Adaptive changes in spatiotemporal gait characteristics in women during pregnancy.

Spatiotemporal gait cycle characteristics were assessed at early (P1), and late (P2) pregnancy, as well as at 2 months (PP1) and 6 months (PP2) postpartum. A substantial decrease in walking speed was observed throughout the pregnancy, with the slowest speed (1±0.2m/s) being during the third trimester. Walking at slower velocity resulted in complex adaptive adjustments to their spatiotemporal gait pattern, including a shorter step length and an increased duration of both their stance and double-support phases. Duration of the swing phase remained the least susceptible to changes. Habitual walking velocity (1.13±0.2m/s) and the optimal gait pattern were fully recovered 6 months after childbirth. Documented here adaptive changes in the preferred gait pattern seem to result mainly from the altered body anthropometry leading to temporary balance impairments. All the observed changes within stride cycle aimed to improve gait safety by focusing on its dynamic stability. The pregnant women preferred to walk at a slower velocity which allowed them to spend more time in double-support compared with their habitual pattern. Such changes provided pregnant women with a safer and more tentative ambulation that reduced the single-support period and, hence, the possibility of instability. As pregnancy progressed a significant increase in stance width and a decrease in step length was observed. Both factors allow also for gait stability improvement.

Pulmonary physiotherapy in patients with bronchial asthma.

In the present study we investigated the effectiveness of a 3-month breathing exercise program in patients with mild-to-moderate asthma, as assessed from spirometric indices. The study group consisted of 28 asthma patients (mean age of 43 years). The physiotherapy program consisted of 45-min exercise sessions, performed twice a week for 3 months. We measured the flow-volume indices (FEV(1), FVC, PEF, MEF(50)) before and after the exercise sessions at the beginning and end of the physiotherapy program. In addition, the patients measured their personal best peak expiratory flow (PEF). We found no significant changes in spirometric indices before and after an exercise session either at the beginning or end of the physiotherapy program, although there was a tendency for lower values after the exercise sessions at both beginning and end of the physiotherapy program. There was a significant decrease in PEF after an exercise session at the beginning of the physiotherapy program; this decrease lost significance after completion of the physiotherapy program. However, PEF values were greater both before and after the exercise sessions at the end of the physiotherapy program compared with the corresponding sessions before the program. We conclude that the breathing exercise program employed in the study failed to appreciably improve lung function in asthmatic patients. However, there was no asthma exacerbations observed during the conduction of breathing exercise program, which underscores the need for pulmonary rehabilitation in asthma treatment.

Impact of excess body weight on walking at the preferred speed.

The implications of a long-lasting mechanical load on the locomotor activity are poorly understood. The objective of the present studies was to determine an impact of excess body weight on basic spatiotemporal gait measures and to test the hypothesis that leg swing phase may account for a load-related adaptation of the stride characteristics. To this end the basic spatial and temporal stride measures were assessed in 100 obese and 36 lean women (age range between 18 and 67 years) walking with their self-selected pace on a 10-meter long and 1 meter wide instrumented pathway. Among the subjects there were: 44 with class I obesity, 27 with class II obesity, and 29 with class III. Subjects' stance and swing times as well as the stride lengths were recorded by means of contact copper-film electrodes attached to a sole of subject' footwear. The acquired gait measures were used then to compute: a mean velocity of walking, double support times and a mean velocity of a foot during swing phase. Data analysis showed that subjects from every experimental groups walked with a very similar speed (1.08 +/- 0.2 m/s) and cadence (106 +/- 10 steps/min). Their stance time was not affected by body weight and it remained at the mean level of 746 +/- 90 ms for all groups. The temporal stride characteristics and the stance-to-swing ratio were, however, substantially modified in obese individuals due to attenuation of the swing time. As a consequence, the remaining normalized (i.e., expressed as percentage of gait cycle time) phases of stride: the stance and the double support were relatively longer. While the swing time negatively correlated with the body mass index (BMI), the normalized stance and the double support exhibited strong positive correlation (r=0.46) with the BMI. The increase of leg swing velocity seems the main and unique adaptation mechanism that is utilized in the preferred walking gait in obese women.

Paffenbarger Physical Activity Questionnaire as an additional tool in clinical assessment of patients with coronary artery disease treated with angioplasty.

BACKGROUND: The association between frequency, intensity and duration of physical activity and the risk of cardiovascular disease has been investigated in several studies. Out of many methods used for assessment of physical activity, a questionnaire seems to be a simple and affordable method of assessing the risk of coronary artery disease (CAD). However, the number of clinical studies investigating the usefulness of physical activity questionnaires is limited. AIM: To analyse the usefulness of Paffenbarger Physical Activity Questionnaire (PPAQ) in assessment of the correlation between the magnitude of physical activity-related energy expenditure and physical capacity assessed with treadmill exercise test (ET), risk of early onset of major adverse cardiovascular events (MACE) and selected haemodynamic parameters in patients with CAD. METHODS: The study group consisted of 211 patients aged 34-79 years (mean 59) with CAD, with or without previous myocardial infarction (MI). All patients were surveyed using PPAQ at the time of PCI and then 6 months later together with ET and echocardiography. RESULTS: There was a significant correlation between the value of activity-related weekly energy expenditure assessed with the PPAQ and selected parameters of ET (duration: r = 0.2966, p < 0.0001; METs: r = 0.2221, p < 0.001; VO(2)max: r = 0.3075, p < 0.0001; resting HR: r = 0.1615, p < 0.01 and maximal HR: r = -0.1475, p < 0.01) and echocardiography (LVESD r = 0.2346, p < 0.0001). After the PCI procedure, there was a considerable increase in physical capacity (ET duration: 5.82 vs. 7.48 min, p < 0.0001; MET: 7.57 vs. 9.18, p < 0.0001; VO(2)max: 29.23 vs. 34.79 ml, p < 0.0001; HRmax: 123 vs. 132 beats/min, p < 0.0001) and LV function (EF% 51.64 vs. 52.45%, p < 0.01). There was an insignificant change in total physical activity-related energy expenditure of low intensity (< 4 MET), not exceeding 2000 kcal/week (from 3120.13 to 3139.18 kcal/week, p > 0.05). Thirty-seven patients with MACE had a trend towards a lower value of average weekly energy expenditure than the remaining 174 patients (2690.71 vs. 3206.06 kcal/week, NS). CONCLUSIONS: High values of correlation coefficients between the questionnaire results and some variables of ET and echocardiography examination make the PPAQ a useful tool in clinical studies.

[Identity of the cardiological rehabilitation with patients with implanted cardioverter-defibrillator]. / Odrebnosc rehabilitacji kardiologicznej u pacjentów po implantacji kardiowertera-defibrylatora.

Implantable cardioverter defibrylator - ICD saves people's life and it protections against sudden cardiac death. Myocardial infarction in the past is the most often factor of the sudden cardiac death risk. The controlled physical activity and psychologists therapeuthical sessions are very important in improvement of quality of life for patients who have implanted ICD.

Effects of excessive body weight on postural control.

Research that evaluated both static and dynamic stability was performed, to clarify the impact of excessive body weight on postural control. The spontaneous center of foot pressure (CP) motion during quiet stance and a range of forward voluntary CP displacements were studied in 100 obese, and 33 lean women. Characteristics of postural sway were acquired while the subjects were standing quiet on a force plate with eyes open (EO) and with eyes closed (EC). Their anterior range of CP voluntary displacements was assessed upon a range of maximal whole body leanings which were directed forward. A substantial reduction of postural sway was observed in all patients which had increased body weight. Main postural sway parameters i.e., the total path length as well as its directional components were negatively correlated with the body mass and body mass index (BMI). The range of a whole body voluntary forward leaning, did not exhibit any significant change in patients with an obesity grade of I and II. Such a deficit was, however, found in subjects with a body mass index above 40. In conclusion, the increased body weight imposed new biomechanical constraints, that resulted in functional adaptation of the control of the erect posture. This functional adaptation was characterized by a reduced postural sway associated with a substantial reduction of the dynamic stability range in subjects with BMI>40.

Modified programme of in-patient (phase I) cardiac rehabilitation after acute myocardial infarction.

A group of 61 men who suffered from myocardial infarction (MI) were divided into two groups: group A (31 patients post MI, one day at intensive care unit (ICU), no beta-blockers, physical therapy according to a seven-day programme) and group B (30 patients post MI, two days at ICU, with beta-blockers, physical therapy according to a seven-day programme). Results from both groups were compared with a control group (C) (38 patients post MI, three days at ICU, physical therapy according to a longer ten-day graded programme). The objective of this study was to assess the efficacy of a proposed modified rehabilitation programme in patients after acute MI on the basis of a submaximal stress test performed on a cycle ergometer and to find out which stress test parameters might be used for the selection of an appropriate phase 2 rehabilitation programme. The performed analysis of correlation between exercise and resting parameters showed statistical relevancy with regard to systolic blood pressure in group A. Maximal load (WATs), metabolic cost (METs), maximal heart rate (beats/min), stress-test time (T-test) and time of normalization for the exercise parameters (t(n)) are the parameters of the stress test that should be taken into consideration for appropriate selection of an out-patient (phase 2) rehabilitation programme.