A qualitative study identifying the knowledge, attitudes and behaviours of young men with mild haemophilia.

The Canadian Physiotherapists in Hemophilia Care (CPHC) sought to learn about attitudes and behaviours of young male adults with mild haemophilia towards their condition and care. Semi-structured in-person or telephone interviews were conducted with 18 young men from and across Canada. This report summarizes the participants' attitudes towards their haemophilia, previous injuries, perceived barriers to seeking treatment, as well as their decision-making process when self-assessing injury. The interviews demonstrated that communication between the young adults and the health care team was not optimal, with common reference to the ineffectiveness of lecture style education. Gaps in knowledge also emerged regarding bleed identification and management.

A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis.

PURPOSE: Despite the decreased gravitational loading that is experienced in an aquatic environment, little research has been conducted on this exercise medium for women with osteoporosis (OP). Aquatic exercise (AE) may improve function and balance, thus ultimately decreasing fall risk and the potential for hip fractures in this high-risk population. METHOD: A total of 68 women with OP, aged 60 years or older, were recruited into a randomized clinical trial evaluating the impact of AE, land exercise (LE), and no exercise (NE) on balance, functional mobility, and quality of life (QOL). RESULTS: Only one balance measure (backward tandem walk) significantly improved with AE compared to LE, but this did not translate into a greater improvement in self-report function. There were no significant differences between the exercise interventions and NE, except for in ratings of global change, where participants in the AE group were three times more likely to report improvement than those in the NE group. CONCLUSION: There were no differences in balance, function, or QOL in women with OP who followed an AE or LE programme compared to those in an NE control group. However, the significant differences in backward tandem walk between the AE and LE groups and self-reported global change between the AE and NE groups warrant further investigation. Significant improvements in balance and global change suggest that AE is a viable alternative for older women with OP who have difficulty exercising on land.

Exercise for treating fibromyalgia syndrome.

BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This is an update of a review published in Issue 2, 2002. OBJECTIVES: The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FMS. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005. We also reviewed reference lists from reviews and meta-analyses of treatment studies. SELECTION CRITERIA: Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected. DATA COLLECTION AND ANALYSIS: Two of four reviewers independently extracted data for each study. All discrepancies were rechecked and consensus achieved by discussion. Methodological quality was assessed by two instruments: the van Tulder and the Jadad methodological quality criteria. We used the American College of Sport Medicine (ACSM) guidelines to evaluate whether interventions had provided a training stimulus that would effect changes in physical fitness. Due to significant clinical heterogeneity among the studies we were only able to meta-analyze six aerobic-only studies and two strength-only studies. MAIN RESULTS: There were a total of 2276 subjects across the 34 included studies; 1264 subjects were assigned to exercise interventions. The 34 studies comprised 47 interventions that included exercise. Effects of several disparate interventions on global well-being, selected signs and symptoms, and physical function in individuals with FMS were summarized using standardized mean differences (SMD). There is moderate quality evidence that aerobic-only exercise training at recommended intensity levels has positive effects global well-being (SMD 0.44, 95% confidence interval (CI 0.13 to 0.75) and physical function (SMD 0.68, 95% CI 0.41 to 0.95) and possibly on pain (SMD 0.94, 95% CI -0.15 to 2.03) and tender points (SMD 0.26, 95% CI -0.28 to 0.79). Strength and flexibility remain under-evaluated. AUTHORS' CONCLUSIONS: There is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

Exercise for treating fibromyalgia syndrome.

BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. OBJECTIVES: The objective of this systematic review was to examine the efficacy of exercise training as an treatment for FMS. SEARCH STRATEGY: We searched 6 electronic bibliographies for studies of exercise training in FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR (1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000) and the Cochrane Controlled Trials Register (2000, issue 4). We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. SELECTION CRITERIA: Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified trials meeting inclusion criteria, rated the methodologic quality using 2 standardized validated instruments, evaluated the adequacy of the exercise training stimulus using the American College of Sports Medicine (ACSM) criteria and evaluated the results. Disagreements were resolved through active discussion and consensus. High quality training studies had scores of 50% or greater on van Tulder methodologic criteria and met the minimum training standards of ACSM. Outcome variables were grouped into 7 constructs: pain, tender points, physical function, global well being, self efficacy, fatigue & sleep, and psychological function. Two reviewers independently extracted data on study characteristics, results and point estimates for selected variables, and used consensus to address discrepancies. MAIN RESULTS: Sixteen trials involving a total of 724 participants were assigned at random to: exercise intervention groups (n=379), control groups (n=277), or groups receiving an alternate treatment (n=68). Seven studies were high quality training studies: 4 aerobic training, 1 a mixture of aerobic, strength and flexibility training, 1 strength training and 2 with exercise training as part of a composite treatment. Flexibility protocols were never described in sufficient detail to allow evaluation. The four high quality aerobic training studies reported significantly greater improvements in the exercise groups versus control groups in aerobic performance (17.1% increase in aerobic performance with exercise versus 0.5% increase in the control groups), tender point pain pressure threshold (28.1% increase versus 7.0% decrease) and improvements in pain (11.4% decrease in pain versus 1.6% increase). Poor description of exercise protocols was common, with insufficient information on intensity, duration, frequency and mode of exercise. Adverse events were also poorly reported. REVIEWER'S CONCLUSIONS: Supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

Effect of maternal exercise on fetal and placental glycogen storage in the mature rat.

The purpose was to determine the effects of exercise on fetal and placental glycogen storage patterns at 20 days gestation (term 21 days) in mature (approximately 12 months of age) Sprague-Dawley rats. The exercise protocol consisted of treadmill running at 30 m min-1, on a 10 incline, for 60 min, 5 days per week, for 4 weeks prior to conception, which continued until day 19 of pregnancy. Exercise produced a significant reduction in fetal body weight, placental weight, and fetal organ weights (heart, kidney, brain, and liver) compared to sedentary control animals (p <.05). However, when fetal body size was taken into account, these differences disappeared, except for the fetal brain:body weight ratio, which was larger in the exercised animals compared to controls (p <.05). Fetal liver glycogen concentrations were significantly lower in exercised animals compared to nonrunning control animals (p <.05). These results demonstrate that exercise of mature rats may compromise fetal development and hepatic glycogen storage in the fetus.

Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.

BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor.

Functional knee braces and dynamic performance: a review.

OBJECTIVE: The purpose of the present review was to examine current experimental research on the effectiveness of functional knee braces (FKBs) used by patients with anterior cruciate ligament injury during dynamic performance tests. DATA SOURCES: Twelve studies published in peer-reviewed journals and listed in the Excerpta Medica system were reviewed. STUDY SELECTION: All studies compared braced and unbraced tests performed by the same subjects, using tests characterized by weight bearing/axial loading. DATA EXTRACTION: Studies were reviewed independently by three investigators. DATA SYNTHESIS: Tests included one-leg hop, figure-of-eight run, stair climbing, walking, cutting, agility runs, straight running, and bicycle ergometry. Experimental situations were classified as follows: (a) maximal effort tests, which compared overall measures of performance such as the distance hopped and the time to run a specific distance; and (b) matched submaximal effort tests, which compared specific variables such as electromyography, range of motion, ground reaction forces, and energy costs. Bracing was found to be advantageous in three of the 16 maximal effort situations, disadvantageous in two, and of no measurable effect in 11. Six of the 10 matched effort situations reported differences in the criterion measurements when braced, while four reported no differences. CONCLUSIONS: If FKB prescription is to be based solely on empirical evidence of efficacy from performance tests, then further investigation is required to provide this evidence. Future research needs to examine the subjective and psychological aspects of FKB usage along with the results of objective performance tests.

Energy expenditure during submaximal walking with Exerstriders.

This study was designed to determine whether Exerstriding, a modified form of walking using walking sticks (Exerstriders), resulted in an augmented cardiorespiratory response and a greater energy expenditure than when walking without Exerstriders. Female subjects (23.6 +/- 4.0 yr; 58.5 +/- 5.5 kg) completed two randomly assigned trials of treadmill walking (6.7 km.h-1; 0% grade; 30 min.) with (Exerstrider (E)) and without Exerstriders (Control (C)). Mean oxygen consumption (E = 20.5 +/- 1.2 ml.min-1.kg-1; C = 18.3 +/- 2.5 ml.min-1.kg-1), heart rate (E = 132.5 +/- 19.2 beats.min-1; C = 121.5 +/- 21.2 beats.min-1) and respiratory exchange ratio (E = .82 +/- .03; C = .78 +/- .04) were significantly greater (P < or = 0.05) while walking with Exerstriders. Total caloric expenditure was also significantly greater during the Exerstrider condition (E = 173.7 +/- 20.9 kcal; C = 140.7 +/- 27.2 kcal.). In contrast, the rating of perceived exertion did not differ significantly between the two conditions. These data suggest that Exerstriding provides a means to increase caloric expenditure during submaximal walking, a factor that may be of critical importance in enhancing health benefits--such as improved body composition and aerobic capacity--typically associated with walking programs.

Training effects on maternal and fetal glucose uptake following acute exercise in the rat.

The purpose of the present study was to determine the effects of chronic maternal exercise on glucose uptake in maternal tissues after one bout of treadmill running during late gestation in the rat and to determine the effects on glucose accumulation in the fetus and placenta. Trained pregnant animals (PR) ran at 30 m.min-1, on a 10 degrees incline for 1 h on day 20 of gestation with a similarly treated trained nonpregnant group (NPR). Immediately after the run the animals were infused with a bolus of 1 g.kg-1 body wt as a 50% dextrose solution mixed with 2-deoxy-D-[1-3H] glucose through a carotid catheter. Sedentary pregnant (P) and nonpregnant animals (C) were also infused with the solution after no food and water for the same time frame. After 60 min, tissues were analyzed for radioactivity. Radioactive tracer was augmented in the red gastrocnemius and soleus of the PR group and the soleus of P rats. However, tracer accumulation in the fetus and placenta of the trained animals was not different than P animals. These results indicate that acute exercise in trained animals increased glucose uptake in maternal skeletal muscles without compromising conceptus glucose accumulation.

Effects of exercise on maternal glycogen storage patterns and fetal outcome in mature rats.

The purpose of the present study was to examine the effects of exercise on maternal glycogen storage patterns and fetal outcome in mature (approximately 12 months of age) Sprague-Dawley rats. The exercise consisted of treadmill running at 30 m.min-1, on a 10 degree incline, for 60 min, 5 days per week, for 4 weeks prior to pregnancy, which continued until day 19 of gestation. In mature animals, chronic exercise increased (p < 0.05) liver glycogen concentration in both pregnant and nonpregnant rats. In pregnant exercised animals, the glycogen concentration of the maternal liver increased almost twofold (p < 0.05) compared with the sedentary pregnant group. There was no difference in the amount of glycogen stored in the gastrocnemius or soleus muscles in response to training, pregnancy, or chronic maternal exercise in the mature rat. In the pregnant groups, there were fewer (p < 0.05) viable fetuses and more (p < 0.05) resorption sites than in young rats. In addition, exercise during pregnancy in the mature animal decreased (p < 0.05) fetal body weight. These results demonstrate that a conflict may exist between maternal exercise and fetal demands for energy in the mature rat. This conflict seems to favour the maternal system, as evidenced by the enhanced maternal liver glycogen storage and the negative effect on fetal growth.

Biomechanical Factors Affecting Dave Dravecky's Return to Competitive Pitching: A Case Study.

Dave Dravecky, pitcher for the San Francisco Giants, returned to competition 10 months after surgical removal of a desmoid tumor in the deltoid muscle and cryosurgery of the humerus of his pitching arm. While delivering a pitch, Dravecky sustained a spiral fracture of his humerus. Abnormal loading and muscle balance, changes in bone geometry, stress concentration, and fatigue failure may have contributed to the fracture that halted Dave Dravecky's comeback. Exploration of these biomechanical factors may help the reader contemplate a baseball pitcher's return to high performance after musculoskeletal injury, trauma, and surgery. J Orthop Sports Phys Ther 1992;16(1):2-5.