[Strength training with elastic bands: measure of its effects in cardiac rehabilitation after coronary diseases]. / Le renforcement musculaire par bandes élastiques : évaluation de ses effets dans le réentraînement à l'effort du coronarien.

OBJECTIVES: To compare high intensity strength training with weightlifting exercises or with elastic bands. SETTING: Outpatient unit of cardiac rehabilitation. TYPE: Prospective randomised clinical trial. POPULATION: Inclusion of coronary patients in phase II after medical or surgical treatment of a myocardiac infarction, without cardiac insufficiency; beta-blockers were accepted. METHOD: Evaluation of coronary patients at beginning and at the end of a 4 week cardiac rehabilitation program. It included progressive aerobic training according to Karvonen method for all the patients, associated with weightlifting exercises (Koch press) in the control group, or use of elastic bands in the experimental group. Cardiac rate, oxygen consumption at rest and at maximum power were the main criteria with also muscle strength of quadriceps, hamstrings, biceps brachii, latissimus dorsi and triceps brachii, body mass indexes, quality of life with SF-36, anxiety (stay T test) and perceived exertion with the Borg 10-point category-ratio scale, myotendinous injuries (Shaw scale). RESULTS: Twenty-six coronary patients, all male from 45 to 65 years old, all receiving beta-blockers, were included, 13 in each group. Control and experimental groups were initially similar. At the end of the 4 week program, all the two groups improved significantly their strength and power and there were no differences between the two groups. Perceived exertion was lower in the group using elastic bands and there were no myotendinous lesions. CONCLUSION: Strength training with elastic bands is a low-cost, attractive, playful technique, proposed to a group of coronary patients, which appears as effective in cardiac rehabilitation as individual weightlifting training.

[Is it necessary to rehabilitate coronary artery disease patients based on ventilatory threshold?]. / Faut-il rééduquer les coronariens au seuil ventilatoire ?

PURPOSE: To compare the efficiency of two programs of exercise-based rehabilitation that are different for heart rate (HR) training in patients with coronary artery disease: heart rate (HR) according to Karvonen formula (HR training =70% (max HR -rest HR) +rest HR) or HR recorded at the gas exchange ventilatory threshold (VT). TYPE: Controlled randomised clinical trial. SETTING: Cardiovascular rehabilitation unit. METHOD: Twenty-four male patients (54 +/-9.5 years old) with coronary artery disease were allocated at random to one of the two groups: KHR group (n =13) according to Karvonen formula (n =11), and VTHR group according to VT determined by exertion test (n =13). The exercised-based program was similar for all the patients, differing only in HR training (five daily sessions a week for four weeks). Assessment tests were performed at D1 and D28 and included: - an exercise test with measure of HR and double product (HR x blood pressure) at rest, submaximal and maximal intensity, with measure of oxygen consumption and gas exchanges at rest and at maximum exercise; - specific functional tests based on daily life activities; - dyspnea assessment at maximal intensity; - quality of life measurement by SF36. It was taken notice of the drugs taken by the patients, specially betablockers. RESULTS: At inclusion, the two groups were not different for parametric (age, body mass index) and non parametric values (medical or surgical treatment, comorbidity). Even though HR training was significantly different (p <10(-6)), at the end of the program there was a significant increase of power and oxygen consumption at VT (+42.6%, p <10(-6); +18.6%, p <10(-5)) and at maximal intensity (+18.7 %, p <10(-6); 14.2 %, p <10(-5)), but differences between the two groups were not significant; double product was significantly lower at rest (-13.9 %, p <10(-5)) and at submaximal exertion (-10.6 %, p < 10(-3)). Yet, the two groups differed in HR, and HR increased in VTHR group and decreased in KHR, the difference being significant at VT (p =0.05), at submaximal (p =0.037) and maximal exercise (p = 0.05). Dyspnea at maximal intensity was higher in VTHR but SF36 values were not different. DISCUSSION AND CONCLUSION: These results confirm the efficiency of cardiac training program according to Karvonen formula as to ventilatory threshold. However, there is a negative chronotropic effect of cardiac training according to Karvonen formula with a higher intensity, which corresponds to a less cardiac work for a same activity.

[Vascular explorations in the diagnosis of algodystrophy]. / Aportación de las exploraciones vasculares al conocimiento de la algodistrofia.

We applied to a group of 44 patients, clinically affected by algodystrophy, a protocol of vascular explorations (Doppler, capillaroscopy, basal plethysmography, reactive hyperemia test and measurements of the oxygen transcutaneous pressure) in order to analyze their contribution to the detection of such disease, concluding that Doppler, capillaroscopy and plethysmography do not contribute with quantifiable results. On the contrary, the reactive hyperemia test and the measurements of the oxygen transcutaneous pressure showed up as explorations able to quantify the degree of microcirculatory disorder in the algodystrophy and to allow its evolutive follow-up.

[Chemical neurolysis using alcohol (alcoholization) in the treatment of spasticity in the hemiplegic]. / Neurolyse chimique à l'alcool (alcoolisation) dans le traitement de la spasticité chez l'hémiplégique.

Spasticity is a source of disability for the hemiplegic patient. It leads to various disorders influencing the quality of gait: at the lower limb varus equinus foot deformity, toe-claw and/or hip adduction with adductors spasticity. At the upper limb, flexion deformity of the wrist and the hand makes grasp and grip ineffective and spasticity of the Pectoralis Major muscle is considered as a main cause of sympathetic dystrophy. Neurolysis with alcohol injection in the nerve trunk or at the motor point destroys the gamma fibers and reduces spasticity, without impairing motor command. The effects on spasticity, motricity, and deformity of 33 chemical neurolysis with alcohol are analysed with a six months follow-up (27 hemiplegic patients, 28 to 62 years old, mean = 54.5). The authors have used 60% alcohol concentration. Sciatic nerve injection significantly reduces triceps spasticity (7/11), improves the range motion of the ankle, and allows the patient to take off the ankle device. Those fair results are still present at the fourth month after injection. Similar results are reported after injection of the obturator nerve for hip adduction deformity (2/3), median nerve injection for wrist and hand deformity (6/6). Pectoralis Major injection in the motor point is effective for 10 of the 13 cases, preventing sympathetic reflex dystrophy or contributing to its dramatic improvement.

[Biphotonic absorptiometry of the foot: methodology and application to algodystrophy]. / L'absorptiométrie biphotonique du pied: méthodologie et application à l'algodystrophie.

A simple methodology for the evaluation of the bone mineral content of the foot by biphotonic absorptiometry is described. From the study of a test population, a pathological demineralization threshold of 10%, given that the measurement is expressed in g, has been defined at the level of the forepart of the tarsus. This threshold enables the significant distinction between the test population and a population with algodystrophy. Biphotonic absorptiometry seems to provide a quantitative diagnostic argument to complement the radiographical and scintigraphical examinations.