Effects of endurance training on brain structures in chronic schizophrenia patients and healthy controls.

The objective of this longitudinal magnetic resonance (MR) imaging study was to examine the effects of endurance training on hippocampal and grey matter volumes in schizophrenia patients and healthy controls. 20 chronic schizophrenia patients and 21 age- and gender-matched healthy controls underwent 3months of endurance training (30min, 3 times per week). 19 additionally recruited schizophrenia patients played table soccer ("foosball" in the USA) over the same period. MR imaging with 3D-volumetric T1-weighted sequences was performed on a 3T MR scanner at baseline, after 6weeks and after the 3-month intervention and 3 additional training-free months. In addition to voxel-based morphometry (VBM), we performed manual and automatic delineation of the hippocampus and its substructures. Endurance capacity and psychopathological symptoms were measured as secondary endpoints. No significant increases in the volumes of the hippocampus or hippocampal substructures were observed in schizophrenia patients or healthy controls. However, VBM analyses displayed an increased volume of the left superior, middle and inferior anterior temporal gyri compared to baseline in schizophrenia patients after the endurance training, whereas patients playing table soccer showed increased volumes in the motor and anterior cingulate cortices. After the additional training-free period, the differences were no longer present. While endurance capacity improved in exercising patients and healthy controls, psychopathological symptoms did not significantly change. The subtle changes in the left temporal cortex indicate an impact of exercise on brain volumes in schizophrenia. Subsequent studies in larger cohorts are warranted to address the question of response variability of endurance training.

Endurance training in patients with schizophrenia and healthy controls: differences and similarities.

The aims were to examine the feasibility of and adaptations to endurance training in persons diagnosed with schizophrenia and to address the question whether the principles and beneficial effects of endurance training established in the healthy population apply also to patients with schizophrenia. In this controlled interventional study, 22 patients with schizophrenia and 22 healthy controls performed a standardized aerobic endurance training on bicycle ergometers over 12 weeks. Another group of 21 patients with schizophrenia played table soccer. Endurance capacity was measured with incremental cycle ergometry before and after the intervention and 3 months later. A specific set of outcome parameters was defined. The training stimuli can be assumed to be similar in both endurance groups. Endurance capacity improved significantly in the endurance groups, but not in the table soccer group. Patients and healthy controls showed comparable adaptations to endurance training, as assessed by physical working capacity and maximal achieved power. Differences were found in changes of performance at a lactate concentration of 3 mmol/l. Endurance training was feasible and effective in both groups. The principles and types of training that are usually applied to healthy controls need to be verified in patients with schizophrenia. Nevertheless, patients benefited from endurance training in terms of improvement of endurance capacity and reduction in the baseline deficit in comparison with healthy controls. Therefore, endurance training should be implemented in future therapy programs. These programs need to pay special attention to the differences between patients with schizophrenia and healthy controls.

Effects of Endurance Training Combined With Cognitive Remediation on Everyday Functioning, Symptoms, and Cognition in Multiepisode Schizophrenia Patients.

Aerobic exercise has been shown to improve symptoms in multiepisode schizophrenia, including cognitive impairments, but results are inconsistent. Therefore, we evaluated the effects of an enriched environment paradigm consisting of bicycle ergometer training and add-on computer-assisted cognitive remediation (CACR) training. To our knowledge, this is the first study to evaluate such an enriched environment paradigm in multiepisode schizophrenia. Twenty-two multiepisode schizophrenia patients and 22 age- and gender-matched healthy controls underwent 3 months of endurance training (30min, 3 times/wk); CACR training (30min, 2 times/wk) was added from week 6. Twenty-one additionally recruited schizophrenia patients played table soccer (known as "foosball" in the United States) over the same period and also received the same CACR training. At baseline and after 6 weeks and 3 months, we measured the Global Assessment of Functioning (GAF), Social Adjustment Scale-II (SAS-II), schizophrenia symptoms (Positive and Negative Syndrome Scale), and cognitive domains (Verbal Learning Memory Test [VLMT], Wisconsin Card Sorting Test [WCST], and Trail Making Test). After 3 months, we observed a significant improvement in GAF and in SAS-II social/leisure activities and household functioning adaptation in the endurance training augmented with cognitive remediation, but not in the table soccer augmented with cognitive remediation group. The severity of negative symptoms and performance in the VLMT and WCST improved significantly in the schizophrenia endurance training augmented with cognitive remediation group from week 6 to the end of the 3-month training period. Future studies should investigate longer intervention periods to show whether endurance training induces stable improvements in everyday functioning.

Verificação da possibilidade de validação do sistema David® como instrumento avaliativo em diagnóstico ortopédico no processo de reintegração para o trabalho ­ estudo piloto / Verification and validation's possibility of David® system as evaluative instrument in orthopaedic diagnostic in the process of reintegration for the work ­ pilot study

Esta investigação teve o propósito de assistir a avaliação física e capacidades funcionais, para a validação de sintomas em diagnósticos ortopédicos dentro do processo de reintegração para o trabalho. A análise do estado funcional da coluna vertebral de uma amostra aleatória de 236 pacientes, através da medição da força máxima isométrica utilizando o Sistema DAVID® de Avaliação foi feita levando em consideração o estado sócio-econômico dos pacientes. O protocolo de teste está coerente com o relatório da avaliação do Centro de Rehabilitação. Os dados da análise funcional biomecânica foram encontrados com auxílio do programa Excel. De acordo com o breve estudo desenvolvido é possível dizer que existe uma signifcativa diferença no desenvolvimento de força máxima durante o movimento de rotação do tronco (para a direita, p = 0,018; para a esquerda, p = 0,046) entre os grupos sócio-econômicos "empregados" ou "desempregados" nos pacientes com dor na parte inferior das costas. Uma vez que o estudo não pode comprovar correlação entre dor crônica da região lombar e desenvolvimento da força, a particularidade patológica em questão permanece irrelevante.(AU)

This research aimed to support the physical assessment and functional capabilities, for the validation of symptoms in orthopaedic diagnoses in the process of reintegration for the work. Analysis of the functional state of the vertebral column of a random sample of 236 patients, through the measurement of the maximum isometric force using the Assessment System DAVID® was accomplished taking into account the socio-economic status of these patients. The test protocol is coherent with the report of the Rehabilitation Center assessment. The data of biomechanical functional analysis were found using the Excel program. In accordance with the brief study developed it is possible to say that there is a signifcant difference in the development of maximum strength during rotation movement of the trunk (to the right, p = 0,018; to the left, p = 0,046) between the socio-economic groups "employees" or "unemployed" in patients with low back pain. Since the study is not able to demonstrate correlation between chronic pain of the lumbar region and strength development, the concerned pathological special features remains irrelevant.(AU)

Accelerometer and gyroscope based gait analysis using spectral analysis of patients with osteoarthritis of the knee.

[Purpose] A wide variety of accelerometer tools are used to estimate human movement, but there are no adequate data relating to gait symmetry parameters in the context of knee osteoarthritis. This study's purpose was to evaluate a 3D-kinematic system using body-mounted sensors (gyroscopes and accelerometers) on the trunk and limbs. This is the first study to use spectral analysis for data post processing. [Subjects] Twelve patients with unilateral knee osteoarthritis (OA) (10 male) and seven age-matched controls (6 male) were studied. [Methods] Measurements with 3-D accelerometers and gyroscopes were compared to video analysis with marker positions tracked by a six-camera optoelectronic system (VICON 460, Oxford Metrics). Data were recorded using the 3D-kinematic system. [Results] The results of both gait analysis systems were significantly correlated. Five parameters were significantly different between the knee OA and control groups. To overcome time spent in expensive post-processing routines, spectral analysis was performed for fast differentiation between normal gait and pathological gait signals using the 3D-kinematic system. [Conclusions] The 3D-kinematic system is objective, inexpensive, accurate and portable, and allows long-term recordings in clinical, sport as well as ergonomic or functional capacity evaluation (FCE) settings. For fast post-processing, spectral analysis of the recorded data is recommended.

Avaliação ergoespirométrica em atleta paraolímpico de esqui alpino:estudo de caso / Cardiopulmonary exercise test on a treadmill for a paralympic alpine skiing athlete: case study

Objetivos: Este trabalho se propõe a verificar o consumo máximo de oxigênio de um atleta paraolímpico da modalidade de esqui alpino, apontando a relação com essa modalidade esportiva, tradicionalmente reconhecida como anaeróbica. Os resultados do teste são apresentados como parâmetro comparativo para a modalidade de esqui alpino.Descrição do caso: O voluntário foi um atleta de esqui alpino de 38 anos de idade, vítima de lesão da medula espinhal desde 1994, classificação LW10/2 dentro do critério dessa modalidade esportiva. O atleta foi testado na própria cadeira de rodas, em esteira ergométrica. O teste foi realizado a uma velocidade constante, sendo a carga aumentada 20 W a cada 3 minutos até a fadiga voluntária. As respostas cardiorrespiratórias foram aferidas continuamente com eletrocardiograma e analisador de gases. Amostras de sangue foram coletadas antes e depois do teste para medir a concentração de lactato sanguíneo. A maior carga desempenhada pelo atleta foi 100 W (mecânica) e 884,07 W (bruto) quando estava no 5o estágio, com eficiência de 11,31%, apresentando consumo de oxigênio de 2501 mL/min e lactato de 11,1 mmol/L. A frequência cardíaca máxima foi de 184 batimentos/min e a pressão arterial de 115/70 mmHg foi medida 5 minutos após o final do teste.Conclusões: O esquiador pôde responder ao procedimento de diferentes cargas durante o teste. No teste aplicado o atleta tem que aprender a gerenciar sua resistência, força e capacidades coordenativas. A avaliação da capacidade aeróbica poderá ajudar o desempenho durante o treinamento e competições, visto que os atletas devem dividir sua atenção com uma gama de exigências que juntas são atendidas em grande parte pelo sistema aeróbio.

Aims: This study aims to determine the maximal oxygen uptake of a paralympic alpine ski athlete and relate it to this sport that is traditionally recognized as being anaerobic. The test results are presented as comparative variables for the alpine skiing sport. Case Description: The volunteer was a 38 year old sitting-class alpine ski athlete, who suffered a spinal cord injury in 1994, and is classified as LW10/2 within the criteria of the sport. The test was performed using their own wheelchair on a treadmill at a constant speed. The load was increased 20 W every 3 minutes until volitional fatigue. The cardiorespiratory responses were monitored continuously with an electrocardiogram and gas analyzer. Blood samples were collected before and after testing to measure blood lactate concentrations. The highest load achieved by the athlete was 100 W (mechanical) and 884.07 W (gross) when in the 5ºstage, with an efficiency of 11.31% and presenting an oxygen consumption of 2501 mL/min and lactate of 11.1%. Maximum heart rate was 184 bpm and blood pressure, measured 5 minutes after test end, was 115/70 mmHg.Conclusions: The skier was able to perform the procedure with increasing loads. The test administered required the athlete to learn how to manage her stamina, strength and coordinative capacities. The assessment of aerobic capacity may help with performance during training and competition, as the athletes must focus their attention on a range of demands that together, are largely met by the aerobic system.

Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue.

BACKGROUND: Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment. The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies. In a randomized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated. PATIENTS AND METHODS: 63 breast cancer patients with cancer-related chronic fatigue were randomized at the beginning of the inpatient rehabilitation. The control group received the standard complex rehabilitation program, the intervention group a structured physical training program and additional muscle strength and aerobic exercises. The effects of the treatment were evaluated by questionnaires at the start of rehabilitation (t1), end of rehabilitation (t2), and 3 months after t2 (t3). Isometric muscle strength and aerobic capacity were evaluated at t1 and t2. RESULTS: There was an improvement of muscle strength at the end of rehabilitation for both groups. The increase from t1 to t2 was significantly higher for the training group. The scores for global quality of life, physical well-being, and functionality increased from t1 to t2, but further improvement in the follow-up (t3) was only observed in the training group. The cancer-related fatigue was significantly reduced in the training group from t1 to t3, however, not in the control group. CONCLUSIONS: Structured physical training programs initiated during inpatient rehabilitation and continuously practiced in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients.