"There's definitely something wrong but we just don't know what it is": A qualitative study exploring rowers' understanding of low back pain.

OBJECTIVES: Low back pain is highly prevalent in rowing and can be associated with significant disability and premature retirement. A previous qualitative study in rowers revealed a culture of concealment of pain and injury due to fear of judgement by coaches or teammates. The aim of this study was to explore rowers' perspectives in relation to diagnosis, contributory factors, and management of low back pain. DESIGN: Qualitative secondary analysis. METHODS: We conducted a secondary analysis of interview data previously collected from 25 rowers (12 in Australia and 13 in Ireland). A reflexive thematic analysis approach was used. RESULTS: We identified three themes: 1) Rowers attribute low back pain to structural/physical factors. Most rowers referred to structural pathologies or physical impairments when asked about their diagnosis. Some participants were reassured if imaging results helped to explain their pain, but others were frustrated if findings on imaging did not correlate with their symptoms. 2) Rowing is viewed as a risky sport for low back pain. Risk factors proposed by the rowers were primarily physical and included ergometer training, individual technique, and repetitive loading. 3) Rowers focus on physical strategies for the management and prevention of low back pain. In particular, rowers considered stretching and core-strengthening exercise to be important components of treatment. CONCLUSIONS: Rowers' understanding of low back pain was predominantly biomedical and focused on physical impairments. Further education of rowers, coaches and healthcare professionals in relation to the contribution of psychosocial factors may be helpful for rowers experiencing low back pain.

Bloqueo de rama izquierda inducido por el ejercicio en la ergometría isotópica. Hallazgos y valor pronóstico / Exercise induced left bundle branch block in isotopic exercise test. Findings and prognostic value

Introducción: El bloqueo completo de rama izquierda inducido por el ejercicio (BCRI-IE) es un fenómeno poco frecuente y de significado incierto. El propósito del presente trabajo ha sido describir las características gammagráficas y el valor pronóstico de dicho hallazgo. Material y método: Se han revisado las características de 1.885 pacientes que habían acudido a nuestro servicio a realizarse una ergometría-GATED SPECT para diagnóstico de cardiopatía isquémica. Siete de ellos presentaron BCRI-IE en la prueba de esfuerzo. Se realizó coronariografía a 4 de los 7 pacientes. Estos pacientes se han seguido durante un tiempo medio de 30±8 meses. Se investigó la aparición de eventos cardiovasculares mayores. Resultados: La prevalencia del BCRI-IE fue del 0,37%. Seis de los 7 pacientes eran mujeres. La perfusión y la función miocárdicas fueron normales en 3 pacientes. Tres pacientes presentaron defectos fijos de la perfusión y uno un defecto reversible. Dos de estos pacientes presentaron una FEVI moderada-severamente deprimida. Las coronarias fueron normales en los 4 pacientes con defectos de la perfusión. Conclusiones: La prevalencia del BCRI-IE entre los pacientes que acudieron a realizarse una ergometría con estudio de perfusión miocárdica fue muy baja. El hallazgo fue mucho más frecuente en mujeres. En nuestra serie 2 pacientes presentaron cardiopatía estructural de origen no isquémico pero ninguno fue diagnosticado de enfermedad coronaria. En nuestra serie la presencia de BCRI-IE no se asoció a un mayor riesgo de eventos cardiovasculares mayores

Introduction: Exercise-induced left bundle branch block (EI-LBBB) is a rare circumstance of unknown significance. The purpose of this paper is to describe the scintigraphic features and the prognostic value of this finding. Material and methods: We reviewed the features of 1,885 patients who had visited our department to undergo GATED-SPECT ergometry to diagnose ischaemic heart disease. Seven patients showed EI-LBBB throughout the exercise testing. Coronary angiography was performed in 4 of them. Patients were followed-up over an average period of time of 30±8 months. The onset of major cardiovascular events was recorded during the follow-up period. Results: The prevalence of EI-LBBB was 0.37%. Six out of 7 patients were women. Myocardial function and perfusion were normal in 3 patients. Three patients had fixed perfusion defects and one patient had a reversible defect. Two out of the 4 patients showing perfusion defects presented a moderate-severe decrease of the left ventricular ejection fraction. None of the 4 patients with perfusion defects were found to have coronary disease on coronary angiography. Conclusions: The prevalence of EI-LBBB among the patients that came to undergo GATED-SPECT ergometry was very low. The finding was more frequent in women. In our series, 2 patients presented non-ischaemic structural heart disease, but no patient was diagnosed with coronary artery disease. In our patients the presence of EI-LBBB did not relate to a greater risk of experiencing a major cardiovascular event

Feasibility, safety, and reliability of exercise testing using the combined arm-leg (Cruiser) ergometer in subjects with a lower limb amputation.

BACKGROUND: Physical fitness of patients with a lower limb amputation predicts their walking ability and may be improved by physical exercise and training. A maximal exercise test is recommended prior to training in order to determine cardiovascular risks and design exercise programs. A potentially suitable ergometer for maximal exercise testing in patients with a lower limb amputation is the combined arm-leg (Cruiser) ergometer. The aim of this study was to determine feasibility, safety, and reliability of (sub)maximal exercise testing on the Cruiser ergometer in subjects with a lower limb amputation. METHODS AND FINDINGS: Subjects with a lower limb amputation performed 1 submaximal exercise test and 3 maximal exercise tests on the Cruiser ergometer. Feasibility was determined by examining whether key variables such as power output, heart rate and oxygen uptake were correctly and reliably measured, by determining whether a test was a maximal aerobic performance, by studying reasons for non-completion, and by measuring gross efficiency. Safety was analyzed by recording complications, electrocardiogram results, and blood pressure. Reliability was tested by comparing the results of the second and third maximal exercise test. Seventeen subjects (14 men and 3 women) out of 21 preselected subjects completed the study. In general, the maximal Cruiser exercise test was feasible. Almost 75% of the subjects reached a maximal aerobic performance. The test was also safe because no complications occurred, although electrocardiogram and blood pressure could only be reliably recorded in most subjects just before and after the test. Reliability was good: Intraclass correlation was 0.84 for peak oxygen uptake. CONCLUSIONS: The Cruiser ergometer is a feasible, safe, and reliable ergometer for measuring physical fitness of subjects with a lower limb amputation.

Impaired immune response to voluntary arm-crank ergometer exercise in patients with cervical spinal cord injury.

STUDY DESIGN: Non-randomized study. OBJECTIVE: The mechanism underlying exercise-induced argumentation of natural killer cell cytotoxic activity (NKCA) in humans remains unclear. To address this, NKCA responses were studied during and after exercise in persons with cervical spinal cord injury (CSCI) and dysfunctional sympathetic nervous system. SETTING: Kibikogen Rehabilitation Center for Employment Injuries. METHODS: We examined the NKCA responses to 20-min arm-crank ergometer exercise at 60% of maximum oxygen consumption in eight persons with CSCI (between C6 and C7) and six able-bodied subjects. NKCA, adrenaline, and cortisol were measured before, immediately after exercise, 1 h after exercise, and 2 h after exercise. RESULTS: In able-bodied subjects, NKCA increased immediately after exercise (P<0.01) and then decreased to below the pre-exercise level 1 h after exercise, before recovering to the baseline level at 2 h after exercise. Plasma adrenaline concentrations increased significantly immediately after exercise (P<0.01) and returned to the baseline level 1 h after exercise. The plasma cortisol level did not change throughout the study. In contrast, NKCA, plasma concentrations of adrenaline, and cortisol did not change throughout the study in subjects with CSCI. CONCLUSION: In subjects with CSCI, the lack of response in NKCA throughout the experiment is probably mainly due to a dysfunctional sympathetic nervous system.

Arm crank ergometry and shoulder pain in persons with spinal cord injury.

OBJECTIVE: To determine whether a primary fitness program utilizing arm crank ergometry would cause increased shoulder pain in persons with spinal cord injury (SCI). DESIGN: Cohort study. SETTING: Clinical research center. PARTICIPANTS: People (N=23) with chronic SCI (>1 y) who were participating in a weight loss study to compare the effectiveness of diet only (1000 kcal/d for 12 wk) versus diet with arm crank ergometry (1000 kcal/d and arm crank ergometry 3 times a week for 12 wk). INTERVENTION: Arm crank ergometry. MAIN OUTCOME MEASURE: Changes in shoulder pain intensity using the Wheelchair User's Shoulder Pain Index (WUSPI). RESULTS: After adjusting for baseline scores, there was no significant difference between the 2 groups on postintervention WUSPI scores (F(1,20)=.85, P=.37, partial eta2=.04). The strength of the relationship between group assignment (diet only vs diet and arm crank ergometry) and final WUSPI score was weak, as assessed by a partial eta2, with group assignment accounting for 4% of the variance on the WUSPI. The adjusted means were lower in the diet and arm crank ergometry group (mean, 7.84) than in the diet only group (mean, 12.22); however, these differences did not appear to be clinically significant. CONCLUSIONS: A primary fitness program using arm crank ergometry does not increase shoulder pain in people with SCI who use wheelchairs. Further investigation with a larger group and what constitutes clinically significant changes on the WUSPI is warranted to confirm our results.

Trombosis aguda de stent tras la realización de una ergometría precoz postimplante de stent / Acute stent thrombosis on exercise testing shortly after stent implantation

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Estudo clínico prospectivo de variáveis nutricionais e cardiorrespiratórioas de obesos tipo II e III submetidos à cirurgia bariátrica / The prospective clinical study of nutricional and cardiorespiratory variables of type II and III obese patients submitted do bariatric surgery

O objetivo foi avaliar a capacidade aeróbica, função pulmonar e composiçãao corporal de pacientes com obesidade classe ii e iii, no pré-operat¢rio e pós-operatório de cirurgia bariátrica. foram estudados prospectivamente 65 pacientes, com predomínio do sexo feminino ( 93,8), com média de idade de 40,4ñ8,36 anos e imc de 49,4ñ5,41 kg/m2. Foi realizado teste ergométrico, espirometria e impedência bioelétrica, para avaliar os parâmetros cardiorrespirat¢rios e de composição corporal do pré-operatório comparados com o primeiro seguimento (4-6 meses) e com o segundo (10-12 meses) pós-operatório, através do teste t de student para amostras pareadas, e correla‡ao de pearson (r) (p<0,05).