Assessment of gastrointestinal function and its' effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome.

BACKGROUND: Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are associated with hypermobility, musculoskeletal pain, a decreased bone mineral density (BMD) and gastrointestinal (GI) complications. The role of GI symptoms and diet in BMD has not been established in this population. The GI complications can lead to an energy deficit due to lack of essential macronutrients. The primary objective of this study was to determine the severity of GI symptoms compared to body composition and BMD in individuals with hEDS/HSD. The secondary objective is to examine GI symptoms on energy balance, body composition and strength. METHODOLOGY: This study was IRB approved. Eighteen female participants (aged 28.2 ± 4.9; BMI 22.5 ± 4.9) with a diagnosis of hEDS or HSD and 18 female healthy control participants (aged 28.1 ± 3.8; BMI 22.8 ±3.9) signed consent to participate. Participants were matched by sex, age, and BMI. The Gastrointestinal Symptom Rating Scale (GSRS) was used to investigate severity of GI symptoms. Dual X-ray absorptiometry was used to determine body composition (body fat%, lean body mass (LBM). BMD was measured by Z- scores of both femurs and lumbar spine. Resting metabolic rate (RMR) was measured using indirect calorimetry and strength was determined using a hand grip dynamometer. RESULTS: All hEDS/HSD participants reported GI symptoms. There was no difference in body composition between hEDS/HSD and controls. Participants with hEDS/HSD had lower BMD both femoral z scores (p=0.02,0.004) and spine z scores (p= 0.04). There was no difference in caloric intake between groups; yet both groups demonstrated caloric deficits. Additionally, hEDS/HSD consumed less protein and more carbohydrates (p=0.03, p=0.03). There were no differences in grip strength. CONCLUSIONS: This study identified that pre-menopausal women with hEDS/HSD presented with significant GI complications and lower BMD than age matched controls. The GI complications and the reduced protein intake long-term may have a lasting impact on bone health. This study found that the GSRS identified and quantified GI symptoms in persons with hEDS/HSD. Future studies are needed for the longitudinal effects of a caloric/protein deficit in this population and to help guide future preventive and nutritional treatment approaches in individuals with hEDS/HSD.

APTA Geriatrics' Guiding Principles for Best Practices in Geriatric Physical Therapy: An Executive Summary.

Geriatric physical therapy requires a unique skill set and knowledge to provide best practice care. The skill set requires clinicians to recognize the significance of the continuum of aging from optimal to pathology-influenced aging and how psychosocial, environmental, behavioral, accessibility, and economic factors affect this aging continuum, optimal health, and wellness. Employing this distinctive skill set while also utilizing evidence-based practice, acknowledging the variability observed in older adults, and utilizing interwoven care systems that impact outcomes are key characteristics of best practice. The Academy of Geriatric Physical Therapy developed best practice guidelines consisting of 6 principles needed to ensure patients receive the care that they deserve. Best practice principles include person-centered care, anti-ageist beliefs, holistic assessment using sound outcome measures, evidence-based interventions, physical activity promotion, and interprofessional collaborative practice. This executive summary presents these principles along with suggested action steps for each element of best practice. The aims are to encourage individual self-assessment, promote improvement in practice on an individual and facility/system level, increase communication and collaboration with other health care providers about global best practices for older adults, and to further target education, resources, and advocacy toward achieving best practice on a larger scale.

The Effects of Below Knee Compression Garments on Functional Performance in Individuals with Parkinson Disease.

BACKGROUND: Symptoms of Parkinson's disease (PD) include bradykinesia, gait abnormalities, balance deficits, restless leg syndrome, and muscular fatigue. Compression garments (CG) have been shown to improve performance in athletes by increasing venous return and reduce lactic acid. OBJECTIVE: Assess the effect of compression garments on the performance of 3 standardized functional tests in persons with PD. METHODOLOGY: The functional tests selected represented strength, endurance, and mobility measures in individuals with PD. Nineteen males and 2 females (age 48-85) with PD participated in this cross-over design study. Subjects were randomly assigned to test under two conditions on two separate days: 1) wearing below knee CG 2) wearing sham stockings. Outcome measures included 5 Times Sit to Stand (5XSTS), gait speed, and 6 Minute Walk Test (6MWT). There were seven days between trials. RESULTS: A paired t-test was used for each dependent variable. Significance was set at p < 0.05. There were no significant differences found between the CG and sham socks for all outcome measures. Paired t-tests for the dependent variables were Gait Speed p=.729; 5XSTS p=.880; 6MWT .265; RPE p. =1.00. CONCLUSION: Data to support the use of compression garments for enhanced proprioception, muscle power, speed, and endurance is in need of further study with the PD population. In particular, it is recommended that future studies assess the possible physiological benefits of compression garments when worn during exercise interventions.

The 6MWT: will different methods of instruction and measurement affect performance of healthy aging and older adults?

BACKGROUND AND PURPOSE: The Six-Minute Walk Test (6MWT) is commonly used to assess the fitness level of healthy adults and of older adults with disabilities. It can also be used as an intervention to increase walking endurance. However, its use may be limited in certain rehabilitation settings due to space requirements. If it can be shown that the measured linear distance walked in the 6-minute walk is comparable to the distance walked as measured by a pedometer, the test may be more widely used in a variety of rehabilitation settings. In addition, questions exist as to whether the method of instruction ("walk as far as you can" vs "walk as fast as you can") can impact the rate of perceived exertion of the person performing the test. The purposes of this study were to assess for differences in the measured linear distance and from the gender-based predicted value when compared to the pedometer measurement. In addition, we assessed the difference, if any, in the rate of perceived exertion (RPE) using the 2 different methods of administration. Furthermore, the distance in meters walked using the 2 different methods of instruction was compared; likewise, comparisons were made of these values to predicted values. METHODS: A group of 26 older adults participated in this descriptive study. After a practice trial, each person completed 2 linear trials using different methods of instruction, ("walk as fast as you can" or "walk as far as you can") of the 6MWT while wearing a DIGI-WALKER SW-651 pedometer. Vital signs were taken before and after each trial. Linear distance, pedometer distance, and numeric value RPE were recorded. RESULTS: Paired t tests demonstrated no gender differences. An intraclass correlation coefficient (2,1) of 0.822 was calculated between all dependent variables. A repeated measures MANOVA was conducted to assess for differences between all variables resulting in no differences (F = 1.98; P = .13). Pairwise comparisons were also insignificant for the distance measurements except predicted value and pedometer fast P = .024. Paired t tests also demonstrated differences between RPE between trials (t = 2.15; P = .041). CONCLUSION: There was good agreement between these distance measures for the 6MWT. The use of a pedometer was found to be a valid measure of walking distance during the 6MWT. It was also found that the method of instruction made no differences in walking distance. Although the change was minimal on the Borg scale, the RPE was found to be significantly different between far and fast trials in healthy adults. From this study, it appears that that either mode of instruction is valid in healthy community-dwelling populations. Future studies should include populations with impairments.

Fatiguing upper body aerobic exercise impairs balance.

Douris, PC, Handrakis, JP, Gendy, J, Salama, M, Kwon, D, Brooks, R, Salama, N, and Southard, V. Fatiguing upper body aerobic exercise impairs balance. J Strength Cond Res 25(12): 3299-3305, 2011-There are many studies that have examined the effects of selectively fatiguing lower extremity muscle groups with various protocols, and they have all shown to impair balance. There is limited research regarding the effect of fatiguing upper extremity exercise on balance. Muscle fiber-type recruitment patterns may be responsible for the difference between balance impairments because of fatiguing aerobic and anaerobic exercise. The purpose of our study was to investigate the effect that aerobic vs. anaerobic fatigue, upper vs. lower body fatigue will have on balance, and if so, which combination will affect balance to a greater degree. Fourteen healthy subjects, 7 men and 7 women (mean age 23.5 ± 1.7 years) took part in this study. Their mean body mass index was 23.6 ± 3.2. The study used a repeated-measures design. The effect on balance was documented after the 4 fatiguing conditions: aerobic lower body (ALB), aerobic upper body (AUB), anaerobic lower body, anaerobic upper body (WUB). The aerobic conditions used an incremental protocol performed to fatigue, and the anaerobic used the Wingate protocol. Balance was measured as a single-leg stance stability score using the Biodex Balance System. A stability score for each subject was recorded immediately after each of the 4 conditions. A repeated-measures analysis of variance with the pretest score as a covariate was used to analyze the effects of the 4 fatiguing conditions on balance. There were significant differences between the 4 conditions (p = 0.001). Post hoc analysis revealed that there were significant differences between the AUB, mean score 4.98 ± 1.83, and the WUB, mean score 4.09 ± 1.42 (p = 0.014) and between AUB and ALB mean scores 4.33 ± 1.40 (p = 0.029). Normative data for single-leg stability testing for this age group are 3.9 ± 1.9. Higher scores reflect greater balance deficits. The AUB condition produced the greatest balance deficit. Our data provide evidence of the important role of the upper body in maintaining unilateral standing balance and supports its inclusion as part of rehabilitation and training protocols designed to improve balance.

Exploring the Role of Body Mass Index on Balance Reactions and Gait in Overweight Sedentary Middle-aged Adults: A Pilot Study.

BACKGROUND/PURPOSE: Being overweight is defined as having a body mass index greater than 25. Reduced postural control has been implicated in the presence of increased body mass index. The purpose of this study was to assess the effects of body mass index on postural stability in healthy sedentary middle-aged adults. Based on body mass index, subjects were divided into 2 groups (25.00-27.49 and 27.50-29.99) to assess for differences in postural control. METHODS: Twenty healthy sedentary subjects between 40 and 64 years (13 women and 7 men) with a mean age of 52.45 years were recruited by convenience. After determination of body mass index, postural control was assessed on all subjects using the Activities Specific Balance Confidence Scale, Berg Balance Scale, Timed Up and Go Test, gait speed measurement, and Biodex Stability Index testing. RESULTS: The Timed Up and Go Test duration was increased in these subjects when compared with normative data. Gait speed was also reduced in those subjects in the fifth and sixth decades when compared with established norms. Biodex SD balance system scores demonstrated reduced postural stability. A 2-tailed t test revealed no significant difference between body mass index ranges of 25.0 to 27.5 and 27.6 to 29.99. CONCLUSION: There may be increased risk for falls with increases in body mass short of obesity thresholds of body mass index 30% for this sedentary middle-aged adult population. Future studies, with larger groups of subjects, that address postural stability and body mass index are necessary. Although these subjects are younger, falls screening measures may prove beneficial as a prevention strategy for sedentary overweight middle-aged adults.

Static stretching does not impair performance in active middle-aged adults.

Recent investigations with young, healthy adult subjects suggest that static stretching before activity decreases performance and should, therefore, be avoided. The purpose of this study was to assess the effects of an acute static stretching protocol on balance and jump/hop performance in active middle-aged adults. Ten subjects (6 men and 4 women aged 40-60 yr) from a martial arts school volunteered to take part in this research study. This was a repeated measures design. Subjects who stretched for 10 minutes using a 30-second hold during 1 session sat quietly for 10 minutes during the alternate session. Sessions were randomly assigned. The following dependent variables were compared: Dynamic Stability Index (DSI) for single-leg dynamic balance (smaller DSI = improved balance); distances for broad jump, single hop, triple hop, and crossover hop; elapsed time for a 6-m timed hop. Group means for balance were significantly different between the stretch and no-stretch conditions (3.5 +/- 0.7 vs. 4.3 +/- 1.4 DSI, respectively; p < 0.05). No significant differences were found between the group means of the stretch and no-stretch conditions for the dependent measures of broad jump, single hop, triple hop, crossover hop, and 6-m timed hop performance. Ten minutes of acute static stretching enhances dynamic balance and does not affect jump/hop performance in active middle-aged adults. Static stretching should be included before competition and before exercise in fitness programs of active middle-aged adults.

Effect of phototherapy on delayed onset muscle soreness.

OBJECTIVE: The purpose of this study was to investigate the effects of phototherapy on delayed onset muscle soreness (DOMS) as measured using the Visual Analog Scale (VAS), McGill Pain Questionnaire, Resting Angle (RANG), and girth measurements. BACKGROUND DATA: Previous research has failed to prove the beneficial effects of phototherapy on DOMS. METHODS: This was a randomized double-blind controlled study with 27 subjects (18-35 years) assigned to one of three groups. The experimental group received 8 J/cm2 of phototherapy each day for five consecutive days using super luminous diodes with wavelengths of 880 and visible diodes of 660 nm at three standardized sites over the musculotendinous junction of the bicep. The sham group received identical treatment from a dummy cluster. The controls did not receive treatment. The study was completed over five consecutive days: on day one baseline measurements of RANG and upper arm girths were recorded prior to DOMS induction. On days 2-5, RANG, girth, and pain were assessed using VAS and the McGill Pain Questionnaire. RESULTS: The experimental group exhibited a significant decrease in pain associated with DOMS compared to the control (p=0.01) and sham groups (p=0.03) based upon the VAS at the 48-h period. The McGill Pain Questionnaire showed a significant difference in pain scores at the 48-h period between the experimental and the sham groups (p=0.01). There were no significant differences day to day and between the groups with respect to girth and RANG. CONCLUSION: The results of this study provide scientific evidence that phototherapy as used in this study provides a beneficial effect to patients who may experience DOMS after a novel exercise session.

The Multiple Tasks Test as a predictor of falls in older adults.

PURPOSE: Falls are among the most common and serious problems facing the elderly. The Berg Balance Scale (BBS) is the gold standard in measuring falls risk. With higher functioning elders, a ceiling effect is often evidenced using the BBS. The purpose of this study was to determine if the Multiple Tasks Test (MTT) when used in high functioning community dwelling elderly correlated with the BBS. Secondly, this study assessed the unidimensionality of the MTT. If a relationship existed between the performance of multiple tasks and the potential loss of balance resulting in falls, then the MTT would be more appropriate than the BBS at predicting falls in higher functioning individuals. METHODS: Twenty-two independent community dwelling older adults were tested using both the MTT and the BBS on the same day at a senior center. DATA ANALYSIS: Correlations between the BBS and the MTT ranged between -0.765 and -0.79. The results of the Guttman's scalability analysis were a plus percentage ratio of 0.75 and an index of reproducibility of 0.93. Scales with these values are regarded as having evidence of unidimensionality. SUMMARY: All of the MTT tests correlated with the BBS. In addition, the MTT was found to be unidimensional. CONCLUSION: Although the MTT correlated with the BBS and was found to be a good cumulative measure, it would benefit from continued study to examine quantifiability, validity and reliability. With further refinement and study, the MTT may be useful at discriminating fallers from non-fallers in high functioning older adults.