The Effect of Joint Hypermobility Syndrome on DOMS and Recovery Time.

Background: Previous research has reported that people with Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) generally experience a high rate of muscular injury and pain. However, there is limited research comparing the recovery times and length of Delayed Onset Muscle Soreness (DOMS) in individuals with JHS to non-hypermobile individuals in response to exercise. Hypotheses/Purpose: The purpose of this study was to investigate JHS and its effects on DOMS and its recovery time. Study Design: Quasi-experimental, observational comparison. Methods: Two groups including a hypermobile group (score >4 on Beighton Scale) and a non-hypermobile group all took part in five-second long standing eccentric bicep curls based using their one- repetition maximum (1-RM) of their dominant arm to failure in order to induce DOMS. Visual analog pain scale (VAS), McGill pain scale, resting arm angle, girth, and the pressure pain threshold, all domains of DOMS, were measured over a five-day period. Results were analyzed using ANOVA with time as the repeated factor. Results: Both groups experienced DOMS following the eccentric exercise. However, VAS reporting was significantly greater in the hypermobile group compared to the non-hypermobile group and there was a significant difference over time. However, other variables did not reveal any other significant findings between groups. Conclusion: Individuals with JHS may experience greater DOMS and require more time to recover between treatment sessions. Therapists need to be aware that patients with hypermobility may experience higher pain levels related to exercise, and they need to adjust treatment parameters appropriately. Level of Evidence: 2b.

Reducing thrombotic risks in video gamers: investigating the benefits of walking and compression sleeves on blood hemodynamics.

With the growing popularity of video gaming, deep vein thromboses are increasingly being reported in gamers. This study aimed to compare the effects of lower leg graduated compression sleeves and a 6-min walking break during prolonged gaming on blood flow and hemodynamics in competitive sport players to help mitigate this risk. Ten healthy gamers (19.6 ± 1.2 yr old; 9 men) consented to participate in this mixed-model crossover design study that consisted of three visits. In visit 1, participants engaged in continuous 2-h video game play wearing no compression (continuous). Visits 2 and 3 involved 2-h play wearing compression sleeves (compression) and 2-h game play interrupted at 1 h by a 6-min walk (walk). Doppler ultrasound measurements of the left popliteal artery were taken at 30, 60, 90, and 120 min, to record vessel diameter, blood flow velocity, and blood flow volume. Participants completed a survey to assess their perception of each approach. There was a significant interaction between conditions for blood flow and blood velocity (P = 0.01, P < 0.001). Post hoc analysis demonstrated a greater decrease in blood flow and blood velocity in the continuous group compared with the walk group at the 90-min mark (P = 0.04, P = 0.01). No differences were found between the compression and walk groups or between the continuous and compression groups (P = 0.42, P = 0.69). No interactions were observed in diameter, mean arterial pressure, or heart rate. This study suggests that incorporating a 6-min walk every 60 min during prolonged gaming is advisable to counteract the negative effects on blood flow hemodynamics.NEW & NOTEWORTHY A 6-min light-intensity walking break during gaming can effectively combat the adverse effects of prolonged sitting, surpassing compression garments. Prolonged sitting reduces blood flow velocity, potentially leading to deep vein thrombosis (DVT). Compression sleeves help, with superior results after a 6-min walk at 60 min. Although compression stockings offer moderate improvements, a 6-min active break proves more effective. These findings offer promising interventions for gamers' health, initiating guidelines to mitigate DVT risk during gaming.

The Acute Effect of Tissue Flossing on Pain, Function, and Perception of Movement: A Pilot Study.

Tissue flossing (TF) is a novel device that has been shown to cause peripheral compression and concurrent change in joint range of motion, perception of mobility and muscular performance. However, the effect of tissue flossing on pain, perception of mobility and function at the elbow joint has not been thoroughly investigated. The purpose of this pilot study was to examine the acute effect of TF on pain and upper extremity functional performance in subjects with musculoskeletal-related complaints of pain surrounding the elbow joint. We utilized a randomized crossover design. Nine resistance trained participants (8 men/1 woman) mean age 35.6 ± 10.7 took part in this study. We measured the following outcome measures; Pain Visual Analog Scale, Short Form McGill Pain Questionnaire II, pain-pressure threshold and hand grip dynamometry (HHD) pre and post and a Likert scale for movement ability questionnaire, posttest only, following a TF and placebo condition for each participant. TF resulted in significant improvement in all test measures, except HHD, pre to post (p ≤ 0.05). All pre to post changes were associated with large effect sizes for TF compared to the placebo condition applied to the elbow improves pain quality and intensity, perception of mobility and pain-pressure threshold in resistance trained individuals with a history of musculoskeletal pain for greater than 1 month. The results of this pilot study suggest that TF may function as an adjunct to treatment in the management of musculoskeletal pathologies at the elbow joint.

The relationship between academic success and sleep, stress and quality of life during the first year of physical therapy school.

Objective: The purpose of this study was to investigate the association between academic success and changes in predictor variables of aerobic fitness, sleep, stress and quality of life (QOL) in students enrolled in the first year of a physical therapist education program. Participants: This prospective longitudinal cohort study utilized 37 first-year Doctor of Physical Therapy students. Methods: We investigated the association between grade point average (GPA) and the various predictor variables. A multiple logistic regression model with backward selection was used to predict GPA. GPA greater than or equal to 3.5 or below 3.5 out of a 4.0 scale were used as the dichotomous events. Results: The regression model with the selected-out predictors was a good fit (p = 0.011). About 60% of the variation in the outcome GPA binary can be explained by the selected predictors that were the changes in sleep and QOL. Conclusions: Achieving academic success can be affected by changes in sleep and QOL.

Esports players, got muscle? Competitive video game players' physical activity, body fat, bone mineral content, and muscle mass in comparison to matched controls.

BACKGROUND: Esports players, like traditional athletes, practice for long hours and, thus, are vulnerable to the negative health effects of prolonged sitting. There is a lack of research on the physical activity and the health ramifications of prolonged sitting by competitive players. The purpose of this study was to investigate activity levels, body mass index (BMI), and body composition in collegiate esports players as compared to age-matched controls. METHODS: Twenty-four male collegiate esports players and non-esports players between 18 and 25 years of age signed a written consent to participate. Physical activity was examined using daily activity (step count) with a wrist-worn activity tracker. A questionnaire assessing physical activity was also administered. Secondary outcomes included body-fat percentage, lean-body mass, BMI, and bone mineral content measured using dual X-ray absorptiometry. RESULTS: The step count in the esports players was significantly lower than the age-matched controls (6040.2 ± 3028.6 vs. 12843.8 ± 5661.1; p = 0.004). Esports players exhibited greater body-fat percentage (p = 0.05), less lean body mass (p = 0.003), and less bone mineral content (p = 0.03), despite no difference in BMI between the esports and non-esports players. CONCLUSION: As compared to non-esports players, collegiate esports players were significantly less active and had a higher body-fat percentage, with lower lean body mass and bone mineral content. The BMIs showed no difference between the 2 groups. Esports athletes displayed significantly less activity and poor body composition, which are all correlated with potential health issues and risk of injury. BMI did not capture this difference and should not be considered as an accurate measure of health in competitive esports players.

Blood flow restriction resistance training in a recreationally active person with Parkinson's disease.

Background: Blood flow restriction (BFR) applied during low intensity resistance training (LIRT) exercise produces hypertrophy and strength gains equivalent to traditional training. The effectiveness of BFR-LIRT on persons with Parkinson Disease (PD) has not been investigated.Objective: To determine the effects of BFR-LIRT on a recreationally active person with PD in regards to function, strength, Restless Leg Syndrome (RLS) and safety. Methods: A single subject, A-B-A design was utilized. Each phase lasted 6 weeks. Outcome measures included: 30-second sit-to-stand; Timed Up and Go (TUG); RLS Questionnaire; 3-RM of Cybex Leg Press (LP); Leg Curl (LC); and Leg Extension (LE) measured every 3 weeks for 18 weeks. The intervention phase (B, weeks 6-12) included four lower extremity resistance exercises (LP, LC, LE, calf presses on the LP) with the addition of BFR. The two standard deviation band method was used to determine significance.Results: All outcome measures except the TUG improved significantly by the end of intervention phase.Conclusion: The combination of BFR with LIRT safely lead to an increase in lower extremity strength and function in a person with PD, while decreasing their RLS (improvement from moderate to mild symptoms) resulting in a better quality of life for the participant.

THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON FUNCTIONAL IMPROVEMENTS IN AN ACTIVE SINGLE SUBJECT WITH PARKINSON DISEASE.

BACKGROUND: Blood flow restriction (BFR) applied during low intensity exercise produces hypertrophy and strength gains equivalent to traditional training. Previous research has shown the positive effects of BFR on younger and older adults. However, the effectiveness of BFR on subjects with Parkinson Disease (PD) has not been investigated. HYPOTHESES/PURPOSE: The purpose of the study was to determine the effects of BFR on a recreationally active person with PD in regards to functional improvements and safety. The hypothesis was that BFR training will demonstrate improvements in motor function, gait and endurance, while decreasing symptoms associated with Restless Leg Syndrome (RLS) in a subject with PD. STUDY DESIGN: A single subject, B-A design was used. METHODS: The subject was an active 65-year-old male recreational boxer diagnosed with PD. Baseline data were measured on day one. The intervention (Phase B) consisted of five, two-minute bouts of walking on treadmill with lower extremity BFR cuffs interspersed with 1 minute rest, three times a week for six weeks, at 0 grade incline, and speed of 50 meters/min. The pressure increased from the initial 120 to 160 mmHg at the end of the phase B as per the subject's tolerance. A four-week baseline phase (A) without the BFR intervention followed phase B. The outcome measures which were measured every two weeks over the 10 weeks included: Timed Up and Go Test, 6-Minute Walk Test, 30-Second Chair Stand Test, and the RLS Questionnaire. RESULTS: All outcome measures steadily improved every two weeks during the six week intervention phase and steadily declined when the intervention was removed during the second four week baseline phase according to visual inspection of the graphed data points. CONCLUSION: The subject enjoyed and tolerated the intervention well without any adverse effects. The results were that BFR training can produce functional improvements, reduce restless leg syndrome symptoms and can be safely utilized with a subject with PD who wishes to maintain his ability to remain recreationally active.

The Effects of Aerobic Exercise and Gaming on Cognitive Performance.

The purpose of our study was to investigate the effects of video gaming, aerobic exercise (biking), and the combination of these two activities on the domains of cognitive performance: selective attention, processing speed, and executive functioning. The study was a randomized clinical trial with 40 subjects (mean age 23.7 ± 1.8 years) randomized to one of four thirty-minute conditions: video gaming, biking, simultaneous gaming and biking, and a control condition. Cognitive performance was measured pre and post condition using the Stroop test and Trails B test. A mixed design was utilized. While video gaming, biking, simultaneous gaming and biking conditions improved selective attention and processing speed (p < 0.05), only the bike condition improved the highest order of cognitive performance, executive function (p < 0.01). There were no changes in cognitive performance for the control condition. Previous studies have shown that if tasks approach the limits of attentional capacity there is an increase in the overall chance for errors, known as the dual-task deficit. Simultaneous biking and gaming may have surpassed attentional capacity limits, ultimately increasing errors during the executive function tests of our cognitive performance battery. The results suggest that the fatiguing effects of a combined physically and mentally challenging task that extends after the exercise cessation may overcome the eventual beneficial cognitive effects derived from the physical exercise.

Martial arts training attenuates arterial stiffness in middle aged adults.

PURPOSE: Arterial stiffness increases with age and is related to an increased risk of coronary artery disease. Poor trunk flexibility has been shown to be associated with arterial stiffness in middle-aged subjects. The purpose of our research study was to measure arterial stiffness and flexibility in healthy middle-aged martial artists compared to age and gender matched healthy sedentary controls. METHODS: Ten martial artists (54.0 ± 2.0 years), who practice Soo Bahk Do (SBD), a Korean martial art, and ten sedentary subjects (54.7 ± 1.8 years) for a total of twenty subjects took part in this cross-sectional study. Arterial stiffness was assessed in all subjects using pulse wave velocity (PWV), a recognized index of arterial stiffness. Flexibility of the trunk and hamstring were also measured. The independent variables were the martial artists and matched sedentary controls. The dependent variables were PWV and flexibility. RESULTS: There were significant differences, between the SBD practitioners and sedentary controls, in PWV (P = 0.004), in trunk flexibility (P= 0.002), and in hamstring length (P= 0.003). CONCLUSION: The middle-aged martial artists were more flexible in their trunk and hamstrings and had less arterial stiffness compared to the healthy sedentary controls. The flexibility component of martial art training or flexibility exercises in general may be considered as a possible intervention to reduce the effects of aging on arterial stiffness.

Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults.

Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit "Free Run" program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min(-1)) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min(-1)). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit "Free Run" with a self-selected intensity. We concluded that Nintendo Wii Fit "Free Run" may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.

Fatiguing upper body aerobic exercise impairs balance.

Douris, PC, Handrakis, JP, Gendy, J, Salama, M, Kwon, D, Brooks, R, Salama, N, and Southard, V. Fatiguing upper body aerobic exercise impairs balance. J Strength Cond Res 25(12): 3299-3305, 2011-There are many studies that have examined the effects of selectively fatiguing lower extremity muscle groups with various protocols, and they have all shown to impair balance. There is limited research regarding the effect of fatiguing upper extremity exercise on balance. Muscle fiber-type recruitment patterns may be responsible for the difference between balance impairments because of fatiguing aerobic and anaerobic exercise. The purpose of our study was to investigate the effect that aerobic vs. anaerobic fatigue, upper vs. lower body fatigue will have on balance, and if so, which combination will affect balance to a greater degree. Fourteen healthy subjects, 7 men and 7 women (mean age 23.5 ± 1.7 years) took part in this study. Their mean body mass index was 23.6 ± 3.2. The study used a repeated-measures design. The effect on balance was documented after the 4 fatiguing conditions: aerobic lower body (ALB), aerobic upper body (AUB), anaerobic lower body, anaerobic upper body (WUB). The aerobic conditions used an incremental protocol performed to fatigue, and the anaerobic used the Wingate protocol. Balance was measured as a single-leg stance stability score using the Biodex Balance System. A stability score for each subject was recorded immediately after each of the 4 conditions. A repeated-measures analysis of variance with the pretest score as a covariate was used to analyze the effects of the 4 fatiguing conditions on balance. There were significant differences between the 4 conditions (p = 0.001). Post hoc analysis revealed that there were significant differences between the AUB, mean score 4.98 ± 1.83, and the WUB, mean score 4.09 ± 1.42 (p = 0.014) and between AUB and ALB mean scores 4.33 ± 1.40 (p = 0.029). Normative data for single-leg stability testing for this age group are 3.9 ± 1.9. Higher scores reflect greater balance deficits. The AUB condition produced the greatest balance deficit. Our data provide evidence of the important role of the upper body in maintaining unilateral standing balance and supports its inclusion as part of rehabilitation and training protocols designed to improve balance.

A meta-analysis of the efficacy of laser phototherapy on pain relief.

OBJECTIVE: Laser phototherapy has been widely used to relieve pain for more than 30 years, but its efficacy remains controversial. To ascertain the overall effect of phototherapy on pain, we aggregated the literature and subjected the studies to statistical meta-analysis. METHODS: Relevant original studies were gathered from every available source and coded. Articles that met preestablished inclusion criteria were subjected to statistical meta-analysis, using Cohen's d statistic to determine treatment effect sizes. RESULTS: Fifty-two effect sizes were computed from the 22 articles that met the inclusion criteria. The resulting overall mean effect size was highly significant; d = +0.84 (95% confidence interval = 0.44-1.23). The effect size remained significant even when a high outlying d value was conservatively excluded from the analysis; d = +0.66 (95% confidence interval = 0.46-0.86). The fail-safe number associated with the overall treatment effect, that is, the number of additional studies in which phototherapy has negative or no effect on pain needed to negate the overall large effect size of +0.84, was 348. DISCUSSION: These findings warrant the conclusion that laser phototherapy effectively relieves pain of various etiologies; making it a valuable addition to contemporary pain management armamentarium.

Static stretching does not impair performance in active middle-aged adults.

Recent investigations with young, healthy adult subjects suggest that static stretching before activity decreases performance and should, therefore, be avoided. The purpose of this study was to assess the effects of an acute static stretching protocol on balance and jump/hop performance in active middle-aged adults. Ten subjects (6 men and 4 women aged 40-60 yr) from a martial arts school volunteered to take part in this research study. This was a repeated measures design. Subjects who stretched for 10 minutes using a 30-second hold during 1 session sat quietly for 10 minutes during the alternate session. Sessions were randomly assigned. The following dependent variables were compared: Dynamic Stability Index (DSI) for single-leg dynamic balance (smaller DSI = improved balance); distances for broad jump, single hop, triple hop, and crossover hop; elapsed time for a 6-m timed hop. Group means for balance were significantly different between the stretch and no-stretch conditions (3.5 +/- 0.7 vs. 4.3 +/- 1.4 DSI, respectively; p < 0.05). No significant differences were found between the group means of the stretch and no-stretch conditions for the dependent measures of broad jump, single hop, triple hop, crossover hop, and 6-m timed hop performance. Ten minutes of acute static stretching enhances dynamic balance and does not affect jump/hop performance in active middle-aged adults. Static stretching should be included before competition and before exercise in fitness programs of active middle-aged adults.

A meta-analysis of the efficacy of phototherapy in tissue repair.

OBJECTIVE: The effect of phototherapy on tissue repair was determined by aggregating the literature and using statistical meta-analysis to analyze pertinent studies published between 2000 and 2007. BACKGROUND DATA: Phototherapy has been used for more than 40 y; however, its efficacy on tissue repair remains contentious. METHOD: Related original studies were gathered from every available source. The papers were then screened and coded; those meeting pre-established inclusion criterion were subjected to meta-analysis, using Cohen's d statistic to determine treatment effect size. RESULTS: Seventy effect sizes were computed from the 23 papers that met the inclusion criteria. The overall mean effect obtained was highly significant, d = +1.94 (95% confidence interval = 0.58-2.50). Further analyses revealed a similarly positive effect of phototherapy on tissue repair in experimental animal studies, d = +2.60, and a small to moderately positive effect in human cases of tissue repair, d = +0.34. The fail-safe number associated with the overall effect was 869; i.e., the number of additional studies in which phototherapy has negative or no effect on wound healing needed to negate the overall large effect size of + 1.94. The corresponding fail-safe numbers for experimental animal and human tissue repair studies were 612 and 64, respectively. CONCLUSION: These findings indicate that phototherapy is a highly effective form of treatment for tissue repair, with stronger supporting evidence resulting from experimental animal studies than human studies.

Martial art training enhances the glutathione antioxidant system in middle-aged adults.

The purpose of this study was to compare the antioxidant capacity of physically active middle-aged martial artists to age-matched sedentary controls. Nine sedentary subjects (mean age 52.9 yr) and 9 martial artists (mean age 51.8 yr) who practice Soo Bahk Do, a Korean martial art and were age- and sex-matched performed a graded exercise test (GXT) using a modified Bruce protocol. Ages ranged from 41 to 58 years. A GXT has been shown to be an effective technique for inducing oxidative stress. Glutathione (GSH) is the body's most highly concentrated antioxidant, is the central component of the antioxidant system, and plays an essential role in protecting tissues against oxidative stress. Free radical oxidation leads to the transformation of GSH to glutathione disulfide (GSSG). Venous blood samples for GSH and GSSG were collected before and immediately after the GXT. Repeated measures analysis of variance were performed on the resting baseline values and immediate post-GXT values of GSH, GSSG, and GSH:GSSG to compare groups. The blood GSH, GSSG, and GSH:GSSG levels were significantly different (p < 0.001) between the 2 groups at rest and after the GXT. The Soo Bahk Do practitioners had higher resting levels of GSH and lower levels of GSSG and responded more effectively to acute oxidative stress than the age-matched sedentary controls. Soo Bahk Do appears to enhance the antioxidant defense system and may be an effective intervention for improving overall health by protecting against the adverse effects of oxidative stress that is associated with the free radical theory of aging. Health professionals should be aware of alternative methods of training, conditioning, and exercise that can improve the general adaptation response to oxidative stress.

The relationship between maximal repetition performance and muscle fiber type as estimated by noninvasive technique in the quadriceps of untrained women.

The purpose of this investigation was to establish a relationship between the number of repetitions an individual can complete at a predetermined load and their percentage of type II muscle fibers in their quadriceps. Subjects included 22 untrained women between the ages of 18 and 35. Day 1 consisted of noninvasive anthropologic testing, 1 repetition maximum (1RM) testing, and recording repetition performance at 70% 1RM. Day 2 consisted of isokinetic dynamometry to determine muscle fiber composition. Results were obtained and analyzed using the Pearson product correlation coefficient (r). The results demonstrated a fair-to-moderate relationship (Pearson r = -0.48, p = 0.02) that individuals with greater percentages of type II muscle fibers performed fewer repetitions at 70% 1RM. The results of this study demonstrate that muscle fiber type composition is an important variable to consider when designing training or rehabilitation programs.