Active behavioural physiotherapy intervention for acute non-specific neck pain: a cluster randomised double-blind pilot and feasibility clinical trial.

PURPOSE: To evaluate the feasibility of an active behavioural physiotherapy intervention (ABPI) and procedures to prevent the transition to chronicity in patients with acute non-specific neck pain (ANSNP). MATERIALS AND METHODS: A cluster-randomised double-blind (assessors and participants), parallel 2-arm (ABPI versus standard physiotherapy intervention [SPI]) pilot and feasibility clinical trial was conducted owing to a pre-specified published protocol. Six public hospitals were recruited and cluster-randomised (computer-generated randomisation with block sampling). Sixty participants (30 in each arm, 10 per hospital) were assessed at baseline and 3 months following baseline for neck disability index, numerical pain rating scale, cervical range-of-motion, fear-avoidance beliefs questionnaire and EuroQol 5-dimension 5-level. RESULTS: All procedures worked well. The participants' median age was 36.5 (range 21-59, interquartile range: 20.75) years. Participants in the ABPI demonstrated better improvement in all outcomes compared to SPI. Furthermore, the number of fully recovered participants following ABPI (27/30, 90.00%) was higher than SPI (16/30, 53.33%) with fewer treatment sessions and lower costs of management. CONCLUSIONS: The findings suggest that the ABPI is feasible and valuable (e.g. a high number of fully recovered participants, fewer treatment sessions and reduced management costs compared to the SPI) in conducting a future definitive trial to evaluate the effectiveness of the ANSNP management. TRIAL REGISTRATION: TCTR20180607001Implications for RehabilitationAn active behavioural physiotherapy intervention (ABPI) is feasible to manage acute non-specific neck pain.The ABPI demonstrated a high number of fully recovered participants, fewer treatment sessions and reduced management costs compared to the standard physiotherapy intervention.The ABPI is valuable to conduct a future definitive trial to evaluate the effectiveness of acute non-specific neck pain management.

Immediate effects of manual hyperinflation on cardiorespiratory function and sputum clearance in mechanically ventilated pediatric patients: A randomized crossover trial.

Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients. Objective: This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation. Methods: A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4 h provided between interventions. Results: The MHI treatment increased the tidal volume [ V t ; 1.2 mL/kg (95% CI, 0.8-1.5)] and static lung compliance [ C stat ; 3.7 mL/cmH2O (95% CI, 2.6-4.8)] immediately post-intervention compared with the baseline ( p < 0 . 05 ). Moreover, the MHI with suction induced higher V t [1.4 mL/kg (95% CI, 0.8-2.1)] and C stat [3.4 mL/cmH2O (95% CI, 2.1-4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7 g (95% CI, 0.6-0.8)] was greater in MHI with suction compared with suction alone ( p < 0 . 05 ). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ( p > 0 . 05 ) between interventions. Conclusions: MHI can improve V t , C stat and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

Translation, cross-cultural adaptation and psychometric evaluation of the Thai version of the fear-avoidance beliefs questionnaire in patients with non-specific neck pain.

OBJECTIVES: Fear-avoidance beliefs questionnaire (FABQ) is a self-report, valid and reliable questionnaire to quantify fear and avoidance beliefs related to physical activity and work. Furthermore, it can be used to predict prolong disability in patients with non-specific neck pain. Although it was originally developed to manage patients with low back pain, it has also been studied in individuals with neck pain. This questionnaire was translated into several languages following reports of potential benefits in patients with neck pain. Recently, Thai neck clinical trials, international multi-centre trials and data sharing are growing throughout the world but no validated Thai version of the FABQ is available for clinical and research uses. Our objectives were to translate and cross-culturally adapt the FABQ into Thai version and evaluate its psychometric properties in Thai patients with non-specific neck pain. METHODS: Cross-cultural translation and adaptation of the FABQ were conducted according to standard guidelines. A total of 129 participants with non-specific neck pain were invited to complete the Thai versions of the FABQ (FABQ-TH), neck disability index and visual analogue scale for pain intensity. Psychometric evaluation included exploratory factor analysis, internal consistency, test-retest reliability, agreement, and convergent validity. Thirty participants completed the FABQ-TH twice with a 48-h interval between tests to assess the test-retest reliability. RESULTS: Factor analysis identified four components for the FABQ-TH (66.69% of the total variance). The intraclass correlation coefficient of test-retest reliability was excellent for the total score (0.986), work attitudes (0.995), physical activity attitudes (0.958), physical activity experiences (0.927), and expected recovery (0.984). Cronbach's alpha for internal consistency was excellent (range 0.87-0.88) for all items. The minimal detectable change of the FABQ-TH was 5.85. The FABQ-TH correlated to its subscales (range 0.470-0.936), indicating the strongest association with work attitude. The weakest correlation was observed between the FABQ-TH and disability (rs =0.206, p=0.01). Missing data and significant floor or ceiling effects were not found. CONCLUSIONS: The Thai version of the FABQ for non-specific neck pain was successfully adapted. It is a valid and reliable instrument to quantify fear and avoidance beliefs among patients with non-specific neck pain who speak and read Thai.

Effects of high-intensity interval training on vascular function and maximum oxygen uptake in young sedentary females.

OBJECTIVE: Sedentary behavior is one of the risk factors for cardiometabolic diseases, including cardiovascular diseases, diabetes mellitus, and metabolic syndrome. High-intensity interval training (HIIT) is one effective way to reduce the risk of cardiometabolic diseases. This research studies the effects of cycling-based HIIT on vascular function and cardiorespiratory fitness in sedentary people. METHODS: Twenty-two female participants were separated into two groups, including HIIT group who receive intervention and control group who did not receive the intervention. Each of the participants was interviewed to collect and record their medical history, and medical parameters including cardio-ankle vascular index (CAVI), flow-mediated dilation (FMD), and maximal oxygen consumption (VO2max) were measured as a baseline pre-test. The intervention was a cycling-based HIIT lasting 6 weeks, with three sessions per week. During each session, the participant completed a set protocol consisting of 1 min on a cycle ergometer, cycling at 80-85% maximal heart rate, followed by a 1-min rest period. This sequence was repeated for a total of 5 times. RESULTS: After 6 weeks of intervention, results showed that the HIIT group had significant improvements in CAVI (6.39 ± 0.76 vs. 5.91 ± 0.58), FMD (9.26 ± 6.5 vs. 14.01 ± 4.3%), and VO2max (20.10 ± 4.31 vs. 24.34 ± 5.71 ml/kg/min) values compared to the pre-test (P < 0.05). In addition, HIIT increased endothelial function as measured by FMD compared to the control group (14.01 ± 4.3 vs. 9.15 ± 4.16 %, P < 0.05). CONCLUSION: Six weeks of HIIT were found to improve vascular function and cardiorespiratory fitness in sedentary people and demonstrated the benefits of HIIT as a time-efficient exercise strategy.

Diminished anaerobic and aerobic exercise fitness in the hemoglobin E traits.

BACKGROUND: There is no information about the exercise performances of the hemoglobin E trait (Hb EA), which is the second most prevalent hemoglobinopathy found in Southeast Asia and Mediterranean. The purpose of the present study was to compare both anaerobic and aerobic exercise performances between young male subjects with Hb EA and with normal hemoglobin (A2A). METHODS: One hundred and twenty-two subjects underwent Hb EA Test screening, which revealed the presence of 17 subjects with Hb EA and 105 subjects with A2A. Thirteen subjects in each of the Hb EA and the normal hemoglobin groups were matched for race, age, height, weight, BMI, %body fat and physical activity profiles. All subjects performed the peak power output and anaerobic capacity tests using the Wingate protocol and the direct VO2max tests using a bicycle ergometer. The results were analyzed with the unpaired t-tests. RESULTS: The Hb EA subjects had lower (P<0.05, unpaired t-test) relative peak anaerobic power (15.58±0.44 W.kg-1, mean±SEM), relative anaerobic capacity (6.50±0.16 W.kg-1) and maximal oxygen uptake (VO2max) (27.39±1.65 mL.kg-1.min-1) when compared to normal hemoglobin group (17.39±0.48 W.kg-1, 7.21±0.18 W.kg-1 and 33.05±1.59 mL.kg-1.min-1, respectively). CONCLUSIONS: The present study suggests that anaerobic exercise and aerobic exercise performances of the Hb EA subjects may be lower than matched normal hemoglobin subjects using the Wingate and the VO2max tests. However, the mechanisms of these results should be further investigated.

Muscle metabolic responses during high-intensity intermittent exercise measured by (31)P-MRS: relationship to the critical power concept.

We investigated the responses of intramuscular phosphate-linked metabolites and pH (as assessed by (31)P-MRS) during intermittent high-intensity exercise protocols performed with different recovery-interval durations. Following estimation of the parameters of the power-duration relationship, i.e., the critical power (CP) and curvature constant (W'), for severe-intensity constant-power exercise, nine male subjects completed three intermittent exercise protocols to exhaustion where periods of high-intensity constant-power exercise (60 s) were separated by different durations of passive recovery (18 s, 30 s and 48 s). The tolerable duration of exercise was 304 ± 68 s, 516 ± 142 s, and 847 ± 240 s for the 18-s, 30-s, and 48-s recovery protocols, respectively (P < 0.05). The work done >CP (W>CP) was significantly greater for all intermittent protocols compared with the subjects' W', and this difference became progressively greater as recovery-interval duration was increased. The restoration of intramuscular phosphocreatine concentration during recovery was greatest, intermediate, and least for 48 s, 30 s, and 18 s of recovery, respectively (P < 0.05). The W>CP in excess of W' increased with greater durations of recovery, and this was correlated with the mean magnitude of muscle phosphocreatine reconstitution between work intervals (r = 0.61; P < 0.01). The results of this study show that during intermittent high-intensity exercise, recovery intervals allow intramuscular homeostasis to be restored, with the degree of restoration being related to the duration of the recovery interval. Consequently, and consistent with the intermittent CP model, the ability to perform W>CP during intermittent high-intensity exercise and, therefore, exercise tolerance, increases when recovery-interval duration is extended.

Muscle metabolic determinants of exercise tolerance following exhaustion: relationship to the "critical power".

We tested the hypothesis that muscle high-energy phosphate compounds and metabolites related to the fatigue process would be recovered after exhaustion during recovery exercise performed below but not above critical power (CP) and that these changes would influence the capacity to continue exercise. Eight male subjects completed single-leg, knee-extension exercise to exhaustion (for ∼180 s) on three occasions, followed by a work-rate reduction to severe-intensity exercise, heavy-intensity exercise (CP conditions (at least 10 min and 39 ± 31 s, respectively; P < 0.05). During passive recovery and CP recovery exercise, neither muscle [PCr] nor pH recovered, reaching ∼37% of the initial baseline and 6.6 ± 0.2, respectively. These results indicate that the muscle metabolic dynamics in recovery from exhaustive >CP differ according to whether the recovery exercise is performed below or above the CP. These findings confirm the importance of the CP as an intramuscular metabolic threshold that dictates the accumulation of fatigue-related metabolites and the capacity to tolerate high-intensity exercise.

Effects of pacing strategy on work done above critical power during high-intensity exercise.

PURPOSE: We investigated the influence of pacing strategy on the work completed above critical power (CP) before exhaustion (W>CP) and the peak V˙O2 attained during high-intensity cycling. METHODS: After the determination of VO(2max) from a ramp incremental cycling (INC) test and the estimation of the parameters of the power-duration relationship for high-intensity exercise (i.e., CP and W') from a 3-min all-out cycling test (AOT), eight male subjects completed a cycle test to exhaustion at a severe-intensity constant work rate (CWR) estimated to result in exhaustion in 3 min and a self-paced 3-min cycling time trial (SPT). RESULTS: The VO(2max) determined from INC was 4.24 ± 0.69 L · min(-1), and the CP and the W' estimated from AOT were 260 ± 60 W and 16.5 ± 4.0 kJ, respectively. W>CP during SPT was not significantly different from W>CP during CWR (15.3 ± 5.6 and 16.6 ± 7.4 kJ, respectively), and these values were also similar to W(>CP) during INC (16.4 ± 4.0 kJ) and W' estimated from AOT. The peak VO(2) during SPT was not significantly different from peak VO(2) during CWR (4.20 ± 0.77 and 4.14 ± 0.75 L · min(-1), respectively), and these values were similar to the VO(2max) determined from INC and the peak VO(2) during AOT (4.10 ± 0.79 L · min(-1)). CONCLUSION: Exhaustion during high-intensity exercise coincides with the achievement of the same peak VO2 (VO(2max)) and the completion of the same W>CP, irrespective of the work rate forcing function (INC or CWR) or pacing strategy (enforced pace or self-paced). These findings indicate that exhaustion during high-intensity exercise is based on highly predictable physiological processes, which are unaffected when pacing strategy is self-selected.

.VO2max is not altered by self-pacing during incremental exercise.

We tested the hypothesis that incremental cycling to exhaustion that is paced using clamps of the rating of perceived exertion (RPE) elicits higher .VO2max values compared to a conventional ramp incremental protocol when test duration is matched. Seven males completed three incremental tests to exhaustion to measure .VO2max. The incremental protocols were of similar duration and included: a ramp test at 30 W min(-1) with constant cadence (RAMP1); a ramp test at 30 W min(-1) with cadence free to fluctuate according to subject preference (RAMP2); and a self-paced incremental test in which the power output was selected by the subject according to prescribed increments in RPE (SPT). The subjects also completed a .VO2max 'verification' test at a fixed high-intensity power output and a 3-min all-out test. No difference was found for .VO2max between the incremental protocols (RAMP1 = 4.33 ± 0.60 L min(-1); RAMP2 = 4.31 ± 0.62 L min(-1); SPT = 4.36 ± 0.59 L min(-1); P > 0.05) nor between the incremental protocols and the peak.VO2max measured during the 3-min all-out test (4.33 ± 0.68 L min(-1)) or the .VO2max measured in the verification test (4.32 ± 0.69 L min(-1)). The integrated electromyogram, blood lactate concentration, heart rate and minute ventilation at exhaustion were not different (P > 0.05) between the incremental protocols. In conclusion, when test duration is matched, SPT does not elicit a higher .VO2max compared to conventional incremental protocols. The striking similarity of .VO2max measured across an array of exercise protocols indicates that there are physiological limits to the attainment of .VO2max that cannot be exceeded by self-pacing.

Modeling the expenditure and reconstitution of work capacity above critical power.

PURPOSE: The critical power (CP) model includes two constants: the CP and the W' [P = (W' / t) + CP]. The W' is the finite work capacity available above CP. Power output above CP results in depletion of the W' complete depletion of the W' results in exhaustion. Monitoring the W' may be valuable to athletes during training and competition. Our purpose was to develop a function describing the dynamic state of the W' during intermittent exercise. METHODS: After determination of V˙O(2max), CP, and W', seven subjects completed four separate exercise tests on a cycle ergometer on different days. Each protocol comprised a set of intervals: 60 s at a severe power output, followed by 30-s recovery at a lower prescribed power output. The intervals were repeated until exhaustion. These data were entered into a continuous equation predicting balance of W' remaining, assuming exponential reconstitution of the W'. The time constant was varied by an iterative process until the remaining modeled W' = 0 at the point of exhaustion. RESULTS: The time constants of W' recharge were negatively correlated with the difference between sub-CP recovery power and CP. The relationship was best fit by an exponential (r = 0.77). The model-predicted W' balance correlated with the temporal course of the rise in V˙O(2) (r = 0.82-0.96). The model accurately predicted exhaustion of the W' in a competitive cyclist during a road race. CONCLUSIONS: We have developed a function to track the dynamic state of the W' during intermittent exercise. This may have important implications for the planning and real-time monitoring of athletic performance.

Exercise tolerance in intermittent cycling: application of the critical power concept.

PURPOSE: This study tested the relevance of the critical power (CP) model for explaining exercise tolerance during intermittent high-intensity exercise with different recovery intensities. METHODS: After estimation of CP and W' from a 3-min all-out test, seven male subjects completed, in randomized order, a cycle test to exhaustion at a severe-intensity constant-work-rate (S-CWR) and four cycle tests to exhaustion using different intermittent ("work-recovery") protocols (i.e., severe-severe (S-S), severe-heavy (S-H), severe-moderate (S-M), and severe-light (S-L)). RESULTS: The tolerable duration of exercise in S-CWR was 384 ± 48 s, and this was increased by 47%, 100%, and 219% for S-H, S-M, and S-L, respectively (all P < 0.05). Consistent with this, compared with S-CWR (22.9 ± 7.4 kJ), the work done above the CP was significantly greater by 46%, 98%, and 220% for S-H, S-M, and S-L, respectively (all P < 0.05). The slope of the relationship between V˙O2 and time was significantly reduced for S-H, S-M, and S-L (0.09 ± 0.02, 0.09 ± 0.01, and 0.07 ± 0.02 L·min⁻², respectively) compared with S-CWR (0.16 ± 0.03 L·min⁻², P < 0.05). In addition, the slope of the relationship between integrated EMG and time showed a systematic decline for S-H, S-M, and S-L compared with S-CWR (P < 0.05). CONCLUSIONS: These results indicate that, when recovery intervals during intermittent exercise are performed below the CP, exercise tolerance is improved in proportion to the reconstitution of the finite W'. The enhanced exercise tolerance with the lower-intensity recovery intervals was associated with a blunted increase in both V˙O2 and integrated EMG with time.

Elevated baseline VO2 per se does not slow O2 uptake kinetics during work-to-work exercise transitions.

We investigated whether the characteristic slowing of pulmonary oxygen uptake (VO2) kinetics during "work-to-work" exercise is attributable to elevations in baseline metabolic rate (VO2) as opposed to the elevated baseline work rate, per se. We hypothesized that a step transition to a higher work rate from "unloaded" cycling, but with elevations in VO2 [and heart rate (HR)] reflective of a work-to-work transition, would result in a lengthened phase II time constant (τ(p)). Seven male subjects (mean ± SD age 27 ± 10 yr) completed 1) transitions to a high-intensity work rate from a moderate-intensity work rate (M→H) and 2) two consecutive bouts of high-intensity exercise (U→H and E→H, respectively) initiated from unloaded cycling, with the time separating the exercise bouts chosen such that the baseline VO2 for the second transition was similar to the baseline VO2 for the M→H transition. The τ(p) for M→H (48 ± 16 s) was significantly greater (P < 0.05) than the τ(p) for U→H (28 ± 8 s) and E→H (27 ± 6 s), which did not differ significantly. These findings suggest that the altered VO2 dynamics that are observed during work-to-work exercise are not related to the elevated baseline VO2 (or HR) per se; rather, these effects appear to be linked to the elevated baseline work rate, which would be expected to dictate the subsequent muscle fiber recruitment profile.