The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta-analysis of selected moderators.

The effectiveness of regular exercise in decreasing both systolic and diastolic blood pressure (BP) is well-established. Our purpose was to assess the impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature. Three databases (PubMed, Embase, Web of Science) were searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home (HBPM) or during 24-h (ABPM). The weighted mean difference was for 24-h systolic/diastolic ABPM (n = 847 participants): -4.06/-2.77 mmHg (95%CI: -5.19 to -2.93/-3.58 to -1.97; P < 0.001), for daytime (ABPM or HBPM, n = 983): -3.78/-2.73 mmHg (95%CI: -5.09 to -2.47/-3.57 to -1.89; P < 0.001) and nighttime ABPM periods (n = 796): -2.35/-1.70 mmHg (95%CI: -3.26 to -1.44/-2.45 to -0.95; P < 0.001). Characteristics significantly influencing BP improvement were: an initial office BP ≥130/85 mmHg and diet-induced weight-loss. We found no differences according to sex, age, or training characteristics (intensity, number of sessions, training duration). Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP ≥130/85 mmHg.

Test-retest reliability and responsiveness of centre of pressure measurements in patients with hip osteoarthritis.

OBJECTIVE: The aim of this study was to determine a set of measures for the evaluation of balance in patients suffering from hip osteoarthritis (OA) that were both reliable and responsive to change. DESIGN: Three groups of subjects; Healthy, hip OA patients without surgery, and hip OA with surgery (pre and post-surgery) were included in this study. Subjects had to perform balance tests in two positions: standard and narrowed stance. CoP-based measures test-retest reliability was assessed in hip OA without surgery group, responsiveness were assessed between all groups and between pre and post-surgery. RESULTS: Intraclass Correlation Coefficient (ICC) values from hip OA without surgery ranged from -0.03 to 0.9 for only five parameters (CoP path length, SD velocity, mean velocity, and antero-posterior Root Mean Square (RMS(AP)) having values over 0.7. SD velocity and RMS(AP) showed significant differences between healthy and surgery group in standard stance whereas narrowed stance revealed most differences between all groups. RMS(AP) showed the best responsiveness (Standardized Response Mean ∼0.5) between pre vs post-surgery in both conditions. RMS(AP) was also capable of discriminating between hip OA with surgery vs without surgery groups with good sensitivity and specificity. CONCLUSIONS: Our results showed there to be reliability and responsiveness of five postural parameters in hip OA patients in two conditions of standing balance. More parameters were significantly different in narrowed stance whereas sensitivity was better in standard stance. SD velocity and RMS(AP) discriminate between degrees of OA severity and highlight potential balance deficits even after arthroplasty. Selected parameters during standing balance could be assessed to complete the set of quantitative measures to quantify hip OA patient deficiencies.

Physiological Interpretation of the Slope during an Isokinetic Fatigue Test.

To assess the relationship between selected measures (the slope and average performance) obtained during a high intensity isokinetic fatigue test of the knee (FAT) and relevant measures of anaerobic and aerobic capacities. 20 well-trained cyclists performed 3 randomly ordered sessions involving a FAT consisting in 30 reciprocal maximal concentric contractions of knee flexors and extensors at 180°.s(-1), a maximal continuous graded exercise test (GXT), and a Wingate anaerobic test (WAnT). The slope calculated from peak torque (PT) and total work (TW) of knee extensors was highly associated to maximal PT (r=-0.86) and maximal TW (r=-0.87) measured during FAT, and moderately associated to peak power output measured during the WAnT (r=-0.64 to -0.71). Average PT and average TW were highly associated to maximal PT (r=0.93) and maximal TW (r=0.96), to mean power output measured during WAnT (r=0.83-0.90) and moderately associated to maximal oxygen uptake (0.58-0.67). In conclusion, the slope is mainly determined by maximal anaerobic power, while average performance is a composite measure depending on both aerobic and anaerobic energy systems according to proportions that are determined by the duration of the test.

[Clinical and paraclinical evaluations of bladder sensitivity. Review of the literature]. / Évaluation clinique et paraclinique de la sensibilité vésicale. Revue de la littérature.

INTRODUCTION: The aim of this work was to carry out a review of the literature on the clinical and paraclinical evaluation of bladder sensory (BS) to better understand BS disorders in nonneurological patients. METHODS: Thirty-three articles were selected from the Medline(®) Database between 1992 and 2012 using the following key words: "sensory/sensitivity bladder evaluation", "sensory/sensitivity bladder scale", "sensory/sensitivity bladder questionnaire", "urodynamic bladder sensory", "urgency questionnaire" and "Overactive Bladder (OAB) questionnaire". RESULTS: Evaluation of BS by asking questions during cystometry is validated (LE 2). The sensation of the desire to void progresses linearly with bladder filling (LE 2). Many symptoms and quality of life questionnaires related to BS anomalies have been proposed. Bladder diaries, frequency/volume curves (LE 2) and clinical algorithms (LE 3) could be an alternative to evaluate BS. CONCLUSION: Current evaluation only provides a partial view of BS. A multidimensional approach should lead to better understanding of BS disorders.

Reproducibility, validity and responsiveness of the 200-metre fast walk test in patients undergoing cardiac rehabilitation.

OBJECTIVE: To investigate the reliability, validity and responsiveness of the 200-metre fast walk test in patients with coronary artery disease engaged in a cardiac rehabilitation programme. DESIGN: Descriptive study. SETTING: Tertiary care hospital. SUBJECTS: Thirty stable patients with coronary artery disease (51.9 ± 8.7 years), referred to the cardiac rehabilitation department after an acute coronary syndrome. INTERVENTION: Not applicable. MAIN MEASURES: Six-minute walk test distance, time to perform the 200-m fast walk test, peak power output of the graded maximal exercise test, before and after the programme; SF-36 quality of life questionnaire at baseline. Walk tests were performed twice at baseline to assess reliability. RESULTS: The 200-m fast walk test was highly reliable (ICC = 0.97). It was significantly correlated with the graded maximal exercise test peak power and the 6-minute walk test at baseline (r = -0.417; P < 0.05; and r = -0.566; P < 0.01, respectively) and after the training programme (r = -0.460, P < 0.05; and r = -0.926; P < 0.01, respectively). At baseline, there was a strong correlation between the 200-m fast walk test time and the physical component score of the SF-36 (r = -0.77; P < 0.01), but not between the 200-m fast walk test time and the SF-36 mental component score. Mean 200-m fast walk test time was significantly different between the patients performing ≤90 W (n = 11) or ≥100 W (n = 19) at the baseline graded maximal exercise test (121.7 ± 13.6 vs. 115.5 ± 10.1 seconds; P < 0.05). The responsiveness was strong with a standardized response mean at 1.11. CONCLUSION: The 200-m fast walk test is a reliable, valid and responsive high-intensity walk test in patients with coronary artery disease after an acute coronary syndrome. It can thus give additional information to that given by the 6-minute walk test and the graded maximal exercise test.

Isokinetic intervention in microtraumatic shoulder instability: an update.

AIM: Aim of the present study was to carry out a critical analysis of the use of isokinetic dynamometers for evaluation and rehabilitation in microtraumatic shoulder instability. METHODS: A non-systematic literature review was conducted on Medline using the following key words: "isokinetics", "shoulder instability", "evaluation", "rehabilitation". We also analyzed the related articles, and compiled a database of expert opinion. RESULTS: Despite a lack of consensus on testing modalities, lateral and medial rotator muscle strength can be safely and reliably assessed on isokinetic devices in subjects presenting with microtraumatic instability of the shoulder, before and after rehabilitation and/or surgery. There is considerable inter-individual variability in the results, leading to consider isokinetic testing as a useful examination before individualized rehabilitation. Its use as a muscle strengthening method in a global rehabilitation program seems interesting in order to correct rotator muscle strength deficiencies and/or asymmetries, which may be infra-clinical, even though strong scientific evidence is still lacking. CONCLUSION: Isokinetics is a safe tool for evaluation and seems to be effective in rehabilitation for microtraumatic instability of the shoulder. It would, however, be necessary to standardize practices thanks to rigorous clinical studies, so as to determine precisely the indications of this technique in the comprehensive management of shoulder instability.

Usefulness of the 6-minute walk test and the 200-metre fast walk test to individualize high intensity interval and continuous exercise training in coronary artery disease patients after acute coronary syndrome: a pilot controlled clinical study.

OBJECTIVE: To study the effects of three individualized exercise training prescriptions using either a percentage of maximal heart rate (HR), maximal 6-minute walk test (6MWT) HR, or maximal 200-metre fast walk test (200-mFWT) HR, on walking performance and exercise capacity in coronary artery disease (CAD) patients. DESIGN: Controlled clinical study. PARTICIPANTS: Twenty-seven outpatients enrolled in a rehabilitation programme after an acute coronary syndrome. SETTING: Cardiac rehabilitation unit. INTERVENTIONS: Three groups: (A): moderate intensity continuous exercise (MICE) at 70% of the maximal HR of the graded maximal exercise test (n = 10); (B): MICE at the maximal 6MWT HR (n = 8); (C): high intensity interval training (HIIT) based on the 6MWT and the 200-mFWT maximal HR (n = 9). Group B and C performed walk tests every 2 weeks, to readjust training HR (THR) if needed. MEASURES: 6MWT and 200-mFWT performances, peak VO(2) and peak power (Pmax). RESULTS: 6MWT and 200-mFWT performances improved significantly and similarly in all groups (P < 0.05). Peak VO(2) improved significantly in all groups (P < 0.05), this improvement being higher in group C (HIIT) versus A (P < 0.05). Group B was closer to the recommended THR during exercise sessions compared to group A. CONCLUSION: This pilot study showed that using the 6MWT and 200-mFWT HR to individualize MICE or HIIT prescription is feasible in CAD patients, and could lead them closer to THR objective, to similar improvements in walking performance, and greater peak VO(2) increase for HIIT. Future randomised studies should investigate long-term effects of programmes prescribed from walk tests HR, especially for HIIT modality.

Does eccentric endurance training improve walking capacity in patients with coronary artery disease? A randomized controlled pilot study.

OBJECTIVE: To examine the effect of eccentric endurance training on exercise capacities in patients with coronary artery disease. DESIGN: Randomized parallel group controlled study. SETTING: Cardiac rehabilitation unit, Dijon University Hospital. PARTICIPANTS: Fourteen patients with stable coronary artery disease after percutaneous coronary intervention. INTERVENTION: Patients followed 15 sessions of training (1 session per day, 3 days a week), either in the concentric group, following a standard programme, or in the eccentric group, performing eccentric resistance exercises using both lower limbs on a specifically designed ergometer. MAIN OUTCOMES MEASURED: Symptom-limited Vo2, peak workload, isometric strength of leg extensor and ankle plantar flexors, distance covered during the 6-minute walk test and time to perform the 200-m fast walk test in both groups, before and after the training period. RESULTS: Patients did not report any adverse effects and were highly compliant. All measured parameters improved in eccentric and concentric group, except for 200-m fast walk test: symptom-limited Vo2 (+14.2% versus +4.6%), peak workload (+30.8% versus +19.3%), 6-minute walk test distance walked (+12.6% versus +10.1%) and leg extensor strength (+7% versus +13%) improved to a similar degree in both groups (P < 0.01); ankle plantar flexor strength improved in both groups with a significantly greater increase in the eccentric group (+17% versus +7%, P < 0.05). CONCLUSION: Patients with stable coronary artery disease can safely engage in eccentric endurance training, which appears to be as efficient as usual concentric training, with reduced oxygen consumption.

Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle.

AIM: Clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The aim of this study was to compare the assessment of clinical signs and the ultrasonographic findings in recent LCL sprain of the ankle. METHODS: This was a retrospective cross-sectional study. Spearman's rank correlation test and multiple regression analysis were used to assess correlations between clinical signs and type of ligament injury. Fisher's linear discriminant analysis was used to determine most contributive signs in ligament tear diagnosis. RESULTS: No single clinical sign was correlated with the severity of ligament injury as revealed by ultrasonography in the 34 patients analyzed. Careful assessment of all the usual clinical signs of severity seems to better guide the diagnosis of the presence or absence of ligament tearing. CONCLUSIONS: These results confirm the lack of correlation between clinical examination and the anatomic injury in distension or partial tearing of the anterior talofibular ligament. They raise questions about the usefulness of clinical classifications and suggest a broadening of the indications for ultrasonographic exam in ambiguous situations, particularly for athletes showing few signs of severe injury, in order to ensure optimal treatment and a faster recovery.

Low-frequency electromyostimulation and chronic heart failure.

Low-frequency electromyostimulation (EMS) acts on the skeletal muscle abnormalities that aggravate intolerance to effort in patients with chronic heart failure (CHF). It improves the oxidative capacity of muscles and thus enhances aerobic performance and physical capacity to almost the same degree, as does conventional physical training. No local or hemodynamic intolerance has been reported, even in cases of severe CHF. However, the presence of a pacemaker is one of the relative contra-indications (prior evaluation of tolerance is required), while that of an implanted defibrillator is one of the absolute contra-indications. EMS is an alternative to physical effort training when the latter is impossible due to a high degree of deconditioning or because there is a contra-indication, which may be temporary, due to the risk of acute decompensation and/or rhythm troubles. EMS can also be used in patients waiting for a heart transplant or in CHF patients who are unwilling to engage in physical activities. As EMS is not expensive and easy to set up, its use is likely to develop in the future.

The Dijon Physical Activity Score: reproducibility and correlations with physical fitness in patients with coronary artery disease.

OBJECTIVES: To study the clinimetric properties of the Dijon Physical Activity Score (PAS) in patients with coronary artery disease (CAD). PATIENTS: Two populations of patients with CAD: one group of stabilized patients from the RICO county-wide monitoring program and one group in the initial phase of a cardiovascular rehabilitation program (CVR group). METHODS: The patients carried out a maximal effort test on a cycle ergometer, plus two walking tests (a six-minute walk test and a 200 m fast walk test). They completed the Dijon PAS questionnaire on two occasions at an interval of 10 days. The reproducibility of the score and the latter's correlations with physical parameters were analyzed. RESULTS: Sixty-seven subjects were included and 52 answered the questionnaire both times. The average time spent answering the questionnaire was 173+/-37 seconds and reproducibility was satisfactory in the RICO group only. In this group, there were significant correlations between total score and maximal power during the effort test (r=0.41; P<0.05) and between the "sports/leisure activities" sub-score and maximal power (r=0.57; P<0.01). No correlations were found in the CVR group. CONCLUSION: The Dijon PAS is a simple, generic, reproducible and reliable score for measuring physical activity in patients with stable coronary artery disease but, because of the conjunction of confounding factors, it is not suitable for subjects who experienced a recent acute cardiac event. It could thus be used in epidemiological studies to determine the impact of a sedentary lifestyle and the efficacy of methods intended to counter sedentariness and to help design personalized secondary prevention programs.

[Complex regional pain syndrome of the knee: early and beneficial action of diphosphonates on pain and function]. / Algodystrophie de genou: effet précoce et spectaculaire des biphosphonates sur la douleur et la fonction.

We report the case of a 24-years-old man with parcellar Complex Regional Pain Syndrome I (CRPS I) of the patella, responsible for major functional limitation. The diagnosis was based on physical exam and X-ray, in the absence of other articular or peri-articular diseases. The patient received two pamidronate perfusions over a week, with a spectacular decrease of pain, which allowed him to follow the rehabilitation program in good conditions. He was therefore able to go back to work. The place of this treatment in CRPS I is discussed.

Exercise training for patients with cardiovascular disease.

This review surveys effort training, a validated and recommended therapy, in patients with atheromatous cardiovascular disease. This true therapy reduces mortality by 25-35%, reduces clinical manifestations and complications (rhythm problems, thrombosis) and improves physical capacity, reintegration and quality of life. The effects are essentially linked to improved metabolic performance of muscles and reduced endothelial dysfunction, insulin resistance and neurohormonal abnormalities. Training also has an impact on the evolution of major risk factors, especially diabetes and arterial hypertension. The risks are limited as long as the contraindications are respected and the programmes supervised. The indications (stable angina, chronic heart failure, peripheral arterial disease) should be described more precisely by taking into account functional criteria: physical deconditioning, exclusion, compliance, mood swings, and seriousness of risk factors. The training programme should be tailor made and based on evaluation of the patient's adaptation to effort, in terms of frequency, intensity and duration of the exercises. Various types of exercise include overall or segmental physical training; concentric, eccentric, even isokinetic muscle contraction exercises; and proprioceptive rehabilitation. However, knowledge is lacking about the molecular mechanisms of the effects of training, the most effective intensity of effort, and strategies to develop physical activity in this ever-growing population for both primary and secondary prevention.

[Does the quality of Web sites related to low back pain meet patients expectations? A systematic review]. / La qualité de l'information disponible sur Internet concernant la lombalgie est-elle adaptée aux attentes des patients? Revue systématique.

INTRODUCTION: An assessment of 36 back-pain-related French-language Web sites, miming a patient search strategy, was previously done by use of evidence-based items. Medical information quality was poor, as already noted about English-language Web sites. Thus, patients' expectations may exceed that provided by Web sites with simple medical information. OBJECTIVES: To study whether French-language Web sites related to low back pain meet patients expectations and to valid a rating scale including patients' expectations. MATERIALS AND METHOD: First we reviewed French-language Web sites with new keywords and medical gateways. Second, we systematically double assessed back pain-related Web sites with a health care professional and patient-centered scale. RESULTS: We found 30 additional Web sites not found with the previous search, 7 focusing on patient information. The rating scale is valid, and its use on a Web site sample leads to results different from those generated by an evidence-based medicine rating scale but close to a more global assessment. DISCUSSION: French-language Web sites related to low back pain do not meet patients' expectations. Patients participation in Web site assessment or construction could help to close the gap between the expectations of people with low back pain and information delivered by doctors.

Qualitative evaluation of the expectations of low back pain patients with regard to information gained through semi-directed navigation on the Internet.

OBJECTIVES: To make a qualitative analysis of the expectations of chronic low back pain (LBP) sufferers with regard to information gained using semi-directed Internet navigation on a sample of French LBP-related websites, and to compare the results with those of physical medicine and rehabilitation (PMR) medical doctors (MD). MATERIAL AND METHODS: Twenty-seven hospitalised chronic LBP sufferers assessed in ecological conditions a sample of seven LBP-related websites. The sites were assessed using a simplified version of a rating scale of patients' expectations. Analysis of the relative importance of the different kinds of information delivered was done using a point sharing method. RESULTS: In a comfortable environment, patients gave high scores for medical and extra-medical information, but low scores for website design. Overall quality assessment was similar for patients and MDs. The relative importance of medical and extra-medical information, and design quality, was similar for Chronic LBP patients and MDs. CONCLUSION: PMR MD seemed able to correctly evaluate the overall expectations of chronic LBP patients with regard to information, but their opinions on the different qualities of websites were different. Doctors and patients should collaborate in order to create or validate high quality websites concerned with LBP.

Barriers to physical activity in coronary artery disease patients: Development and validation of a new scale.

OBJECTIVE: To develop and validate a self-report questionnaire to measure barriers to regular physical activity (PA) in patients with stable coronary artery disease (CAD). METHODS: Phase 1: 17 patients completed a semi-structured interview. After grouping and reformulating the reported barriers, their pertinence was reevaluated by the patients. Then, a decision algorithm was used to select items. A principal component analysis was performed to determine content validity. Phase 2: 49 patients completed the questionnaire resulting from phase 1 twice, 7 days apart, and questionnaires to evaluate depression, anxiety, and the level of physical activity. Construct validity was evaluated by analysis of Spearman's correlation coefficient between the total score for the questionnaire and a convergent dimension (anxiety), as well as a divergent dimension (Dijon physical activity score). Internal consistency was evaluated by Cronbach's alpha coefficient. Test-retest reliability was evaluated by the intraclass coefficient (ICC). RESULTS: Eleven items were selected after phase 1. The questionnaire presented good face validity and the content validity seemed satisfactory after analysis of the literature by the experts. Construct validity was moderate. Internal consistency was very good (Cronbach's α>0.81). Reproducibility was excellent with an ICC at 0.95. Feasibility was good with less than 3minutes to complete the questionnaire. CONCLUSION: This questionnaire presents good psychometric properties. A further prospective study should evaluate sensitivity to change and help determine a threshold value indicating the need for a specific behavioral strategy to alleviate barriers to physical activity in these patients.

[Isokinetic dynamometer measurement of shoulder rotational strength in healthy elite athletes (swimming, volley-ball, tennis): comparison between dominant and nondominant shoulder]. / Mesure de la force des muscles rotateurs de l'épaule chez des sportifs sains de haut niveau (natation, volley-ball, tennis) par dynamomètre isocinétique: comparaison entre épaule dominante et non dominante.

OBJECTIVE: To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball). MATERIALS AND METHODS: Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60 degrees and 180 degrees s(-1)) and analysed peak torque of LR and MR and LR/MR ratios. RESULTS: TENNIS: The MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. SWIMMING: The LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60 degrees/second. Both shoulders showed comparable strength in women. VOLLEYBALL: Shoulder muscular strength was symmetrical. CONCLUSION: The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before.

The involvement of ankle muscles in maintaining balance in the upright posture is higher in elderly fallers.

The purpose of this study was to determine whether the mechanical contribution of ankle muscles in the upright stance differed among young adults (YA) (n=10, age: ~24.3), elderly non-fallers (ENF) (n=12, age: ~77.3) and elderly fallers (EF) (n=20, age: ~80.7). Torque and electromyographic (EMG) activity were recorded on the triceps surae and tibialis anterior during maximum and submaximum contractions in the seated position. EMG activity was also recorded in subjects standing still. Plantar flexor (PF) and dorsal flexor (DF) torques generated in the upright posture were estimated from the torque-EMG relationship obtained during submaximum contractions in the seated position. Center of pressure (CoP) displacement was measured to quantify postural stability. Results showed that, in upright standing, EF generated greater ankle muscle relative torque (i.e. PF+DF torque in the upright stance/PF+DF during maximum isometric torque) than non-fallers (i.e. ENF, YA). The greater involvement of ankle muscles in EF was associated with higher CoP displacement. PF+DF torque in the upright stance was no different among the groups, but PF+DF torque during maximum effort was impaired in older groups compared with YA and was lower in EF than ENF. These results suggest that the postural stability impairment observed with aging is highly related to ankle muscle weakness.