Effects of Plyometric-Based Hydro-Kinesiotherapy on Pain, Muscle Strength, Postural Stability, and Functional Performance in Children with Hemophilic Knee Arthropathy: A Randomized Trial.

AIM: To explore how plyometric-based hydro-kinesiotherapy (Plyo-HKT) would affect pain, muscle strength, postural stability, and functional performance in a convenience sample of children with hemophilic knee arthropathy (HKA). METHODS: Forty-eight children with HKA (age: 8-16 years) were randomly allocated to the Plyo-HKT group (n = 24; underwent the Plyo-HKT for 45 min, twice/week over 12 wk in succession) or the comparison group (n = 24; performed the standard exercise rehabilitation at an equivalent frequency and duration). Pain, peak concentric torque of quadriceps and hamstring (produced at two angular velocities: 120 and 180 o/sec), dynamic limits of postural stability (DLPS), and functional performance [Functional Independence Score in Hemophilia (FISH) and 6-Minute Walk Test (6-MWT)] were assessed pre- and post-intervention. RESULTS: In contrast with the comparison group, the Plyo-HKT group achieved more favorable pre-to-post changes in pain (p = .028, η2p = 0.10), peak torque of quadriceps [120°/sec (p = .007, η2P = 0.15); 180°/sec (p = .011, η2P = 0.13)] and hamstring [120°/sec (p = .024, η2P = 0.11); 180°/sec (p = .036, η2P = 0.09)], DLPSdirectional [forward (p = .007, η2P = 0.15); backward (p = .013, η2P = 0.12); affected side (p = .008, η2P = 0.14); non-affected side (p = .002, η2P = 0.20)], DLPSoverall (p < .001, η2P = 0.32), and functional performance [FISH (p < .001, η2p = 0.26); 6-MWT (p = .002, η2p = 0.19)]. CONCLUSION: Plyo-HKT is likely helpful for reducing pain, improving strength, enhancing postural stability, and boosting functional capabilities in children with HKA. Physical rehabilitation practitioners should, therefore, consider this intervention strategy.

The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: a placebo-controlled randomized clinical investigation.

OBJECTIVE: Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA. METHODS: This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for ∼35 min, thrice/week over 12 weeks. The maximal inspiratory (IPmax) and expiratory (EPmax) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index], and asthma control test (ACT) were assessed before and after the intervention. RESULTS: The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (P=.031 and P=.009 respectively) or the In-MT (P=.029 and P=.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (P=.001, P=.004, and P=.0005 respectively) or In-MT (P=.038, P=.037, and P=.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (P<.001) or In-MT (P=.002) training. CONCLUSION: This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA.

Normative values for hand grip and pinch strength for 6 to 18 year-olds in Saudi Arabia.

BACKGROUND: Normative values for hand grip and pinch strength among children in Saudi Arabia has not been well established. Therefore, the main aim of this study is to establish normative values for hand grip and pinch strength in children aged 6 to 18 years in Saudi Arabia. METHODS: A cross-sectional study was conducted from different 5 regions in Saudi Arabia. Participants between the age of 6 years and 18 years old were recruited through different primary and secondary schools in Saudi Arabia. Data for age, gender, Body Mass Index, and preferred hand were collected. Hand grip strength was measured using digital hand dynamometer and the tip pinch, palmar pinch, and key pinch strength were measured using the hydraulic pinch gauge. RESULTS: A total of 616 participants included in this study (318 boys and 298 girls). Participants were stratified into 5 chronological age groups of 6-7 years, 8-9, 10-11, 12-13, 14-15, 16-17, and 18 years. The results showed an overall trend of increasing hand grip strength and pinch strength with age regardless of hand preference. Boys had significantly higher grip strength than girls in all age groups (P < 0.05). CONCLUSION: This study established normative values for hand grip and pinch strength in the healthy Saudi pediatric and adolescent population, using boys and girls aged 6 to 18. The outcomes of this study also demonstrated that gender, age, and hand preference can all have an impact on how strong a handgrip develops.

Aqua-Plyometric Exercises-Induced Changes in Muscle Strength, Bone Mineral Properties, and Physical Fitness in Patients With Juvenile Idiopathic Arthritis: A 12-Week, Randomized Controlled Trial.

PURPOSE: To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. METHODS: A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12-18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. RESULTS: A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P = .016, left side: P = .025] or 180°/s [right side: P = .007, left side: P = .029]). Besides, a considerably greater improvement in the areal BMD (P = .0006), volumetric BMD (P = .027), bone mineral content (P = .002), and BMD Z score (P = .0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P < .001) was revealed in the AquaPlyo group. CONCLUSION: AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis.

Exploring Temporospatial Gait Asymmetry, Dynamic Balance, and Locomotor Capacity After a 12-Week Split-Belt Treadmill Training in Adolescents with Unilateral Cerebral Palsy: A Randomized Clinical Study.

AIM: To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). METHODS: Fifty-two adolescents with ULCP (age: 10-16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity [6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)] were assessed pre- and post-intervention. RESULTS: The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p < .001, η2partial = 0.27), LoSdirectional [affected side direction (p = .033, η2partial = 0.09), forward direction (p = .004, η2partial = 0.16), and backward direction (p = .01, η2partial = 0.12)], and LoSoverall (p < .001, η2partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p < .001, η2partial = 0.38), TUDS (p = .032, η2partial = 0.09), 10mSRT (p = .021, η2partial = 0.10)] as compared to the control group. CONCLUSION: The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP.

Low-energy laser therapy application on knee joints as an auxiliary treatment in patients with polyarticular juvenile idiopathic arthritis: a dual-arm randomized clinical trial.

Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.

Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial.

AIM: To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). METHODS: A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. RESULTS: By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). CONCLUSIONS: Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

A randomized placebo-controlled study investigating the efficacy of inspiratory muscle training in the treatment of children with bronchial asthma.

OBJECTIVE: To investigate the efficacy of inspiratory muscle training (IMT) on respiratory functions, respiratory muscle strength, and asthma symptoms in asthmatic children. METHODS: In a randomized placebo-controlled assessor-blinded study, 34 children with asthma were randomized to receive either the IMT at 40% of the maximal inspiratory pressure (IPmax) for 20 min/session, thrice/week, over 12 consecutive weeks (IMT group; n = 17) or placebo IMT at 5% of IPmax (placebo group; n = 17). Additionally, both groups received the conventional respiratory rehabilitation (CRR) program. Outcome measurements performed pre- and post-treatment, included respiratory functions [forced expiratory volume at the first second (FEV1), forced vital capacity (FEV), and FEV1/FVC], respiratory muscle strength [represented by IPmax and maximal expiratory pressure (EPmax), and asthma control test (ACT). RESULTS: At a significance level adjusted to P<.008, there were significant post-treatment differences between the IMT and placebo groups in FEV1 (P=.003), FVC (P=.001), FEV1/FVC (P=.004), IPmax (P=.002), EPmax (P=.004), and ACT (P=.001) adjusted to the pretreatment values, in favor of the IMT group. CONCLUSION: Incorporation of IMT in the CRR program for children with asthma can improve respiratory function, enhance respiratory muscle strength, and improve children's perception of asthma symptoms.

Within 5-year off-chemotherapy: How the cardio-respiratory response to exercise is related to energy expenditure, fatigue, and adiposity in children with acute lymphoblastic leukaemia?

OBJECTIVE: To explore the cardio-respiratory response to exercise and examine the relationships among specific measures of cardio-respiratory function, energy expenditure (EE), fatigue and adiposity in children survivors of acute lymphoblastic leukaemia (ALL). METHODS: Seventy survivors of ALL (13.31 ± 2.60 years) and 34 controls from the siblings (12.71 ± 2.36 years) participated and were assessed for submaximal and maximal exercise capacity, body composition, EE and fatigue. RESULTS: ALL survivors had significantly lower submaximal (VO2 ; p = 0.002) and maximal (VO2peak ; p Ë‚ 0.001) cardio-respiratory capacity than their controls. At the submaximal exercise test, EE was significantly lower in ALL survivors (p < 0.001), but the heart rate (HR) was significantly higher (p = 0.005). The VO2 and HR were significantly correlated [r (95%CI) = 0.689 (0.542 to 0.795), p < 0.001]. The VO2peak negatively associated with adiposity [r (95%CI) = -0.368 (-0.554 to -0.145), p = 0.002]. Fatigue significantly correlated with the VO2peak [r (95%CI) = 0.581 (0.401 to 0.718), p < 0.001] and adiposity [r (95%CI) = -0.303 (-0.502 to 0.073), p = 0.012]. CONCLUSION: Children survivors of ALL experience low cardio-respiratory fitness within 5-year off-chemotherapy. Associations exist between measures of cardio-respiratory fitness, EE, fatigue and adiposity. However, it has not yet been proven whether these are cause or effect.

Effect of 8 Weeks of Incremental Aerobic Training on Inflammatory Mediators, Cardiorespiratory Indices, and Functional Capacity in Obese Children With Bronchial Asthma.

PURPOSE: To appraise the effects of incremental aerobic training (IAT) on systemic inflammatory mediators, cardiorespiratory indices, and functional capacity in obese children with bronchial asthma. METHODS: This study included 30 children with asthma (age = 8-16 y) allocated randomly into either the control group (n = 15; received the traditional pulmonary rehabilitation program) or IAT group (n = 15; engaged in 8 weeks of IAT in addition to the traditional pulmonary rehabilitation program). The systemic inflammatory mediators (high-sensitivity C-reactive protein and interleukin-6), cardiorespiratory indices (peak oxygen uptake, minute ventilation, maximum heart rate, heart rate recovery at 1 min after exercises, and oxygen pulse), and functional capacity (represented by 6-min walk test) were analyzed pretreatment and posttreatment. RESULTS: A significant reduction in the level of high-sensitivity C-reactive protein and interleukin-6 and increase in peak oxygen uptake, minute ventilation, maximum heart rate, and heart rate recovery at 1 minute after exercises was observed among the IAT group as compared with the control group. In addition, the IAT group covered a longer distance in the 6-minute walk test than the control group, suggesting favorable functional capacity. CONCLUSION: The study results imply that IAT has the potential to improve the inflammatory profile, cardiorespiratory fitness, and functional capacity of obese children with bronchial asthma.

Therapeutic value of kinesio taping in reducing lower back pain and improving back muscle endurance in adolescents with hemophilia.

OBJECTIVE: This study evaluated whether the use of kinesio taping (KT) would enhance the effect of physical therapy in relieving pain, improving muscle endurance, and boosting functional capacity in adolescents with hemophilia who experience low back pain. METHODS: Forty-five adolescents with hemophilia (age; 10-13 years) assigned randomly into three treatment arms; KT applied paraspinal alongside a physical exercise program conducted three times/week for three successive months (KT group; n=15), placebo taping plus physical exercise (Placebo group; n=15), or physical exercise only (Control group; n=15). Lower back pain, back muscle endurance, and functional capacity assessed pre- and post-treatment. RESULTS: Lower back pain reduced significantly in the KT group as compared to the control group (P=.001), but not to the placebo group (P=.19). Back muscle endurance increased significantly in the KT group relative to either the placebo (P=.004) or the control group (P=.043). Additionally, functional capacity improved significantly in the KT group as compared to the control (P=.039) group but not to the placebo group (P=.58). CONCLUSION: KT is an effective adjunctive therapy to reduce lower back pain, improve back muscle endurance, and enhance functional capacity in adolescents with hemophilia.

A Randomized, Controlled Trial on the Effectiveness of Photobiomodulation Therapy and Non-Contact Selective-Field Radiofrequency on Abdominal Adiposity in Adolescents With Obesity.

BACKGROUND AND OBJECTIVES: Structured physical activities and dietary control have traditionally been used with the aim of controlling obesity. However, effective auxiliary modalities still needed to reduce local obesity, specifically abdominal obesity. This study examined the adjunct effect of photobiomodulation therapy (PBMT), and non-contact selective-field radiofrequency (NcRF) on abdominal adiposity in adolescents with obesity. STUDY DESIGN/MATERIALS AND METHODS: Fifty-four adolescents with obesity (33 females and 21 males) took part in this study and were distributed randomly into three treatment-based groups. Control group (n = 18, age; 14.61 ± 1.14 years), PBMT group (n = 18, age; 14.22 ± 0.88 years), and NcRF group (n = 18, age; 15.11 ± 0.96 years). A dietary control plan of 1,000-1,200 kcal/day, and a 60-minute aerobic exercise program conducted day-by-day over 4 weeks were provided for all participants. Additionally, the PBMT group received 12 20-minute PBMT on the abdominal area (energy/session ~4.08 J/cm2 ) thrice/week, and the NcRF group underwent four 30-minute treatments with NcRF on the abdominal area once/week. Waist/hip ratio (W-to-H ratio), intra-abdominal fat thickness (IAFT), and the subcutaneous-abdominal fat thickness (SAFT) were observed at the baseline and after 4 weeks. RESULTS: The W-to-H ratio and SAFT reduced significantly in the PBMT group compared with either the control group (P = 0.001 and 0.001, respectively) or the NcRF group (P < 0.001 and P = 0.046, respectively) post-intervention. However, the IAFT and IAFT/SAFT ratio did not differ significantly among the study groups (P > 0.05). CONCLUSION: Our analysis shows that PBMT is more efficient than NcRF for the reduction of W-to-H ratio and SAFT in adolescents with obesity. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Pulsed Nd:YAG laser: effects on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy.

Hemophilic ankle arthropathy features joint pain, impaired postural control, and abnormal weight-bearing pattern. This study was designed to investigate the effects of pulsed Nd:YAG laser on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy. Forty children diagnosed with hemophilia type A (age, 8-16 years) were randomly allocated to either the treatment group (n = 20) who received a three-phase active therapy with pulsed Nd:YAG laser thrice/week (total energy was 1500 J) plus a physical exercise program for four consecutive weeks, or the placebo group (n = 20) who received placebo laser plus the physical exercise program. Pain, postural control (i.e., directional control [DC], endpoint excursion [EE], center-of-gravity movement velocity [CoG-MV], and maximum excursion [MXE]), and weight-bearing pattern (i.e., pressure peaks of the hindfoot [PP-HF] and forefoot [PP-FF], and the foot contact area [FCA]) were assessed pre- and post-treatment. The treatment group showed greater improvement in pain (P = .004), DC (P = .02), EE (P = .003), and CoG-MV (P = .003) compared to the placebo group. However, there was no statistically significant difference between both groups regarding the MXE (P = .15). In addition, the treatment group achieved favorable improvements in PP-HF (P = .003), PP-FF (P = .027), and FCA (P = .002) relative to the placebo group. Pulsed Nd:YAG laser is a potentially effective therapy for pain relief, postural control enhancement, and weight-bearing pattern adjustment in children with hemophilic ankle arthropathy.

Integrated Electromyography: Discriminant Analysis and Prediction of Recovery 3 to 6 Years After Brachial Plexus Birth Injury.

PURPOSE: To assess the recovery likelihood, 3 to 6 years after brachial plexus birth injury (BPBI), and predict the functional recovery from integrated electromyography (IEMG). METHODS: Thirty children with BPBI limited to C5-C6 lesion participated. Maximal electromyography activity of deltoid and biceps brachii was measured at entry. Shoulder and elbow functions were assessed at the baseline and at 4 intervals across 2 years. RESULTS: Shoulder and elbow function significantly changed across the follow-up period. Shoulder and elbow functions were significantly dependent on deltoid and biceps brachii muscles' IEMG level, respectively, with the groups showing higher IEMG achieving better recovery. The deltoid and biceps IEMG explained a portion of the improvement in shoulder and elbow function over 2 years. CONCLUSION: Recovery of the shoulder and elbow function continues 3 to 6 years after BPBI. IEMG may partially explain variation in the prognosis for children with BPBI.

Plyometric exercises: subsequent changes of weight-bearing symmetry, muscle strength and walking performance in children with unilateral cerebral palsy.

OBJECTIVE: To evaluate the subsequent effects of plyometric training on weight-bearing symmetry, muscle strength, and gait performance in children with unilateral cerebral palsy. METHODS: Thirty-nine children with spastic hemiplegia (age 8-12 years) were randomly divided into either the PLYO group (n=19, received a 30-minute plyometric exercise program plus the traditional physical rehabilitation, twice/week for eight consecutive weeks) or Non-PLYO group (n=20, received the traditional physical rehabilitation only). The weight-bearing symmetry index (WB-SI), maximum isometric muscle strength (MIMS) of quadriceps and hamstring muscles, and spatial-temporal gait parameters were assessed pre and post-intervention. RESULTS: From pre- to post-intervention, changes of WB-SI among PLYO and Non-PLYO groups did not differ significantly (P=.81; hindfoot and P=.23; forefoot). MIMS of quadriceps and hamstring muscles at 90° knee flexion (P=.008 and .013 respectively) increased significantly in PLYO compared to Non-PLYO group. Walking speed (P=.033), stride length (P=.002), and step time (P<.001) improved markedly in PLYO group more than in Non-PLYO group. The proportion of single leg support (P=.14) among PLYO and Non-PLYO groups did not differ significantly. CONCLUSION: Addition of plyometric exercises to the physical rehabilitation programs of children with unilateral CP could achieve greater improvement in muscles strength and walking performance, but not in WB-SI.

Effects of Radial Shockwave Therapy and Orthotics Applied with Physical Training on Motor Function of Children with Spastic Diplegia: A Randomized Trial.

Aims: To explore the effects of radial shockwave therapy (rSWT) combined with standard orthotic management (SOM) on spasticity, functional balance, and gait in children with spastic diplegia. Methods: Sixty children with diplegia were allocated to group I (rSWT, n = 20), group II (SOM, n = 20), or group III (rSWT + SOM, n = 20). All groups received a physical training program 3 times/week for 3 months. Assessments were completed before and immediately after the intervention and included the Hoffman reflex/Myogenic response ratio of the soleus muscle (H/M ratio), balance, and gait. Results: At a significance criterion adjusted to p ˂ .006, there were no between-group differences in balance or gait (p > .006). The rSWT + SOM group had a greater improvement of H/M ratio compared to rSWT alone (p = .001) but not to SOM alone (p = .04). Within-group analysis demonstrated significant improvement of all variables for rSWT + SOM (p ˂ .006). The H/M ratio and knee midstance angle exhibited clinically meaningful improvement for rSWT alone (p ˂ .006). No significant changes were observed in any variable for SOM alone (p > .006). Conclusions: Radial shockwave and orthotics together, or either of them along with physical training did not differ in improving balance or gait. Their combination was more effective than rSWT alone in reducing spasticity.

Effectiveness of a dose-graded aerobic exercise regimen on cardiopulmonary fitness and physical performance in pediatric survivors of acute lymphoblastic leukemia: a randomized clinical trial.

PURPOSE: To determine whether a 12-week supervised dose-graded aerobic exercise (D-GAE) training, when implemented in conjunction with traditional rehabilitation, could help pediatric survivors of acute lymphoblastic leukemia (ALL) enhance their cardiopulmonary capacity and improve their physical performance. METHODS: Fifty-eight pediatric survivors of ALL (age 13.78 ± 2.47 years; boys 60.34%) were assigned at random to either undergo the D-GAE in addition to the traditional physical rehabilitation (D-GAE group; n = 29) or the traditional physical rehabilitation solely (control group; n = 29). The cardiopulmonary fitness (peak oxygen uptake (VO2peak), ventilatory equivalent (VEq/VO2), minute ventilation (VE, L/min), oxygen pulse (O2P), maximum heart rate (HRmax), 1-min heart rate recovery (HRR1), and respiratory exchange ratio (RER)) and physical performance (6-min walk test (6-MWT), timed up and down stairs (TUDS), and 4 × 10-m shuttle run test (4 × 10mSRT)) were assessed on the pre- and post-intervention occasions. RESULTS: The mixed-model ANOVA revealed a meaningful increase of VO2peak (P = .002), VE (P = .026), O2P (P = .0009), HRmax (P = .004), and HRR1 (P = .011), and reduction of VEq/VO2 (P = .003) and RER (P = .003) in the D-GAE group compared with the control group. Besides, the analysis detected a favorable increase in the physical performance for the D-GAE group (6-MWT (P = .007), TUDS (P < .001), 4 × 10mSRT (P = .009)). CONCLUSION: A 12-week D-GAE program in conjunction with traditional rehabilitation holds promise in enhancing cardiopulmonary fitness and improving the physical performance of pediatric survivors of ALL. Clinicians and physical rehabilitation professionals can, therefore, integrate the D-GAE into the traditional rehabilitation protocols for such a patient population to optimize their cardiopulmonary fitness and physical function, while also facilitating a gradual transition to practice and adaption. IMPLICATIONS FOR CANCER SURVIVORS: The favorable outcomes of this study bolster the inclusion of D-GAE as a crucial element in the care and rehabilitation of pediatric survivors of ALL. By embracing these findings, healthcare professionals and oncologists can contribute to mitigating the long-term cardiopulmonary and physical complications associated with cancer treatments and fostering a state of enhanced well-being and increased physical activity among survivors.

Inspiratory muscle training impact on respiratory muscle strength, pulmonary function, and quality of life in children with chest burn: A randomized controlled trial.

PURPOSE: Respiratory muscle function is compromised in children recovering from chest wall burns, which potentially leads to more impact on exercise capacity and quality of life. This study investigates the effects of an inspiratory muscle training intervention accompanied with a pulmonary rehabilitation program on respiratory muscle strength, lung function, functional capacity, and quality of life in chest burned children. METHODS: Forty children with burns, aged from 10 to 18 years old and total body surface area of 30% to 50%, were randomly allocated to the inspiratory muscle training group (IMT- G: n = 20) or control group (CG: n = 20). They received IMT plus pulmonary rehabilitation or pulmonary rehabilitation with sham IMT, respectively for eight weeks. The outcomes were the respiratory muscle strength measured by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); lung functions (FEV1, FVC and FEV1/FVC ratio); functional capacity as well as Pediatric Quality of Life to measure physical and psychosocial functioning. outcome measures were assessed at before and after intervention (after eight weeks). RESULTS: Based on the pre-intervention assessments, we found no significant difference between both groups (p > 0.05). Significant post-intervention differences were reported between both groups in MIP (P = .003), MEP (P = .017), FVC (P = .001), FEV1 (P = .007), FEV1/FVC ratio (P = .028), functional capacity (P = .003), physical domain of QoL (P = .006) and psychological domain of QoL (P = .002) in favor of the IMT group. CONCLUSIONS: Eight weeks of inspiratory muscle training combined with pulmonary rehabilitation program improved children with chest burns' respiratory muscles strength, lung functions, functional capacity, and quality of life. Inspiratory muscle training may be employed in burn rehabilitation programs. It is a safe and effective therapy in chest burned children.

The key determinants of low back pain among lifestyle behaviors in adolescents: A cross-sectional study from Saudi Arabia.

Establishing preventive measures and treatment strategies for adolescents with low back pain (LBP) may be greatly enhanced by fully grasping the complex interaction between LBP and lifestyle behaviors. The key objective of this study was to explore the possible associations between lifestyle behaviors and LBP among adolescents in Saudi Arabia. A cross-sectional study was conducted among high school students from 5 major regions in Saudi Arabia. Participants were enlisted for the research project between May and November 2021. To evaluate the presence/severity of LBP, physical activity, sedentary duration, sleep quality, nutrition, health responsibility, interpersonal relationships, spiritual growth, and stress management, a well-established web-based survey was employed. A total of 2000 students participated, with 57.9% reporting LBP. Students with LBP had lower scores on overall health-promoting lifestyle behaviors and all subscales, including physical activity, compared to those without LBP. Linear regression analysis revealed significant associations between sedentary duration and global sleep quality with pain severity among students with LBP. This study highlights the association between lifestyle behaviors and LBP among adolescents in Saudi Arabia. Promoting physical activity, reducing sedentary behavior, and improving sleep quality may be crucial in preventing and managing LBP in this population. Comprehensive strategies targeting lifestyle behaviors should be implemented to improve the well-being of adolescents and reduce the burden of LBP. Further research is needed to better understand the underlying mechanisms and develop effective preventive and treatment strategies for LBP among adolescents.

Adolescents with hemophilic knee arthropathy can improve their gait characteristics, functional ability, and physical activity level through kinect-based virtual reality: A randomized clinical trial.

Background: Hemophilic arthropathy is caused by recurrent intra-articular bleeding, most commonly in the knee joints. In terms of physical impact, this arthropathy causes significant disability and hampers the physical activity and functionality of he affected individuals. Objective: This study intended to examine the effect of a physical rehabilitation program incorporating Kinect-based virtual reality (KBVR) on gait characteristics, functional ability, and physical activity level in adolescents diagnosed with hemophilic knee arthropathy (HKA). Materials and methods: In a randomized clinical trial, 56 boys, aged 10-14 years, with moderate HKA, were randomly allocated into two groups. The control group (n = 28) received conventional physical therapy (CPT), while the KBVR group (n = 52) received a 30-min KBVR exercise program in addition to the CPT. Training was conducted three times/week for 12 successive weeks. Gait characteristics (step length, cadence, velocity, peak knee extension moment during stance, and knee flexion amplitude during swing) were assessed using a gait analysis system, the functional ability was assessed through the 6-min walk test, and physical activity level assessed by the Adolescents' Physical Activity Questionnaire on the pre- and post-treatment occasions. Results: The KBVR group achieved more favorable changes in the gait characteristics [step length (P = 0.015), cadence (P = 0.004), velocity (P = 0.024), peak knee extension moment during stance (P = 0.018), and Knee flexion amplitude during swing (P = 0.032)], functional capacity (P = 0.002), and physical activity levels (P = 0.007) compared to the control group. Conclusion: The use of KBVR exercises within a rehabilitation program is a potentially effective therapeutic option for the total care of adolescents with HKA.