610 Medizin und Gesundheit
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Background: The fascia has been demonstrated to represent a potential force transmitter intimately connected to the underlying skeletal muscle. Sports-related soft tissue strains may therefore result in damage to both structures.
Purpose: To elucidate the prevalence of connective tissue lesions in muscle strain injury and their potential impact on return-to-play (RTP) duration.
Study Design: Systematic review; Level of evidence, 3.
Methods: Imaging studies describing frequency, location, and extent of soft tissue lesions in lower limb muscle strain injuries were identified by 2 independent investigators. Weighted proportions (random effects) were pooled for the occurrence of (1) myofascial or fascial lesions, (2) myotendinous lesions, and (3) purely muscular lesions. Study quality was evaluated by means of an adapted Downs and Black checklist, which evaluates reporting, risk of bias, and external validity.
Results: A total of 16 studies (fair to good methodological quality) were identified. Prevalence of strain injury on imaging studies was 32.1% (95% CI, 24.2%-40.4%) for myofascial lesions, 68.4% (95% CI, 59.6%-76.6%) for myotendinous lesions, and 12.7% (95% CI, 3.0%-27.7%) for isolated muscular lesions. Evidence regarding associations between fascial damage and RTP duration was mixed.
Conclusion: Lesions of the collagenous connective tissue, namely the fascia and the tendinous junction, are highly prevalent in athletic muscle strain injuries. However, at present, their impact on RTP duration is unclear and requires further investigation.
Perceptual-cognitive function and unplanned athletic movement task performance: a systematic review
(2020)
The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable biomechanics in the lower limb. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between (1) the biomechanical and functional safety of unplanned sports-related movements (e.g., jumps/runs with a spontaneously indicated landing leg/cutting direction) and (2) markers of perceptual–cognitive function (PCF). A literature search in three databases (PubMed, ScienceDirect and Google Scholar) identified five relevant articles. The study quality, rated by means of a modified Downs and Black checklist, was moderate to high (average: 13/16 points). Four of five papers, in at least one parameter, found either an association of PCF with task safety or significantly reduced task safety in low vs. high PCF performers. However, as (a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and (b) only two out of five studies had an adequate control condition (pre-planned movement task), the evidence was classified as conflicting. In summary, PCF may represent a factor affecting injury risk and performance during unplanned sports-related movements, but future research strengthening the evidence for this association is warranted.
Experiments in cadavers have demonstrated significant mechanical interactions between constituents of myofascial chains. However, evidence for such force transmission effects is scarce under in vivo conditions. The purpose of this trial was to examine the impact of ankle motion on soft tissue displacement of the dorsal thigh. Eleven healthy active individuals (26.8 ± 4.3 years, six males), in prone position and with the knee extended, underwent passive calf stretches (ankle dorsal extension) imposed by an isokinetic dynamometer. High-resolution ultrasound was used to simultaneously capture the displacement of the semimembranosus muscle, which was quantified by means of cross-correlation analysis. Inactivity of the leg muscles was controlled using surface electromyography (EMG). One participant had to be excluded due to major EMG activity during the experiment. According to a one-sample t test testing the difference to the neutral zero position, ankle dorsal extension induced substantial caudal muscle displacements (5.76 ± 2.67 mm, p < 0.0001). Correlation analysis (Spearman), furthermore, revealed a strong association between maximal dorsal extension and semimembranosus motion (rho = 0.76, p = 0.02). In conclusion, the present trial provides initial in vivo evidence for a mechanical force transmission between serially connected skeletal muscles. This means that local alterations of the mechanical tissue properties may modify flexibility in neighboring (superior or inferior) joints.
Highlights
• Investigation of how the peripheral muscle system responds to imagination in interaction with proprioceptive information.
• Motor imagery altered time to contraction but not velocity and maximal displacement of the muscle belly.
• Findings indicate that MI might impact on the initiation of contraction.
Abstract
Many studies have investigated the activation of cortical areas and corticospinal excitability during motor imagery (MI) in relation to motor execution. Similar activation of cortical areas during imagined and executed bodily movements and increased corticospinal excitability while imagining movements has been demonstrated. Despite these similarities on the central nervous system level, there is no overt movement during MI. This suggests that centrally generated signals must be inhibited at some level. Second, even in the absence of movement, some studies find behavioral effects of MI interventions. Most of the studies have investigated the role of MI on the cortical or spinal level, but less is known about the peripheral level, such as the muscle system. Testing muscular excitability during MI will give further hints whether and how low-threshold motor commands during MI reach the muscular system. Furthermore, the extent of the shown effects during imagery depends considerably on type of imagery, available proprioceptive information, and imagery ability. Therefore, this study investigates muscular excitability of the biceps brachii muscle manipulating imagery mode (MI vs. visual imagery) and proprioceptive information (with or without muscle effort). 40 participants were included in the analysis. The mechanical response of the muscle after a single electrical stimulus was assessed via tensiomyography. The corresponding variables maximal displacement, delay time, and contraction velocity were used to calculate 2 × 2 ANOVAs with repeated measurements. The absence of interaction effects shows that possible imagery effects on the muscle system are not increased by effort. MI altered time to contraction with lower delay time compared to control condition. Velocity and maximal displacement of the muscle belly during contraction did not differ between imagery conditions. This indicates that MI might impact on the initiation of muscle contraction but does not change the contraction itself. Thus, neuronal factors are moving further into focus in the context of MI research.
Erkrankungs- und transplantationsassoziierte Nebenwirkungen (z.B. Mukositis, Neutropenie) und Komplikationen (z.B. Infektionen, Abstoßung) führen zu einem radikalen Rückgang der körperlichen Leistungsfähigkeit während der Hämatopoetischen Stammzelltransplantation (HSZT). Ein Großteil der Patienten leidet vor Beginn der Transplantation bereits an ausgeprägten muskulären sowie kardiopulmonalen Defiziten. Randomisiert-kontrollierte Interventionsstudien mit Erwachsenen weisen auf positive multidimensionale Effekte einer Bewegungstherapie vor, während und nach der Transplantation hin. Wiskemann et al. [2013] identifizierten zudem das Fitnesslevel zu Transplantationsbeginn als relevanten Prädiktor für trainingsinduzierte Adaptionen. Im klinischen Sektor der pädiatrischen HSZT wird der wissenschaftliche Forschungsstand im als unzureichend eingestuft. Neben der Evaluation der Wirksamkeit pädiatrischer Bewegungsprogramme besteht dringender Bedarf zur Identifikation geeigneter Trainingsmethoden. Auf Basis dessen evaluierte die vorliegende Arbeit als Primärziel den Einfluss der körperlichen Leistungsfähigkeit zu Transplantationsbeginn auf die Effekte einer Sporttherapie während pädiatrischer HSZT. Darüber hinaus erfolgte eine Überprüfung der Machbarkeit des Interventionskonzeptes und eine explorative Analyse der sportlichen Belastbarkeit während der stationären Behandlung.
In dieser Subanalyse der BISON-Studie (RCT, n=70) wurden 53 hämato-onkologisch erkrankte Kinder und Jugendliche (35 m 18 w, 10.9±3.5 Jahre) mit Indikation zur HSZT computergestützt in eine Interventions- (IG) oder bewegungsarme Kontrollgruppe (KG) randomisiert. Im Rahmen der Transplantation führte die IG eine Sporttherapie, bestehend aus einem täglichen Ausdauer-, Kraft- und Beweglichkeitstraining (täglich, 30–60min), die KG ein Konzentrations- und Entspannungstraining von gleichem Umfang durch. Die individualisierten Trainingseinheiten fanden supervidiert statt und wurden von den behandelnden Sporttherapeuten dokumentiert. Zur Evaluation der Therapieeffekte erfasste ein 6-Minuten Gehtest (6MWT) die Ausdauerleistungsfähigkeit im Eingangs- und Retest (T1 Aufnahme, T2 Entlassung). Im Sinne der primären Zielsetzung erfolgte für die Auswertung eine retrospektive Dichotomisierung beider Studiengruppen anhand der referenzwertbezogenen Baslinewerte (cut off: 80 % 6MWDREFT1). Gruppenunterschiede (IGUNFIT n=14, IGFIT n=12, KGUNFIT n=16, KGFIT n=11) der relativen Veränderung im pre-post Design wurden mittels Kruskal-Wallis mit post-hoc-Test analysiert. Die Machbarkeit des sporttherapeutischen Interventionskonzeptes wurde anhand von neun Outcomeparametern (Bedarf, Akzeptanz, Durchführbarkeit, Adhärenz, Toleranz, Verträglichkeit, Sicherheit, Medizinische Barrieren, Non-Compliance) bewertet.
Vor Transplantation legten die Kinder und Jugendlichen im 6MWT ohne Auftreten unerwünschter Ereignisse durchschnittlich 470.9±79.1 m bzw. referenzwertbezogen 76±12% zurück. Die nichtparametrische Testung ergab für das Gesamtkollektiv bereits vor Beginn der Behandlung signifikante Einbußen der Gehstrecke im Vergleich zu den Normwerten gesunder Gleichaltriger (p<.001).
Insgesamt 25 Kinder und Jugendliche der IG (74%) trainierten über den stationären Verlauf kontinuierlich 2–4x pro Woche (50.3±6.3 min/TE) mit einem subjektiven Anstrengungsempfinden (RPE) von 11 bis 16. Die Adhärenzrate lag in der Untersuchung bei 94 (64–100)%. Das Training beinhaltete ein Ausdauertraining auf dem Fahrradergometer, als Aerobic-Einheit oder in spielerischer Form (2.5±0.9x/wk, 20.9±5.1 min/TE, 70.7±6.5% der HFmax), ein kleingerätegestütztes Krafttraining (2.4±0.6x/wk, 3.7±0.7 Übungen, 1.9±0.3 Serien, 10.4±1.1 Wiederholungen) und Stretchingübungen (2.3 ±0.7x/wk, 75% aktiv, 25% passiv). In insgesamt 13 von 410 Therapieeinheiten musste aufgrund von Gegenanzeigen abgebrochen werden.
Beim Vergleich der Trainingseffekte zeigte sich, dass die IGFIT ihre Ausdauerleistung im Rahmen der Transplantation um +0.7% steigerte, während die IGUNFIT eine Verbesserung um +7.7% aufwies (p>.05). In Bezug auf die relative Veränderung konnten ausschließlich signifikante Unterschiede zwischen der IGUNFIT und der KGUNFIT (-13.7%, p<.05) bzw. KGFIT (-15.9%, p>.05) erhoben werden. Bei Entlassung absolvierte die Gruppe IGFIT weiterhin 85.5±10.3% der referenzwertbezogenen Gehstrecke und differierte diesbezüglich bei Entlassung signifikant zu den beiden initial leistungsreduzierten Gruppen (KGUNFIT p<.001, IGUNFIT p<.01).
Negative Auswirkungen der Grunderkrankung und hämato-onkologischer Vorbehandlungen führen auch bei der Mehrheit betroffener Kinder und Jugendlicher bereits vor der Transplantation zu einer defizitären Leistungsfähigkeit im Vergleich zu Gesunden. Vor dem Hintergrund einer progressiven transplantationsinduzierten Dekonditionierung zeigt sich eine supportive Sporttherapie während pädiatrischer HSZT von moderater und hoher Intensität als sicher, machbar sowie effizient. Das konstante Training sowie die hohe Compliance erfordern ein tägliches, flexibles und kreatives Angebot unter fachtherapeutischer Anleitung und Betreuung. Alle Patienten können über den gesamten Verlauf der Transplantation ca. 3x pro Woche zwischen 40–60 min trainieren. Wie bei Gesunden könnten insbesondere initial leistungslimitierte Kinder und Jugendliche sowie Patienten mit schweren Nebenwirkungen von einer supportiven Bewegungsförderung profitieren. Unter Berücksichtigung der Ergebnisse lässt sich außerdem ableiten, dass ein optimaler Versorgungsansatz für die pädiatrische HSZT zusätzlich ein bewegungstherapeutisches Aufbautraining vor Transplantation vorsieht.
Background: Physical activity and sleep quality are both major factors for improving one's health. Knowledge on the interactions of sleep quality and the amount of physical activity may be helpful for implementing multimodal health interventions in older adults. Methods: This preliminary cross-sectional study is based on 64 participants [82.1 ± 6.4 years (MD ± SD); 22 male: 42 female]. The amount of physical activity was assessed by means of an accelerometer (MyWellness Key). Self-reported sleep parameters were obtained using the Pittsburgh Sleep Quality Index. The Barthel Index was used for physical disability rating. Bivariate correlations (Spearman's Rho) were used to explore relationships between the amount of physical activity and sleep quality. To analyse differences between categorial subgroups univariate ANOVAs were applied; in cases of significance, these were followed by Tukey-HSD post-hoc analyses. Results: No linear association between physical activity and sleep quality was found (r = 0.119; p > 0.05). In subgroup analyses (n = 41, Barthel Index ≥90 pts, free of pre-existing conditions), physical activity levels differed significantly between groups of different sleep duration (≥7 h; ≥6 to <7 h; ≥5 to <6 h; <5h; p = 0.037). Conclusion: There is no general association between higher activity levels and better sleep quality in the investigated cohort. However, a sleep duration of ≥5 to <6 h, corresponding to 7.6 h bed rest time, was associated with a higher level of physical activity.
Background: Individuals afflicted with nonspecific chronic low back pain (CLBP) exhibit altered fundamental movement patterns. However, there is a lack of validated analysis tools. The present study aimed to elucidate the measurement properties of a functional movement analysis (FMA) in patients with CLBP.
Methods: In this validation (cross-sectional) study, patients with CLPB completed the FMA. The FMA consists of 11 standardised motor tasks mimicking activities of daily living. Four investigators (two experts and two novices) evaluated each item using an ordinal scale (0–5 points, one live and three video ratings). Interrater reliability was computed for the total score (maximum 55 points) using intra class correlation and for the individual items using Cohen’s weighted Kappa and free-marginal Kappa. Validity was estimated by calculating Spearman’s Rho correlations to compare the results of the movement analysis and the participants’ self-reported disability, and fear of movement.
Results: Twenty-one participants (12 females, 9 males; 42.7 ± 14.3 years) were included. The reliability analysis for the sum score yielded ICC values between .92 and.94 (p < .05). The classification of individual scores are categorised "slight" to "almost perfect" agreement (.10–.91). No significant associations between disability or fear of movement with the overall score were found (p > .05). The study population showed comparably low pain levels, low scores of kinesiophobia and disability.
Conclusion: The functional movement analysis displays excellent reliability for both, live and video rating. Due to the low levels of disability and pain in the present sample, further research is necessary to conclusively judge validity.
Background: The vascular effects of training under blood flow restriction (BFR) in healthy persons can serve as a model for the exercise mechanism in lower extremity arterial disease (LEAD) patients. Both mechanisms are, inter alia, characterized by lower blood flow in the lower limbs. We aimed to describe and compare the underlying mechanism of exercise-induced effects of disease- and external application-BFR methods. Methods: We completed a narrative focus review after systematic literature research. We included only studies on healthy participants or those with LEAD. Both male and female adults were considered eligible. The target intervention was exercise with a reduced blood flow due to disease or external application. Results: We identified 416 publications. After the application of inclusion and exclusion criteria, 39 manuscripts were included in the vascular adaption part. Major mechanisms involving exercise-mediated benefits in treating LEAD included: inflammatory processes suppression, proinflammatory immune cells, improvement of endothelial function, remodeling of skeletal muscle, and additional vascularization (arteriogenesis). Mechanisms resulting from external BFR application included: increased release of anabolic growth factors, stimulated muscle protein synthesis, higher concentrations of heat shock proteins and nitric oxide synthase, lower levels in myostatin, and stimulation of S6K1. Conclusions: A main difference between the two comparators is the venous blood return, which is restricted in BFR but not in LEAD. Major similarities include the overall ischemic situation, the changes in microRNA (miRNA) expression, and the increased production of NOS with their associated arteriogenesis after training with BFR.
Background: The effects of blood flow restriction (training) may serve as a model of peripheral artery disease. In both conditions, circulating micro RNAs (miRNAs) are suggested to play a crucial role during exercise-induced arteriogenesis. We aimed to determine whether the profile of circulating miRNAs is altered after acute resistance training during blood flow restriction (BFR) as compared with unrestricted low- and high-volume training, and we hypothesized that miRNA that are relevant for arteriogenesis are affected after resistance training.
Methods: Eighteen healthy volunteers (aged 25 ± 2 years) were enrolled in this three-arm, randomized-balanced crossover study. The arms were single bouts of leg flexion/extension resistance training at (1) 70% of the individual single-repetition maximum (1RM), (2) at 30% of the 1RM, and (3) at 30% of the 1RM with BFR (artificially applied by a cuff at 300 mm Hg). Before the first exercise intervention, the individual 1RM (N) and the blood flow velocity (m/s) used to validate the BFR application were determined. During each training intervention, load-associated outcomes (fatigue, heart rate, and exhaustion) were monitored. Acute effects (circulating miRNAs, lactate) were determined using pre-and post-intervention measurements.
Results: All training interventions increased lactate concentration and heart rate (p < 0.001). The high-intensity intervention (HI) resulted in a higher lactate concentration than both lower-intensity training protocols with BFR (LI-BFR) and without (LI) (LI, p = 0.003; 30% LI-BFR, p = 0.008). The level of miR-143-3p was down-regulated by LI-BFR, and miR-139-5p, miR-143-3p, miR-195-5p, miR-197-3p, miR-30a-5p, and miR-10b-5p were up-regulated after HI. The lactate concentration and miR-143-3p expression showed a significant positive linear correlation (p = 0.009, r = 0.52). A partial correlation (intervention partialized) showed a systematic impact of the type of training (LI-BFR vs. HI) on the association (r = 0.35 remaining after partialization of training type).
Conclusions: The strong effects of LI-BFR and HI on lactate- and arteriogenesis-associated miRNA-143-3p in young and healthy athletes are consistent with an important role of this particular miRNA in metabolic processes during (here) artificial blood flow restriction. BFR may be able to mimic the occlusion of a larger artery which leads to increased collateral flow, and it may therefore serve as an external stimulus of arteriogenesis.
Background: Immigration has a strong impact on the development of health systems, medicine and science worldwide. Therefore, this article provides a descriptive study on the overall research output.
Methods: Utilizing the scientific database Web of Science, data research was performed. The gathered bibliometric data was analyzed using the established platform NewQIS, a benchmarking system to visualize research quantity and quality indices.
Findings: Between 1900 and 2016 a total of 6763 articles on immigration were retrieved and analyzed. 86 different countries participated in the publications. Quantitatively the United States followed by Canada and Spain were prominent regarding the article numbers. On comparing by additionally taking the population size into account, Israel followed by Sweden and Norway showed the highest performance. The main releasing journals are the Public Health Reports, the Journal of Immigrant and Minority Health and Social Science & Medicine. Over the decades, an increasing number of Public, Environmental & Occupational Health articles can be recognized which finally forms the mainly used subject area.
Conclusion: Considerably increasing scientific work on immigration cannot only be explained by the general increase of scientific work but is also owed to the latest development with increased mobility, worldwide crises and the need of flight and migration. Especially countries with a good economic situation are highly affected by immigrants and prominent in their publication output on immigration, since the countries’ publication effort is connected with the appointed expenditures for research and development. Remarkable numbers of immigrants throughout Europe compel medical professionals to consider neglected diseases, requires the public health system to restructure itself and finally promotes science.
This case study evaluated the response of objective and subjective markers of overreaching to a highly demanding conditioning training mesocycle in elite tennis players to determine 1) whether players would become functionally or non-functionally overreached, and 2) to explore how coherently overreaching markers would respond. Performance, laboratory and cardiac autonomous activity markers were evaluated in three experienced male tennis professionals competing at top 30, top 100 and top 1000 level before and after their strength and conditioning training was increased by 120, 160 and 180%, respectively, for 30 days. Every week, subjective ratings of stress and recovery were evaluated by means of a questionnaire. After 74, 76 and 55 h of training, increases in V̇O2max (+8, +5 and +18%) and speed strength indices (+9, +23 and +5%) were observed in all players. Changes of maximal heart rate (-5, -6, +4 beats per minute), laboratory markers (e.g. insulin-like growth factor -26, -17, -9%; free testosterone to cortisol ratio -63, +2, -12%) and cardiac autonomous activity markers (heart rate variability -49, -64, -13%) were variable among the players. Improved performance provides evidence that overreaching was functional in all players. However, several overreaching markers were altered and these alterations were more pronounced in the two top 100 players. The response of overreaching indicators was not coherent.
Der Mensch ist dazu geschaffen, sich zu bewegen. Tut er es nicht, beispielsweise weil seine Arbeit ihn vor den Computerbildschirm zwingt und er seiner Nahrung nicht mehr hinterherjagen muss, wird er krank. So betrifft der "Altersdiabetes" inzwischen immer mehr Kinder und Jugendliche. Bei erwachsenen Männern, und zunehmend auch bei Frauen, führt die Kombination von Stress und Bewegungsarmut häufig zu Herz- und Kreislauferkrankungen. Frauen sind vor allem nach den Wechseljahren durch Osteoporose, Gebärmutterhals- und Brustkrebs bedroht. Erstmals sterben weltweit mehr Menschen an nicht übertragbaren Erkrankungen als an Infektionserkrankungen. Aber es gibt auch eine gute Nachricht: Regelmäßige körperliche Aktivität kann diesen chronischen Erkrankungen vorbeugen und spielt bei ihrer Therapie eine bedeutsame Rolle.
We are pleased to introduce the sixth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Strength and Conditioning, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for sport and exercise seen from a scientific point of view. The Editorial Board members wish you an inspiring read.
Die hämatopoetische Stammzelltransplantation (HSZT) stellt für zahlreiche Erkrankungen die einzige Chance auf Heilung dar. Gleichzeitig ist dieses Therapieverfahren mit einer hohen Morbidität und Mortalität verbunden, welche auf diverse akute Nebenwirkungen aber auch langfristige Komplikationen zurückzuführen ist. Unter anderem wurden vielfältige Funktionsbeeinträchtigungen erfasst, welche in einer gravierenden körperlichen Dekonditionierung sowie einem erhöhtem Risiko für kardiovaskuläre Folgeerkrankungen münden können. Sport- und Bewegungstherapie konnte sich in diesem Rahmen als Supportivmaßnahme vor allem bei erwachsenen Krebspatienten etablieren. Die Studienlage für Kinder und Adoleszenten mit Krebs ist nicht gleichsam evident. In der pädiatrischen SZT gibt es bis dato lediglich vier international publizierte Studien. Aufgrund des skizzierten Forschungsdefizits, sollten im Rahmen der vorliegenden randomisiert-kontrollierten Untersuchung, die physischen und psychischen Effekte einer strukturierten Sporttherapie während und nach der HSZT evaluiert werden.
Die erste Studienphase bezieht sich auf die stationäre Behandlung der Patienten und wurde in einem randomisiert-kontrollierten Design durchgeführt. Mit stationärer Aufnahme wurden teilnehmende Probanden in eine von zwei Studiengruppen randomisiert (Interventionsgruppe (IG) oder Kontrollgruppe (KG)). Während die IG ein Ausdauer-, Kraft- und Beweglichkeitstraining erhielt, führte die KG Konzentrations- und Entspannungsübungen durch. Beiden Gruppen wurde das altersentsprechende sowie individualisierte Training täglich zwischen 30–60min angeboten. Mit stationärer Entlassung gingen die Patienten in Phase II, die ambulante Nachbehandlung über. In dieser Pilotstudie sollten neben der Machbarkeit von Sporttherapie, die physischen Effekte bis 6 Monate nach HSZT analysiert werden. Aufgrund der wohnortgestützten ambulanten Weiterbehandlung wurde eine Neu-Stratifizierung der Patienten durchgeführt, wodurch vier Gruppen entstanden: IG–IG, IG–KG, KG–IG und KG–KG. Als MZP dienten die stationäre Aufnahme (T0) und Entlassung (T1) sowie für die Phase II Tag+100 (T2) und Tag+200 (T3). Die Testungen inkludierten motorische Testverfahren (6-Minuten-Walking-Test (6MWT), Spiroergometrie, Handkraft (Hk), Beinkraft (Bk)), psychometrische Testverfahren (Lebensqualität (LQ)) sowie klinische Parameter (z.B. Blutwerte) und die Körperzusammensetzung.
In vier Studienjahren (2011-2014) wurden 70 Patienten mit einem mittleren Alter von 11,0 Jahren (5–18Jahre) eingeschlossen. Stationär kam es zu einer Drop out Rate von 18,6% sowie zu Tag+200 von 54,3%. Die Patientencharakteristika zeigten abgesehen vom BMI bei Aufnahme (p<.05) keine Gruppenunterschiede.
Das stationäre Training wurde von beiden Gruppen mit 3,1 (2–4; IG) bzw. 2,9 (0,3–4; KG) Trainingseinheiten pro Woche ähnlich gut angenommen (je ~51min/Trainingseinheit). Für drei von den vier motorischen Testverfahren zeigte sich anhand der relativen Veränderungen für die IG ein Erhalt der Leistungsfähigkeit (6MWT: 2,4 (-66,1–25,7)%; Hk: -3,6±16,3%; Bk: -1,6 (-52,6–144,4)%). Gleichzeitig reduzierte die KG diese Daten jeweils signifikant (6MWT: -14,6 (-73,2–18,0)%; Hk: -10,9±20,0%; Bk: -13,0 (-57,9–131,7)%; p<.05). Die VO2peak ml/kg/min der Spiroergometrie zeigte innerhalb beider Gruppen eine signifikante Verschlechterung (IG: 15,0±16,7%; KG: -18,7±22,7%; p<.05). Die LQ präsentierte dagegen ein uneinheitliches Bild für beide Studiengruppen. Für die Körperzusammensetzung und klinischen Parameter konnten keine signifikanten Unterschiede berechnet werden.
Im ambulanten Setting demonstrierte die Aufbereitung des Trainings eine generelle Machbarkeit. Das Training wurde in 53,6±10,2% der Ambulanztermine integriert. Die hohe Ausfallrate war primär auf Kontraindikationen (63,3±22,1%) und Sondertermine (14,6±7,0%) zurückzuführen. Die Trainingshäufigkeit belief sich insgesamt auf 0,7 Trainingseinheiten/Woche bei 42,5min pro Trainingseinheit. Die Betrachtung der physischen Effekte zeigte eine generelle Verbesserung der Daten innerhalb aller Gruppen. Gruppen mit sportlicher Intervention (stationär oder ambulant) wiesen partiell (6MWT, Bk) höhere Messwerte und Verbesserungen auf. Signifikanzen lagen keine vor.
Gesamt betrachtet konnte in Studienphase 1 dem therapieassoziiertem körperlichen Abbau durch Bewegungstherapie entgegengewirkt werden. Gleichzeitig zeigte das Assessment, ausgenommen LQ, Körperzusammensetzung sowie die Spiroergometrie eine gute Anwendbarkeit in dem Setting. Für die ambulante Studienphase kann eine generelle Machbarkeit von Sporttherapie nach HSZT postuliert werden. Weitere Erhebungen wären in diesem Setting hinsichtlich der Trainingseffekte noch erforderlich. Zukünftige Studien sollten multizentrisch durchgeführt werden, um mit Hilfe größerer Fallzahlen umfassendere Erkenntnisse zu erlangen.
Versucht eine gesunde Person, regungslos auf einer Stelle zu stehen, so kann man feststellen, dass diese vermeintlich einfache Aufgabe nicht zu erfüllen ist. Dieses scheinbar statische Gleichgewicht beim ruhigen Stehen ist bei genauer Betrachtung beherrscht von subtilen, kontinuierlichen Körperschwankungen. Warum treten solche variablen Muster im Gleichgewichtsprozess auf? Die Untersuchung (Ursachenforschung, Beschreibung, Bewertung) dieser Fluktuationen ist Gegenstand der vorliegenden grundlagenwissenschaftlichen Arbeit.
Moderate physical activity improves various cognitive functions, particularly when it is applied simultaneously to the cognitive task. In two psychoneuroendocrinological within-subject experiments, we investigated whether very low-intensity motor activity, i.e. walking, during foreign-language vocabulary encoding improves subsequent recall compared to encoding during physical rest. Furthermore, we examined the kinetics of brain-derived neurotrophic factor (BDNF) in serum and salivary cortisol. Previous research has associated both substances with memory performance.In both experiments, subjects performed better when they were motorically active during encoding compared to being sedentary. BDNF in serum was unrelated to memory performance. In contrast we found a positive correlation between salivary cortisol concentration and the number of correctly recalled items. In summary, even very light physical activity during encoding is beneficial for subsequent recall.
Fascial tissues form a ubiquitous network throughout the whole body, which is usually regarded as a passive contributor to biomechanical behavior. We aimed to answer the question, whether fascia may possess the capacity for cellular contraction which, in turn, could play an active role in musculoskeletal mechanics. Human and rat fascial specimens from different body sites were investigated for the presence of myofibroblasts using immunohistochemical staining for α-smooth muscle actin (n = 31 donors, n = 20 animals). In addition, mechanographic force registrations were performed on isolated rat fascial tissues (n = 8 to n = 18), which had been exposed to pharmacological stimulants. The density of myofibroblasts was increased in the human lumbar fascia in comparison to fasciae from the two other regions examined in this study: fascia lata and plantar fascia [H(2) = 14.0, p < 0.01]. Mechanographic force measurements revealed contractions in response to stimulation by fetal bovine serum, the thromboxane A2 analog U46619, TGF-β1, and mepyramine, while challenge by botulinum toxin type C3–used as a Rho kinase inhibitor– provoked relaxation (p < 0.05). In contrast, fascial tissues were insensitive to angiotensin II and caffeine (p < 0.05). A positive correlation between myofibroblast density and contractile response was found (rs = 0.83, p < 0.001). The hypothetical application of the registered forces to human lumbar tissues predicts a potential impact below the threshold for mechanical spinal stability but strong enough to possibly alter motoneuronal coordination in the lumbar region. It is concluded that tension of myofascial tissue is actively regulated by myofibroblasts with the potential to impact active musculoskeletal dynamics.
Background: WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies.
Methods: A search for "WATSU OR watershiatsu OR (water AND shiatsu)" was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals).
Results: Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges’s g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges’s g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges’s g = -0.68, 95% CI = -1.02 to -0.35).
Conclusion: Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.
Purpose: Hamstring injuries are common among football players. There is still disagreement regarding prevention. The aim of this review is to determine whether static stretching reduces hamstring injuries in football codes.
Methods: A systematic literature search was conducted on the online databases PubMed, PEDro, Cochrane, Web of Science, Bisp and Clinical Trial register. Study results were presented descriptively and the quality of the studies assessed were based on Cochrane’s ‘risk of bias’ tool.
Results: The review identified 35 studies, including four analysis studies. These studies show deficiencies in the quality of study designs.
Conclusion: The study protocols are varied in terms of the length of intervention and follow-up. No RCT studies are available, however, RCT studies should be conducted in the near future.
Background: Aging is associated with loss of balance and activity in daily life. It impacts postural control and increases the risk of falls. The current study was conducted to determine the feasibility and long-term impact of stochastic resonance whole-body vibration (SR-WBV) on static and dynamic balance and reaction time among elderly individuals.
Methods: A randomized crossover pilot study with blinding of the participants. Twenty elderly were divided into group A (SR-WBV 5 Hz, Noise 4/SR-WBV 1 Hz, Noise 1) or group B (SR-WBV 1 Hz, Noise 1/SR-WBV 5 Hz, Noise 1). Feasibility outcomes included recruitment, compliance and safety. Secondary outcomes were Semi-Tandem Stand (STS), Functional Reach Test (FRT), Expanded Timed Get Up-and-Go (ETGUG), walking under single (ST) & dual task (DT) conditions, hand and foot reaction time (RTH/RTF). Puri and Sen Rank-Order L Statistics were used to analyse carry-over effects. To analyse SR-WBV effects Wilcoxon signed-ranked tests were used.
Results: With good recruitment rate (55%) and compliance (attrition 15%; adherence 85%) rates the intervention was deemed feasible. Three participants dropped out, two due to knee pain and one for personal reasons. ETGUG 0 to 2 m (p = 0.143; ES: 0.36) and ETGUG total time (p = 0.097; ES: 0.40) showed medium effect sizes.
Conclusions: Stochastic resonance training is feasible in untrained elderly resulting in good recruitment and compliance. Low volume SR-WBV exercises over 12 training sessions with 5 Hz, Noise 4 seems a sufficient stimulus to improve ETGUG total time. The stimulation did not elicit changes in other outcomes.
Trial registration: This trial has been registered at the U.S. National Institutes of Health under ClinicalTrials.gov: NCT01045746 .
Background: This study evaluated the effects of a combined innovative training regime consisting of stochastic resonance whole-body vibration (SR-WBV) and a dance video game (DVG) on physical performance and muscle strength in long-term-care dwelling elderly.
Methods: Thirthy long-term-care elderly were randomly allocated to an intervention group (IG; n = 16) receiving combined SR-WBV training and DVG, or a sham group (SG; n = 14). IG performed five sets one minute of SR-WBV, with one minute rest between sets (base frequency 3 Hz up to 6 Hz, Noise 4) during the first five weeks on three days per week. From week five to eight a DVG was added to SR-WBV for IG on three days per week. SG performed a five-set SR-WBV program (1 Hz, Noise 1) lasting five times one minute, with one minute rest in between, three days a week. From week five to eight stepping exercises on a trampoline were added on three days per week. Primary outcome: Short physical performance battery (SPPB). Secondary outcome: isometric maximal voluntary contraction (IMVC), and sub phases of IMVC (Fsub), isometric rate of force development (IRFD) and sub time phases of IRFD (IRFDsub) were measured at baseline, after four and eight weeks. ANOVA with repeated measures was used for analyses of time and interaction effects and MANOVA determined between group intervention effects.
Results: Between group effects revealed significant effects on the SPPB primary outcome after four weeks F(1, 27) = 6.17; p = 0.02) and after eight weeks F(1,27) = 11.8; p = 0.002). Secondary muscle function related outcome showed significant between group effects in IG on IRFD, Fsub 30 ms, 100 ms, 200 ms and IRFDsub 0-30 ms, 0-50 ms, 0-100 ms and 100-200 ms compared to SG (all p < 0.05).
Conclusions: Eight weeks SR-WBV and DVG intervention improved lower extremity physical function and muscle strength compared to a sham intervention in long-term-care elderly. SR-WBV and DVG seems to be effective as a training regime for skilling up in long-term-care elderly.
Aus dem Bereich der, bei Sportlern vermehrt auftretenden dermatologischen Erkrankungen, werden nach ausführlicher Darstellung der Mykoseproblematik in unterschiedlichen Sportbereichen, die Prävalenz und prädisponierende Faktoren für die Tinea pedis-Infektionen bei einem Kollektiv von 235 Marathonläufern erhoben. Auf Grundlage der gewonnenen Studienergebnisse sollen Prophylaxeempfehlungen für die Sporttreibenden formuliert und Grundlagen für weiterführende Studien geschaffen werden. Zur medizinischen Einführung in die Studienthematik wird im zweiten Kapitel ein Exkurs in die Fuß- und Nagelpilzerkrankungen vorangestellt. Die klinischen Krankheitsbilder und klassische Transfektionswege von Tinea pedis interdigitalis, Onychomykosen und Tinea pedis vom Mokassin-Typ werden so weit beschrieben, wie es für das Verständnis der Studie notwendig ist. Die Studie basiert auf drei, mit insgesamt 296 Teilnehmern, zwischen Februar 1998 und Juni 2000 durchgeführten Pilotstudien. Im Verlauf der Pilotstudien wurden unterschiedliche Studienschwerpunkte, so zum Beispiel die Fragen nach der mykologischen Prävalenz von Sportlern, ob Mykoseerreger auch in Sportschuhen nachgewiesen werden können oder ob Sportler und Schuh schnell und effektiv saniert werden können bearbeitet. Über die Durchführung der Pilotstudien hinweg wurde ein Prüfbogen entwickelt, der es im Rahmen einer Sportgroßveranstaltung, dem Euro Marathon 2000, in Frankfurt ermöglichte, studienrelevante Variablen der Stichprobenmitglieder vor bzw. parallel zu den durch Mediziner durchgeführten klinischen Inspektionen zu erfassen. Die klinischen Befunde wurden durch anschließende labortechnische Untersuchungen überprüft und spezifiziert. Auf der Basis des gewonnenen Datenmaterials wurden die primären Fragestellungen: „Wie hoch ist die mykotische Infektionsrate bei der Stichprobe? Welche Verteilung der mykotischen Erkrankungen Onychomykose, Tinea pedis interdigitalis oder Mokassin-Typ liegen bei der untersuchten Stichprobe vor? Welche Abhängigkeiten zwischen erhobenen Begleitvariablen und mykotischen Erkrankungen können festgestellt werden?“ sowie die sekundären Fragestellungen: „Wie sind die mykotischen Erkrankungen auf die einzelnen Füße, Zehen, Zehenzwischenräume verteilt? Welchen Ausprägungsgrad weisen die mykotischen Erkrankungen im Fußbereich auf? Sind Abhängigkeiten zwischen Ausprägungsgrad und erhobenen Begleitvariablen festzustellen? Welche Erreger können durch die Laboruntersuchungen nachgewiesen werden? Können frühere Pilot-Studienergebnisse durch diese Studie bestätigt werden?“ mit Hilfe statistischer Verfahren, ausgewertet und interpretiert. Die Probanden wiesen zu 59,6% positive mykotische Befunde im Fußbereich auf. Einige der erhobenen Begleitvariablen, so zum Beispiel Alter der Sportler und Anzahl der betriebenen Sportarten, stehen in signifikantem Zusammenhang zum Auftreten positiver mykologischer Befunde. Weitere Einflussvariablen liesen bei der Korrelationsanalyse Gefährdungstendenzen erkennen. Mit Hilfe der logistischen Regression wurde die Hypothese „Die Wahrscheinlichkeit für positive mykotische Befunde ist abhängig von der Anzahl der vorhandenen Risikofaktoren“ stufenweise in ein Modell mit den vier Risikofaktoren: Alter des Sportlers >= 40 Jahre, nur ein bis zwei betriebene Sportarten, drei und mehr Sportschuhe in Gebrauch und Gewicht >= 70 kg angepasst und überprüft. Die Darstellung von vier exemplarischen Einzelfällen veranschaulicht die in den Korellationsbetrachtungen uni- und multivariat beschriebenen Risikofaktoren. Die Arbeit schließt mit einem therapeutischen Exkurs, in dem für die drei beschriebenen Tinea pedis-Infektionen die gängigen Therapien aber auch pespektivisch zu erwartende Wirkstoffkombinationen genannt werden. Sportspezifische und allgemeine Prophylaxeempfehlungen komplettieren das letzte Kapitel.
We are glad to introduce the sixth Journal Club. This edition is focused on several relevant studies published in recent years in the field of Motor Control and Learning, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.
Nineteen-channel EEGs were recorded from the scalp surface of 30 healthy subjects (16 males and 14 females, mean age: 34 years, SD: 11.7 years) at rest and under trains of intermittent photic stimulation (IPS) at rates of 5, 10 and 20 Hz. Digitalized data were submitted to spectral analysis with fast fourier transformation providing the basis for the computation of global field power (GFP). For quantification, GFP values in the frequency ranges of 5, 10 and 20 Hz at rest were divided by the corresponding data obtained under IPS. All subjects showed a photic driving effect at each rate of stimulation. GFP data were normally distributed, whereas ratios from photic driving effect data showed no uniform behavior due to high interindividual variability. Suppression of alpha-power after IPS with 10 Hz was observed in about 70% of the volunteers. In contrast, ratios of alpha-power were unequivocal in all subjects: IPS at 20 Hz always led to a suppression of alpha-power. Dividing alpha-GFP with 20-Hz IPS by alpha-GFP at rest (R = a-GFPIPS/a-GFPrest) thus resulted in ratios lower than 1. We conclude that ratios from GFP data with 20-Hz IPS may provide a suitable paradigm for further investigations. Key words: EEG, Brain mapping, Intermittent photic stimulation, IPS, Global field power ratios
Altitude training and respiratory muscle training (RMT) have been reported to improve performance in elite and well-trained athletes. Several devices (altitude and RMT) have been developed to help athletes gain the competitive edge. The Elevation Training Mask 2.0 (ETM) purportedly simulates altitude training and has been suggested to increase aerobic capacity (VO2max), endurance performance, and lung function. Twenty-four moderately trained subjects completed 6 weeks of high-intensity cycle ergometer training. Subjects were randomized into a mask (n = 12) or control (n = 12) group. Pre and post-training tests included VO2max, pulmonary function, maximal inspiration pressure, hemoglobin and hematocrit. No significant differences were found in pulmonary function or hematological variables between or within groups. There was a significant improvement in VO2max and PPO in both the control (13.5% and 9.9%) and mask (16.5% and 13.6%) groups. There was no difference in the magnitude of improvement between groups. Only the mask group had significant improvements in ventilatory threshold (VT) (13.9%), power output (PO) at VT (19.3%), respiratory compensation threshold (RCT) (10.2%), and PO at RCT (16.4%) from pre to post-testing. The trends for improvements in VT and PO at VT between groups were similar to improvements in RCT and PO at RCT, but did not reach statistical significance (VT p = 0.06, PO at VT p = 0.170). Wearing the ETM while participating in a 6-week high-intensity cycle ergometer training program does not appear to act as a simulator of altitude, but more like a respiratory muscle training device. Wearing the ETM may improve specific markers of endurance performance beyond the improvements seen with interval training alone.
Water-filtered infrared-A (wIRA) can act as a penetration enhancer for topically applied substances
(2008)
Background: Water-filtered infrared-A (wIRA) irradiation has been shown to enhance penetration of clinically used topically applied substances in humans through investigation of functional effects of penetrated substances like vasoconstriction by cortisone.
Aim of the study: Investigation of the influence of wIRA irradiation on the dermatopharmacokinetics of topically applied substances by use of optical methods, especially to localize penetrating substances, in a prospective randomised controlled study in humans.
Methods: The penetration profiles of the hydrophilic dye fluorescein and the lipophilic dye curcumin in separate standard water-in-oil emulsions were determined on the inner forearm of test persons by tape stripping in combination with spectroscopic measurements. Additionally, the penetration was investigated in vivo by laser scanning microscopy. Transepidermal water loss, hydration of the epidermis, and surface temperature were determined. Three different procedures (modes A, B, C) were used in a randomised order on three separate days of investigation in each of 12 test persons. In mode A, the two dyes were applied on different skin areas without water-filtered infrared-A (wIRA) irradiation. In mode B, the skin surface was irradiated with wIRA over 30 min before application of the two dyes (Hydrosun® radiator type 501, 10 mm water cuvette, orange filter OG590, water-filtered spectrum: 590–1400 nm with dominant amount of wIRA). In mode C, the two dyes were applied and immediately afterwards the skin was irradiated with wIRA over 30 min. In all modes, tape stripping started 30 min after application of the formulations. Main variable of interest was the ratio of the amount of the dye in the deeper (second) 10% of the stratum corneum to the amount of the dye in the upper 10% of the stratum corneum.
Results: The penetration profiles of the hydrophilic fluorescein showed in case of pretreatment or treatment with wIRA (modes B and C) an increased penetration depth compared to the non-irradiated skin (mode A): The ratio of the amount of the dye in the deeper (second) 10% of the stratum corneum to the amount of the dye in the upper 10% of the stratum corneum showed medians and interquartile ranges for mode A of 0.017 (0.007/0.050), for mode B of 0.084 (0.021/0.106), for mode C of 0.104 (0.069/0.192) (difference between modes: p=0.0112, significant; comparison mode A with mode C: p<0.01, significant). In contrast to fluorescein, the lipophilic curcumin showed no differences in the penetration kinetics, in reference to whether the skin was irradiated with wIRA or not. These effects were confirmed by laser scanning microscopy. Water-filtered infrared-A irradiation increased the hydration of the stratum corneum: transepidermal water loss rose from approximately 8.8 g m-2 h-1 before wIRA irradiation to 14.2 g m-2 h-1 after wIRA irradiation and skin hydration rose from 67 to 87 relative units. Skin surface temperature increased from 32.8°C before wIRA to 36.4°C after wIRA irradiation.
Discussion: The better penetration of the hydrophilic dye fluorescein after or during skin irradiation (modes B and C) can be explained by increased hydration of the stratum corneum by irradiation with wIRA.
Conclusions: As most topically applied substances for the treatment of patients are mainly hydrophilic, wIRA can be used to improve the penetration of substances before or after application of substances – in the first case even of thermolabile substances – with a broad clinical relevance as a contact free alternative to an occlusive dressing.
Fit to play : posture and seating position analysis with professional musicians - a study protocol
(2017)
Background: Musical performance-associated musculoskeletal disorders (MSD) are a common health problem among professional musicians. Considering the manifold consequences arising for the musicians, they can be seen as a threat for their professional activity. String players are the most affected group of musicians in this matter. Faults in upper body posture while playing the instrument, causing un-ergonomic static strain on the back and unergonomic limp-movements, are a main reason for musculoskeletal disorders and pain syndromes.
Methods: A total of 66 professional musicians, divided into three groups, are measured.
The division is performed by average duration of performance, intensity of daily exercise and professional experience. Video raster stereography, a three-dimensional analysis of the body posture, is used to analyse the instrument-specific posture. Furthermore the pressure distribution during seating is analysed. Measurements are performed because the musician is sitting on varying music chairs differing in structure and/or construction of the seating surface. The measurements take place in habitual seating position as well as during playing the instrument.
Results: To analyse the influence of different chairs, ANOVA for repeated measurements or Friedman-test is used, depending on normality assumptions. Comparison of posture between amateur musicians, students, and professional orchestral musicians is carried out the non-parametric Jonckheere-Terpstra-test.
Conclusions: Our method attempts to give the musicians indications for the right music chair choice by analyzing the chair concepts, so that thereby preemptively MSD can be reduced or prevented.
Introduction: Musicians often perform in forced postures over a long period of time, which in the worst case may lead to playing-related musculoskeletal disorders. In this context, the ergonomics of the musician's chair (construction and surface quality) can be an influencing factor, with impact on the seating position of the upper body and the pressure distribution of the bottom. Therefore, the relationship between different musician chairs and musicians of different playing levels (professional, amateur or student) was analyzed in order to gain useful insights whether playing experience, playing level, playing style (symmetrical or asymmetrical) or gender have an impact.
Method: The total dataset of 47 musicians (3 playing levels: professional, amateur, student) were analysed on six musician chairs with different ergonomic layout. Sitting on each chair without instrument (condition 1) and with instrument (condition 2), the upper body posture (videorasterstereography) and the seat pressure (load distribution) were recorded.as Also, a subjective assessment concerning constitutional data, sitting behaviour, prevailing pain in the musculoskeletal system, sport activity and chair comfort rating, was completed using a questionnaire.
Results: There were significant differences shown in 6 of 17 variables, where all between and within factors were accounted for with a MANOVA. Two measurements of the upper body posture (scapular distance and scapular height) differentiated between playing level. Four of the pressure measurements (pressure under the sit bone and the thigh for the left and the right side) differentiated between chairs and the two conditions (with and without instrument). Chairs with soft cushioning had a mean pressure reduction of about 30%. The pressure was increased by about 10% while playing an instrument. Subjective rating was correlated to age for some of the chairs.
Discussion: Differences between chairs are mainly associated with the pressure distribution under the sitting surface. Playing with an instrument puts an additional force onto the surface of the chair that is more than the weight of the instrument. No relationship between pressure data and upper body posture data could be found. Therefore, it can be speculated that the intersubject variability is larger than systematic differences introduced by the chair or instrument.
Background: Effects of playing high stringed bow instruments on the upper body posture have not been analysed so far. The instrument-specific seating position when playing in an orchestra is compared to the habitual seating position.
Methods: Three dimensional back scans were performed in 13 professional violinists and viola players of a radio orchestra (8 f / 5 m). Trunk position in their habitual seating position and in the instrument- specific seating position imitating playing was compared. Statistical differences were calculated using Wilcoxon Matched Pairs Test with Bonferroni Holm correction.
Results: Significant differences were found between the seated position with instrument and without (p < 0.001, 0.03, 0.02 or 0.01) in the spine (trunk length, sagittal trunk decline, lumbar bending angle, maximal rotation, standard deviation rotation, lumbar lordosis), the shoulder (scapula distance, scapula rotation, scapula angle right) and pelvis distance.
Conclusions: Playing an instrument changes the static seating position by increased rotation of the spine and specific shoulder adaptations holding the instrument (left arm) and the bow (right arm), with minor effects on the pelvis. This forced position may result in chronic health effects. The method used in this study is an approach to better understand the involved muscular structures and possible resulting health damages.
Objective: Classifications of posture deviations are only possible compared with standard values. However, standard values have been published for healthy male adults but not for female adults.
Design: Observational study.
Setting: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main.
Participants: 106 healthy female volunteers (21–30 years old; 25.1±2.7 years) were included. Their body weight ranged from 46 to 106 kg (60.3±7.9 kg), the heights from 1.53 to 1.82 m (1.69±0.06 m) and the body mass index from 16.9 kg/m² to 37.6 kg/m² (21.1±2.6 kg/m²).
Outcome measures: A three-dimensional back scan was performed to measure the upper back posture in habitual standing. The tolerance ranges and CI were calculated. Group differences were tested by the Wilcoxon Mann-Whitney U test.
Results: In normal posture, the spinal column was marginally twisted to the left, and the vertebrae were marginally rotated to the right. The kyphosis angle is larger than the lumbar angle. Consequently, a more kyphotic posture is observed in the sagittal plane. The habitual posture is slightly scoliotic with a rotational component (scapular depression right, right scapula marginally more dorsally, high state of pelvic right, iliac right further rotated anteriorly).
Conclusions: Healthy young women have an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. Compared with young males, women show only marginal differences in the upper body posture. These values allow a comparison to other studies, both for control and patient data, and may serve as guideline in both clinical practice and scientific studies.
Background: How a dentist works, such as the patterns of movements performed daily, is also largely affected by the workstation Dental tasks are often executed in awkward body positions, thereby causing a very high degree of strain on the corresponding muscles. The objective of this study is to detect those dental tasks, during which awkward postures occur most frequently. The isolated analysis of static postures will examine the duration for which these postures are maintained during the corresponding dental, respectively non-dental, activities.
Methods: 21 (11f/10 m) dentists (age: 40.1 ± 10.4 years) participated in this study. An average dental workday was collected for every subject. To collect kinematic data of all activities, the CUELA system was used. Parallel to the kinematic examination, a detailed computer-based task analysis was conducted. Afterwards, both data sets were synchronized based on the chronological order of the postures assumed in the trunk and the head region. All tasks performed were assigned to the categories "treatment" (I), "office" (II) and "other activities" (III). The angle values of each body region (evaluation parameter) were examined and assessed corresponding to ergonomic standards. Moreover, this study placed a particular focus on static positions, which are held statically for 4 s and longer.
Results: For "treatment" (I), the entire head and trunk area is anteriorly tilted while the back is twisted to the right, in (II) and (III) the back is anteriorly tilted and twisted to the right (non-neutral position). Static positions in (I) last for 4–10s, static postures (approx. 60%) can be observed while in (II) and (III) in the back area static positions for more than 30 s are most common. Moreover, in (II) the back is twisted to the right for more than 60 s in 26.8%.
Conclusion: Awkward positions are a major part of a dentists’ work. This mainly pertains to static positions of the trunk and head in contrast to "office work." These insights facilitate the quantitative description of the dentist profession with regard to the related physical load along with the health hazards to the musculoskeletal system. Moreover, the results allow for a selective extraction of the most unfavorable static body positions that dentists assume for each of the activities performed.
Background: This study aims at identifying orthodontic activities with the highest frequency of unfavorable/awkward and static postures held over a period of more than 4 s based on kinematic analysis. Moreover, a separate analysis of static postures for orthodontic and non-orthodontic activities serves to evaluate the duration for which these particular postures are assumed.
Methods: In total, 21 (13f/8 m) orthodontists (age: 31.5 ± 3.8 years) participated in this study. CUELA, a personal measurement system, was used to collect kinematic data for all orthodontic activities in a working day. Angle values of the head and torso were evaluated in accordance with ergonomic standards. Only those postures that were held statically for 4 s and longer were selected for further analysis. Alongside the kinematic analysis, the activities performed on-site were also subject to a detailed computerized analysis. The synchronization of data collected from both measurements arranges the patterns of posture found chronologically and in conjunction with the orthodontic activities performed ((I) "treatment" (II) "office" and (III) "other activities").
Results: For (I) we observed an anterior inclination of the head and torso area as well as a twist of the head and neck area to the right. We found anterior back inclination and lateral back torsion to the right for (II) and (III). If, furthermore, we differentiate the duration of static postures, there are primarily short to medium-term (4–30s) static postures identified for (I). Also, categories (II) and (III) predominantly demonstrate static back postures with a duration of up to 30 s. With regard to (II) we observed that the back is ventrally inclined for 10.1% of the total activity duration.
Conclusions: During treatment static strains are observed in the entire head and torso area. On the contrary, static postures prevalent in the torso area are essential for activities of the other categories, particularly office work. These findings allow for a careful selection of unfavorable and static postures for each of the activities performed and help to develop specific preventive measures.
Background: Up to 80% of breast cancer patients suffer from Cancer Related Cognitive Impairments (CRCI). Exercise is suggested as a potential supportive care option to reduce cognitive decline in cancer patients. This study will investigate the effects of a high-intensity interval endurance training (HIIT) on CRCI in breast cancer patients. Potentially underlying immunological and neurobiological mechanisms, as well as effects on patients’ self-perceived cognitive functioning and common cancer related side-effects, will be explored.
Methods: A single-blinded randomized controlled trial will be carried out. The impact of HIIT on CRCI will be compared to that of a placebo-intervention (supervised myofascial release training). Both interventions will be conducted simultaneously with the patients’ first-line chemotherapy treatment typically lasting 12–18 weeks. Fifty-nine women with breast cancer will be included in each of the two groups. The study is powered to detect (α = .05, β = .2) a medium effect size difference between the two groups (d = .5) in terms of patients’ change in cognitive testing performances, from baseline until the end of the exercise-intervention. The cognitive test battery, recommended by the International Cancer and Cognition Task Force to assess CRCI, will be used as primary measure. This includes the Hopkins Verbal Learning Test (learning/verbal memory), the Controlled Oral Word Association Test (verbal fluency) and the Trail-Making-Test A/B (attention/set-switching). The following endpoints will be assessed as secondary measures: Go-/No-Go test performance (response inhibition), self-perceived cognitive functioning, serum levels of pro- and antiinflammatory markers (tumor necrosis factor alpha, Interleukin-6, Interleukin-1 alpha, Interleukin-1 beta, C-reactive protein, Interleukin-1 receptor antagonist and Interleukin-10), serum levels of neurotrophic and growth factors (brain-derived neurotrophic factor, insulin-like growth factor 1 and vascular endothelial growth factor), as well as common cancer-related side effects (decrease in physical capacity, fatigue, anxiety and depression, sleep disturbances, quality of life and chemotherapy compliance).
Discussion: This study will provide data on the question whether HIIT is an effective supportive therapy that alleviates CRCI in breast cancer patients. Moreover, the present study will help shed light on the underlying mechanisms of potential CRCI improving effects of exercise in breast cancer patients.
Trial registration: DRKS.de, German Clinical Trials Register (DRKS), ID: DRKS00011390, Registered on 17 January 2018.
Motion analysis in the field of dentistry : a kinematic comparison of dentists and orthodontists
(2016)
Objectives: To conduct a kinematic comparison of occupational posture in orthodontists and dentists in their workplace.
Design: Observational study.
Setting: Dentist surgeries and departments of orthodontics at university medical centres in Germany.
Participants: A representative sample of 21 (10 female, 11 male) dentists (group G1) and 21 (13 female, 8 male) orthodontists (G2) with one male dropout in G2.
Outcome measures: The CUELA (computer-assisted acquisition and long-term analysis of musculoskeletal loads) system was used to analyse occupational posture. Parallel to the recording through the CUELA system, a software-supported analysis of the activities performed (I: treatment; II: office; III: other activities) was carried out. In line with ergonomic standards the measured body angles are categorised into neutral, moderate and awkward postures. Activities between the aforementioned groups are compared using the stratified van Elteren U test and the Wilcoxon–Mann–Whitney U test. All p values are subject to the Bonferroni–Holm correction. The level of significance is set at 5%.
Results: The percentage of time spent on activities in categories I–II–III was as follows: dentists 41%–23%–36% and orthodontists 28%–37%–35%. The posture analysis of both groups showed, for all percentiles (P5–95), angle values primarily in the neutral or moderate range. However, depending on the activity performed, between 5% and 25% of working hours were spent in unfavourable postures, especially in the head-and-neck area. Orthodontists have a greater tendency than dentists to perform treatment activities with the head and torso in unfavourable positions. The statistically significant differences between the two groups with regard to the duration and the relevance of the activities performed confirm this assumption for all three categories (p<0.01, p<0.05).
Conclusions: Generally, both groups perform treatment activities in postures that are in the neutral or medium range; however, dentists had slightly more unfavourable postures during treatment for a greater share of their work day.
Background: Arising from the relevance of sensorimotor training in the therapy of nonspecific low back pain patients and from the value of individualized therapy, the present trial aims to test the feasibility and efficacy of individualized sensorimotor training interventions in patients suffering from nonspecific low back pain.
Methods and study design: A multicentre, single-blind two-armed randomized controlled trial to evaluate the effects of a 12-week (3 weeks supervised centre-based and 9 weeks home-based) individualized sensorimotor exercise program is performed. The control group stays inactive during this period. Outcomes are pain, and pain-associated function as well as motor function in adults with nonspecific low back pain. Each participant is scheduled to five measurement dates: baseline (M1), following centre-based training (M2), following home-based training (M3) and at two follow-up time points 6 months (M4) and 12 months (M5) after M1. All investigations and the assessment of the primary and secondary outcomes are performed in a standardized order: questionnaires – clinical examination – biomechanics (motor function). Subsequent statistical procedures are executed after the examination of underlying assumptions for parametric or rather non-parametric testing.
Discussion: The results and practical relevance of the study will be of clinical and practical relevance not only for researchers and policy makers but also for the general population suffering from nonspecific low back pain.
Background: We aimed to investigate the potential effects of a 4-week motor–cognitive dual-task training on cognitive and motor function as well as exercise motivation in young, healthy, and active adults.
Methods: A total of 26 participants (age 25 ± 2 years; 10 women) were randomly allocated to either the intervention group or a control group. The intervention group performed a motor–cognitive training (3×/week), while the participants of the control group received no intervention. Before and after the intervention period of 4 weeks, all participants underwent cognitive (d2-test, Trail Making Test) and motor (lower-body choice reaction test and time to stabilization test) assessments. Following each of the 12 workouts, self-reported assessments (rating of perceived exertion, enjoyment and pleasant anticipation of the next training session) were done. Analyses of covariances and 95% confidence intervals plotting for between group and time effects were performed.
Results: Data from 24 participants were analysed. No pre- to post-intervention improvement nor a between-group difference regarding motor outcomes (choice-reaction: F = 0.5; time to stabilization test: F = 0.7; p > 0.05) occurred. No significant training-induced changes were found in the cognitive tests (D2: F = 0.02; Trail Making Test A: F = 0.24; Trail Making Test B: F = 0.002; p > 0.05). Both enjoyment and anticipation of the next workout were rated as high.
Discussion: The neuro-motor training appears to have no significant effects on motor and cognitive function in healthy, young and physically active adults. This might be explained in part by the participants’ very high motor and cognitive abilities, the comparably low training intensity or the programme duration. The high degree of exercise enjoyment, however, may qualify the training as a facilitator to initiate and maintain regular physical activity. The moderate to vigorous intensity levels further point towards potential health-enhancing cardiorespiratory effects.
Background: Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction.
Methods and design: A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only.
Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines.
Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes.
Trial registration: German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.
Patienten mit chronisch-unspezifischen Nackenschmerzen weisen Studien zufolge ein gegenüber symptomfreien Personen pathologisch verändertes Bewegungsverhalten der Halswirbelsäule auf. Aktuelle Untersuchungen bestätigen dabei eine im Vergleich zu gesunden, symptomfreien Probanden verminderte Beweglichkeit der Zervikalregion. Mit dem Fokus auf sensomotorische Funktionen deuten Studien zudem ein erhöhtes Maß an nicht-intendierter Bewegungsvariabilität sowie ein vermindertes Maß an Nebenbewegungen in andere Ebenen bei der Durchführung zweidimensionaler Bewegungsabfolgen an. Demgegenüber verändert sich bei symptomfreien Personen das zervikale Bewegungs-verhalten im Altersverlauf. Aktuelle Untersuchungen indizieren dabei eine im Alter erhöhte Bewegungsvariabilität. Zusätzlich indizieren Studien ein mit zunehmendem Alter geringer werdendes maximales Bewegungsausmaß der Halswirbelsäule. Publizierte Normwerte drücken diese altersabhängigen Veränderungen jedoch nur grob kategorisierend für größere Altersspannen aus. Daten zu möglichen Zuordnungsmöglichkeiten von Patienten und gesunden Personen anhand trennscharfer Schwellenwerten zum Bewegungsausmaß und zur Bewegungskonsistenz fehlen gänzlich.Vor diesem Hintergrund war das Ziel der Studie die Entwicklung und Validierung klassifikatorischer Modelle zur Diskriminierung von symptomatischem und asympto-matischem zervikalem Bewegungsverhalten. Symptomfreie Probanden (120) wurden konsekutiv der Modellentwicklung (n = 100, 18 – 75 Jahre, 36 f) bzw. der Modellvalidierung zugeteilt (n = 20, 23 – 75 Jahre, 15 f). Zusätzlich wurden zur Modellvalidierung ebenfalls 20 Patienten mit chronisch-unspezifischen Nackenschmerzen eingeschlossen (22 – 71 Jahre, 15 f). Alle Probanden absolvierten initial eine Bewegungsanalyse zur Erhebung des Bewegungsverhaltens der Halswirbelsäule. Diese beinhaltet ein Set zu fünf repetitiven zervikalen Flexions-/Extensions-Bewegungszyklen. Die kinematischen Variablen wurden dabei ultraschalltopometrisch erfasst. Diese standardisierte Erhebung erfolgte in stabiler aufrechter Positionierung und selbstgewählter Geschwindigkeit unter Verwendung eines nichtinvasiven 3D-Bewegungsanalysesystems. Die kinematischen Charakteristika, bestehend aus maximalem Bewegungsausmaß in der Sagittalebene (ROM), den Variationskoeffizienten (CV) sowie den mittleren Nebenbewegungen in Frontal- und Transversalebene (NEB) wurden final aus den Rohdaten berechnet. Im Anschluss erfolgte die Modellentwicklung auf Basis von Cut-Offs. Dies geschah mittels der Erstellung von voraussetzungskonformen linearen Regressionsmodellen. Unabhängige Variable war dabei das Alter, die abhängige Variable stellte das jeweilige kinematische Charakteristikum dar. Die Cut-Offs beschrieben jeweils die Prognose-Konfidenzintervalle der Regressionsgeraden (90% Prognose-Konfidenzintervall für individuelle Werte (ind) und 95% Prognose-Konfidenzintervall für Mittelwerte (MW)). Die Werte der kinematischen Analyse jedes Probanden, der in die Modellvalidierung der entwickelten Cut-Offs eingeschlossen wurde, wurden anschließend mittels dieser Cut-Offs klassifiziert als ‘asymptomatisch’ oder ‘symptomatisch’. Auf der Basis dieser Zuteilung wurden die Cut-Offs stringent mittels Vierfeldertafeln auf ihre Trennschärfe in der Diskriminierung von chronisch-unspezifischen Nackenschmerzpatienten und symptomfreien Personen überprüft. Alle entwickelten Modelle wiesen einen gerichteten linearen Zusammenhang zwischen Alter und dem jeweiligen kinematischen Charakteristikum auf. Auf Basis der internen Validierung beinhaltet das 95%-Konfidenzintervall der Steigung der Regressionsgeraden in dem vorliegenden Modell den Nullwert nicht und schließt zudem bei allen drei Modellen die bei der Erstellung des Modells gefundene Steigung ein. Bei der Modellvalidierung ergab die Bewertung der Vierfeldertafeln überzufällige Unterschiede zwischen erwarteter und beobachteter Häufigkeitsverteilung der mittels Prognose-Konfidenzintervalle für Mittelwerte für ROM (ROMMW; Chi2= 6.8; p< .01) und CV (CVMW; Chi2= 6.42; p< .05) klassierten kinematischen Größen, nicht jedoch für die vier anderen Klassifikatoren (p> .05). Im Anschluss ergab die Analyse der Trennschärfe der Modelle mit überzufälliger Merkmalsverteilung eine Sensitivität von 60 % für ROMMW und von 75 % für CVMW. Die Spezifität betrug 85 % für ROMMW und 65 % für CVMW. Die Resultate demonstrieren einerseits einen linearen Zusammenhang von Alter und verschiedener kinematischer Charakteristika sowie eine überzufällige Merkmalsverteilung für die Modelle ROMMW und CVMW mit ausreichender Spezifität und Sensitivität und – daraus hervorgehend – eine ausreichende Trennschärfe der klassifikatoren in der Differenzierung von symptomatischen und asymptomatischen Bewegungsmustern. Die Resultate sind einerseits im Einklang mit anderen – kategorisierenden – Studienresultaten und ergänzen andererseits – durch die Erstellung und Bewertung trennscharfer Klassifikatoren – den aktuellen Forschungsstand konsekutiv. Die Trennschärfe-Indizes bewegen sich dabei in vergleichbarer Größenordnung wie andere (subjektive) Klassifikatoren (z.B. Schmerzstärke) zur Einordnung von Nackenschmerzpatienten. Insbesondere in der individuellen Beurteilung, aber auch für mögliche prospektive Vergleiche sind valide Ein ordnungskriterien von Belangen und bieten gegenüber einfachen kategorisierenden Gruppenwerten genauere und verlässlichere Klassierungen. Zukünftige Forschungsaktivitäten sollten sich insbesondere mit der Übertragbarkeit vorliegender Cut-Offs auf interventionsinduzierte individuelle Veränderungen auseinandersetzen.
Stabilization exercise (SE) is evident for the management of chronic non-specific low back pain (LBP). The optimal dose-response-relationship for the utmost treatment success is, thus, still unknown. The purpose is to systematically review the dose-response-relationship of stabilisation exercises on pain and disability in patients with chronic non-specific LBP. A systematic review with meta-regression was conducted (Pubmed, Web of Knowledge, Cochrane). Eligibility criteria were RCTs on patients with chronic non-specific LBP, written in English/German and adopting a longitudinal core-specific/stabilising/motor control exercise intervention with at least one outcome for pain intensity and/or disability. Meta-regressions (dependent variable = effect sizes (Cohens d) of the interventions (for pain and for disability), independent variable = training characteristics (duration, frequency, time per session)), and controlled for (low) study quality (PEDro) and (low) sample sizes (n) were conducted to reveal the optimal dose required for therapy success. From the 3,415 studies initially selected, 50 studies (n = 2,786 LBP patients) were included. N = 1,239 patients received SE. Training duration was 7.0 ± 3.3 weeks, training frequency was 3.1 ± 1.8 sessions per week with a mean training time of 44.6 ± 18.0 min per session. The meta-regressions’ mean effect size was d = 1.80 (pain) and d = 1.70 (disability). Total R2 was 0.445 and 0.17. Moderate quality evidence (R2 = 0.231) revealed that a training duration of 20 to 30 min elicited the largest effect (both in pain and disability, logarithmic association). Low quality evidence (R2 = 0.125) revealed that training 3 to 5 times per week led to the largest effect of SE in patients with chronic non-specific LBP (inverted U-shaped association). In patients with non-specific chronic LBP, stabilization exercise with a training frequency of 3 to 5 times per week (Grade C) and a training time of 20 to 30 min per session (Grade A) elicited the largest effect on pain and disability.
Aim of the study: Investigation, whether water-filtered infrared-A (wIRA) irradiation during moderate bicycle ergometer endurance exercise has effects especially on local fat reduction and on weight reduction beyond the effects of ergometer exercise alone.
Methods: Randomised controlled study with 40 obese females (BMI 30-40 (median: 34.5), body weight 76-125 (median: 94.9) kg, age 20-40 (median: 35.5) years, isocaloric nutrition), 20 in the wIRA group and 20 in the control group. In both groups each participant performed 3 times per week over 4 weeks for 45 minutes bicycle ergometer endurance exercise with a constant load according to a lactate level of 2 mmol/l (aerobic endurance load, as determined before the intervention period). In the wIRA group in addition large parts of the body (including waist, hip, and thighs) were irradiated during all ergometries of the intervention period with visible light and a predominant part of water-filtered infrared-A (wIRA), using the irradiation unit “Hydrosun® 6000” with 10 wIRA radiators (Hydrosun® Medizintechnik, Müllheim, Germany, radiator type 500, 4 mm water cuvette, yellow filter, water-filtered spectrum 500-1400 nm) around a speed independent bicycle ergometer.
Main variable of interest: change of “the sum of circumferences of waist, hip, and both thighs of each patient” over the intervention period (4 weeks). Additional variables of interest: body weight, body mass index BMI, body fat percentage, fat mass, fat-free mass, water mass (analysis of body composition by tetrapolar bioimpedance analysis), assessment of an arteriosclerotic risk profile by blood investigation of variables of lipid metabolism (cholesterol, triglycerides, high density lipoproteins HDL, low density lipoproteins LDL, apolipoprotein A1, apolipoprotein B), clinical chemistry (fasting glucose, alanin-aminotransferase ALT (= glutamyl pyruvic transaminase GPT), gamma-glutamyl-transferase GGT, creatinine, albumin), endocrinology (leptin, adiponectin (= adipo Q), homocysteine, insulin). All variables were at least measured before and after the intervention period. Ergometry (ECG, blood pressure behaviour, lactate curve with power at 2, 3 and 4 mmol/l) before the intervention period. In addition: nutrition training ahead of and during the intervention period with a nutrition protocol over one week for assessment of the daily energy intake; calculation of basic metabolic rate and total energy requirement. Assessment of undesired effects.
Only methods of non-parametric statistics were used, both descriptive (median, percentiles of 25 and 75 (= interquartile range), minimum, maximum) and confirmatory (two-sided Mann-Whitney U test for unpaired samples for the only one main variable of interest). Total error probability: .05 (5%). An intention to treat analysis ITT with last observed carry forward method was used preferably (presented results) and in addition an on treatment analysis OT. Only 2 (treatment group) and 4 (control group) drop-outs occurred (mostly due to lack of time).
Results: The “sum of circumferences of waist, hip, and both thighs of each patient” decreased during the 4 weeks significantly more (p<.001) in the wIRA group than in the control group: medians and interquartile ranges: -8.0 cm (-10.5 cm/-4.1 cm) vs. -1.8 cm (-4.4 cm/0.0 cm).
As well “body weight of each patient” decreased during the 4 weeks markedly more in the wIRA group than in the control group: medians and interquartile ranges: -1.9 kg (-4.0 kg/0.0 kg) vs. 0.0 kg (-1.5 kg/+0.4 kg); median of body weight changed from 99.3 kg to 95.6 kg (wIRA) vs. 89.9 kg to 89.6 kg (control). A similar effect showed the body mass index BMI.
Blood variables of interest remained unchanged or showed some slight improvements during the treatment period, concerning most variables with no obvious differences between the two groups; insulin showed a slight trend to decrease in the wIRA group and to increase in the control group.
Undesired effects of the treatment were not seen.
Discussion: The results of the study suggest, that wIRA – during moderate bicycle ergometer endurance exercise as lipolytic stimulus – increases local lipolysis with a local fat reduction (thighs) in the otherwise bradytrophic fatty tissue. The presumably underlying mechanisms of wIRA have already been proven: wIRA acts both by thermal effects and by non-thermal effects. Thermal effects of wIRA are the generation of a therapeutic field of warmth with the increase of tissue temperature, tissue oxygen partial pressure, and tissue blood flow, and by this regional metabolism. As fatty tissue normally has a slow metabolism (bradytrophic and hypothermic tissue) with a low rate of lipolysis, wIRA can increase lipolysis in fatty tissue and the mobilized fats are burned in musculature during the ergometer exercise.
Conclusion: The results of the study indicate, that wIRA irradiation during moderate ergometer endurance exercise can be used – in combination with an appropriate nutrition – to improve body composition, especially local fat distribution, and the reduction of fat and body weight in obese persons.
Keywords: water-filtered infrared-A (wIRA), weight reduction, local fat reduction, bicycle ergometer endurance exercise, lipolysis, randomised controlled study, intervention trial, body weight, body mass index BMI, analysis of body composition, tetrapolar bioimpedance analysis, lactate, lipid metabolism, cholesterol, triglycerides, high density lipoproteins HDL, low density lipoproteins LDL
Aim of the study: Investigation, whether water-filtered infrared-A (wIRA) irradiation during moderate bicycle ergometer endurance exercise has effects especially on local fat reduction and on weight reduction beyond the effects of ergometer exercise alone.
Methods: Randomised controlled study with 40 obese females (BMI 30-40 (median: 34.5), body weight 76-125 (median: 94.9) kg, age 20-40 (median: 35.5) years, isocaloric nutrition), 20 in the wIRA group and 20 in the control group. In both groups each participant performed 3 times per week over 4 weeks for 45 minutes bicycle ergometer endurance exercise with a constant load according to a lactate level of 2 mmol/l (aerobic endurance load, as determined before the intervention period). In the wIRA group in addition large parts of the body (including waist, hip, and thighs) were irradiated during all ergometries of the intervention period with visible light and a predominant part of water-filtered infrared-A (wIRA), using the irradiation unit “Hydrosun® 6000” with 10 wIRA radiators (Hydrosun® Medizintechnik, Müllheim, Germany, radiator type 500, 4 mm water cuvette, yellow filter, water-filtered spectrum 500-1400 nm) around a speed independent bicycle ergometer.
Main variable of interest: change of “the sum of circumferences of waist, hip, and both thighs of each patient” over the intervention period (4 weeks). Additional variables of interest: body weight, body mass index BMI, body fat percentage, fat mass, fat-free mass, water mass (analysis of body composition by tetrapolar bioimpedance analysis), assessment of an arteriosclerotic risk profile by blood investigation of variables of lipid metabolism (cholesterol, triglycerides, high density lipoproteins HDL, low density lipoproteins LDL, apolipoprotein A1, apolipoprotein B), clinical chemistry (fasting glucose, alanin-aminotransferase ALT (= glutamyl pyruvic transaminase GPT), gamma-glutamyl-transferase GGT, creatinine, albumin), endocrinology (leptin, adiponectin (= adipo Q), homocysteine, insulin). All variables were at least measured before and after the intervention period. Ergometry (ECG, blood pressure behaviour, lactate curve with power at 2, 3 and 4 mmol/l) before the intervention period. In addition: nutrition training ahead of and during the intervention period with a nutrition protocol over one week for assessment of the daily energy intake; calculation of basic metabolic rate and total energy requirement. Assessment of undesired effects.
Only methods of non-parametric statistics were used, both descriptive (median, percentiles of 25 and 75 (= interquartile range), minimum, maximum) and confirmatory (two-sided Mann-Whitney U test for unpaired samples for the only one main variable of interest). Total error probability: .05 (5%). An intention to treat analysis ITT with last observed carry forward method was used preferably (presented results) and in addition an on treatment analysis OT. Only 2 (treatment group) and 4 (control group) drop-outs occurred (mostly due to lack of time).
Results: The “sum of circumferences of waist, hip, and both thighs of each patient” decreased during the 4 weeks significantly more (p<.001) in the wIRA group than in the control group: medians and interquartile ranges: -8.0 cm (-10.5 cm/-4.1 cm) vs. -1.8 cm (-4.4 cm/0.0 cm).
As well “body weight of each patient” decreased during the 4 weeks markedly more in the wIRA group than in the control group: medians and interquartile ranges: -1.9 kg (-4.0 kg/0.0 kg) vs. 0.0 kg (-1.5 kg/+0.4 kg); median of body weight changed from 99.3 kg to 95.6 kg (wIRA) vs. 89.9 kg to 89.6 kg (control). A similar effect showed the body mass index BMI.
Blood variables of interest remained unchanged or showed some slight improvements during the treatment period, concerning most variables with no obvious differences between the two groups; insulin showed a slight trend to decrease in the wIRA group and to increase in the control group.
Undesired effects of the treatment were not seen.
Discussion: The results of the study suggest, that wIRA – during moderate bicycle ergometer endurance exercise as lipolytic stimulus – increases local lipolysis with a local fat reduction (thighs) in the otherwise bradytrophic fatty tissue. The presumably underlying mechanisms of wIRA have already been proven: wIRA acts both by thermal effects and by non-thermal effects. Thermal effects of wIRA are the generation of a therapeutic field of warmth with the increase of tissue temperature, tissue oxygen partial pressure, and tissue blood flow, and by this regional metabolism. As fatty tissue normally has a slow metabolism (bradytrophic and hypothermic tissue) with a low rate of lipolysis, wIRA can increase lipolysis in fatty tissue and the mobilized fats are burned in musculature during the ergometer exercise.
Conclusion: The results of the study indicate, that wIRA irradiation during moderate ergometer endurance exercise can be used – in combination with an appropriate nutrition – to improve body composition, especially local fat distribution, and the reduction of fat and body weight in obese persons.
Das Phänomen der Bewegungsvariabilität erfährt in den letzten Jahren ein gesteigertes Interesse. Die Betrachtung von Modellen der Motorik zeigt, dass innerhalb traditioneller Theorien Variationen in der Bewegungsausführung als Fehler des Systems aufgefasst werden, während aktuellere Theorien Variabilität als dem System inhärente Erscheinung und als möglichen Kompensationsmechanismus betrachten. Eine Operationalisierung der Variabilität als Messwert ist abhängig vom theoretischen Ausgangspunkt. Nichtlineare und klassische Auswerteverfahren – wie die detrended fluctuation analysis, die Standardabweichung, der Variationskoeffizient, u.a. – schließen sich jedoch keinesfalls aus, sondern können sich in der Erweiterung des Verständnisses der zugrundeliegenden physiologischen Mechanismen ergänzen. In der empirischen Untersuchung wurde geprüft, ob der Einsatz von dreidimensionalen Beschleunigungsaufnehmern in der Ganganalyse die Möglichkeit bietet – neben den schon in diversen Untersuchungen dargestellten Schrittzyklusdauer und Schrittbreite – weitere Teilaspekte der Bewegung zu beschreiben und insbesondere deren Variabilität nicht ausschließlich über eine Aneinanderreihung von diskreten Werten, die jeweils einen einzelnen Zyklus abbilden, zu betrachten. 48 Sportstudenten gingen hierzu 20 bis 25 Minuten kontinuierlich, bei selbstgewählter Geschwindigkeit, die nicht willentlich verändert werden sollte, und ebenem Untergrund. Dabei trugen sie an jedem Fuß jeweils einen triaxialen Beschleunigungssensor am distalen Ende des Os metatarsale III und unterhalb des Malleolus lateralis. Über zwei Doppellichtschranken wurde die Lokomotionsgeschwindigkeit der Probanden erfasst. Anhand des Fersenkontaktes wurden die Beschleunigungs-Zeitverläufe der Versuchspersonen in einzelne Schrittzyklen getrennt und deren Dauer bestimmt. Außerdem wurde die Dauer der Stand- und Schwungphase sowie die double-support-time identifiziert. Die einzelnen Schrittzyklen pro Versuchsperson wurden zeitnormiert und für jede Achse getrennt aufsummiert, um eine ensemble-averagecurve (Punkt zu Punkt Verfahren) zu erstellen. Aus den Standardabweichungen in Allen drei Achsen wurde darüber hinaus ein Variabilitätsquader für jeden Zeitpunkt des Schrittzyklus berechnet. Diese wurden für die bereits angesprochen Phasen zusammengefasst und auf Unterschiede geprüft. Die statistische Analyse ergab, dass sich die Variabilität im Raum zwischen den Phasen signifikant unterscheidet (Signifikanzniveau 0,05), jedoch keine Unterschiede zwischen der rechten und der linken Seite bestanden. Für die Zeitreihen, die aus der Schrittzyklus-, Standphasen- und Schwungphasendauer sowie den double-support-times zusammengesetzt waren, wurde eine detrended fluctuation analysis durchgeführt. Der Vergleich dieser Zeitreihen mit fiktiven Zeitreihen, die die gleicheStandardabweichung und den gleichen Mittelwert allerdings eine andere zeitliche Struktur aufwiesen, zeigte, dass die Zeitreihen Langzeitkorrelationen aufwiesen. Für die Schrittzyklusdauer liegen die α-Werte mit im Gruppendurchschnitt 0,856 im Bereich derer, die in der Literatur für Normalpersonen zu finden sind. Die α-Werte für die Stand- (0,776) und Schwungphasendauer (0,656) sowie die double-support-time (0,624) können nicht mit anderen Untersuchungen verglichen werden, da – soweit bekannt – keine weiteren Studien existieren, die diese Parameter mittels DFA untersucht haben. Die Ursache der Bewegungsvariabilität – innerhalb der mechanisch zulässigen Grenzen – entsteht innerhalb des neuronalen Systems. Zytologisch lassen sich ca. 100 verschiedene Neuronentypen klassifizieren. Die Vielfalt der Ionenkanalausprägung ist allerdings noch größer. Leckströme, ungerichtete Ausschüttung von Transmittern, Veränderungen des Zellvolumens, transzelluläre Boten u.a. sind für Schwankungen der intra- und extrazellulären Ionenkonzentrationen und somit für die Fluktuationen des Membranpotentials einer Nervenzelle verantwortlich. Auch die synaptische Übertragung ist variabel: Das gleiche präsynaptische Potential sorgt nicht für die Ausschüttung der gleichen Menge an Vesikeln. Auch die Wirkung des Neurotransmitters an der postsynaptischen Membran ist von diversen Mechanismen modulierbar. Aus energetischer Sicht muss man das Henneman-Prinzip für die Rekrutierung von motorischen Einheiten innerhalb des Motoneuronenpools nach Größe in Frage stellen. Ohne weitere modulierende Faktoren würden bei wiederholter Ausführung einer submaximalen Belastung immer die gleichen motorischen Einheiten aktiviert. In Abhängigkeit der Intensität und der metabolischen Ausgangssituation würde eben dies über kurz oder lang zu einer Ermüdung führen. Dies jedoch stellt eine Gefährdung des Organismus dar. Eine Rotation in der Rekrutierungsreihenfolge der Motoneurone könnte einer Ermüdung vorbeugen. Da nun aber nicht alle Muskelfasern exakt parallel vom Ansatz zum Ursprung verlaufen, würde im Falle einer solchen Rotation gegebenenfalls zwar die gleiche Kraft, aber eventuell in leicht veränderter Richtung produziert. Es ist davon auszugehen, dass dies einen Teil derbeobachtbaren Variabilität darstellt. Aus Sicht der Sensorik ist Variabilität zu begrüßen. Wiederkehrende Reize haben keinerlei Neuigkeitswert und werden demnach schnell nicht mehr detektiert. Die Interaktion mit der Umwelt setzt aber eine möglichst präzise und umfangreiche sensorische Wahrnehmung voraus. Produziert nun die Motorik Variabilität, die dafür sorgt , dass die Sensorik ihre Detektionsqualität steigern oder zumindest länger aufrecht erhalten kann, so stellt dies eine Win-Win Situation dar.
Background: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects.
Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up.
Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used.
Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5°C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy.
Discussion and conclusions: wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA.
wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life.
Objective: The influence of the jaw position on postural control, body posture, walking and running pattern has been reported in the literature. All these movements have in common that a relatively small, but well controlled muscle activation is required. The induced effects on motor output through changed jaw positions have been small. Therefore, it has been questioned if it could still be observed in maximal muscle activation.
Method: Twenty-three healthy, mid age recreational runners (mean age = 34.0 ± 10.3 years) participated in this study. Three different jump tests (squat jump, counter movement jump, and drop jumps from four different heights) and three maximal strength tests (trunk flexion and extension, leg press of the right and left leg) were conducted. Four different dental occlusion conditions and an additional familiarization condition were tested. Subjects performed the tests on different days for which the four occlusion conditions were randomly changed.
Results: No familiarization effect was found. Occlusion conditions with a relaxation position and with a myocentric condylar position showed significantly higher values for several tests compared to the neutral condition and the maximal occlusion position. Significance was found in the squat jump, countermovement jump, the drop jump from 32cm and 40cm, trunk extension, leg press force and rate of force development. The effect due to the splint conditions is an improvement between 3% and 12% (min and max). No influence of the jaw position on symmetry or balance between extension and flexion muscle was found.
Conclusion: An influence of occlusion splints on rate of force development (RFD) and maximal strength tests could be confirmed. A small, but consistent increase in the performance parameters could be measured. The influence of the occlusion condition is most likely small compared to other influences as for example training status, age, gender and circadian rhythm.
There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. To date, little is known about the neurometabolic and molecular mechanisms underlying this positive effect. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. This is a randomised controlled assessor-blinded two-armed trial (n=53) to explore exercise-induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age >65) were allocated to a 12-week individualised aerobic exercise programme intervention (n=29) or a 12-week waiting control group (n=24). The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group. No effect of training was seen on cerebral N-acetyl-aspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuroprotective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.