Sunday, March 31, 2013

Neuromuscular responses during aquatic resistance exercise with different devices and depths.

Neuromuscular responses during aquatic resistance exercise with different devices and depths.

Mar 2013


1Laboratory of Physical Activity and Health, Department of Physical Education and Sports, University of Valencia, Valencia, Spain. 2Exercise Research Laboratory, Physical Education School, Federal University of Rio Grande do Sul. 3Austral University of Chile, Faculty of Pedagogy in Physical Education, Sports and Recreation, Valdivia, Chile.


Little research has been reported regarding the effects of using different devices and immersion depths during the performance of resistance exercises in a water environment. The purpose of this study was to compare muscular activation of upper extremity and core muscles during shoulder extensions performed at maximum velocity with different devices and at different depths. Volunteers (N=24) young fit male university students performed 3 repetitions of shoulder extensions at maximum velocity using 4 different devices and at 2 different depths. Maximum amplitude of the electromyographic root mean square of the latissimus dorsi (LD), rectus abdominis (RA) and erector lumbar spinae (ES) was recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction. No significant differences were found in the neuromuscular responses between the different devices used during the performance of shoulder extension at xiphoid process depth. Regarding comparisons of muscle activity between the two depths analyzed in the present study, only the LD showed significantly (p≤0.05) higher activity at xiphoid process depth compared to clavicle depth. Therefore, if maximum muscle activation of the extremities is required, the xiphoid depth is a better choice than clavicle depth, and the kind of device is not relevant. Regarding core muscles, neither the kind of device nor the immersion depth modify muscle activation.

Sunday, February 24, 2013

Exercise-induced muscle damage and running economy in humans.

Exercise-induced muscle damage and running economy in humans.



Human Performance Laboratory, UNESP, Avenue 24 A, Bela Vista-Rio, 13506-900 Rio Claro, SP, Brazil.


Running economy (RE), defined as the energy demand for a given velocity of submaximal running, has been identified as a critical factor of overall distance running performance. Plyometric and resistance trainings, performed during a relatively short period of time (~15-30 days), have been successfully used to improve RE in trained athletes. However, these exercise types, particularly when they are unaccustomed activities for the individuals, may cause delayed onset muscle soreness, swelling, and reduced muscle strength. Some studies have demonstrated that exercise-induced muscle damage has a negative impact on endurance running performance. Specifically, the muscular damage induced by an acute bout of downhill running has been shown to reduce RE during subsequent moderate and high-intensity exercise (>65% VO(2)max). However, strength exercise(i.e., jumps, isoinertial and isokinetic eccentric exercises) seems to impair RE only for subsequent high-intensity exercise(~90% VO(2)max). Finally, a single session of resistance exercise or downhill running (i.e., repeated bout effect) attenuates changes in indirect markers of muscle damage and blunts changes in RE.

Friday, February 8, 2013

Water-Based Exercise for Patients with Chronic Arm Lymphedema: A Randomized Controlled Pilot Trial.

Water-Based Exercise for Patients with Chronic Arm Lymphedema: A Randomized Controlled Pilot Trial.

Jan  2013


From the Institution of Health Science, Department of Physiotherapy, Lund University, Lund, Sweden (KJ); School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Australia (SH); Department of Biostatistics and Epidemiology and Department of Anesthesiology, University of Pennsylvania, Philadelphia (RMS); and Division of Clinical Epidemiology, Department of Biostatistics and Epidemiology, and Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia (KHS).



The aim of this study was to evaluate the feasibility and effect of a water-based exercise program on lymphedema status and shoulder range of motion among women with breast cancer-related lymphedema.


This was a single-blinded, randomized controlled pilot trial. Twenty-nine eligible breast cancer survivors (median, 10 yrs after surgery) with arm lymphedema (median, 21% interlimb difference) were included and randomized into the intervention (n = 15) or control (n = 14) group. Twenty-five participants completed the study. The intervention was at least twice-weekly water-based exercise for 8 wks, initially supervised but performed independently during the study period. Outcomes of interest were feasibility as measured by retention and adherence; lymphedema status as measured by optoelectronic perometry, bioimpedance spectroscopy, and tissue dielectric constant; and shoulder range of motion as measured by goniometer.


 Four participants were not measured at postintervention and were not included in the analysis (retention). Four participants in the intervention group did not perform the minimum water-based exercise criteria set (adherence). No effect was found on lymphedema status. Compared with the control group, median range of motion change for flexion was 6 (1-10) degrees and 6  degrees  for external rotation.A clinically relevant increase in the intervention group was found for 36% in flexion and 57% in external rotation (P ≤ 0.05) compared with controls.


This study shows that water-based exercise is feasible for breast cancer survivors with arm lymphedema and that shoulder range of motion can be improved years after cancer treatment has been completed.

Friday, February 1, 2013

Trampoline injuries in children

Trampoline injuries in children


[Article in Finnish]


Oulun yliopistollinen sairaala, Lastenkirurgian ja -ortopedian yksikkö.


Trampolines for home use have become common in Finland during the past ten years, being especially favored by children.Trampoline jumping is beneficial and constructive physical exercise, but poses a significant risk for injuries. The most common injuries include sprains and strains. During summertime, trampoline injuries account for as many as 13% of children's accidents requiring hospital care. Fractures are by far the most common trampoline injuries requiring hospital care. Injuries can be prevented by using safety nets. Only one child at a time is allowed to jump on the trampoline.

Computer-assisted upper extremity training using interactive biking exercise (iBikE) platform.

Computer-assisted upper extremity training using interactive biking exercise (iBikE) platform.



Upper extremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upper extremity training however effective use of these devices at patient homes is hampered by lack of remote connectivity with clinical rehabilitation team, inability to monitor exercise progress in real time using simple graphical representation, and absence of an alert system which would prevent exertion levels exceeding those approved by the clinical rehabilitation team. We developed an interactive biking exercise (iBikE) platform aimed at addressing these limitations. The platform uses a miniature wireless 3-axis accelerometer mounted on a patient wrist that transmits the cycling acceleration data to a laptop. The laptop screen presents an exercise dashboard to the patient in real time allowing easy graphical visualization of exercise progress and presentation of exercise parameters in relation to prescribed targets. The iBikE platform is programmed to alert the patient when exercise intensity exceeds the levels recommended by the patient care provider. The iBikE platform has been tested in 7 healthy volunteers (age range: 26-50 years) and shown to reliably reflect exercise progress and to generate alerts at pre-setup levels. Implementation of remote connectivity with patient rehabilitation team is warranted for future extension and evaluation efforts.

Electric motor assisted bicycle as an aerobic exercise machine.

Electric motor assisted bicycle as an aerobic exercise machine.



The goal of this study is to maintain a continuous level of exercise intensity around the aerobic threshold (AT) during riding on an electric motor assisted bicycle using a new control system of electrical motor assistance which uses the efficient pedaling rate of popular bicycles. Five male subjects participated in the experiment, and the oxygen uptake was measured during cycling exercise using this new pedaling rate control system of electrical motor assistance, which could maintain the pedaling rate within a specific range, similar to that in previous type of electrically assisted bicycles. Results showed that this new pedaling rate control system at 65 rpm ensured continuous aerobic exercise intensity around the AT in two subjects, and this intensity level was higher than that observed in previous type. However, certain subjects were unable to maintain the expected exercise intensity because of their particular cycling preferences such as the pedaling rate. It is necessary to adjust the specific pedaling rate range of the electrical motor assist control according to the preferred pedaling rate, so that this system becomes applicable to anyone who want continuous aerobic exercise.

Monday, January 28, 2013

Compression Garments do not Enhance High Intensity Exercise in Hot Radiant Conditions.

Compression Garments do not Enhance High Intensity Exercise in Hot Radiant Conditions.

Jan 2013


Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, U.K.



To establish the thermal and performance effects of wearing a lower-body graduated compression garment (GCG; COMPRESSION) in a hot environment (35.2 (0.1)°C) with a representative radiant heat load (~800 W.m2) in contrast to a CONTROL (running shorts) and SHAM condition (a compression garment 1-size larger than that recommended by the manufacturer) with the latter included to establish any placebo effect.


Eight participants (mean [SD]); age 21 [2]years; height 1.77 [0.06]m; mass 72.8 [7.1]kg; surface area, 1.89 [0.10]m2) completed three treadmill tests at a fixed speed for 15-minutes followed by a self-paced 5 kilometre time trial (TT). Performance (completion time) and pacing (split time), thermal responses (aural [Tau], skin [Tskin], mean body temperature [Tb], cardiac frequency [fc]) and perceptual responses (rating of perceived exertion [RPE], thermal sensation [TS], thermal comfort [TC]) were measured.


Performance in COMPRESSION was not different to either SHAM or CONTROL at any stage (p>0.05); completion time 26.08 (4.08), 26.05 (3.27), 25.18 (3.15) minutes, respectively. At the end of the 5 km TT, RPE was not different; 19 (1) across conditions. In general, thermal and perceptual responses were not different although the radiant heat load increased site-specific skin temperature (quadricep) in the garment conditions.


GCG did not enhance performance in a hot environment with a representative radiant heat load. The SHAM treatment did not benefit perception. GCG provided no evidence of performance enhancement.

**Note: Those of us with lymphedema however, MUST, wear our compression garments and/or wraps.**

Saturday, January 19, 2013

Exercise Addiction.

Exercise Addiction.

Dec 2012

Landolfi E.


Department of Kinesiology, University of the Fraser Valley, 33844 King Road, Abbotsford, BC, V2S-7M8, Canada,


This article examines the nature of exercise addiction. It presents a broad, congruent and discerning narrative literature review with the aim of providing a deeper understanding of the condition 'exercise addiction', including symptoms and options for treatment. In addition, guidelines are provided with respect to 'healthy' levels of exercise. Criteria used for determining the eligibility of studies evaluated in the review included the provision of relevant information in studies identified using pertinent search terms. The review highlights some of the key distinctions between healthy levels of exercise and exercise addiction. The findings suggest that an individual who is addicted to exercise will continue exercising regardless of physical injury, personal inconvenience or disruption to other areas of life including marital strain, interference with work and lack of time for other activities. 'Addicted' exercisers are more likely to exercise for intrinsic rewards and experience disturbing deprivation sensations when unable to exercise. In contrast, 'committed' exercisers engage in physical activity for extrinsic rewards and do not suffer severe withdrawal symptoms when they cannot exercise. Exercisers must acquire a sense of life-balance while embracing an attitude conducive to sustainable long-term physical, psychological and social health outcomes. Implementation of recommendations by the Canadian Society for Exercise Physiology, which states that all apparently healthy adults between 18 and 64 years of age should accumulate at least 150 minutes of moderate (5 or 6 on a scale of 0-10) to vigorous (7 or 8 on a scale of 0-10) intensity aerobic physical activity per week in bouts of 10 minutes or more, also expressed as 30 minutes per day distributed over 5 days per week, would be a good start.

Friday, January 11, 2013

Treatment for Restless Legs Syndrome

Treatment for Restless Legs Syndrome [Internet].


**A number of lymphedema patients also report having restless leg syndrome.**


Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov. Report No.: 12(13)-EHC147-EF.
AHRQ Comparative Effectiveness Reviews.



 Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a distressing, irresistible urge to move them. RLS severity and burden vary widely, and the condition may require long-term treatment.


 To review the comparative effectiveness, efficacy, and safety of pharmacologic and nonpharmacologic treatments for RLS.


 We searched bibliographic databases MEDLINE (via OVID), Embase, and Natural Standards through June 2012.


 Eligible efficacy studies included randomized controlled trials (RCTs) of individuals with RLS published in English that lasted at least 4 weeks and compared pharmacologic and/or nonpharmacologic treatments with placebo or active treatment. We assessed RLS symptom impact, sleep scale scores, disease-specific quality of life, withdrawals, and adverse effects. We included observational studies that assessed long-term (>6 months) treatment adverse effects and withdrawals.


 Of the 53 studies included, one active comparator and 33 placebo-controlled RCTs provided efficacy and harms data, and 18 observational studies assessed long-term harms and adherence. RCTs were typically small and of short duration, and enrolled adult subjects with severe primary RLS of long duration. Placebo-controlled RCTs (18 trials) demonstrated that dopamine agonists (pramipexole, rotigotine, ropinirole, and cabergoline) increased the percentage of subjects who had a clinically important response defined as ≥50 percent reduction from baseline in mean International RLS symptom scale scores (IRLS responders) (risk ratio [RR]=1.60; [95% confidence interval [CI]: 1.38 to 1.86], k=7), improved RLS symptom scores, patient-reported sleep scale scores (effect size=0.38; [95% CI: 0.29 to 0.46], k=8), and disease-specific quality of life (effect size=−0.37; [95% CI: −0.48 to −0.27], k=9). Dopamine agonists resulted in more patients who experienced at least one adverse event (high-strength evidence for all outcomes). Long-term augmentation (drug-induced worsening of symptoms) and treatment withdrawal were common. Alpha-2-delta ligands (gabapentin enacarbil, gabapentin, and pregabalin) increased the number of IRLS responders (RR=1.66; [95% CI: 1.33 to 2.09], k=3, high strength of evidence) and mean change in IRLS symptom scores (k=3, high strength of evidence). Intravenous ferric carboxymaltose reduced IRLS symptom scale scores versus placebo (k=1, moderate strength of evidence). Four studies assessed nonpharmacologic interventions. Compression stockings but not the botanical extract valerian improved IRLS symptom scale scores more than sham or placebo treatments. Strength of evidence was moderate for compression stockings and low for valerian. Exercise improved symptoms more than control (low-strength evidence). Near-infrared light treatment improved IRLS symptom scores more than sham (low-strength evidence). Two trials compared active treatments. In one small crossover trial, pramipexole and levodopa/benserazide resulted in similar improvements in IRLS scores (low-strength evidence). Cabergoline improved IRLS scores and resulted in less augmentation than levodopa (moderate-strength evidence). Iron improved symptoms in adults with iron deficiency (k=2) (low-strength evidence). No studies enrolled pregnant women, children, or those with end-stage renal disease. Withdrawal from mostly dopamine agonist and levodopa treatment at 1 year or more ranged from 13 to 57 percent. Treatment withdrawals were due to lack of efficacy (6% to 37%) as well as augmentation and other adverse events.


 Compared to placebo, dopamine agonists and alpha-2-delta ligands reduce RLS symptoms and improve patient-reported sleep outcomes and disease-specific quality of life. Adverse effects of pharmacologic therapies and long-term treatment withdrawals due to adverse effects or lack of efficacy are common. Long-term effectiveness as well as applicability for adults with milder or less frequent RLS symptoms, individuals with secondary RLS, and children is unknown.

see also:

Friday, January 4, 2013

Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study.

Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study.

Oct 2012


Lymphoedema Clinic, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, 3rd floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK,


Exercise is considered to be a key aspect of lymphoedema treatment, although there is little evidence for the therapeutic effect of exercise in managing breast cancer-related lymphoedema (BCRL). This small randomised controlled trial (RCT) was designed to determine the feasibility, prior to undertaking a larger RCT, of researching a daily home-based exerciseprogramme to treat stable BCRL. An experimental design compared the exercise intervention combined with standard lymphoedema self-care to self-care alone over a 6-month period. Twenty-three women with stable unilateral BCRL of ≥10 % excess limb volume (ELV) were randomly allocated to a daily home-based exercise programme and self-care (n = 11) or self-care measures alone (n = 12). The primary objective was to determine difference in limb volume reduction for the two groups. Secondary objectives were to monitor change in other areas that impact BCRL: quality of life, arm function and range of shoulder movement. All 23 women completed the trial, providing full data for each time point. The intervention group showed a clinically and statistically significant improvement in relative ELV at week 26 (95 % confidence interval (CI) -26.57 to -5.12), whereas the control group improvement crossed the line of no effect (95 %CI -17.71 to 1.1). This study demonstrated the feasibility of conducting a RCT of exercise as a therapeutic intervention in the management of BCRL. Although the sample was small, the results support the findings of other exercise studies which have shown trends towards improvement.