Neuromuscular Adaptations to Low-Frequency Stimulation Training in a Patient with Chronic Heart Failure

Electrical myostimulation (EMS) has recently been proposed as an interesting rehabilitation tool in patients with chronic heart failure (CHF). Although its beneficial effects on exercise capacity and muscle strength have been demonstrated, the neuromuscular adaptations responsible for improved performance are not well understood. This preliminary case report was therefore planned to investigate the neural and muscular adaptations to a 5-wk EMS program in one patient. An increase in maximal strength (10.5%) was accompanied by increased twitch torque (13.9%) and slowing of muscle contractile properties (half-relaxation time, time to peak torque, and maximal rate of relaxation increased by 7.1…

Rehabilitación en la arteriopatía de los miembros inferiores

La rehabilitacion en la arteriopatia de los miembros inferiores se basa en programas personalizados que asocian readaptacion al esfuerzo y educacion terapeutica. Aumenta las capacidades fisicas, sobre todo la distancia de la marcha, permite reanudar las actividades, reduce los factores de riesgo y mejora los frecuentes trastornos del estado de animo que se observan en estos pacientes. Mejora las anomalias fisiopatologicas, en especial el desequilibrio neurovegetativo y la disfuncion endotelial. Se recomienda un programa ambulatorio de al menos tres sesiones por semana durante 2-3 meses. La evaluacion funcional (pruebas de esfuerzo maximo, pruebas de marcha) permite adaptar el programa de re…

Do Women and Men over 70 Years Old Similarly Benefit from a One-Year Training Program?

Background and Aims : Exercise capacity declines with age and is improved with exercise training. The aim of this study was to characterize the effects of a one-year combined exercise training in subjects over 70 years old, and to examine the eventual differences obtained between men and women. Methods : After baseline evaluation, 24 subjects (12 men and 12 women) over 70 years old underwent moderate intensity training with aerobic and resistance exercises, 3 hours a week over one year. Workload, oxygen uptake (VO2) and heart rate were measured during a symptom-limited exercise test. The distance walked in 6 minutes (6-MWT) was also registered, and the maximal strength was measured on knee …

Reproducibility, validity and responsiveness of the 200-metre fast walk test in patients undergoing cardiac rehabilitation

Objective: To investigate the reliability, validity and responsiveness of the 200-metre fast walk test in patients with coronary artery disease engaged in a cardiac rehabilitation programme. Design: Descriptive study. Setting: Tertiary care hospital. Subjects: Thirty stable patients with coronary artery disease (51.9 ± 8.7 years), referred to the cardiac rehabilitation department after an acute coronary syndrome. Intervention: Not applicable. Main measures: Six-minute walk test distance, time to perform the 200-m fast walk test, peak power output of the graded maximal exercise test, before and after the programme; SF-36 quality of life questionnaire at baseline. Walk tests were performed tw…

One year of training with FES has impressive beneficial effects in a 36-year-old woman with spinal cord injury

International audience; CONTEXT:Reductions of muscular and cardiorespiratory functions are often observed in people with spinal cord injury (SCI) and several studies demonstrated the benefits of aerobic and strengthening exercise training for this population. Functional Electrical Stimulation (FES) of paralyzed muscles has been proposed as a strategy to assist patients in executing functional movement but its utilization during long durations has never been investigated. The purpose of the present study was to assess the effects of a one-year training program with FES (strengthening and rowing) in one subject with SCI. Evoked torque, quadriceps muscle thickness, aerobic exercise capacity an…

Effects of an eccentric training personalized by a low rate of perceived exertion on the maximal capacities in chronic heart failure: a randomized controlled trial

International audience; BACKGROUND: The eccentric (ECC) training, in spite of its potential interest (slightest request of the cardiorespiratory system) compared with the concentric (CON) training, is not applied during the rehabilitation of the chronic heart failure (CHF). The main reasons are the difficulty personalizing the ECC exercises by avoiding the muscle complications and the lack of information concerning the specific effects on the maximal capacities in CHF patients.AIM: To compare — following a prior study on the feasibility and on the functional impacts — the effects on maximal capacities and tolerance in CHF of ECC training tailored by a low rate of perceived exertion (RPE) an…

Are first ventilatory threshold and 6-minute walk test heart rate interchangeable? A pilot study in healthy elderlies and cardiac patients

International audience; BACKGROUND: Heart rate (HR) at the ventilatory threshold (VT) is often used to prescribe exercise intensity in cardiac rehabilitation. Some studies have reported no significant difference between HR at VT and HR measured at the end of a 6-min walk test (6-MWT) in cardiac patients. The aim of this work was to assess the potential equivalence between those parameters at the individual level. METHOD: Three groups of subjects performed a stress test and a 6-MWT: 22 healthy elderlies (GES, 77 +/- 3.7 years), 10 stable coronary artery disease (CAD) patients (GMI, 50.9 +/- 4.2 years) and 30 patients with chronic heart failure (GHF, 63.3 +/- 10 years). We analyzed the correl…

Poststroke Disposition and Associated Factors in a Population-Based Study

Background and Purpose— The organization of poststroke care will be a major challenge in coming years. We aimed to assess hospital disposition after stroke and its associated factors in clinical practice. Methods— All cases of stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, and prestroke treatments were recorded. Admission stroke severity was assessed using the National Institutes of Health Stroke Scale score. At discharge, we collected dementia, disability using the modified Rankin Scale, length of stay, and hospital disposition (home, rehabilitation, convalescent home, and nursing home). Multivariate…

Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis

Abstract Objective Evaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms. Methods Open-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CI…

Microcirculatory Assessment of Arterial Below-Knee Stumps: Near-Infrared Spectroscopy Versus Transcutaneous Oxygen Tension—A Preliminary Study in Prosthesis Users

International audience; Objective: To examine metrologic properties of near-infrared spectroscopy (NIRS) versus transcutaneous oxygen tension (TcPO2) for micro-circulatory assessment of vascular transtibial stumps at the stabilized period of prosthesis fitting, as a preliminary step before exploring its ability to predict stump healing, considering the previously identified limits of TcPO2 (borderline area between 15 and 35mmHg).Design: Prospective single-center observational study.Setting: University-based rehabilitation center.Participants: Individuals with unilateral transtibial amputation for peripheral artery disease, at the definitive stage of prosthesis fitting, able to perform a 2-m…

Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure.

Physical training is recommended as an efficient therapy in patients with chronic heart failure (CHF). Low-frequency electrical myostimulation (EMS) has recently been suggested as a good alternative to conventional aerobic training. The aim of this study was to compare the effects of EMS and conventional exercise training in patients with moderate to severe CHF.Twenty-four patients with stable CHF (56.7+/-7.3 years, New York Heart Association grades II and III) underwent 5 weeks of exercise training, 5 h a week, using EMS (n=12) or conventional (n=12) training programmes. At baseline and after the training period, patients performed a symptom-limited cardiopulmonary test, a 6-min and a 200-…

Age-Related Adaptations of Lower Limb Intersegmental Coordination During Walking

Lower-limb intersegmental coordination is a complex component of human walking. Aging may result in impairments of motor control and coordination contributing to the decline in mobility inducing loss of autonomy. Investigating intersegmental coordination could therefore provide insights into age-related changes in neuromuscular control of gait. However, it is unknown whether the age-related declines in gait performance relates to intersegmental coordination. The aim of this study was to evaluate the impact of aging on the coordination of lower limb kinematics and kinetics during walking at a conformable speed. We then assessed the body kinematics and kinetics from gait analyses of 84 volunt…

Cross-Talk Correction Method for Knee Kinematics in Gait Analysis Using Principal Component Analysis (PCA): A New Proposal

International audience; Background: In 3D gait analysis, the knee joint is usually described by the Eulerian way. It consists in breaking down the motion between the articulating bones of the knee into three rotations around three axes: flexion/extension, abduction/adduction and internal/external rotation. However, the definition of these axes is prone to error, such as the "cross-talk'' effect, due to difficult positioning of anatomical landmarks. This paper proposes a correction method, principal component analysis (PCA), based on an objective kinematic criterion for standardization, in order to improve knee joint kinematic analysis. Methods: The method was applied to the 3D gait data of …

Is the Short and Fast Step Test a safe and feasible tool for exploring anaerobic capacities of individuals with coronary heart disease in clinical practice?

Background While its importance in daily living, the anaerobic metabolism is not taken into account in clinical practice. The lack of validated functional performance tests for patients with chronic disabilities may explain this defect. In this context, the Short and Fast Step Test (SFST) was recently developed and validated in healthy volunteers. Aim The purpose of this study was to investigate the safety, feasibility and reliability of the SFST, a functional test exploring anaerobic metabolism in coronary patients during cardiac rehabilitation. Design This study was a monocentric prospective study. Settings This study took place in the rehabilitation center of the University Hospital Cent…

Effects of a home-based rehabilitation program in obese type 2 diabetics.

International audience; OBJECTIVE: To assess, in obese type 2 diabetics (T2D), the impact of a home-based effort training program and the barriers to physical activity (PA) practice. METHOD: Twenty-three obese T2D patients (52.7 ± 8.2 years, BMI = 38.5 ± 7.6 kg/m(2)) were randomized to either a control group (CG), or an intervention group (IG) performing home-based cyclergometer training during 3 months, 30 min/day, with a monthly-supervised session. The initial and final measurements included: maximal graded effort test on cyclergometer, 6-minute walk test (6MWT) and 200-meter fast walk test (200mFWT), quadriceps maximal isometric strength, blood tests and quality of life assessment (SF- 3…

La force des muscles mobilisateurs de la cheville est-elle prédictive du risque de chute ?

Activité physique : contextes et effets sur la santé - Synthèse et recommandations

1L’activité physique peut s’effectuer dans différents contextes.Elle peut être liée à l’activité professionnelle, se pratiquer àl’occasion de loisirs ou au cours de travaux domestiques et égalements’intégrer aux déplacements.Pour une grande partie de la population, l’exercice physiquen’est plus aujourd’hui associé aux activités professionnelles etaux déplacements de la vie quotidienne. L’accroissementdu travail sédentaire et des activités récréatives physiquementpassives (télévision, jeux vidéo…) a diminué la dépenseénergétique venant équilibrer les apports. L’activité physiquedépend donc principalement chez l’adulte de sa motivationà la pratiquer au cours de ses loisirs de manière spontané…

Effects of a one-year exercise training program in adults over 70 years old: a study with a control group

Background and aims: Exercise training is known to improve exercise tolerance in elderly subjects. Therefore the present study aimed at investigating the effects of one year of combined endurance and resistance training in healthy older people. Methods: After baseline evaluation, subjects were assigned to either the training group (n=24, age 77.2±3.6) or the control group (n=16, age 76.1±4.8). Subjects in the control group did not change anything in their everyday activities, whereas subjects in the training group underwent moderately intensive combined exercise training, 3 hours a week over the course of one year. Breath-by-breath oxygen uptake and heart rate were measured at each workload…

Walking Speed as an Alternative Measure of Functional Status in Patients with Lumbar Spinal Stenosis

Objective The main objective was to compare estimated walking perimeter (WP) and actual WP during a free walking test (6-minute walk test [6MWT]) in patients with lumbar spinal stenosis (LSS). The second objective was to describe the correlation between measured gait parameters and functional parameters. Methods This was a single-center prospective study including 38 patients with symptomatic LSS (23 men, 15 women; mean age, 69.3 ± 7.9 years). The intervention was the 6MWT. For the main outcome measure, patients were first asked to verbally estimate their WP. Then, WP was evaluated using a 6MWT at a self-selected speed. In the absence of need to stop, and if a distance of 500 m was not reac…