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1.
Eur J Appl Physiol ; 123(6): 1241-1255, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36781425

RESUMO

PURPOSE: This study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI). METHODS: Seventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness ([Formula: see text]O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes. RESULTS: UBROW increased [Formula: see text]O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = - 0.56) and FMD% (r = - 0.60), both P < 0.05. CONCLUSION: These results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).


Assuntos
Aptidão Cardiorrespiratória , Traumatismos da Medula Espinal , Adulto , Humanos , Masculino , Feminino , Artéria Braquial , Fatores de Risco Cardiometabólico , Biomarcadores
2.
Spinal Cord ; 60(2): 190-192, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35046537

RESUMO

Public health guidelines and health promotion efforts have traditionally focused on weekly accumulation of moderate to vigorous physical activity (MVPA) via structured exercise. There has been a recent paradigm shift towards the organic incorporation of MVPA in daily leisure and non-leisure time, termed "Lifestyle Physical Activity" (LPA). However, this paradigm shift and the underlying research has neglected manual wheelchair users (MWCUs) with spinal cord injury (SCI), who could benefit from LPA. This article argues for expanding the LPA paradigm shift into research and health promotion efforts involving MWCUs with SCI. We suggest a working definition of LPA for MWCUs and candidate metrics for quantifying LPA. This is followed by brief overviews of LPA correlates, outcomes/consequences, and interventions and the need for theory based approaches to study these domains. We lastly suggest an approach for mitigating potential negative outcomes of increased LPA in MWCUs and suggest a research agenda.


Assuntos
Traumatismos da Medula Espinal , Cadeiras de Rodas , Exercício Físico , Humanos , Estilo de Vida , Saúde Pública , Traumatismos da Medula Espinal/epidemiologia
3.
Exp Aging Res ; 48(1): 86-98, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34096474

RESUMO

Postural control may be automated and leave residual attentional capacity for concurrent cognitive challenges - i.e. dual-task capacity. In old people and impaired individuals, the automatization is lost but dual-task performance may deteriorate even earlier in life.A convenience sample of 112 healthy individuals represented three subgroups: <30 years, 30-60 years and >60 years. They were challenged in a novel dual-task test on postural control and attentional capacity, which allowed participants to improve the performance time compared with their baseline provided they had residual attentional capacity to utilize leading cues in their movement strategies.Performance time in the baseline motor task (single task) increased with age, and relative improvement with cue (attentional capacity during dual task) decreased with age: correlation coefficients: 0.32 and -0.41. There were differences between the age groups in the improvement with cues: young 26.6% (6.6), middle aged 19.1% (12.2) and elderly 10.1% (11.6).In general, all age groups performed the task faster with cues, but individual differences were large. The middle-aged group as well as the elderly group had a poorer dual-task performance than the young group. This suggests that attentional capacity during dual-task balance may be affected even before the sixties.


Assuntos
Envelhecimento , Análise e Desempenho de Tarefas , Idoso , Atenção , Cognição , Sinais (Psicologia) , Humanos , Pessoa de Meia-Idade , Equilíbrio Postural
4.
Arch Phys Med Rehabil ; 102(4): 687-693, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33091383

RESUMO

OBJECTIVE: To identify physical activity barrier prevalence and severity among manual wheelchair users (MWCUs) and test whether barrier impact is associated with self-reported physical activity level (PAL). DESIGN: Cross-sectional survey. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) was translated from English to Danish and administered online. The BPAQ-MI includes barriers within 4 domains and 8 subdomains and queries if an item hindered physical activity participation in the last 3 months (yes/no). If "yes," participants graded barrier severity from very small (1) to very big (5). Barrier impact scores were summed within and across domains. SETTING: General community. PARTICIPANTS: Danish MWCUs (N=181; 52.5% female, mean age, 48±14y.). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PAL was rated from not active (1) to extremely active (10). Individual barrier prevalence (frequency, %) and severity (median [interquartile range]) was computed. Unadjusted (Spearman rank correlations, domains, subdomains) and adjusted (multivariate linear regression, subdomains) associations between PAL and barrier impact were computed. RESULTS: The 5 most prevalent barriers were reported by ≥49.6% of participants (2 intrapersonal and 3 community). The 5 most severe barriers all had a median of 5 (1 organizational and 4 community). Unadjusted analysis showed that PAL was inversely associated with total intrapersonal (r=-0.487, P<.01) and overall (r=-0.241, P<.01) impact and the intrapersonal "health" (r=-0.477, P<.01) and "beliefs/attitudes"(r=-0.307, P<.01) subdomains. Adjustment for shared variance revealed only the "health" subdomain impact score was independently associated with PAL (P<.001). CONCLUSIONS: Intrapersonal barriers were highly prevalent. Health-related barriers were inversely related to PAL. When organizational and community barriers were present, they were rated as particularly severe. These results provide novel information that can guide the design of future interventions aiming to increase MWCUs PALs.


Assuntos
Acessibilidade Arquitetônica , Atitude Frente a Saúde , Pessoas com Deficiência/psicologia , Exercício Físico , Cadeiras de Rodas , Adulto , Estudos Transversais , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Pain Med ; 17(6): 1174-80, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26814252

RESUMO

OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed bilaterally by pain pressure thresholds (PPTs). RESULTS: The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for all PPT sites except for the forearm (P < 0.012). Moreover, the PPTs on the leg were generally reduced on the injured side compared with the non-injured side (P < 0.04). CONCLUSIONS: This study suggests that localized, distal, and bilateral hyperalgesia are common following an isolated tibial shaft fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.


Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Hiperalgesia/etiologia , Dor Pós-Operatória/etiologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Hiperalgesia/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/epidemiologia , Adulto Jovem
6.
Arch Orthop Trauma Surg ; 136(10): 1395-402, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27498104

RESUMO

INTRODUCTION: To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. MATERIALS AND METHODS: The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months. RESULTS: Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001). CONCLUSIONS: Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.


Assuntos
Fixação Intramedular de Fraturas , Força Muscular , Qualidade de Vida , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Contração Isométrica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
7.
Arch Phys Med Rehabil ; 96(3): 395-401, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25450134

RESUMO

OBJECTIVE: To compare a computer-assisted home exercise program with conservative home-training following printed instructions in the rehabilitation of elderly patients with vestibular dysfunction. DESIGN: Single-blind, randomized, controlled trial. SETTING: Geriatric department of a university hospital. PARTICIPANTS: Patients with chronic dizziness due to vestibular dysfunction (N=63) were randomly assigned to either rehabilitation in the clinic followed by computer-assisted home exercises (intervention group: n=32) or rehabilitation in the clinic followed by home exercises according to printed instructions (control group: n=31). INTERVENTIONS: Patients in the intervention group received assisted rehabilitation by a computer program. MAIN OUTCOME MEASURES: Measurements at baseline and at 8 and 16 weeks were compared. These included the One Leg Stand Test, Dynamic Gait Index, Chair Stand Test, Motion Sensitivity Test, Short Form-12, Dizziness Handicap Inventory, and visual analog scale. RESULTS: Both groups improved significantly during 16 weeks of rehabilitation. However, neither t tests nor repeated-measures analysis of variance demonstrated any significant differences between the 2 groups. The overall compliance rate to computer program exercises during 16 weeks was 57%. CONCLUSIONS: A computer-assisted program to support the home training of elderly patients with vestibular dysfunction did not improve rehabilitation more than did printed instructions.


Assuntos
Tontura/reabilitação , Terapia por Exercício/métodos , Terapia Assistida por Computador/métodos , Doenças Vestibulares/reabilitação , Idoso , Doença Crônica , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Resultado do Tratamento , Doenças Vestibulares/fisiopatologia
8.
J Aging Phys Act ; 22(2): 269-75, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23752090

RESUMO

The aims of the current study were to examine the intrarater intersession reproducibility of the Nintendo Wii agility and stillness tests and explore the concurrent validity in relation to gold-standard force-plate analysis. Within-day intersession reproducibility was examined in 30 older adults (age 71.8 ± 5.1 yr). No systematic test-retest differences were found for the Wii stillness test; however, the Wii agility test scores differed systematically between test sessions (p < .05). The Wii stillness test yielded a test-retest ICC of .86 (95% CI 0.74-0.93), CV of 6.4%, LOA of 11.0, and LOA% of 17.9%. Likewise for the Wii agility test ICC was .73 (95% CI 0.50-0.86), CV 5.3%, LOA 1.8, and LOA% of 14.6%. Wii stillness scores correlated to force plate measures (r = .65-.82, p < .01), reflecting moderate to excellent validity. In conclusion, it appears that the Wii stillness test represents a low-cost, objective, reproducible, and valid test of undisturbed postural balance in community-dwelling older adults.


Assuntos
Equilíbrio Postural/fisiologia , Terapia Recreacional/instrumentação , Jogos de Vídeo/estatística & dados numéricos , Idoso , Feminino , Humanos , Vida Independente , Masculino , Reprodutibilidade dos Testes , Esportes/fisiologia
9.
Aging Clin Exp Res ; 25(3): 299-304, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23740580

RESUMO

BACKGROUND: Falls among the elderly are often associated with walking on uneven ground. Obstacle negotiation requires both postural reaction strategies and anticipatory strategies which may be impaired with age. Anticipatory strategies are necessary in many daily living situations such as crossing the street and negotiating a kerb. The aim of this study was to evaluate whether elderly and young people use different step adjustment strategies during the approach to a raised surface. METHODS: Eleven community-dwelling elderly adults and 14 young adults participated in the study. Characteristics in the gait pattern leading to the negotiation of a raised surface were examined by the use of an electronic gait mat in a laboratory setting. RESULTS: Both groups changed their gait pattern to adjust the placement of the last step leading to negotiation of the obstacle. The young participants had a tendency to gradually increase their step velocity and step length while the elderly participants slowed their velocity and shortened their step length. Major step length adjustments began four steps prior to ascending the platform among the young participants, but one step later among the elderly. CONCLUSION: Elderly people use more cautious anticipatory strategies. These strategies allow more time for postural adjustments, but they also result in a loss of forward momentum which may influence the negotiation of a raised surface negatively.


Assuntos
Envelhecimento/fisiologia , Antecipação Psicológica/fisiologia , Teste de Esforço , Marcha/fisiologia , Caminhada/fisiologia , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Equilíbrio Postural/fisiologia , Ajustamento Social , Fatores de Tempo
10.
Physiother Theory Pract ; 39(4): 761-771, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35068327

RESUMO

BACKGROUND: Patients with dizziness are severely affected in their daily life. The dizziness may be caused by vestibular neuritis and this condition may be severe and result in hospitalization. Qualified municipal rehabilitation services are warranted for these patients after edischarge from the hospital. However, very few specialized municipal initiatives in Denmark are targeting this patient group. METHODS: This paper reports on the development of a clinically applicable municipality-based vestibular neuritis rehabilitation program and evaluates the acceptability of this initiative. RESULTS: The study recognized the need for a rehabilitation program after hospital discharge. However, the program was not evaluated as acceptable for multiple reasons. The exercise program was applicable and feasible but was experienced as a limitation for the practitioner, when addressing other balance issues was needed. It proved challenging to inform both the administrative staff and the clinicians about the new rehabilitation service to allow for sufficient implementation. CONCLUSION: Although the rehabilitation program was not considered an unequivocal success, there were several derived valuable snowball effects of the program. This paper advocates that focus should not only lie on the success of a single program, but also explore the derived benefits for patients and organizations, as well as the practice-oriented knowledge these programs generate.


Assuntos
Neurite (Inflamação) , Doenças Vestibulares , Neuronite Vestibular , Humanos , Tontura , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/complicações , Neuronite Vestibular/reabilitação , Resultado do Tratamento , Vertigem , Neurite (Inflamação)/complicações , Doenças Vestibulares/complicações , Equilíbrio Postural
11.
J Spinal Cord Med ; : 1-11, 2023 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-37534922

RESUMO

OBJECTIVE: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up. DESIGN: Six-month follow-up. SETTING: University/hospital. PARTICIPANTS: Seventeen wheelchair-dependent participants with SCI. INTERVENTIONS: 12-week of exercise training (UBROW) or control (CON). OUTCOME MEASURES: Aerobic fitness (POpeak and V̇O2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report. RESULTS: Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, POpeak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either POpeak (P = 0.22) or V̇O2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities. CONCLUSION: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..

12.
Spinal Cord Ser Cases ; 8(1): 48, 2022 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-35487894

RESUMO

STUDY DESIGN: Exploratory clinical investigation. OBJECTIVES: To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI). SETTING: University exercise laboratory. METHODS: Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality. RESULTS: All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001). CONCLUSIONS: Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.


Assuntos
Traumatismos da Medula Espinal , Esportes Aquáticos , Cadeiras de Rodas , Estudos de Viabilidade , Humanos , Dor de Ombro , Traumatismos da Medula Espinal/complicações
13.
Disabil Health J ; 14(4): 101119, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34099418

RESUMO

BACKGROUND: Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers. OBJECTIVE: We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics. METHODS: Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers. RESULTS: Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r2≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r2=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064). CONCLUSIONS: Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.


Assuntos
Pessoas com Deficiência , Traumatismos da Medula Espinal , Cadeiras de Rodas , Adulto , Acessibilidade Arquitetônica , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção
14.
Nord J Psychiatry ; 64(3): 210-7, 2010 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-20100135

RESUMO

BACKGROUND: Persons with common mental disorders are at risk of lowered physical activity. AIMS: To investigate if patients with depressive and/or anxiety disorders can achieve a level of physical activity meeting public health recommendations, increase their physical fitness and quality of life (QoL) through participation in a physical exercise programme. METHODS: In a non-blinded controlled study, 48 patients referred by private psychiatric clinics and private general practices were either treated in an intervention (n=27) or a control group (n=21). The intervention group took part in 20 weeks of group exercise consisting of aerobic training and non-aerobic weight-lifting. All participants were interviewed and tested at baseline, week 20 and at week 32. RESULTS: The intervention group increased in physical activity (120 min/week) and VO(2)max (0.48 ml O(2)/min). The VO(2)max increase was maintained after a 12-week follow-up period. Findings should be conservatively interpreted because of high attrition rate. CONCLUSIONS: Patients with anxiety and/or depressive disorders who participated in a structured, supervised exercise programme achieved in accordance with public health recommendations a higher level of physical activity and VO(2)max. CLINICAL IMPLICATIONS: The clinical implications of the study may be a suggestion of offering physical exercise to milder and moderate severe cases of depression and anxiety.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Exercício Físico/psicologia , Adolescente , Adulto , Afeto , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Feminino , Seguimentos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Cooperação do Paciente/psicologia , Pacientes Desistentes do Tratamento/psicologia , Satisfação do Paciente , Inventário de Personalidade/estatística & dados numéricos , Educação Física e Treinamento , Aptidão Física , Psicometria , Recidiva , Adulto Jovem
15.
BMJ Open ; 10(10): e040727, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067301

RESUMO

INTRODUCTION: Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI. METHODS AND ANALYSIS: A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function. ETHICS AND DISSEMINATION: This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication. TRIAL REGISTRATION NUMBER: NCT04390087.


Assuntos
Traumatismos da Medula Espinal , Esportes Aquáticos , Cadeiras de Rodas , Fatores de Risco Cardiometabólico , Exercício Físico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medula Espinal
16.
Phys Ther Sport ; 35: 133-138, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554122

RESUMO

OBJECTIVES: Ankle sprains often lead to a history of recurrent injuries and functional joint instability. This study evaluated a new method for assessing functional impairment in patients with chronic ankle instability. DESIGN: Case-control study for construct validation purpose. SETTING: The participants were tested during one-leg standing for 20 s on an instrumented wobble board and on a balance platform. PARTICIPANTS: Twenty-five young people with previous ankle sprain and an instability score >11 in the "Identification of Functional Ankle Instability questionnaire" and an age-matched control group of 25 healthy individuals. MAIN OUTCOME MEASURES: Wobble board variation of tilt angle measured by two accelerometers placed horizontally in the board. RESULTS: The variation in angular tilt of the wobble board in the medio-lateral direction (standard deviation of tilt angle) was higher in the group with perceived ankle instability than in the control group: 1.5 (0.7) versus 1.1 (0.3). ICC for intra-tester reliability: 0.87 and correlation with COP area measures from the stable balance platform: 0.64. CONCLUSIONS: People with functional ankle instability display poorer postural stability in the medio-lateral direction when challenged on an unstable surface. The instrumented wobble board may serve as a relevant tool in the clinical evaluation of functional ankle stability.


Assuntos
Tornozelo/fisiopatologia , Teste de Esforço/instrumentação , Instabilidade Articular/diagnóstico , Equilíbrio Postural , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
17.
PLoS One ; 14(6): e0218371, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31246971

RESUMO

INTRODUCTION: Assessment of balance is key to identifying individuals with postural control deficits and an increased fall risk. Subjects may compensate for their deficits by utilizing other strategies; to avoid this, it is recommended to assess postural control using a dual-task test. In most dual-task tests, it is difficult to monitor the performance in the secondary task and the individual's task prioritisation. This study evaluated a new dual-task testing approach. MATERIALS AND METHODS: A convenience sample of 54 community-dwelling elderly (age 65+ years) and a reference group of 20 young participants were included in the study. They performed a test in which they could utilize cues to improve their baseline performance, provided their level of postural control allowed them residual attention capacity for this cognitive task. RESULTS: Significant performance differences were seen between the young and the elderly. The young group improved their performance time by 23.9% (10.7) and 7.1% (14.2) with a cue and a reverse cue, respectively, whereas the elderly failed to improve their performance time. The test was unable to distinguish between individuals within the elderly group due to a floor effect. DISCUSSION: The test reveals an individual's capacity to use cues for anticipatory postural control strategies in a dual-task setting and thereby estimates automatization of postural control. While the young subjects were capable of improving their performance during dual-task conditions, the elderly subjects apparently had no residual attentional capacity allowing them to utilize the facilitating cues. Within the elderly group, the dual-task aspects of the test added no value with respect to differentiation in the level of postural control.


Assuntos
Equilíbrio Postural , Postura , Análise e Desempenho de Tarefas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Sinais (Psicologia) , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores de Tempo
18.
Gait Posture ; 28(1): 62-8, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18023353

RESUMO

UNLABELLED: Balance reactions can be seen as responses to sensory information on a feedback basis, but when a balance threatening situation can be predicted, an anticipatory postural control strategy can be used. This study describes characteristics of proactive postural adjustments related to repetitive rhythmic perturbations. Furthermore, the study aimed to investigate age dependency of these anticipatory strategies. Fourteen young (age 27+/-2 years) and 10 community-dwelling elderly adults (76+/-5 years) participated in this study. Centre of pressure displacement was evaluated while the participants were standing on a moveable force plate. Perturbations consisted of alternating left/right frontal plane tilts of the platform or alternating forward/backward slides in the sagittal plane. Automation of postural control was evaluated by a dual task approach after familiarization to the perturbations. Centre of pressure displacement 200 ms before a tilt perturbation was significantly related to the direction of the perturbation. This early postural adjustment was significantly increased during the dual task condition. The dual task effect was more pronounced in the elderly, but this age-effect was not significant due to large inter-individual variation. The frequency of stepping reactions as response to slide perturbations decreased with conditioning, but increased again in the elderly during dual task condition. CONCLUSION: This study showed that both young and elderly use anticipatory postural control strategies to minimize the impact of predictable perturbations. The proactive postural adjustments are further enhanced when a concurrent cognitive task is introduced. Postural control seems less automated in elderly and becomes insufficient during very challenging perturbations.


Assuntos
Equilíbrio Postural/fisiologia , Adulto , Fatores Etários , Idoso , Humanos
19.
Hum Mov Sci ; 27(3): 496-512, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18226839

RESUMO

Walking is considered an automatic function which demands little attentional resources. Thus a residual attentional capacity is available for a concurrent task (dual task). Minor age-related deficits in postural control may minimize the residual attentional capacity, however this may not be detected by a simple examination of the individuals gait performance. This study investigated the use of challenging dual task combinations to detect age related changes in gait performance. Eleven community-dwelling elderly (mean age 76 years) and 13 young subjects (mean age 26 years) participated in the study. The participants walked along a figure-of-eight track at a self-selected speed. The effect of introducing a concurrent cognitive task and a concurrent functional motor task was evaluated. Stride-to-stride variability was measured by heel contacts and by trunk accelerometry. In response to the cognitive task the elderly increased their temporal stride-to-stride variability by 39% in the walking task and by 57% in the combined motor task. These increases were significantly larger than observed for the young. Equivalent decreases in trunk acceleration autocorrelation coefficients and gait speed were found. A combination of sufficiently challenging motor tasks and concurrent cognitive tasks can reveal signs of limited residual attentional capacity during walking amongst the elderly.


Assuntos
Marcha/fisiologia , Equilíbrio Postural , Postura/fisiologia , Caminhada/fisiologia , Atividades Cotidianas , Adulto , Idoso , Índice de Massa Corporal , Humanos , Seleção de Pacientes , Valores de Referência
20.
J Negat Results Biomed ; 6: 2, 2007 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-17257414

RESUMO

BACKGROUND: Falls amongst elderly people are often associated with fractures. Training of balance and physical performance can reduce fall risk; however, it remains a challenge to identify individuals at increased risk of falling to whom this training should be offered. It is believed that fall risk can be assessed by testing balance performance. In this study a test battery of physiological parameters related to balance and falls was designed to address fall risk in a community dwelling elderly population. RESULTS: Ninety-four elderly males and females between 70 and 80 years of age were included in a one year follow-up study. A fall incidence of 15% was reported. The test battery scores were not different between the fallers and non-fallers. Test scores were, however, related to self-reported health. In spite of inclusion of dynamic tests, the test battery had low fall prediction rates, with a sensitivity and specificity of 50% and 43% respectively. CONCLUSION: Individuals with poor balance were identified but falls were not predicted by this test battery. Physiological balance characteristics can apparently not be used in isolation as adequate indicators of fall risk in this population of community dwelling elderly. Falling is a complex phenomenon of multifactorial origin. The crucial factor in relation to fall risk is the redundancy of balance capacity against the balance demands of the individuals levels of fall-risky lifestyle and behavior. This calls for an approach to fall risk assessment in which the physiological performance is evaluated in relation to the activity profile of the individual.


Assuntos
Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Nível de Saúde , Humanos , Incidência , Modelos Logísticos , Masculino , Atividade Motora , Equilíbrio Postural , Valor Preditivo dos Testes , Medição de Risco , Autoavaliação (Psicologia) , Inquéritos e Questionários
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