The effect of factors from different time points on psychological readiness following ACL reconstruction.

OBJECTIVE: The purpose of this study was to examine factors correlated with psychological readiness to return to activity after ACLR. DESIGN: cross sectional study. SETTING: controlled laboratory. PARTICIPANTS: 164 patients (82 M/82 F, 22.5 ± 8.9yr, 171.6 ± 11.0 cm, 77.4 ± 18.6 kg, 8.6 ± 3.4 months post-ACLR) participated in this study after a primary, isolated, and uncomplicated ACLR. MAIN OUTCOME MEASURES: ACL Return to Sport Index (ACL-RSI). RESULTS: ACL-RSI scores demonstrated a weak positive correlation with activity level at the time of injury and a fair positive correlation with activity level at the time of post-operative testing (p-values: 0.004, <0.001). ACL-RSI scores showed a statistically significant fair negative correlation with pain and a moderate negative correlation with kinesiophobia during rehabilitation (p-values: <0.001, <0.001). There was no statistical significance between ACL-RSI and the surgical variables (p-value range: 0.10-0.61). CONCLUSIONS: Outcomes from testing during postoperative rehabilitation were most correlated with psychological readiness to return to activity after ACLR. Increased pain and kinesiophobia were associated with a decreased psychological readiness. Increased activity level prior to injury and activity level at the time of testing during rehabilitation were both correlated with increased psychological readiness. Psychological readiness to return to activity may need to be customized based on potentially modifiable patient-specific factors during the post-operative rehabilitation.

Effect of lower-extremity muscle power training on muscle strength, balance function and walking ability in older adults with heart failure: a randomized controlled trial.

PURPOSE: This study investigated the combined effect of lower-extremity muscle power training and regular cardiac rehabilitation on muscle strength, balance function, and walking ability of older adults with heart failure. METHODS: Thirty-one patients, comprising 17 males and 14 females, aged between 66 and 89 years and diagnosed with non-severe heart failure, were randomly assigned to either the intervention group (n = 15) or control group (n = 16). Both groups participated in a 12-week regular rehabilitation program, with the intervention group receiving additional lower-extremity muscle power training. Various outcome measures, including muscle strength (the five-times-sit-to-stand test and knee extensor peak torque), balance function (Berg balance scale and functional reach test), and walking ability (4-m walk and Timed Up-and-Go tests) were assessed at baseline and 12 weeks after the intervention. RESULTS: Of the 31 participants, 27 completed the study protocol. The intervention group demonstrated significantly greater improvement in the five-times-sit-to-stand test time, indicating enhanced lower-extremity muscle power compared to the control group. Both groups showed significant differences in the Berg balance scale, functional reach test, 4-m walk test, and Timed Up-and-Go test between baseline and 12 weeks. However, the effect sizes for the changes during the study period were larger in the intervention group (d = 0.74-1.19) than the control group (d = 0.57-0.96). CONCLUSION: Combining lower-extremity muscle power training with regular cardiac rehabilitation may lead to additional improvements in muscle function for older adults with heart failure, resulting in enhanced dynamic balance and walking ability. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION: UMIN000032087/April 4, 2018.

Comparison of Muscle Activity and Muscle Thickness According to Knee Flexion Angle during Supine Bridge Exercises using the Abdominal Drawing-in Maneuver on an Unstable Surface.

This study evaluated changes in deep trunk muscle thickness and lower extremity muscle activities during bridge exercises with the abdominal drawing-in maneuver. Bridge exercises were conducted on an unstable surface at different knee flexion angles (60º, 90º and 120º), with the aim of identifying more effective angles for bridge exercises. This study included 21 healthy adults, aged 20-27 years. Biceps femoris (BF), rectus abdominis, and rectus femoris activity was measured using surface electromyography. The thicknesses of the transverse abdominis (TrA), external oblique (EO) and internal oblique (IO) muscles were measured. BF (p = 0.000, partial η2 = 0.670) activity increased considerably as the knee flexion angle decreased. TrA (p = 0.000, partial η2 = 0.883) and IO (p = 0.000, partial η2 = 0.892) thickness significantly increased, while EO (p = 0.000, partial η2 = 0.893) thickness decreased as the knee flexion angle decreased. When performing bridge exercises using the abdominal drawing-in maneuver on an unstable surface, the knee flexion angles should be at 120º and 60º to increase trunk stability and lower extremity muscle activity, respectively.

Effects of an 8-week lunge exercise on an unstable support surface on lower-extremity muscle function and balance in middle-aged women.

PURPOSE: This study aimed to develop a more effective exercise program for lower extremity muscle function by evaluating the effects of an 8-week lunge exercise performed on an unstable support surface on lower extremity muscle function, body composition, and body balance in middle-aged women. METHODS: Twenty participants were divided into two groups (control group: exercise on a stable support surface, n=10; experimental group: exercise on an unsta ble support surface, n=10). Each participant performed the exercise program for 8 weeks (three sessions a week, 50 min/session). RESULTS: The results revealed that body fat percentage decreased significantly in the experimental group (p<0.01). Additionally, lower-extremity muscle mass and function increased significantly in both groups (p<0.05), but with no significant difference between the groups. Moreover, the results of the static and dynamic balance tests indicated that balance improved in both groups, with significantly greater improvements in the experimental group than in the control group (p<0.05). CONCLUSION: Lunge exercise on stable and unstable support surfaces improves muscle function and static balance in middle-aged women. In particular, lunge exercise on an unstable support surface was more effective at reducing body fat than lunge exercise on a stable support surface and was also found to improve dynamic balance. Therefore, a program consisting of lunge exercises on an unstable support surface may be suitable for body improvements in middle-aged women.

Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults.

BACKGROUND: The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. METHODS: We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test's participate. RESULTS: A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. DISCUSSION: Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. CONCLUSION: Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

THE RELIABILITY AND MINIMAL DETECTABLE CHANGE OF THE ELY AND ACTIVE KNEE EXTENSION TESTS.

BACKGROUND: Muscle length is a common component of the physical therapy examination, which may include the prone knee flexion (Ely) and active knee extension (AKE) tests. Clinicians using these tests should understand the clinimetric properties. PURPOSE: To investigate the reliability and minimal detectable change (MDC95) of the Ely and AKE tests. STUDY DESIGN: Reliability analysis. METHODS: Seventy-one asymptomatic adults (mean age 24.6 + /- 2.8 years) were recruited based on a convenience sample. Two examiners each performed the Ely and AKE test one time each in an intrasession design for the interrater reliability component, with one examiner repeating the tests one time 48 hours later to determine the intra-rater reliability. Results were recorded based on one trial per test and utilized a pelvic strap for the Ely test and an adjustable bolster for the AKE test. A separate researcher recorded measurements and results were blinded from the examiners. RESULTS: The Ely test had excellent intra-rater and inter-rater reliability with an intraclass correlation coefficient (ICC) (3,1) of 0.900 and ICC (2,1) of 0.914 respectively. The intra-rater and inter-rater reliability of the AKE test was good with ICC (3,1) of 0.882 and ICC (2,1) 0.886 respectively. The MDC95 indicated that a change greater than or equal to 8° and 12° is required to exceed the threshold of error for the Ely and AKE test respectively. CONCLUSION: The Ely and AKE tests have good to excellent inter-rater and intra-rater reliability for measuring rectus femoris and hamstring muscle length when stabilization of the pelvis and hip is accounted for. The MDC should be considered as a threshold for true change in the asymptomatic adult population. LEVELS OF EVIDENCE: 2b.

[Effects of the Otago Exercise Program on Lower Extremity Strength in Residents of a Long-Term Care Institution].

BACKGROUND: Falls are a very common problem in older adults. Improving lower extremity muscle strength is the primary objective of fall-prevention programs. PURPOSE: The aim of the study was to evaluate the effects of the Otago Exercise Program (OEP) on the lower extremity muscle strength of residents living in a long-term care institution. METHODS: In this repeated measurement study, participants were allocated into either the experimental group (EG) or the control group (CG). All of the participants maintained normal activities, and EG participants were additionally enrolled in a 6-month group OEP led by a physiotherapist. The OEP, comprising warm-up exercises, strength training, balance training, and walking training, requires about 45 minutes per session, 3 times a week. A total of 78 OEP sessions were performed during the 6-month intervention. A 30-Second Sit-to-Stand Test and lower extremity muscle strength measurements were performed at baseline, after 3 months, and after 6 months. RESULTS: The twenty participants in this study had a mean age over 80 years and were recruited from a long-term care institution in southern Taiwan. There were ten participants in each group, and the mean total OEP session attendance for EG participants was 92.8%. Although the EG had lower extremity muscle strength than the CG at baseline, the EG had achieved significant improvements in the muscle strength values for the knee extensor, knee flexor, ankle plantar flexors, and dorsiflexors after 6 months (group x time interaction, p < .05). In addition, the results of the 30-second sit-to-stand test for the EG were poor at baseline and significantly better after 6 months, while the results for the CG worsened between baseline and 6 months. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support that participating in a group-based OEP three times per week over 6 months effectively improves lower extremity muscle strength in older adults. Therefore, OEP should be incorporated into fall-prevention programs organized in long-term care institutions.

Fall Risk Analysis of Elderly People with Different Load Distributions during Obstacle Crossing Based on Surface Electromyography / 医用生物力学

Objective To study the factors leading to the increased risk of falls when the elderly cross obstacles with different load distributions in their hands, and to explore the gait strategies to prevent falls for elderly people with different load distributions during obstacle crossing. Methods Twelve young healthy (control group) and 12 elderly healthy participants performed walking tasks with or without obstacle crossing at their daily speed under different load distributions. Surface electromyography (sEMG) signals were collected from both sides of the lateral femoris, rectus femoris and medial femoris. Then the average sEMG was analyzed and compared. The numbers of contact incident during obstacle touching were also recorded. Results Age, weight carrying and obstacle all had significant influences on the activity level of lower limb muscles in elderly people. A total of 9 contact incidents occurred in 1 152 obstacle crossing tests. In addition, the contribution of right vastus medialis muscle was the greatest in the elderly and young adults when they completed the weight carrying and obstacle crossing tasks. Conclusions The elderly people had the lowest risk of falling down by taking advantage of the dominant side of the leg to take the lead in obstacle crossing under the uniform distributions of load. The research findings provide references for systematic assessment of fall risk in the elderly and have certain guiding significance for lower limb exercise or rehabilitation training in the elderly.

Lumbar spinal stenosis associated with progression of locomotive syndrome and lower extremity muscle weakness.

PURPOSE: The purpose of this study was to evaluate the association between the early stages of lumbar spinal stenosis (LSS) and the risk of locomotive syndrome, as well as its effect upon muscle strength of the back, upper extremities, and lower extremities. PATIENTS AND METHODS: LSS was diagnosed with a self-administered, self-reported history questionnaire. Participants (n=113) who agreed to be tested by the diagnostic support tool for LSS underwent three risk tests for locomotive syndrome: a stand-up test, a two-step test, and a 25-question Geriatric Locomotive Function Scale (GLFS-25), as well as measurements of the strength of their grip, back extensor, hip flexor, and knee extensor muscles. RESULTS: Twenty-three participants were diagnosed with LSS by the questionnaire. Results of the stand-up test in the LSS group were significantly worse than those in the no-LSS group (P=0.003). The results of the two-step test and the total score on the GLFS-25 in the LSS group were significantly worse than those in the no-LSS group (P=0.002 and P<0.0001, respectively). The stages of locomotive syndrome assessed by the stand-up test, two-step test, and the GLFS-25 were significantly worse in the LSS group than in the no-LSS group (P=0.0004, P=0.0007, and P<0.0001, respectively). Hip flexor and knee extensor strength, but not grip and back extensor strength, in the LSS group were significantly lower than that in the no-LSS group. CONCLUSIONS: LSS diagnosed using the self-reported support tool worsened the stage of locomotive syndrome in older people. Furthermore, participants with LSS had significant lower extremity weakness.

Validity and Reliability of an Electronic Contact Mat for Drop Jump Assessment in Physically Active Adults.

The aim of the present study was to investigate the concurrent validity and the test-retest reliability of an electronic contact mat for drop jump assessment in physically active adults. Seventy-nine young, physically active adults participated in the validity study, and 49 subjects were recruited for the reliability study. The motor task required subjects to perform two-legged drop jumps using drop heights of 24, 43, and 62 cm as well as one-legged drop jumps with the left and right leg using a drop height of 24 cm. Ground contact times were simultaneously quantified with an electronic contact mat, a force plate (i.e., gold standard), and a light-barrier system (another criterion device). Concurrent validity was assessed using intraclass correlation coefficient (ICC), systematic bias, limits of agreement, and linear regression analysis. Test-retest reliability (one week apart) was determined by calculating the ICC, the standard error of measurement (SEM), the coefficient of variation (CV), and Lin´s concordance correlation coefficient (рc). Further, we determined the minimal detectable change (MDC95%). Irrespective of drop height and jump condition, good agreements between testing devices (ICC ≥ 0.95) were shown. Compared to the force plate (-0.6 to 3.1 ms) but not to the light-barrier system (31.4 to 41.7 ms), the contact mat showed low systematic bias values. In terms of test-retest reliability, our analyses showed that the measuring devices are in agreement (ICC: 0.70-0.92; SEM: 8.5-18.4 ms; CV: 3.6-6.4%). Depending on the measurement device, drop height, and jump condition, a MDC95% value ranging from 23.6 to 50.9 ms represents the minimum amount of change needed to identify practical relevant effects in repeated measurements of drop jump performance. Our findings indicate that the electronic contact mat is a valid and reliable testing device for drop jump assessment from different drop heights in young physically active adults.

Effect of different muscle strength of lower extremity on deep venous thrombosis in patients with neurological ICU / 中国实用护理杂志

Objective@#To discuss the correlation between different muscle strength of lower extremitiess and the formation of deep vein thrombosis (DVT) in neurological ICU patients, and to provide evidence for effective nursing intervention.@*Methods@#A questionnaire was developed to investigate the factors related to lower extremities DVT in patients with neurological ICU.By collecting clinical data of 195 patients from neurological ICU in Xuanwu Hospital of Capital Medical University, using the UK Medical Research Council(MRC) scale of freehand muscle strength for grading evaluation, patients were divided into a muscle strength grade 4-5 group (at least one extremities muscle strength grade 4) and a muscle strength grade 0-3 group (both lower extremities muscle strength grade 3).Gender, age, deep venous catheterization, Glasgow Coma Scale(GCS) score, bed time, fibrinogen value, D-dimer value were compared between the two groups.The main influencing factors of lower extremities DVT with different muscle strength were analyzed, and the incidence of lower extremities DVT with different muscle strength was compared.@*Results@#The comparison between muscle strength grade 4-5 group and muscle strength grade 0-3 group in neurological ICU patients showed that bed time, GCS score, and D-dimer of the 0-3 muscle strength group were 18.96(14.00, 27.00) d, 9.00(6.00, 10.15), and 2.15(1.24, 3.58) mg/L, while those of the 4-5 muscle strength group were 13.50(5.75, 22.00)d, 13.50(10.00, 15.00), 1.52(0.76, 2.99) mg/L, the difference was statistically significant (Z=-3.767, -5.811, -2.296, P<0.01 or 0.05).While gender, catheterization, fibrinogen, anticoagulant use and age had no statistical significance (P > 0.05). Grouping comparison of unilateral lower extremities muscle strength showed that the left lower extremities muscle strength group,the incidence of thrombosis in grade 0-3 group was 26.9%(32/119), and that in grade 4-5 group was 14.5%(11/76), the incidence of left lower extremities DVT had statistical significance (χ2=4.160, P<0.05),and the right lower extremities muscle strength group,the incidence of thrombosis was 32.8%(41/125) in the 0-3 group and 15.7%(11/70) in the 4-5 group, the incidence of right lower extremities DVT had statistical significance (χ2=6.698, P<0.05).@*Conclusions@#Patients with grade 0-3 lower extremities muscle strength in neurological ICU have more factors influencing DVT.The incidence of DVT is high in the lower extremities with unilateral extremities muscle strength grade 0-3, and early monitoring of lower extremities DVT should be strengthened to prevent the occurrence of lower extremities DVT.

Effects of modified pulmonary rehabilitation on patients with moderate to severe chronic obstructive pulmonary disease: A randomized controlled trail.

OBJECTIVES: This study aimed to assess the effects of modified pulmonary rehabilitation (PR) on patients with moderate to severe chronic obstructive pulmonary disease (COPD). METHODS: A total of 125 patients (63 in the PR group and 62 in the control group) were recruited in this study. The patients in the PR group received 12 weeks of conventional treatment, nursing, and modified pulmonary rehabilitation, while the patients in the control group underwent 12 weeks of conventional treatment, nursing, pursed-lip breathing training, and abdominal breathing training. Baseline characteristics, St. George's Respiratory Questionnaire (SGRQ), the six-minute walk test (6MWT), modified medical research council (MMRC) dyspnea scale, and lung function were compared between the two groups. RESULTS: A total of 112 patients (58 patients in the PR group and 54 patients in the control group) completed the 12-week monitoring and follow-up. The SGRQ scores, symptoms (54.933 ± 11.900), activity (52.644 ± 14.334), impact (55.400 ± 9.905), and total score (54.655 ± 10.681) of the PR group did not significantly differ in pre- and post-treatments (P < 0.05). No significant change was also observed in the control group (P > 0.05). 6MWT [(372.089 ± 67.149) m] was significantly improved in the PR group (P < 0.05) but was not significantly different in the control group (P > 0.05). MMRC (actual rank sum 1719, rank sum 2047.5) was significantly reduced in the PR group (P < 0.05) but not in the control group (P > 0.05). The lung function (FVC, FEV1, FEV1/FVC, FEV1% and PEF) of the patients in both groups did not significantly change (P > 0.05). CONCLUSION: Modified PR reduces the symptoms of dyspnea, increases exercise capacity, and improves the quality of life of patients with moderate to severe COPD.

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.

Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93-0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population.

Concurrent validity of the Gyko inertial sensor system for the assessment of vertical jump height in female sub-elite youth soccer players.

BACKGROUND: The aim of the present study was to verify concurrent validity of the Gyko inertial sensor system for the assessment of vertical jump height. METHODS: Nineteen female sub-elite youth soccer players (mean age: 14.7 ± 0.6 years) performed three trials of countermovement (CMJ) and squat jumps (SJ), respectively. Maximal vertical jump height was simultaneously quantified with the Gyko system, a Kistler force-plate (i.e., gold standard), and another criterion device that is frequently used in the field, the Optojump system. RESULTS: Compared to the force-plate, the Gyko system determined significant systematic bias for mean CMJ (-0.66 cm, p < 0.01, d = 1.41) and mean SJ (-0.91 cm, p < 0.01, d = 1.69) height. Random bias was ± 3.2 cm for CMJ and ± 4.0 cm for SJ height and intraclass correlation coefficients (ICCs) were "excellent" (ICC = 0.87 for CMJ and 0.81 for SJ). Compared to the Optojump device, the Gyko system detected a significant systematic bias for mean CMJ (0.55 cm, p < 0.05, d = 0.94) but not for mean SJ (0.39 cm) height. Random bias was ± 3.3 cm for CMJ and ± 4.2 cm for SJ height and ICC values were "excellent" (ICC = 0.86 for CMJ and 0.82 for SJ). CONCLUSION: Consequently, apparatus specific regression equations were provided to estimate true vertical jump height for the Kistler force-plate and the Optojump device from Gyko-derived data. Our findings indicate that the Gyko system cannot be used interchangeably with a Kistler force-plate and the Optojump device in trained individuals. It is suggested that practitioners apply the correction equations to estimate vertical jump height for the force-plate and the Optojump system from Gyko-derived data.

ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS.

BACKGROUND: High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries. PURPOSE: To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners. MATERIALS/METHODS: Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury. RESULTS: During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury. CONCLUSIONS: High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners. LEVEL OF EVIDENCE: 2b.

Does functional fitness decline in accordance with our expectation? - a pilot study in healthy female.

BACKGROUND: Aging may cause various functional abilities gradually deteriorate. With changes in social forms, the trend of functional fitness decline will change accordingly. Therefore, this study endeavored to identify the trends in functional fitness decline by comparing the differences in the functional fitness of females in various age groups. METHODS: Thirty six healthy females were divided into 3 age groups: young healthy females (20 to 30 y); middle-age (45 to 55 y); and older (65 to 75 y). Functional fitness test battery included flexibility, muscle strength/endurance, aerobic endurance, balance and agility. RESULTS: The performance in the elderly group was significantly worse (P < .05) in all the tests, whereas the muscle strength and endurance, as well as aerobic endurance for the middle-age group showed significantly lower than young groups (P < .05). CONCLUSIONS: The reduction in lower extremity muscle strength occurs in the middle-age group. We recommend that middle-age women be conscious of the reduction in their lower extremity muscle strength and conduct advanced preparations for future aging.

Changes in lower extremity muscle mass and muscle strength after weight loss in obese men: A prospective study.

BACKGROUND: Obesity is not only associated with internal diseases but also with surgical problems. Surgical diseases related to obesity frequently occur in the load bearing joints of the lower limbs. To decrease the occurrence of surgical diseases related to obesity, weight loss has been recommended. It is important for obese men to maintain muscle mass and muscle strength after weight loss because low muscle mass and muscle strength are also related to the occurrence of surgical diseases. To date, the importance of muscle mass and muscle strength after weight loss in obese men has been underappreciated. OBJECTIVE: The purpose of this study was to investigate changes in lower extremity muscle mass and muscle strength resulting from a weight loss programme consisting of caloric restriction and exercise. METHODS: All participants concurrently attended a 12-week diet class 1day/week and a 12-week exercise class 3days/week. Body weight and body composition by dual-energy X-ray absorptiometry and knee extensor strength by dynamometry were assessed. RESULTS: The weight loss programme led to a 14.1% weight loss accompanied by significant loss of leg muscle mass, static maximal muscle strength, dynamic maximal muscle strength and dynamic muscle endurance but not with significant loss of dynamic muscle power. Decline of muscle strength was related to a decrease in muscle mass, but not completely dependent on a decrease in muscle mass. Body weight-normalised muscle strength increased significantly. CONCLUSION: We recommend utilising resistance exercise to restore muscle mass and muscle strength in the legs after substantial weight loss.

EXTRACORPOREAL SHOCKWAVE TERAPY TO TREAT CHRONIC MUSCLE INJURY.

OBJECTIVE: To evaluate the low energy extracorporeal shock waves therapy (ESWT) associated with physical therapy in the treatment of chronic muscle injuries classified as grades 2 and 3 in the lower limbs of amateur athletes. METHODS: Eight athletes presenting with lower limb muscle injury for more than three weeks were treated with physiotherapy and ESWT. We evaluated the following parameters during treatment: palpable gap, muscle strength, pain, and Tegner score, as well as ultrasound image features and the ability to return to sports practice. RESULTS: The average time of the first evaluation of the injury was 8.75 weeks. All patients presented muscle strength grade V after eight weeks. The pain score evolved from 5.75 to 0.5 points of the visual analogue scale (VAS), at the end of the treatment. The Tegner score after treatment was six points on average. Patients returned to sports practice after 8.14 weeks. CONCLUSION: ESWT associated with physical therapy proved to be effective to treat long-term muscle injury, with good performance and the ability to return to sport practice for all patients. Level of Evidence IV, Case Series, Prospective Study.

Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation.

[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity.

Fitness-Related Factors Associated with Changes in Walking Speed in Elderly Women / 体力科学

The purpose of the present study was to investigate the relation between the deterioration of walking speed and physical fitness. Sixty-two elderly women (80.4±4.0 years old) volunteered to participate as subjects. Walking speeds at normal and fast speeds on a 10 m straight course, as well as muscular strength, flexibility, agility and balance were measured.<BR>Normal and fast walking speeds decreased through aging, and mostly depended on the strength of lower extremity muscles (hip extensor, hip abductor, knee extensor and ankle plantar flexor ; normal walking : r=0.596-0.666, p<0.01, fast walking : r=0.623-0.727, p<0.01) . However, the distributions of walking speed to the strength of each measured muscle were divided into two phases. The weaker group of lower extremity muscle strength had much slower walking speed. The two groups, divided according to muscular strength (the sum of the T scores of the four muscular strengths of the lower extremity) showed the following differing results. In the “high” muscular strength group (n=31) the highest factor was lower extremity muscle strength, but it was the delay of nerve reaction time in the “low” muscular strength group (n=31) .<BR>From these results, it was clarified that the main factor in the deterioration of walking speed in elderly women was the decline of lower extremity muscle strength. However, it was suggested that the functional decline of the nervous system would greatly affect the decrease of walking speed in elderly with weaker muscular strength.