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 effects of regular aerobic exercise on renal functions in streptozotocin induced diabetic rats.

Diabetic nephropathy is a feared complication of diabetes since it can lead to end-stage renal failure and also it is a risk factor of cardiovascular disease. The important clinical problems caused by diabetic nephropathy are proteinuria and decreased renal function. Exercise is a cornerstone of diabetes management, along with diet and medication. Since acute exercise causes proteinuria and decreases glomerular filtration rate, the effect of exercise on diabetic nephropathy is controversial. The aim of this study was to investigate the effect of regular aerobic exercise on microalbuminuria and glomerular filtration rate in diabetic rats. Moderate diabetes was induced by streptozotocin (45 mg/kg IV) in rats and an aerobic exercise- training program on a treadmill was carried out for 8 weeks. Four groups of rats; control sedentary (CS), control exercise (CE), diabetic sedentary (DS) and diabetic exercise (DE) were included in the study. Blood glucose levels were determined from the plasma samples taken at the end of 4 weeks of stabilization period and 8 weeks of training program. Creatinine clearance (CCr) and microalbuminuria (MA) levels were determined to evaluate renal functions. The analyzed data revealed that regular aerobic exercise: 1) significantly decreased the plasma glucose level of the DE group compared to the DS group (p < 0.05), 2) significantly decreased the microalbuminuria level of the DE group compared to those of DS group (p < 0.01), 3) significantly decreased the creatinine clearance levels of the DE and CE groups compared to those of CS group (p < 0.05). The results of this study suggest that despite of decreasing creatinine clearance, regular submaximal aerobic exercise has a preventive effect on development of microalbuminuria and thus may retard nephropathy in diabetic rats. Key pointsRegular submaximal aerobic exercise can facilitate the control of blood glucose level in diabetic rats.Streptozotocin induced diabetes may cause microalbuminuria and regular submaximal aerobic exercise may have a preventive effect on renal functions.

Determination of an Optimal Threshold Value for Muscle Activity Detection in EMG Analysis.

It is commonly agreed that one needs to use a threshold value in the detection of muscle activity timing in electromyographic (EMG) signal analysis. However, the algorithm for threshold determination lacks an agreement between the investigators. In this study we aimed to determine a proper threshold value in an incremental cycling exercise for accurate EMG signal analysis. Nine healthy recreationally active male subjects cycled until exhaustion. EMG recordings were performed on four low extremity muscle groups; gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SOL) and vastus medialis (VM). We have analyzed our data using three different threshold levels: 25%, 35% and 45% of the mean RMS EMG value. We compared the appropriateness of these threshold values using two criteria: (1) significant correlation between the actual and estimated number of bursts and (2) proximity of the regression line of the actual and estimated number of bursts to the line of identity. It had been possible to find a significant correlation between the actual and estimated number of bursts with the 25, 35 and 45% threshold values for the GL muscle. Correlation analyses for the VM muscle had shown that the number of bursts estimated with the 35% threshold value was found to be significantly correlated with the actual number of bursts. For the GM muscle, it had been possible to predict the burst number by using either the 35% or 45% threshold value and for the SOL muscle the 25% threshold value was found as the best predictor for actual number of burst estimation. Detailed analyses of the actual and estimated number of bursts had shown that success of threshold estimation may differ among muscle groups. Evaluation of our data had clearly shown that it is important to select proper threshold values for correct EMG signal analyses. Using a single threshold value for different exercise intensities and different muscle groups may cause misleading results. Key pointsα priori accepted threshold value may cause erroneous results in EMG analysis.Using a single threshold value for different exercise intensities and different muscle groups may cause misleading results.The investigators may need to use different threshold selection strategies for different workloads.The investigators have to justify the choice of threshold selection with valid arguments before detailed EMG signal analyses.

The effects of aerobic exercise on skeletal muscle metabolism, morphology and in situ endurance in diabetic rats.

The effects of aerobic exercise training on skeletal muscle endurance capacity were examined in diabetic rats in situ. Moderate diabetes was induced by iv injection of streptozotocin and an exercise training program on a treadmill was carried out for 8 weeks. The animals randomly assigned to one of the four experimental groups: control-sedentary (CS), control-exercise (CE), diabetic-sedentary (DS) or diabetic-exercise (DE). The changes in the muscle endurance capacity were evaluated through the square wave impulses (supramaximal) of 0.2-ms duration at 1 Hz in the in situ gastrocnemius-soleus muscle complex. Muscle was stimulated continuously until tension development reduced to the half of this maximal value. Time interval between the beginning and the end of stimulation period is defined as contraction duration. Following the training period, blood glucose level reduced significantly in the DE group compared to DS group (p < 0.05). The soles muscle citrate synthase activity was increased significantly in both of the trained groups compared to sedentary animals (p < 0.05). Fatigued muscle lactate values were not significantly different from each other. Ultrastractural abnormality of the skeletal muscle in DS group disappeared with training. Presence of increased lipid droplets, mitochondria clusters and glycogen accumulation was observed in the skeletal muscle of DE group. The contraction duration was longer in the DE group than others (p < 0.001). Fatigue resistance of exercised diabetic animals may be explained by increased intramyocellular lipid droplets, high blood glucose level and muscle citrate synthase activity. Key PointsAerobic training of diabetic animals increased the endurance capacity.Presence of abnormal ultrastructural alterations with diabetes disaapered with regular training.Increased intramyocelluler lipid droplets, high blood glucose level with citrate synthase activity may explain this finding.

Analysis of isokinetic knee extension / flexion in male elite adolescent wrestlers.

Wrestling requires strength of the upper and lower body musculature which is critical for the athletic performance. Evaluation of the adolescent's skeletal muscle is important to understand body movement, especially including those involved in sports. Strength, power and endurance capacity are defined as parameters of skeletal muscle biomechanical properties. The isokinetic dynamometer is an important toll for making this type of evaluation. However, load range phase of range of motion has to be considered to interpret the data correctly. With this in mind we aimed to investigate the lover body musculature contractile characteristics of adolescent wrestlers together with detailed analyses of load range phase of motion. Thirteen boys aged 12 - 14 years participated to this study. Concentric load range torque, work and power of knee extension and flexion were measured by a Cybex Norm dynamometer at angular velocities from 450°/sec to 30°/sec with 30°/sec decrements for each set. None of the wrestlers were able to attain load range for angular velocities above 390°/sec and 420°/sec for extension and flexion respectively. Detailed analyses of the load range resulted in statistically significant differences in the normalized load range peak torque for extension at 270°/sec (1.44 ± 0.28 Nm·kg(-1) and 1.14 ± 0.28 Nm·kg(-1) for total and load range peak torque respectively, p < 0.05), and for flexion at 300°/sec (1.26 ± 0.28 Nm·kg(-1) and 1.03 ± 0.23 Nm·kg(-1) for total and load range peak torque respectively, p < 0.05), compared to total peak torque data. Similarly, the significant difference was found for the work values at 90°/sec (1.91 ± 0.23 Nm·kg(-1) and 1.59 ± 0.24 Nm·kg(-1) for total and load range work respectively for extension and 1.73 ± 0.21 Nm·kg(-1) and 1.49 ± 0.19 Nm·kg(-1) for total and load range work respectively for flexion, p < 0.05), and was evident at higher angular velocities (p < 0.001) for both extension and flexion. At extension, load range power values were significantly smaller than total power for all angular velocities except 150°/sec (p < 0.05 for 120 and 180°/sec, p < 0.001 for others). Finally, load range flexion power was found to be higher than total power with statistically significance (p < 0.05 for 60, 120, 150, 180, 210, 270 and 300°/sec, p < 0.001 for 240 °/sec). Extra caution is required for correct interpretation of load range data in terms of considering the load range during limb movement. Evaluation of muscle performance of these adolescent wrestlers at regular intervals may give us an opportunity to obtain a healthy maturation profile of these adolescent wrestlers. Key PointsConsideration of load range for peak torque, work and power calculation resulted significant differences in the data presented by isokinetic dynamometer. Therefore evaluation of the dynamometer data required consideration of the load range for correct analysis and interpretation.Contraction velocity has critical importance in determining the load range attaining ability for a moving limb during load range evaluation. In fact alterations in contraction speed may be due to a number of changes in muscle morphology, subjects' age and the ratio between type I and type II muscle fiber area.