volleyball players may improve respiratory functions and lung age.

Differences in strength, flexibility and stability in freestyle and Greco-Roman wrestlers.

BACKGROUND AND OBJECTIVES: Wrestling includes a variety of functional properties: muscular strength, flexibility, neuromuscular coordination, and static and dynamic balance. The aim of the study was to identify differences in the strength, flexibility, postural stability and core stabilization of young national and international wrestlers in different weight groups. MATERIAL AND METHOD: Eighty-one male wrestlers (17-21 years old) were divided into 6 groups according to their body mass (light, middle and heavy) and wrestling style. The lumbosacral flexion, extension and lateral flexion range of motion, hamstring extensibility, back and leg muscle strength, postural stability, and core stabilization were assessed. RESULTS: Greco-Roman wrestlers had a higher lean body mass (6-12%) compared with freestyle wrestlers. However, the trunk lateral flexion flexibility was better in the Greco-Roman wrestlers (6-7%) than in the freestyle wrestlers, and the absolute back strength (BS) and leg strength (LS) were similar for both styles of wrestling. The BS/LBM and LS/LBM in the freestyle wrestlers were greater than in the Greco-Roman wrestlers, and the Light weight Greco-Roman wrestlers had the highest BS/LBM. The heavy weight Greco-Roman wrestlers and the light weight freestyle wrestlers had the greatest LS/LBM values. The postural control was similar for the two styles of wrestlers; however, the heavy weight Greco-Roman wrestlers had greater postural control in all directions compared with the light and middle weight Greco-Roman wrestlers. The core stabilization did not differ for the Greco-Roman and freestyle wrestlers except in the lateral bridge. CONCLUSION: The style of wrestling demonstrates different strength, flexibility and stability demands on the body. The differences between Greco-Roman and freestyle wrestlers may be due to the wrestling style differences in training and to competition-related demands. LEVEL OF EVIDENCE: Comparative study, level lV (case series).

The effects of vitamin C supplementation on oxidative stress and antioxidant content in the brains of chronically exercised rats.

The purpose of this study was to ascertain whether vitamin C supplementation during chronic exercise training alters rat brain antioxidant content. Female Wistar albino rats were exercised on a treadmill for 30 min/day for 6.5 weeks and were administered daily intraperitoneal injections of vitamin C (20 mg/kg). After the training period, chronically exercised rats showed no significant changes in total brain thiobarbituric acid reactive substances (TBARS) levels. In contrast, rats supplemented with vitamin C during the training period showed significantly elevated brain TBARS levels. If such results were extrapolated to man, where vitamin supplementation is a common practice, this would indicate that vitamin C supplementation may not protect brain tissue against exercise-induced oxidative damage, in such circumstances, this water-soluble antioxidant behaves as a pro-oxidant.