Orthostatic Intolerance-Type Events Following Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty. METHODS: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool. RESULTS: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event. CONCLUSIONS: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy.

Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient-related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incorporating aerobic exercise, resistance training and pelvic floor muscle training programmes can positively influence the return to continence in men after radical prostatectomy. Traditional approaches to improving urinary continence after radical prostatectomy have typically focused on interventions delivered during the postoperative period (rehabilitation). However, the limited efficacy of these postoperative approaches has led to a shift from the traditional reactive model of care to more comprehensive interventions incorporating exercise-based programmes that begin in the preoperative period (prehabilitation) and continue after surgery. Comprehensive prehabilitation interventions include appropriately prescribed aerobic exercise, resistance training and specific pelvic floor muscle instruction and exercise training programmes. Transperineal ultrasonography is a non-invasive and validated method for the visualization of the action of the pelvic floor musculature, providing real-time visual biofeedback to the patient during specific pelvic floor muscle instruction and training. Importantly, the waiting time before surgery can be used for the delivery of comprehensive prehabilitation exercise-based interventions to increase patient preparedness in the lead-up to surgery and optimize continence and health-related quality-of-life outcomes following radical prostatectomy.

The test-retest reliability and criterion validity of a high-intensity, netball-specific circuit test: The Net-Test.

OBJECTIVES: To examine the test-retest reliability and criterion validity of a high-intensity, netball-specific fitness test. DESIGN: Repeated measures, within-subject design. METHODS: Eighteen female netball players competing in an international competition completed a trial of the Net-Test, which consists of 14 timed netball-specific movements. Players also completed a series of netball-relevant criterion fitness tests. Ten players completed an additional Net-Test trial one week later to assess test-retest reliability using intraclass correlation coefficient (ICC), typical error of measurement (TEM), and coefficient of variation (CV). The typical error of estimate expressed as CV and Pearson correlations were calculated between each criterion test and Net-Test performance to assess criterion validity. RESULTS: Five movements during the Net-Test displayed moderate ICC (0.84-0.90) and two movements displayed high ICC (0.91-0.93). Seven movements and heart rate taken during the Net-Test held low CV (<5%) with values ranging from 1.7 to 9.5% across measures. Total time (41.63±2.05s) during the Net-Test possessed low CV and significant (p<0.05) correlations with 10m sprint time (1.98±0.12s; CV=4.4%, r=0.72), 20m sprint time (3.38±0.19s; CV=3.9%, r=0.79), 505 Change-of-Direction time (2.47±0.08s; CV=2.0%, r=0.80); and maximum oxygen uptake (46.59±2.58 mLkg-1min-1; CV=4.5%, r=-0.66). CONCLUSIONS: The Net-Test possesses acceptable reliability for the assessment of netball fitness. Further, the high criterion validity for the Net-Test suggests a range of important netball-specific fitness elements are assessed in combination.

Effect of physical activity in the first five days after cardiac surgery.

OBJECTIVES: To quantify physiotherapist-supervised and independent physical activity undertaken from the first to the fifth day after cardiac surgery (POD1 to POD5), and to relate the amount of physical activity undertaken with hospital stay and postoperative physiological functional capacity on POD6. METHODS: Physiotherapist-supervised and independent physical activity were monitored in 83 adult patients undergoing cardiac surgery, using a bi-axial accelerometer and skin sensors that measured, galvanic skin response and body temperature. Patients completed a 6-min walk test (6MWT) on POD6. Step count and physical activity intensity (METs; metbolic equivalents) were the main outcome measures. RESULTS: Males exhibited significantly higher physiotherapist-supervised and independent physical activity step counts and time ≥ 3 METS (p < 0.0001). The 6MWT distance on POD6 was greater in men (mean 393 m, standard deviation (SD) 108 m) than women (mean 300 m, SD 121 m) (p = 0.005). Mean length of stay in hospital was 9 days (SD 3 days) and was negatively correlated with overall physiotherapist-supervised (R = -0.70), independent physical activity step counts (R = -0.62), and combined physiotherapist-supervised (R = -0.65) and independent (R = -0.43) physical activity time ≥ 3 METs. CONCLUSION: Physiotherapist-supervised activity fosters improvements in postoperative physiological functional capacity and reduces length of stay in hospital following cardiac surgery.

Regular walking improves plasma protein concentrations that promote blood hyperviscosity in women 65-74 yr with type 2 diabetes.

BACKGROUND: The purpose of the present study was to investigate the effects of regular treadmill walking on plasma factors that increase low-shear blood viscosity and red blood cell aggregation in older women with type 2 diabetes. METHODS: Eighteen women with type 2 diabetes (age: 69±3 yr; body mass index: 30.5±5.0 kg⋅m-2) performed 12-wk of 120 min⋅wk-1 of supervised treadmill walking at an intensity equivalent to the gas-exchange threshold. Peak exercise values, anthropometry and blood indices of diabetic status, markers of inflammation, and plasma fibrinogen were analysed during a 6-wk pre-training 'control' period, and then after 6 and 12-wk of regular walking. RESULTS: Regular walking significantly increased peak oxygen uptake (p = 0.01). Body mass, waist to hip ratio, and glycaemic control did not change. Systolic and diastolic blood pressures decreased by 8.5% (p < 0.01) and 7.2% (p < 0.01) respectively, cholesterol to high-density lipoprotein (HDL) ratio decreased by 9.6% (p = 0.01), and HDL concentration significantly increased (p = 0.01). While 12 wk of regular walking did not significantly alter plasma concentrations of interleukin-6 (IL-6), tumour necrosis factor-α, or C-reactive protein, plasma fibrinogen concentration decreased by 6.9% (p < 0.01) and plasma interleukin-10 (IL-10) concentration increased from 1.15±0.32 to 1.62±0.22 mmol⋅L-1 (p < 0.04). CONCLUSIONS: Improved plasma inflammatory profile and decreased plasma fibrinogen concentration is induced by regular walking, independent of glycaemic control. These factors may mediate the improved haemorheology associated with exercise training in metabolic disorders.

Preliminary findings in the heart rate variability and haemorheology response to varied frequency and duration of walking in women 65-74 yr with type 2 diabetes.

Heart rate variability (HRV) and haemorheology adaptations to 12 wk of varied-dose treadmill walking were investigated in women aged 65-74 yr with type 2 diabetes. Subjects were randomly allocated into two groups where exercise frequency and session duration were manipulated (Group 1: 2 × 60 min·wk(-1) or Group 2: 4 × 30 min·wk(-1)), but intensity and accumulated weekly duration of exercise were consistent between groups (100% gas-exchange threshold; 120 min·wk(-1)). Twelve weeks of exercise training significantly improved peak oxygen uptake, time to exhaustion, and gas-exchange threshold (p < 0.05), independent of exercise group. Exercise training did not significantly change glycaemic control or body mass. Red blood cell (RBC) aggregation and RBC deformability significantly decreased (p < 0.05) for both groups. No change in HRV was observed for Group 1, whereas several key indicators of HRV were significantly improved in Group 2 (p < 0.05). The present study was the first to report decreased RBC aggregation following an exercise-only intervention and that exercise training improved RBC aggregation without a concomitant improvement in glycaemic control. The accumulated weekly exercise duration may be the most important training component for the prescription of exercise in older women with type 2 diabetes.

Biochemical and endocrine responses to impact and collision during elite Rugby League match play.

The purpose of this study was to investigate the relationship between the prematch and short-term postmatch biochemical and endocrine responses to the intensity, number, and distribution of impacts associated with collisions during elite Rugby League match play. Seventeen elite male Rugby League players each provided blood and saliva samples 24 hours prematch, 30 minutes prematch, 30 minutes postmatch, and then at 24-hour intervals for a period of 5 days postmatch to determine plasma creatine kinase concentration ([CK]) and salivary cortisol concentration ([sCort]). The intensity, number, and distribution of impact forces experienced by players during match play were recorded using portable global positioning systems (GPSs). The change in the dependent variables at each sample collection time was compared to 24 hours prematch and 30-minute prematch measures. The [CK] and [sCort] increased significantly (p < 0.05) during match play. Significant correlations (p < 0.05) were observed between the number of hit-ups and peak [CK] 24 hours postmatch, 48 hours postmatch, and 72 hours postmatch (p < 0.05). The number of impacts recorded in zone 5 (8.1-10.0G) and zone 6 (>10.1G) during match play was significantly correlated (p < 0.05) to [CK] 30 minutes postmatch, 24 hours post, 48 hours post, and 72 hours postmatch. The GPS was able to provide data on the intensity, number, and distribution of impacts resulting from collisions during match play. Elite Rugby League match play resulted in significant skeletal muscle damage and was highly dependent on the number of heavy collisions >8.1G. [CK] remained elevated 120 hours postmatch identifying that at least 5 days modified activity is required to achieve full recovery after elite Rugby League match play.

Performance analysis of elite Rugby League match play using global positioning systems.

The aim of this study was (a) to examine the physiological demands of competitive Rugby League match play using portable Global Positioning Systems (GPSs) to monitor players' movement patterns and heart rate (HR) and (b) examine positional comparisons to determine if players' physiological requirements are influenced by their playing position during Rugby League match play. Twenty-two elite male Rugby League players were monitored during 5 regular season competition matches using portable GPS software. There was no difference in the total distance traveled between backs (5,573 ± 1,128 m) and forwards (4,982 ± 1,185 m) during match play. Backs and forwards had an average HR of approximately 80% of their maximum (162 ± 11 and 165 ± 12 b · min(-1), respectively) throughout each match. Backs achieved greater maximum running speed (8.6 ± 0.7 m · s(-1)), completed a greater number of sprints (18 ± 6), had less time between sprints (3.2 ± 1.1 minutes), achieved a greater total duration of sprinting (44.7 ± 9.1 seconds), and covered more distance sprinting (321 ± 74 m) than forwards did (6.8 ± 0.7 m · s(-1), 11 ± 5, 5.2 ± 2.2 minutes, 25.8 ± 9.2 seconds, and 153 ± 38 m, respectively). The GPS successfully provided real-time feedback to identify significant positional differences in distances covered, running speed characteristics, and the physiological demands of competitive Rugby League match play.

The role of rate of force development on vertical jump performance.

The purpose of this study was to examine a) the relationship between rate of force development (RFD) and vertical jump (VJ) performance during a counter movement jump (CMJ), and b) the reliability of RFD recorded during the CMJ and squat jump (SJ) forms of the VJ. Twenty-three physically active men aged 23 ± 3.9 years participated in the study. Subjects completed 3 unloaded CMJ and 3 unloaded SJ in random order on a force plate. The RFD was measured during CMJ and SJ movements with vertical jump displacement (VJD) measured simultaneously during the CMJ only. Subjects incorporated arm swing to their CMJ technique to reach up as high as possible, and VJD was measured. All SJ were executed with both hands on the hips throughout the full range of movement. Peak rate of force development (PRFD), peak force (PF), and time to peak force (TPF) were significantly correlated to VJD during the CMJ (r = 0.68, r = 0.51, and r = -0.48, respectively). The RFD and TPF during the CMJ and SJ were associated with low test-retest reliability (coefficient of variation [CV]: 11.8-7.9%). Peak and average power, PF, and VJD produced high test-retest reliability (CV: 2.8-5.1%) during both the CMJ and SJ movements. Our results indicate that PRFD, a measure of explosive strength, and PF, a measure of maximal strength, are the primary contributors to VJD during the CMJ in physically active men. However, caution must be used when interpreting data using PRFD because of its low retest reliability.

Markers of postmatch fatigue in professional Rugby League players.

The aim of the present study was to identify neuromuscular, biochemical, and endocrine markers of fatigue after Rugby League match play. Seventeen elite Rugby League players were monitored for a single match. Peak rate of force development (PRFD), peak power (PP), and peak force (PF) were measured during a countermovement jump (CMJ) on a force plate pre and postmatch play. Saliva and blood samples were collected 24 hours prematch, 30 minutes prematch, 30 minutes postmatch, and then at 24-hour intervals for a period of 120 hours to determine plasma creatine kinase concentration ([CK]) and salivary cortisol concentration ([sCort]). There were significant (p < 0.05) decreases in PRFD and PP up to 24 hours postmatch with PF significantly (p < 0.05) decreased immediately postmatch. The [sCort] significantly (p < 0.05) increased from 24 hours prematch to 30 minutes prematch and up to 24 hours postmatch compared with 24 hours prematch. Plasma [CK] significantly (p < 0.05) increased 30 minutes postmatch with a peak occurring 24 hours postmatch and remained elevated above 24 hours prematch for at least 120 hours postmatch. There were significant (p < 0.05) correlations between the increase in [CK] and reduction in PRFD 30 minutes postmatch and 24 hours postmatch. The [sCort] was significantly (p < 0.05) correlated with the reduction in PF 30 minutes postmatch. Results demonstrate that neuromuscular function is compromised for up to 48 hours after match play. Elevated [CK] despite 120-hour recovery indicate that damage to muscle tissue after Rugby League match play may persist for at least 5 days postmatch. Despite the prolonged presence of elevated [CK] postmatch, strength training 48 hours postmatch may have resulted in a compensatory increase in PRFD supporting the inclusion of strength training during the short-term postmatch recovery period.

Heart rate variability is related to impaired haemorheology in older women with type 2 diabetes.

Impaired heart rate variability (HRV)and haemorheology are independently associated with cardiovascular disease and diabetic complications. The aim of the present study was to investigate the relationships between parameters of HRV,and red blood cell (RBC) aggregation and deformability, in older women with type 2 diabetes. Twenty women (age 69 ± 2 yr) with uncomplicated type 2 diabetes and twenty controls (age 69 ± 3 yr) participated in the study. Beat-to-beat cardiac (RR) intervals over 5 min were analysed for HRV parameters in the time and frequency domains. Blood was sampled for RBC deformability, as well as RBC aggregation in two suspending mediums: haematocrit adjusted plasma and 3% dextran 70. RBC aggregation was increased and HRV was impaired for those with type 2 diabetes when compared with control. RBC aggregation was negatively related to low frequency power of HRV, and was positively related to high frequency power of HRV, for subjects with type 2 diabetes. RBC deformability was positively related to HRV only for those with type 2 diabetes. Impaired haemorheology is associated with reduced HRV in older women with type 2 diabetes, suggesting changes in the microcirculation may result in impaired modulation of cardiac cycles.

Creatine kinase and endocrine responses of elite players pre, during, and post rugby league match play.

The purpose of the present study was to (a) examine player-movement patterns to determine total distance covered during competitive Rugby League match play using global positioning systems (GPSs) and (b) examine pre, during, and postmatch creatine kinase (CK) and endocrine responses to competitive Rugby League match play. Seventeen elite rugby league players were monitored for a single game. Player movement patterns were recorded using portable GPS units (SPI-Pro, GPSports, Canberra, Australia). Saliva and blood samples were collected 24 hours prematch, 30 minutes prematch, 30 minutes postmatch, and then at 24-hour intervals for a period of 5 days postmatch to determine plasma CK and salivary testosterone, cortisol, and testosterone:cortisol ratio (T:C). The change in the dependent variables at each sample collection time was compared to 24-hour prematch measures. Backs and forwards traveled distances 5,747 ± 1,095 and 4,774 ± 1,186 m, respectively, throughout the match. Cortisol and CK increased significantly (p < 0.05) from 30 minutes prematch to 30 minutes postmatch. Creatine kinase increased significantly (p < 0.05) postmatch, with peak CK concentration measured 24 hours postmatch (889.25 ± 238.27 U·L). Cortisol displayed a clear pattern of response with significant (p < 0.05) elevations up to 24 hours postmatch, compared with 24 hours prematch. The GPS was able to successfully provide data on player-movement patterns during competitive rugby league match play. The CK and endocrine profile identified acute muscle damage and a catabolic state associated with Rugby League match play. A return to normal T:C within 48 hours postmatch indicates that a minimum period of 48 hours is required for endocrine homeostasis postcompetition. Creatine kinase remained elevated despite 120 hours of recovery postmatch identifying that a prolonged period of at least 5 days modified activity is required to achieve full recovery after muscle damage during competitive Rugby League match play.