Maximal Exercise Tolerance, Objective Trunk Strength, and Mobility Measurements in Axial Spondyloarthritis.

OBJECTIVE: Although exercise therapy is safe, effective, and recommended as a nonpharmacological treatment for axial spondyloarthritis (axSpA), there is a lack of guidelines regarding type and dosage. Insufficient knowledge about physical and physiological variables makes designing effective exercise programs challenging. Therefore, the goal of this study was to simultaneously assess trunk strength, spinal mobility, and the cardiorespiratory fitness of patients with axSpA. METHODS: In a cross-sectional study, 58 patients with axSpA (mean age 40.8 yrs, 50% male, mean symptom duration 10.3 yrs) performed maximal cervical and trunk mobility and isometric strength tests in all planes (using David Back Concept devices) and a maximal cardiopulmonary bicycle exercise test (n = 25). Mobility and strength data were compared to healthy reference data. Cut-off values for clinical cardiopulmonary exercise testing interpretation were used to judge normality. Patients were compared based on radiographic involvement and symptom duration. RESULTS: Both strength (P ≤ 0.02) and mobility (P ≤ 0.001) were significantly lower for the patients with axSpA compared to the reference. Strength deficits were comparable between the radiographic and nonradiographic groups (P > 0.05, except trunk extension [P = 0.03]), whereas mobility showed higher deficits in the radiographic group (cervical extension [P = 0.02] and rotation [P = 0.01], and trunk extension [P = 0.03] and rotation [P = 0.03]), regardless of symptom duration. Similarly, symptom duration positively affected oxygen pulse (P = 0.03), relative anaerobic threshold (P = 0.02), and aerobic capacity (P = 0.02). CONCLUSION: In patients with axSpA, strength is more affected than mobility when compared to healthy controls. Likewise, mainly the metabolic component of aerobic capacity is impaired, affecting cardiopulmonary fitness. These findings indicate that future personalized exercise programs in patients with axSpA should incorporate exercises for cardiopulmonary fitness next to strength and mobility training.

The effect of ankle muscle strength and flexibility on dolphin kick performance in competitive swimmers.

The velocity of a swimmer is determined by biomechanical and bioenergetics factors. However, little is known about the effect of ankle flexibility on dolphin kick performance. Next to this, scientific evidence is lacking concerning the influence of ankle muscle strength. Therefore, the aim of this study was to investigate the effect of ankle flexibility and muscle strength on dolphin kick performance in competitive swimmers. Ankle range of motion (ROM) and ankle muscle strength were measured in 26 healthy competitive swimmers. The effect of both was assessed on the swimmer's velocity and lower extremity joint angles during three maximal dolphin kick trials. Additionally, the effect of a flexibility restriction by a tape on the dolphin kick performance was assessed. Correlations were calculated between the flexibility, muscle strength and dolphin kick performance and differences were investigated between the unrestricted and restricted condition. Muscle strength of dorsal flexors and internal rotators were positively significantly correlated with the velocity. Active and passive plantar flexion ROM and internal rotation ROM were not significantly correlated. A plantar flexion-internal rotation restriction during the dolphin kick showed a significant decrease in velocity. This restriction was associated with a changed movement pattern in the knee towards more flexion. The results suggest that dolphin kick velocity might be enhanced by ankle muscle strength exercises and that subjects with a restricted ankle flexibility might profit from a flexibility program.

Scapular muscle recruitment pattern: electromyographic response of the trapezius muscle to sudden shoulder movement before and after a fatiguing exercise.

STUDY DESIGN: Test-retest reliability study and single-group repeated measures design. OBJECTIVES: To evaluate the muscle latency times of the 3 portions of the trapezius muscle to a sudden arm movement in normal shoulders and to determine if this recruitment pattern is altered as a result of fatigue. BACKGROUND: It has been suggested that shoulder impingement may be related to altered muscle activity and muscle fatigue in the scapular stabilizers. Fatigue-induced changes in latency times of the trapezius might influence scapular stability. METHODS AND MEASURES: Muscle latency times were investigated in 30 healthy shoulders with surface electromyography. Muscle activity was measured in all 3 sections of the trapezius and the middle deltoid muscle during a sudden downward falling movement of the arm. Subsequently the shoulder was fatigued on an isokinetic dynamometer, after which muscle latency time measurement was repeated. RESULTS: ANOVA for repeated measures revealed significant differences in latency times (P < 0.05) among the 4 muscles of interest. Although there were no significant differences among the 3 sections of the trapezius muscle, they all were recruited after the initialization of the deltoid muscle. The recruitment order of the shoulder muscles did not change with muscle fatigue. However, after fatigue, muscle responses were significantly slower in all muscles except for the lower trapezius (P < 0.05). CONCLUSIONS: There is a specific recruitment sequence in the shoulder muscles in response to a sudden arm movement characterized by initial activation of the middle deltoid muscle and followed by simultaneous contraction of all 3 sections of the trapezius. This muscle activation pattern is delayed but not altered with fatigue.