Influence of elevated sleep-time blood pressure on vascular risk and hypertension-mediated organ damage.

We report the analysis of 252 hypertensive patients whose blood pressure (BP) was assessed by around-the-clock ambulatory BP monitoring compared to office BP measurement during a follow-up investigation of 8.7 y (SD: 2.43 y) that evaluated the added value of measuring sleep-time BP values. We found that 37.3% of the patients had mismatched diagnoses between the two techniques of BP assessment, with 11.5% of the patients showing white-coat hypertension and 25.8% masked hypertension. Only 12.3% of the diagnosed and treated patients presented normal BP values. Nocturnal (sleep-time) hypertension was present in 70.63%. The sleep-time systolic BP mean was found to be an independent vascular risk factor (F = 9.005, p < .001), indirectly measured through the 10-year risk of morbidity and mortality. Additionally, the elevated sleep-time systolic BP mean was a better marker of subclinical hypertension-mediated organ damage (ρ = 0.19, p < .01) than either the awake (ρ = 0.168, p < .01) or 24 (ρ = 0.184, p < .01) systolic BP means. In conclusion, the accuracy and sleep-time measurements provided by ambulatory BP make it particularly relevant in hypertension diagnosis and management. The use of the ambulatory BP measurement method could end up modifying current therapeutic targets, with sleep-time systolic BP mean becoming a main one, in order to optimize hypertension control and reduce hypertension-related organ pathology and cardiovascular disease morbidity and mortality.

The approach of physiatrists to low back pain across Europe.

BACKGROUND: Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE: The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS: The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS: The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION: The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

Effect of therapeutic horseback riding on balance and gait of people with multiple sclerosis.

BACKGROUND: Exercise therapy is an important part of symptomatic and supportive treatment in patients with multiple sclerosis (PwMS). According to the literature, equine-assisted therapies--such as therapeutic horseback riding (THR) and hippotherapy (HT)--are exercise therapies that can have positive physical effects on coordination, muscle tone, postural alignment, stiffness/flexibility, endurance and strength, correcting abnormal movement patterns and improving gait and balance. While HT is known to have a positive effect on balance in PwMS, data about THR are limited. OBJECTIVE: The aim of the present work was to determine the effect of THR on the balance and gait of ambulatory PwMS. METHODS: Twenty-seven PwMS were included in the study. Patients were divided into two groups: 12 underwent THR and 15 traditional physiotherapy (for both groups, two series of 10 weekly sessions were performed). Before and after the study period, the following outcome measures were applied: Extended Disability Status Scale (EDSS), Barthel Index, Tinetti Performance-Oriented Mobility Assessment (POMA). In addition, patients of the THR group underwent a gait analysis to assess spatiotemporal gait parameters and ground reaction forces. RESULTS: The THR group showed a significant improvement in POMA scores (p<0.005) and two gait parameters: stride time (p<0.04) and ground reaction forces (p<0.01). No statistically significant change was found in the control group. CONCLUSION: The results of the study show that THR can improve balance and gait of ambulatory PwMS. Findings are preliminary, but promising and in line with the recent literature.

Effects of training status on fibers of the musculus vastus lateralis in professional road cyclists.

OBJECTIVE: To evaluate possible changes occurring in muscle fibers related to the training status of professional road cyclists. DESIGN: A comparative study was performed on two groups of male road cyclists: ten 21-yr-old cyclists with a history of 3 yr of sport competition (RC21) and ten 25-yr-old cyclists with a history of 7 yr of competition (RC25). The control group was formed by two subgroups of five nontrained, sedentary volunteers who were matched for age with the study subjects (NT21 and NT25). Biopsies of the vastus lateralis muscle were obtained to determine the fiber variables: percentage, cross-sectional area, mitochondrial volume, and capillary density. RESULTS: Control group variables were within the normal range. According to their training status, cyclists showed an increased percentage of type I and IIC fibers (RC25 > RC21 > NT) and decreased percentage of type IIA (RC25 < RC21 < NT) and IIB fibers (RC25 = RC21 < NT), an increased cross-sectional area of all fiber types after 3 yr of training (RC25 = RC21 > NT) except IIB fibers (RC25 > RC21), an increased mitochondrial volume in all fiber types (RC25 > RC21 > NT) except type IIA fibers (RC25 > RC21 = NT21), and an increased capillary density (RC25 > RC21 > NT). CONCLUSIONS: Findings indicate a progressive increase in the muscle fiber types that are mostly implicated in endurance sports, accompanied by phenotypic changes in the fiber population of lesser participation.