One leg testing in hip and knee osteoarthritis: A comparison with a two-leg oriented functional outcome measure and self-reported functional measures.

OBJECTIVE: To compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments. METHOD: Data was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen's standardised mean difference for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests. RESULTS: The maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI 0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor (r = 0.188 to 0.226) (p = 0.018 to 0.048). CONCLUSION: The unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs.

Effects of exercise training in patients with chronic obstructive pulmonary disease--a narrative review for FYSS (Swedish Physical Activity Exercise Prescription Book).

The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. This review was performed in PubMed and Cochrane Library. Included studies investigated patients with COPD who had been randomised to exercise training or no training. Six systematic reviews were included. The methodological quality was scored using a grading system (GRADE). The analysis showed that aerobic and resistance training in patients in a stable state of COPD results in improved health-related quality of life and decreased dyspnoea, anxiety and depression (moderately strong scientific evidence, grade +++), and increased physical capacity and decreased dyspnoea in daily activities (limited scientific evidence, grade ++). In patients with an acute exacerbation, aerobic and resistance training, performed directly after the exacerbation, results in improved health-related quality of life (moderately strong scientific evidence, grade +++), improved exercise capacity and decreased mortality and hospitalisation (limited scientific evidence, grade ++). Thus, patients with COPD should be recommended to take part in exercise training.

Exercise-induced dyspnea is a problem among the general adolescent population.

RATIONALE: Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. OBJECTIVE: To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. METHODS: A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). RESULTS: Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often than the group without EID. No difference was found in the level of physical activity between participants with and without EID. CONCLUSION: Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms.

Hospital-based pulmonary rehabilitation in patients with COPD in Sweden--a national survey.

Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.

Extended NO analysis applied to patients with COPD, allergic asthma and allergic rhinitis.

The recommended method to measure exhaled nitric oxide (NO) cannot reveal the source of NO production. We applied a model based on the classical Fick's first law of diffusion to partition NO in the lungs. The aim was to develop a simple and robust solution algorithm with a data quality control feature, and apply it to patients with known alterations in exhaled NO. Subjects with allergic rhinitis, allergic asthma, chronic obstructive pulmonary disease (COPD) smokers and controls were investigated. NO was measured at three expiratory flow rates. An iteration method was developed to partition NO. The airway tissue content of NO was increased in asthma, 144 +/- 80 ppb (P = 0.04) and decreased in smokers, 56 +/- 36 ppb (P = 0.02). There was no difference between subjects with rhinitis, 98 +/- 40 ppb and controls, 98 +/- 44 ppb. The airway transfer rate was increased in allergic asthma and allergic rhinitis, 12 +/- 4 vs. 12 +/- 5 ml sec(-1), compared to controls, 8 +/- 2 ml sec(-1) (P < 0.001). The alveolar levels were no different from controls, 2 +/- 1 ppb. In COPD the alveolar levels were increased, 4 +/- 2 ppb (P < 0.001). Extended NO analysis reveals from where in the respiratory system NO is generated. Hence, this new test can be added to the tools the physician has for the diagnosis and treatment of patients with respiratory disorders.

Exercise-induced bronchoconstriction in adults with asthma--comparison between running and cycling and between cycling at different air conditions.

The bronchial response to cycling and running was compared in six adult asthmatic persons. The effects of different air conditions during cycling regarding the induction of bronchoconstriction was studied. The exercise consisted of 6 minutes' work at an intensity of 80-85% of maximal heart rate. Heart rate, oxygen consumption and ventilation were measured to check that the exercise level was the same in all tests. Peak expiratory flow (PEF) was used to test for bronchoconstriction. Bicycling and treadmill running were performed under indoor conditions and bicycling while breathing cold, dry air (-18 degrees C) and room-tempered humid air (60% RH), respectively. No difference in bronchoconstriction was found between cycling and running under indoor conditions. However, bicycling exercise with inhalation of cold dry air provoked more bronchoconstriction than when inhalating humid air (PEF reductions of 19.4+/-6% and 6.1+/-2%, respectively). No differences were found between the exercise modes in heart rate, oxygen consumption, ventilation per minute, respiratory rate, carbon dioxide elimination or subjective ratings of perceived exertion and breathlessness. It is concluded that it is not the type of exercise, but the ventilation demand and humidity of the inspired air that are the main determinants of the occurrence and degree of bronchoconstriction.

High-intensity physical training in adults with asthma. A comparison between training on land and in water.

The purpose of this study was to determine whether inactive asthmatic patients could perform high-intensity physical training equally well on land as in water, and to compare the effects of these training forms. Thirty-two adults with asthma, randomized into two groups, underwent a 10-week supervised rehabilitation program with emphasis on physical training. All patients, irrespective of training form, were able to exercise to maximal intensity (80-90% of estimated maximal heart rate). No asthmatic attacks occurred in connection with the training sessions. Respiratory variables remained almost unchanged in both groups. The asthma symptoms declined during the rehabilitation period, and the subjects needed less acute asthma care after the rehabilitation. The cardiovascular condition improved significantly and similarly in the two groups. Ten patients, 5 in each group, had exercise-induced asthma at the start of the rehabilitation. Only 3 patients, 2 from the water group and 1 from the land group, had exercise-induced asthma after 10 weeks. We conclude that indoor training, either on land or in water, is beneficial. The effects of these two training forms are almost equivalent.

Asthmatic patients' views of a comprehensive asthma rehabilitation programme: a three-year follow-up.

BACKGROUND AND PURPOSE: Twenty-one asthmatic patients aged 27-59 years, with mild to moderate asthma, participated in a 10-week group rehabilitation programme covering physical training and theoretical and practical education in medication, self-management strategies and physiotherapy. This study was undertaken retrospectively to investigate (1) the patients' reasons for joining the programme, (2) their experiences of the programme, and (3) their ways of coping with disease-related problems before joining and three years after completion of the programme. METHODS: Patients were followed up every six months for three years and were interviewed after the three years. The semi-structured interviews were tape-recorded, transcribed and revised. RESULTS: The life-situation of most of the patients before the 10-week programme was characterized by helplessness at exacerbations, anxiety/insecurity about medications and their side-effects, and/or concern about future health. More than half of the subjects felt physical limitations in daily life or when exercising. All wished to increase their knowledge of asthma by joining the programme, but only nine patients expected asthma improvement. The experience that they were able to carry out physical exercise to a maximal intensity and that physical training improved their asthma, with increased knowledge about medications were mentioned by all as the most valuable effects of the programme. Moreover, most patients emphasized their increased ability in self-management strategies (stress reduction and breathing technique). The increased knowledge and improved practical skills contributed to a better life-situation after the rehabilitation. After the three years virtually all the patients' lives were characterized by improved self-management, increased physical activity and a sense of security. Almost half of them expressed a wish to take responsibility for the disease. CONCLUSIONS: In addition to medical therapy and education, physical training and techniques for relaxation and breathing should form part of the treatment of asthma.

A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training.

OBJECTIVE: To determine if asthmatic patients who had participated in a 10-week rehabilitation program with emphasis on physical training (1) continued with physical training, (2) maintained their improved cardiovascular condition and lung function, and (3) retained their good asthma control through the following 3 years. DESIGN: A descriptive 3-year follow-up study. PATIENTS AND SETTING: A convenience sample of 58 patients who had previously undergone a 10-week outpatient rehabilitation program were followed up 6 months and 1, 1.5, 2, and 3 years after the start of the program at a lung clinic in a university hospital. MAIN OUTCOME MEASURES: A training log was kept by each patient to record frequency, intensity, and mode of training. Physical condition was evaluated with a submaximal 6-minute ergometry test and a 12-minute walking test, respiratory function with static and dynamic spirometry, and bronchial hyperreactivity with a metacholine provocation test. Asthma symptoms and asthma control were measured with a study-specific questionnaire. RESULTS: Thirty-nine subjects (68%) exercised regularly during all 3 years. The cardiovascular condition and lung function values remained almost unchanged in all 58 patients. There was a significant decrease in number of emergency room visits the year after the 10-week rehabilitation program compared to the year before. It remained stable throughout the following 2 years. There was also a decrease in asthma symptoms in all patients, but the decrease was significant only in a subgroup of 26 patients, who exercised one or two times a week. CONCLUSIONS: It is possible for asthmatic subjects to exercise at a moderate intensity level on a long-term basis without deleterious effects. Moreover, the high compliance rate might indicate that inactive asthmatic patients who are taught how to exercise choose to continue to be physically active.

High-intensity physical training in adults with asthma. A 10-week rehabilitation program.

Twenty-six adults (23 to 58 years) with mild to moderate asthma underwent a 10-week supervised rehabilitation program, with emphasis on physical training. In the first 2 weeks, they exercised daily in an indoor swimming pool (33 degrees C) and received education about asthma, medication, and principles of physical training. In the following 8 weeks, they exercised in the pool twice a week. Every training session lasted 45 min. The training sessions were made as suitable as possible for the individual subjects, in order to minimize "drop outs" from the program. The aim of the study was to evaluate the efficacy of the rehabilitation program and to determine if inactive asthmatic adults can exercise at high intensity. The rehabilitation program was preceded by a 6-min submaximal cycle ergometry test, a 12-min walking test, spirometry, and a methacholine provocation test. The subjects also responded to a five-item questionnaire related to anxiety about exercise, breathlessness, and asthma symptoms using a visual analogue scale. All subjects were able to perform physical training at a very high intensity, to 80 to 90% of their predicted maximal heart rate. No asthmatic attacks occurred in connection with the training sessions. Twenty-two of the 26 subjects completed the rehabilitation program, felt confident with physical training, and planned to continue regular physical training after the 10-week program. Improvements in cardiovascular conditioning, measured as a decreased heart rate at the same load on the cycle ergometer (average of 12 beats/min), and as a longer distance at the 12-min walking test (average of 111 m), were observed during the program. FEV1 increased significantly from 2.2 to 2.5 L. Forced expiratory flow at 25% of vital capacity also increased slightly but significantly. Methacholine provocation dose causing a fall in FEV1 by 20% was unchanged. Seventeen subjects had a peak expiratory flow reduction of more than 15% after the preprogram ergometry test and were classified as having exercise-induced asthma (EIA). Only three of these subjects had EIA after 10 weeks. The asthmatic subjects were less afraid of experiencing breathlessness during exercise and less anxious about exercising at a high intensity after 10 weeks (p < 0.05). The asthma symptoms abated significantly during the rehabilitation program and the subjects needed less acute asthma care after the rehabilitation program. The results indicate that asthmatic persons benefit from a rehabilitation period, including physical training. Rehabilitation programs are therefore of value as a supplement to conventional pharmacologic treatment of asthma. This rehabilitation program can be adapted for use in clinical practice.

Growth hormone regulation of lipid metabolism in cells transfected with growth hormone receptor cDNA.

The functional properties of the growth hormone (GH) receptor was studied using cellular transfection of GH receptor cDNA. GH treatment (1.5-2 h) of Chinese hamster ovary cells, stably transfected with GH receptor cDNA (CHO4), resulted in increased cellular lipid synthesis (240% of control). This effect was blocked by staurosporine, suggesting a dependence on cellular kinases. However, if GH treatment of CHO4 cells was prolonged (16 h), this instead stimulated lipolysis (128% of control). The GH receptor in CHO4 cells was also shown to be functional in terms of ligand internalization. A GH receptor mutant, in which 183 amino acids had been deleted in the carboxyterminal of the intracellular domain was functionally active, while a receptor without its intracellular domain was shown to be inactive. In conclusion, GH receptors expressed in CHO cells are functional and GH was also shown to have both an acute insulin-like effect, which was kinase dependent, and a long-term anti-insulin-like effect on the lipid metabolism. This suggests that an approach using GH receptor cDNA transfected cells can be of value in understanding the mechanism of GH action.

Characterization of putative growth hormone receptors in human choroid plexus.

The ability to bind iodine-labelled human growth hormone ([125I]hGH) was measured in different parts of the human brain. The choroid plexus contained the highest amount of binding sites (receptors) and was therefore selected for further studies. The binding between [125I]hGH and the receptor was saturable, of high affinity (Ka = 0.63 nM-1) and pH- as well as time-dependent. After solubilization with Triton X-100 the receptors retained their hormone-binding properties and eluted in the high molecular weight range (greater than 500,000) upon molecular sieve chromatography. Analysis by an affinity cross-linking technique indicated a hormone-binding unit of molecular weight 51,000. The molecular characteristics of the identified binding sites are discussed in comparison to those of growth hormone receptors of human and animal origin.

Growth hormone (GH) stimulates protein synthesis in cells transfected with GH receptor complementary DNA.

An expression vector containing a rat GH receptor cDNA was transfected into Chinese hamster ovary (CHO) cells, and stable cell lines expressing GH receptors were established. In contrast to nontransfected CHO cells, expression of GH receptors in transfected cells resulted in the appearance of high affinity (Kd = 1.53 nM) specific binding of GH. Cross-linking of [125I]hGH to the receptors and subsequent sodium dodecyl sulfate (SDS)-electrophoresis gave an estimated receptor mol wt of 84,000. GH treatment stimulated protein synthesis 60% over basal levels in GH receptor-expressing CHO cells, but not in the receptor-negative parental cells. The effect was observed only under serum-free conditions and was time and dose dependent. These results show that heterologous expression of the rat GH receptor results in the appearance of specific binding of GH and the acquisition of a functional GH response.

Characterization of cytosolic female rat liver receptors of the lactogenic type.

Some properties of cytosolic receptors of the lactogenic type from female rat liver were studied and compared with those of membrane-bound (microsomal) receptors. The association constant between the cytosolic receptors and human growth hormone was 2.2 l/nmol, which was not significantly different from the value obtained for the microsomal receptors (3.6 l/nmol). Since unlabeled hGH and human prolactin, but not bovine growth hormone, displaced [125I]hGH bound to receptors from both sources, the cytosolic receptors, like the microsomal receptors, must be lactogenic. Furthermore, the cytosolic receptors were recognized by a monoclonal antibody raised against microsomal receptors from female rat liver. However, covalent cross-linking of cytosolic receptors to [125I]hGH and subsequent sodium dodecyl sulphate electrophoresis gave a single band corresponding to a molecular weight of 42,200 (after subtraction of the molecular weight of hGH), which differs significantly (p less than 0.01) from the values determined for the two distinct bands given by the microsomal fraction. Moreover, upon molecular sieve chromatography the receptor activity in the two fractions appeared at significantly (p less than 0.05) different elution volumes. These results show that the cytosolic and microsomal receptors have some structural features in common but are definitely not identical.

Identification and partial characterization of a growth hormone-binding protein in rat serum.

A binding protein for growth hormone in serum from female rats has been identified and partially characterized. Serum was incubated with 125I-labelled human GH and fractionated on an agarose HPLC column. Complexes between the binding protein and 125I-hGH were detected as a peak eluted at a volume corresponding to a relative molecular weight of 159,000 +/- 11,000 (N = 8). The peak was not seen when the incubation was carried out in the presence of excess unlabelled hGH. The 125I-hGH bound with high affinity (Ka = 0.87 +/- 0.3 l/nmol; N = 3) and the binding was time- and dose-dependent. Bound 125I-hGH was displaced by rat GH and bovine GH, but not by rat prolactin. The protein was not detected in radioreceptor assay by the commonly used polyethylene glycol precipitation technique and was not recognized by a monoclonal antibody raised against lactogenic receptors from female rat liver. Covalent cross-linking of 125I-hGH to serum revealed in SDS electrophoresis two labelled complexes with molecular weights of 62,300 +/- 3900 and 77,600 +/- 4100, respectively (N = 10).

A monoclonal antibody to lactogenic receptors from female rat liver.

Affinity-purified lactogenic receptors from female rat liver microsomal membranes were used to raise antibodies in female Balb/c mice. Mouse spleen and myeloma cells were fused and hybridoma-derived monoclonal antibodies (Mabs) were produced by in-vitro cell culture. Mab from a selected clone was sequentially purified by chromatography on a thiophilic gel and on agarose-bound protein A. The Mab was found to be of IgG1 subclass and of kappa type. The Mab recognized membrane-bound and solubilized (by the detergent heptaoxyethylene lauryl ether; G3707) receptors as well as receptors purified by affinity chromatography and subsequent sodium dodecyl sulphate (SDS) electrophoresis from female rat liver. The Mab bound to receptors from several other female rat tissues, such as ovary, kidney and adrenal, whereas there was no binding to liver receptors from cow and rabbit. Displacement experiments showed that the Mab was specific for a lactogenic type of receptor, in agreement with the finding that the Mab did not recognize receptors from male rat liver. The Mab also bound to cytoplasmic receptors (present in the supernatant after centrifugation at 100,000 g) from female rat liver, suggesting a structural similarity between the cytoplasmic and the microsomal receptors. Analysis of purified receptors by SDS electrophoresis and subsequent Western blot with 125I-labelled Mab as a probe showed one band corresponding to an Mr of 45,500 +/- 2500 (n = 5). The same band was obtained with 125I-labelled human GH, showing that the Mab binds to the unit which accommodates the hormone-binding site.(ABSTRACT TRUNCATED AT 250 WORDS)

The actions of growth hormone and prolactin on rat hepatocytes are not mediated by changes in cytoplasmic Ca2+.

In connection with measurement of the binding of growth hormone and prolactin to rat hepatocytes we investigated whether such binding is associated with changes in the cytoplasmic Ca2+ concentration. Whereas hepatocytes from male animals were found to have essentially only somatogenic receptors, lactogenic receptors were dominant in females. All hepatocyte preparations responded to epinephrine and vasopressin with transient peaks of cytoplasmic Ca2+. However, no effects on cytoplasmic Ca2+ were obtained when cells from female or male animals were exposed to growth hormone or prolactin. We therefore conclude that signal transduction of the growth hormone and prolactin responses in the rat liver does not involve an early messenger function for Ca2+.