"Task-oriented" exercise improves hamstring strength and spastic reflexes in chronic stroke patients.
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BACKGROUND AND PURPOSE: Despite the belief that after cerebral infarction only limited functional gains are possible beyond the subacute period, we tested the hypothesis that a 12-week program of "task-oriented" treadmill exercise would increase muscle strength and decrease spastic reflexes in chronic hemiparetic patients. METHODS: Fourteen subjects, aged 66+/-3 (mean+/-SEM) years, with residual gait deviations due to remote stroke (>6 months), underwent repeated measures of reflexive and volitional (concentric and eccentric) torque with use of isokinetic dynamometry on the hamstring musculature bilaterally. Torque output was measured at 4 angular velocities (30(o), 60(o), 90(o), and 120(o)/s). RESULTS: After 3 months of 3 times/wk low-intensity aerobic exercise, there were significant main effects (2 legs [P<0.01]x2 times [P<0. 01]x4 angular velocities [P<0.05]) for concentric torque production. Torque/time production in the concentric mode also improved significantly in the paretic (50%, P<0.01) and nonparetic hamstrings (31%, P<0.01). Eccentric torque/time production increased by 21% (P<0.01) and 22% (P<0.01) in the paretic and nonparetic hamstrings, respectively. Passive (reflexive) torque/time generation in the paretic hamstrings decreased by 11% (P<0.027). Reflexive torque/time was unchanged in the nonparetic hamstrings (P=0.45). CONCLUSIONS: These findings provide evidence that progressive treadmill aerobic exercise training improves volitional torque and torque/time generation and reduces reflexive torque/time production in the hemiparetic limb. Strength changes associated with improved functional mobility in chronic hemiparetic stroke survivors after treadmill training will be reported in future articles. (+info)
Nicorandil abolished repolarisation alternans in a patient with idiopathic long QT syndrome.
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A 23 year old woman with idiopathic long QT syndrome had repeated syncopal attacks associated with torsades de pointes. T wave alternans (TWA) was recorded and the QT interval was abnormally prolonged during treadmill exercise test. Monophasic action potential (MAP) alternans also appeared after an abrupt shortening of the cycle length in electrophysiological study. After intravenous administration of nicorandil 6 mg, both TWA and MAP alternans disappeared. (+info)
Results of a multicenter randomized clinical trial of exercise and long-term survival in myocardial infarction patients: the National Exercise and Heart Disease Project (NEHDP).
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BACKGROUND: This study examined whether a supervised exercise program improved 19-year survival in 30- to 64-year-old male myocardial infarction patients. METHODS AND RESULTS: The men (n=651) were participants in the National Exercise and Heart Disease Project, a 3-year multicenter randomized clinical trial conducted in the United States (1976-1979). The treatment group (n=315) exercised for 8 weeks in a laboratory. Thereafter, they jogged, cycled, or swam in a gymnasium/pool setting guided by an individualized target heart rate. Participants in the control group (n=319) were to maintain normal routines but not participate in any regular exercise program. Participants were followed up until their death or December 31, 1995. Cox proportional hazards analysis revealed the all-cause mortality risk estimates (95% CIs) in the exercise group compared with controls to be 0.69 (0.39 to 1.25) after an average follow-up of 3 years, 0.84 (0.55 to 1.28) after 5 years, 0.95 (0.71 to 1.29) after 10 years, 1.02 (0.79 to 1.32) after 15 years, and 1.09 (0.87 to 1. 36) after 19 years. Cardiovascular disease (CVD) mortality risk estimates (95% CI) for the same follow-up periods were 0.73 (0.37 to 1.43), 0.98 (0.60 to 1.61), 1.21 (0.79 to 1.60), 1.14 (0.84 to 1.54), and 1.16 (0.88 to 1.52). However, each 1-MET increase in work capacity from baseline to the end of the original trial resulted in consistent reductions in all-cause and CVD mortality risk at each follow-up period, regardless of initial work-capacity level. CONCLUSIONS: These findings indicate exercise-program participation resulted in nonsignificantly reduced mortality risks early in the follow-up period. Benefits diminished as time since participation increased, which suggests that the protective mechanisms associated with the program may be short term. Contamination between groups over time could also explain the diminished effects, because increased work capacity provided survival benefits up to 19 years. (+info)
Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study.
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BACKGROUND: Recurrent syncope represents a debilitating disorder and quality of life deteriorates as a function of recurrence of symptoms. Although the administration of beta-blockers, vasoconstrictors, fludrocortisone, and serotonin reuptake inhibitors may be helpful in preventing episodes, many patients are intolerant of or respond poorly to these agents. Orthostatic training has been reported to be effective in preventing refractory syncope. Thus, to determine whether a tilt training program could prevent symptoms in adolescents, the following controlled study was undertaken. METHODS AND RESULTS: Forty-seven consecutive adolescents (18 male and 29 female, mean age 16.0+/-2.2 years) with recurrent syncope and positive head-up tilt test refractory to previous traditional therapies were distributed between 2 groups, depending on their consent (24 patients) or refusal (controls, 23 patients) to enter the program. Orthostatic training was started, in the presence of a family member, with a series of 5 in-hospital sessions. The 24 patients and their relatives were then instructed to perform the tilt training at home by standing against a wall twice a day for a planned duration of up to 40 minutes, depending on the in-hospital orthostatic tolerance. Head-up tilt response was reevaluated after 1 month, and the clinical effect was noted over a mean follow-up of 18. 2+/-5.3 months (range 15 to 23); 26.1% of patients in the control group and 95.8% of patients in the training group became tilt-negative (P<0.0001). Spontaneous syncope was observed in 56.5% versus 0% in the control and training group, respectively (P<0.0001). CONCLUSIONS: Orthostatic training was found to significantly improve symptoms of adolescents with neurocardiogenic syncope unresponsive to or intolerant of traditional medications. Twice-a-day training sessions of 40 minutes were well accepted by patients. (+info)
Endurance training of the trunk extensor muscles in people with subacute low back pain.
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BACKGROUND AND PURPOSE: Clinicians treating patients with low back pain often use exercise to reduce pain and improve function. The aim of this study was to evaluate the effectiveness of trunk extensor endurance training in reducing pain and decreasing disability in subjects with subacute low back pain (ie, onset of back pain within 7 days to 7 weeks). SUBJECTS AND METHODS: Patients were randomly assigned to either an experimental group or a control group. A visual analog scale and the pain rating index (PRI) of the McGill Pain Questionnaire (MPQ) were used to obtain baseline measurements of pain. The Roland Morris Disability Questionnaire (RMDQ) was used to measure disability, and the Sorensen Test was used to measure trunk extensor endurance. Subjects in the experimental group attended exercise sessions 3 times a week for 6 weeks. Subjects in the control group did not do exercises. Both groups were given back care advice and hot packs for 15 minutes, 3 to 5 times per week. Reassessments were carried out at 3 and 6 weeks. RESULTS: There were differences between the 2 groups at 3 weeks in regard to pain intensity during the evaluation session and pain experienced over the preceding 24 hours, the total MPQ PRI, the sensory component of the MPQ PRI, and the RMDQ. At 6 weeks, no differences were found for pain measurements, disability scores, and holding time on the Sorensen Test. CONCLUSION AND DISCUSSION: Trunk extensor endurance training reduced pain and improved function at 3 weeks but resulted in no improvement at 6 weeks when compared with the control group. Endurance exercise is considered to expedite the recovery process for patients with an acute episode of low back pain. (+info)
Patellofemoral pain syndrome: a review and guidelines for treatment.
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Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction. The initial treatment plan should include quadriceps strengthening and temporary activity modification. Additional exercises may be incorporated as dictated by the findings of the physical examination. Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered. (+info)
Effects of exercise training on the recovery of the autonomic nervous system and exercise capacity after acute myocardial infarction.
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This study investigated the effects of aerobic exercise training on the early phase of the recovery process following acute myocardial infarction (AMI) in terms of the autonomic nervous system, cardiac function and exercise capacity. Twenty-eight patients in the first week after the onset of AMI were assigned randomly to either a training group or a control group. The training group performed aerobic exercise for 2 weeks. Cardiopulmonary exercise testing was performed 3 times during the 3 months after the onset. Heart rate variability, plasma norepinephrine (NE) levels, and cardiac index (CI) during exercise were measured. In the training group, plasma NE level and deltaCI (peak CI-rest CI) were significantly improved from 1 to 3 weeks after the onset, and the high frequency of heart rate variability and peak oxygen uptake were significantly increased up to 3 months after the onset. In the control group, the plasma NE level and the deltaCI during the 1-3 weeks post-AMI, the high frequency of heart rate variability and the peak oxygen uptake showed a tendency to improve up to 3 months after the onset. These results indicate that sympathetic nervous activity improves soon after the onset of AMI, in conjunction with improvement in cardiac function, and that this improvement is not affected by exercise training. In contrast, the recovery of parasympathetic nervous activity requires a longer period, along with the recovery of exercise capacity, which is facilitated by even short-term aerobic exercise training. (+info)
Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.
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BACKGROUND: after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial. OBJECTIVE: we aimed to assess the effectiveness of the programme over 2 years. SUBJECTS: women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. METHODS: falls and compliance to the exercise programme were monitored for 2 years. RESULTS: 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49-0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42-0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group. CONCLUSIONS: falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period. (+info)