Rehabilitation implications of stepper exercise technique on exertion and hip extensor muscle activation--a small exploratory study.

This study evaluated which of two different stair-stepping techniques produced a higher level of perceived physical exertion and whether magnetic resonance imaging (MRI) can identify gluteus maximus activation during stepper exercise and/or differences in gluteus maximus activation between exercise techniques. The study was a prospective, single-blind, randomized, two-period, crossover trial. The stair-stepping techniques were 15-minute sessions of (1) short steps with arms unsupported (Short) or (2) full steps with arms supported (Full). The main outcomes measured were time to reach a rating of perceived exertion (RPE) of 13, StairMaster console intensity level, volunteers' judgment as the most strenuous technique, and gluteus maximus MRI signal intensity. We found that participants performing the Short exercise technique reached an RPE of 13 sooner (mean difference 105 +/- 54 seconds, p = 0.04) and were unable to reach higher StairMaster intensity levels (mean difference 2.7 +/- 0.2, p < 0.001). Eighty-three percent of subjects declared the Short technique more demanding (p = 0.002). For both group sessions, the MRI signal after exercise was higher than at rest (p < 0.001). We found no MRI differences between stepping techniques. Rehabilitation and conditioning programs may benefit from the Short technique because it is perceived as a more challenging physical training activity; MRI can be used to identify metabolic muscle activation during aerobic exercise.

Normative values for the unipedal stance test with eyes open and closed.

PURPOSE: Limited normative data are available for the unipedal stance test (UPST), making it difficult for clinicians to use it confidently to detect subtle balance impairments. The purpose of this study was to generate normative values for repeated trials of the UPST with eyes opened and eyes closed across age groups and gender. METHODS: This prospective, mixed-model design was set in a tertiary care medical center. Healthy subjects (n= 549), 18 years or older, performed the UPST with eyes open and closed. Mean and best of 3 UPST times for males and females of 6 age groups (18-39, 40-49, 50-59, 60-69, 70-79, and 80+) were documented and inter-rater reliability was tested. RESULTS: There was a significant age dependent decrease in UPST time during both conditions. Inter-rater reliability for the best of 3 trials was determined to be excellent with an intra-class correlation coefficient of 0.994 (95% confidence interval 0.989-0.996) for eyes open and 0.998 (95% confidence interval 0.996-0.999) for eyes closed. CONCLUSIONS: This study adds to the understanding of typical performance on the UPST. Performance is age-specific and not related to gender. Clinicians now have more extensive normative values to which individuals can be compared.

Sleep disturbance in patients with chronic low back pain.

OBJECTIVE: To document the relationship between sleep disturbance and chronic low back pain in patients referred to a physical medicine and rehabilitation clinic. DESIGN: This is a prospective cross-sectional survey of 268 patients 18 yrs or older being evaluated for low back pain of greater than 6 months at a tertiary medical center. The survey consisted of a 43-item composite form that contained the Short-Form McGill Pain Questionnaire (SF-MPQ); the Pittsburgh Sleep Quality Index (PSQI); a pain visual analog scale (VAS); and questions regarding bed type, sleep position, and patients' sleep description. RESULTS: There was a significant relationship between pain and sleep (P<0.0005) with a 55% increase in the proportion of subjects reporting restless/light sleep after pain onset. There was no corresponding increase in sleep medication use. There was a significant direct correlation between SF-MPQ and PSQI (r=0.44, P<0.0005); between PSQI and VAS (r=0.41, P<0.0005); and between overall quality of sleep and VAS (r=0.31, P<0.0005). Finally, PSQI scores were the worst in subjects sleeping on an orthopedic mattress (P=0.001). CONCLUSIONS: Chronic low back pain significantly affects quality of sleep. Sleep problems should be addressed as an integral part of the pain management plan.