Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV.

PURPOSE: This randomized controlled trial tested the effects of a specially designed strength and endurance training on the independence and quality of life in lung cancer patients in stages IIIA/IIIB/IV during palliative chemotherapy. METHODS: Between August 2010 and December 2011, 46 patients were randomized into two groups receiving either conventional physiotherapy or special physiotherapeutic training. The Barthel Index served as primary endpoint. The secondary endpoints were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ C-30/LC-13) questionnaire, the 6-Minute Walk Test (6MWT), stair walking, the Modified Borg Scale, and muscle strength. Nonparametrical data were analyzed with the Wilcoxon and Mann-Whitney U test. For parametric, data student t tests were used. A p value of ≤.05 was accepted. RESULTS: Twenty-nine patients completed the trial (Intervention group (IG), n = 18; control group (CG), n = 11). Significant differences were detectable in the Barthel Index (IGmean = 92.08; CGmean = 81.67; p = .041), in single scores of the EORTC QLQ C-30/LC-13 questionnaire (physical functioning, p = .025; hemoptysis, p = .019; pain in arms or shoulder, p = .048; peripheral neuropathy, p = .050; cognitive functioning, p = .050), in the 6MWT, stair walking, strength capacity, and in the patient's dyspnoea perception during submaximal walking activities (IG > CG). CONCLUSION: According to these findings, lung cancer patients should receive enhanced physical activity intervention during palliative chemotherapy.

Comparing performance and kinematics of throwing with a circular and whip-like wind up by experienced handball players.

The aim of this study was to compare the performance (throwing velocity of the ball) and kinematics of overarm throwing with the circular and whip-like wind up in elite handball players. Twenty-two elite handball players (11 men and 11 women) conducted both types of throws. The ball release velocity, maximal ball acceleration, maximal velocity of the end points of the five segments and maximal angles, angles at ball release and maximal angular velocities of the 11 joint movements and their timing during the throw were analyzed. Significantly higher ball release velocities (21.9 m/s vs 20.6 m/s) were reached together with higher maximal linear velocities of the end points of all segments and longer throwing time with the circular wind up than with the whip-like wind up. Furthermore, it seems that the timing and amount of maximal angular pelvis rotation was the main contributor to the difference in the maximal ball release velocity between the two wind ups. The findings support the observation that overarm throwing with the circular wind up results in higher ball releases but also a longer throwing movement in comparison to whip-like wind up throws.

In vivo measurement of the 3D kinematics of the temporomandibular joint using miniaturized electromagnetic trackers: technical report.

OBJECTIVE: The aim of this study was to evaluate the use of miniaturized electromagnetic trackers (1 × 0.5 × 0.5 cm) fixed on teeth of the maxilla and mandible to analyse in vivo the 3D kinematics of the temporomandibular joint (TMJ). A third sensor was fixed to the forehead, and a fourth sensor was used as a stylus pointer to detect several anatomical landmarks in order to embed a local frame on the cranium. Temporomandibular opening/closing, chewing, laterotrusion and protrusion were examined. RESULTS: The prime objective within this study was to rigidly attach electromagnetic minisensors on teeth. The key for a successful affixation was the kevlar interface. The distances between the two mandibular affixed sensors and between the two maxillar affixed sensors were overall smaller than 0.033 cm for position and 0.2° for attitude throughout the temporomandibular motions. The relative motions between a forehead sensor and the maxilla affixed sensor are too big to suggest a forehead sensor as an alternative for a maxilla affixed sensor. CONCLUSION: The technique using miniaturized electromagnetic trackers furthers on the methods using electromagnetic trackers on external appliances. The method allows full range of motion of the TMJ and does not disturb normal TMJ function.

Knee proprioception after exercise-induced muscle damage.

The purpose of the present study was to investigate whether exercise-induced quadriceps muscle damage affects knee proprioception such as joint position sense (JPS), force sense and the threshold to detect passive movement (TTDPM). Fourteen young men performed sets of eccentric quadriceps contractions at a target of 60% of the maximal concentric peak torque until exhaustion; the exercise was interrupted whenever the subject could not complete two sets. Muscle soreness, JPS, the TTDPM and force sense were examined before the exercise as well as one, 24, 48, 72 and 96 h after exercise. The results were compared using one-way repeated-measure ANOVA. Plasma CK activity, collected at the same times, was analyzed by the Friedman's test to discriminate differences between baseline values and each of the other assessment moments (p<0.05). Relative to the proprioception assessment, JPS at 30 and 70 degrees of knee flexion and force sense were significantly decreased up to 48 h, whereas TTDPM decreased significantly at only one hour and 24 h after exercise, at 30 and 70 degrees of the knee flexion, respectively. The results allow the conclusion that eccentric exercise leading to muscle damage alters joint proprioception, suggesting that there might be impairment in the intrafusal fibres of spindle muscles and in the tendon organs.

Reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score--Physical Function Short-form (KOOS-PS).

OBJECTIVE: To test the reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score--Physical Function Short-form (KOOS-PS). METHODS: The Portuguese full KOOS and Medical Outcomes Study e 36 item Short-Form (SF-36) questionnaires, and a form of individual characteristics of the patients were applied to 85 subjects with knee osteoarthritis (OA). RESULTS: Cronbach's alpha coefficient was 0.89 and intraclass correlation coefficient (ICC) was 0.85, certifying that KOOS-PS reliability was acceptable. Construct validity was supported by the confirmation of the five predefined hypotheses involving expected correlations between KOOS-PS scale, KOOS subscales and SF-36 subscales. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining higher KOOS-PS scale scores (P = 0.011). Responsiveness to 4 weeks of conventional physical therapy treatments and to a 6-week health education and exercise program was demonstrated with a standardized effect size of 0.88 and 0.50, and a standardized response mean of 1.21 and 0.73, respectively. CONCLUSION: The Portuguese KOOS-PS evidenced acceptable psychometric characteristics.

Cross-cultural adaptation and validation of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score (KOOS).

OBJECTIVE: The objective of this study was to translate and culturally adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) to the Portuguese language and to test its reliability, validity, floor/ceiling effects and responsiveness. METHODS: This new version was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese KOOS and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, visual analogue scales (VAS) of pain, disability and discomfort, and a form for the characteristics of the patients were applied to 223 subjects with knee osteoarthritis (OA). RESULTS: Reliability was acceptable with Cronbach's alpha coefficients between 0.77 and 0.95, and intraclass correlation coefficients (ICC) ranging from 0.82 to 0.94 for the KOOS subscales. Construct validity was supported by the confirmation of six of the seven predefined hypotheses involving expected correlations between KOOS subscales, SF-36 subscales and VAS. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining lower scores in all five KOOS subscales (P< or =0.001). Floor/ceiling effects were considered to be not present, except for the subscale function in sport and recreation (33.6% of the subjects reported worst possible score). Responsiveness to 4 weeks of physical therapy was demonstrated with standardized effect size between 0.78 and 1.08, and standardized response mean ranging from 0.83 to 1.37 for the KOOS subscales. CONCLUSION: The Portuguese KOOS evidenced acceptable psychometric characteristics.

[Cross-cultural validation of the Oswestry disability index in French]. / Validation transculturelle de l'Oswestry disability index en français.

AIM: The aim of this study was to interpret and validate a French version of the Oswestry disability index (ODI), using a cross-cultural validation method. The validity and reliability of the questionnaire was assessed in order to ensure the psychometric characteristics. METHOD: The cross-cultural validation was carried out according to Beaton's methodology. The study was conducted with 41 patients suffering from low back pain. The correlation between the ODI and the Roland-Morris disability questionnaire (RMDQ), the medical outcome survey short form-36 (MOS SF-36) and a pain visual analogical scale (VAS) was assessed. RESULTS: The validity of the Oswestry questionnaire was studied using the Cronbach Alpha coefficient calculation: 0.87 (n=36). The significant correlation between the ODI and RMDQ was 0.8 (P<0.001, n=41) and 0.71 (P<0.001, n=36) for the pain VAS. The correlation between the ODI and certain subscales (physical functioning 0.7 (P<0.001, n=41), physical role 0.49 et bodily pain 0.73 (P<0.001, n=41)) of the MOS SF-36 were equally significant. The reproducibility of the ODI was calculated using the Wilcoxon matched pairs test: there was no significant difference for eight out of ten sections or for the final score. CONCLUSION: This French translation of the ODI should be considered as valid and reliable. It should be used for any future clinical studies carried out using French language patients. Complimentary studies must be completed in order to assess its sensitivity to change in the event of any modifications in the patients functional capacity.

[Cardiopulmonary responses during high intensity weight training in male handball players]. / Kardiopulmonale Reaktionen während intensiven Krafttrainings bei männlichen Handballspielern.

OBJECTIVE: Strength training has become popular and accepted as part of a well-rounded fitness program. Moreover, resistance training is currently prescribed by many health organizations for improving health and fitness. The purpose of this study was to evaluate the possible influence of high intensity heavy weight training on endurance related parameters. Hence the characteristics of oxygen uptake (VO2) kinetics and the heart rate (HR) kinetics have been assessed during a typical session of strength training in twelve healthy male handball players, aged 20-30 years. METHODS: The oxygen uptake and the heart rate were measured continuously using a portable breath-by-breath exercise system. The training consisted of 4 exercises (squat, bench press, lat pull, and neck press), each performed for ten repetitions at an intensity of 80% of one repetition maximum over a 30-seconds period with a 1:4 work/test ratio. RESULTS: During weight training, the VO2 ranged from 0.8 +/- 0.2 l x min(-1) to 2.4 +/- 0.4 l x min(-1). The lowest values were measured during load, while peak values were reached 40 to 70 seconds after load. Mean (+/- SE) VO2 was 1.22 +/- 0.05 l x min(-1), or 26.5% of the treadmill-determined VO2(max). Mean (+/- SE) HR was 117 +/- 4 beats x min(-1), or 61% of the treadmill-determined HR(max). CONCLUSION: The findings in the present study indicate that high intensity weight training is not able to produce adaptive improvement in cardiovascular function. The physiological responses measured during this experiment provide support to previous studies, that the lack of cardiovascular adaptation may be due to the low percentage of VO2(max)elicited by this form of training.

Post-mortem limitations of body composition analysis by computed tomography.

Few of the indirect methods for measuring body composition have every been validated against direct human cadaver evidence. Computed tomography (CT), like NMR, has proved to be an important diagnostic tool and they appear to be the techniques of the future for body composition studies. The purpose of the present study (Cadaver Analysis Study III), undertaken at the Vrije Universiteit Brussel in a joint venture with the University of Göteborg, Sweden, was to validate tomographic measurements of volumes and areas from different tissues using data from CT-scanning of unembalmed deep-frozen cadavers and data collected by dissection of the same cadavers. Six Belgian adults were extensively measured and dissected. The body was divided into several slices for comparison of the CT image with photography of the same slice and comparison of tissue-volumes per segment for the whole body. Due to post-mortem changes and the frozen state of the cadavers, the CT measurements were greatly affected by artefacts disturbing adipose tissue (AT) and muscle area determinations. Only the bone area measurements were similar between the two techniques. However, when the volumes (per segment) of the same tissues were considered, no apparent difference was found between CT and dissection data for the muscle volume.

Power, muscular work, and external forces in cycling.

Cycling performance is affected by the interaction of a number of variables, including environment, mechanical, and human factors. Engineers have focused on the development of more efficient bicycles. Kinesiologists have examined cycling performance from a human perspective. This paper summarizes only certain aspects of human ergonomics of cycling, especially those which are important for the recent current research in our departments. Power is a key to performance of physical work. During locomotion an imaginary flow of energy takes place from the metabolism to the environment, with some efficiency. The 'useful' mechanical muscle power output might be used to perform movements and to do work against the environment. The external power is defined as the sum of joint powers, each calculated as the product of the joint (net) moment and angular velocity. This definition of external power is closely related to the mean external power as applied to exercise physiology: the sum of joint powers reflects all mechanical power which in principle can be used to fulfil a certain task. In this paper, the flow of energy for cycling is traced quantitatively as far as possible. Studies on the total lower limb can give insight into the contribution of individual muscles to external power. The muscle velocity (positive or negative) is obtained from the positions and orientations of body segments and a bar linkage model of the lower limb. The muscle activity can be measured by electromyography. In this way, positive and negative work regions in individual muscles are identified. Synergy between active agonistic/antagonistic muscle groups occurs in order to deliver external power. Maximum power is influenced by body position, geometry of the bicycle and pedalling rate. This has to be interpreted in terms of the length-tension and force-velocity-power relationships of the involved muscles. Flat road and uphill cycling at different saddle-tube angles is simulated on an ergometer. The measured pedal forces (magnitude and direction) are only dependent on the intersegmental orientation of saddle tube, crank position, upper and lower leg, and foot. The changed direction of the gravitational force with respect to the saddle-tube does not interfere with the co-ordinated force production pattern. During locomotory cycling at constant speed the external power is mainly used to overcome the aerodynamic friction force. This force and the rolling resistance are determined by coasting down experiments, yielding the external power.(ABSTRACT TRUNCATED AT 400 WORDS)

The influence of triazolam and flunitrazepam on isokinetic and isometric muscle performance.

The influences of two benzodiazepines (triazolam 0.25 mg and flunitrazepam 2 mg) on isokinetic and isometric muscle performance and on cardiovascular parameters were examined after a standard period of sleep. A randomized and double-blind test procedure was used (n = 15). Triazolam had no significant (p < 0.05) influence on either of the test conditions. Administration of flunitrazepam significantly lowered values for maximal isometric force and for the cardiovascular parameters. It was concluded that triazolam does not influence performance. On the other hand, flunitrazepam does influence a number of strength characteristics and cardiovascular parameters in effort situations.

Electromyography and the study of sports movements: a review.

Within electromyography (EMG), a particular specialty has been developed wherein the aim is to use EMG for the study of muscular function and co-ordination. This area of research is usually called kinesiological EMG. The general aims of kinesiological EMG are to analyse the function and co-ordination of muscles in different movements and postures, in healthy subjects as well as in the disabled, in skilled actions as well as during training, in humans as well as in animals, under laboratory conditions as well as during daily or vocational activities. This is often done by a combination of electromyographical and kinesiological or biomechanical measurement techniques. Because there are over 400 skeletal muscles in the human body and both irregular and complex involvement of the muscles may occur in neuromuscular diseases and in voluntary occupational or sports movements, it is impossible to sample all of the muscles of the entire body during the performance of complex motor skills. In addition, the measurement of kinesiological EMG in sport and specific field circumstances, such as the track and/or soccer field, the alpine ski slope, the swimming pool and the ice rink, demands a specific technological and methodological approach, adaptable to both the field and the sport circumstances. Sport movement techniques and skills, training approaches and methods, ergonomic verification of the human-machine interaction have, amongst others, a highly specialized muscular activity in common. The knowledge of such muscular action in all its aspects, its evaluation and its feedback should allow for the optimization of movement, of sports materials, of training possibilities and, in the end, of sports performance. Drawing conclusions from a review of the EMG research of 32 sports, covering over 100 different complex skills, including methodological approaches, is an impossible task. We have attempted to set standards concerning the EMG methodology at the beginning of this review. Electromyography and sports is a vast area and a complete review is impossible, as information will be found scattered in many different journals, including those on the sports sciences, ergonomics, biomechanics, applied physiology, in different congress proceedings, and so on. Consequently, many important aspects and possibly important publications may have been omitted from this review.

Isokinetic exercise in rehabilitation.

Since isokinetic equipment was first designed in the late 1960s, many investigations have focused on the agonist-antagonist relationships, left-right imbalances and so on, in order to present normative data for the assessment of musculoskeletal injuries. Furthermore, the isokinetic principle has been applied in rehabilitation to minimise rehabilitation time, because it is thought that it may give a close-to-optimal training stimulus to the musculoskeletal system. However, much research still needs to be carried out in this field, in order to determine which evaluation protocols are relevant, which training regimen is optimal, and which angular velocities should be used to assess and/or rehabilitate muscle strength.

Isokinetic strength aspects in human joints and muscles.

The isokinetic concept of exercise has become an increasingly popular means to assess musculoskeletal function. The isokinetic apparatus enables the control of angular velocity of the moving limb (which is held constant during the range of movement) whilst giving an accomodated resistance. The resistance produced by the device is accommodated to the net external moment exerted by the subject. Some of the advantages of isokinetic assessment are discussed. However, a number of restrictions and limitations should be considered when interpreting these strength measurements.

Isokinetic strength aspects of human joints and muscles.

The need to develop objective methods for determining muscle strength has been a major concern in rehabilitation, biomechanics, work physiology, and other related research areas for several decades. Because of the growing need for better standardization and control of resistive exercises in dynamic conditions, not only in clinical but in research settings also (as training/testing devices, and as a method for scientific evaluation of the force-velocity relationship), development of special devices or dynamometers using computerized techniques became relevant. This article examines the perspectives of muscle function with respect to the particular characteristics of strength and velocity in general and to isokinetic strength aspects in particular in human joints and muscles. The "isokinetic" movement condition as a tool for assessing and rehabilitating strength, clinical, and ergonomic applications, and the limitations of the methodology, is critically reviewed.