Background:
The increasing popularity of distance running has been accompanied by an increase in running-related injuries, such that up to 85% of novice runners incur an injury in a given year. ...Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with many running ailments. However, softer footfalls may not necessarily prevent running injury.
Purpose:
To examine vertical loading rates before and after a gait retraining program and assess the effectiveness of the program in reducing the occurrence of running-related injury across a 12-month observation period.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
A total of 320 novice runners from the local running club completed this study. All the participants underwent a baseline running biomechanics evaluation on an instrumented treadmill with their usual running shoes at 8 and 12 km/h. Participants were then randomly assigned to either the gait retraining group or the control group. In the gait retraining group (n = 166), participants received 2 weeks of gait retraining with real-time visual feedback. In the control group (n = 154), participants received treadmill running exercise but without visual feedback on their performance. The training time was identical between the 2 groups. Participants’ running mechanics were reassessed after the training, and their 12-month posttraining injury profiles were tracked by use of an online surveillance platform.
Results:
A significant reduction was found in the vertical loading rates at both testing speeds in the gait retraining group (P < .001, Cohen’s d > 0.99), whereas the loading rates were either similar or slightly increased in the control group after training (P = .001 to 0.461, Cohen’s d = 0.03 to −0.14). At 12-month follow-up, the occurrence of running-related musculoskeletal injury was 16% and 38% in the gait retraining and control groups, respectively. The hazard ratio between gait retraining and control groups was 0.38 (95% CI, 0.25-0.59), indicating a 62% lower injury risk in gait-retrained runners compared with controls.
Conclusion:
A 2-week gait retraining program is effective in lowering impact loading in novice runners. More important, the occurrence of injury is 62% lower after 2 weeks of running gait modification.
Registration:
HKUCTR-1996 (University of Hong Kong Clinical Trials Registry).
Abstract
Background
fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to ...reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed.
Objective
to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people.
Method
randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews.
Results
a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance.
Conclusions
CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.
Objective:
To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation ...parameters for TENS.
Review methods:
A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance.
Results:
In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges’ g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges’ g = –0.884; 95% CI = –1.140 to −0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges’ g = 0.468; 95% CI = 0.201–0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges’ g = 0.254; 95% CI = –0.106–0.614).
Conclusion:
The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.
The present study investigated the effects of pulsed electromagnetic field (PEMF) on the tensile biomechanical properties of diabetic wounds at different phases of healing. Two intensities of PEMF ...were adopted for comparison. We randomly assigned 111 10-week-old male streptozotocin-induced diabetic Sprague-Dawley rats to two PEMF groups and a sham control group. Six-millimetre biopsy punched full thickness wounds were made on the lateral side of their hindlimbs. The PEMF groups received active PEMF delivered at 25 Hz with intensity of either 2 mT or 10 mT daily, while the sham group was handled in a similar way except they were not exposed to PEMF. Wound tissues were harvested for tensile testing on post-wounding days 3, 5, 7, 10, 14 and 21. Maximum load, maximum stress, energy absorption capacity, Young's modulus and thickness of wound tissue were measured. On post-wounding day 5, the PEMF group that received 10-mT intensity had significantly increased energy absorption capacity and showed an apparent increase in the maximum load. However, the 10-mT PEMF group demonstrated a decrease in Young's modulus on day 14. The 10-mT PEMF groups showed a significant increase in the overall thickness of wound tissue whereas the 2-mT group showed a significant decrease in the overall maximum stress of the wounds tissue. The present findings demonstrated that the PEMF delivered at 10 mT can improve energy absorption capacity of diabetic wounds in the early healing phase. However, PEMF (both 2-mT and 10-mT) seemed to impair the material properties (maximum stress and Young's modulus) in the remodelling phase. PEMF may be a useful treatment for promoting the recovery of structural properties (maximum load and energy absorption capacity), but it might not be applied at the remodelling phase to avoid impairing the recovery of material properties.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND AND PURPOSE—Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether ...cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes.
METHODS—Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks(1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention.
RESULTS—Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants.
CONCLUSIONS—Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke.
CLINICAL TRIAL REGISTRATION—URLhttp://clinicaltrials.gov. Unique identifierNCT02937532
The consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical ...exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke.
The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life.
The proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients. We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life.
ClinicalTrials.gov, NCT02937532 . Registered on 17 October 2016.
Objective:
To determine whether frequency and exposure time to whole body vibration influenced its effects on physical performance in seniors with sarcopenia.
Design:
Randomized controlled trial
...Setting:
A university sports training laboratory.
Subjects:
Eighty community dwelling seniors with sarcopenia were recruited.
Interventions:
Participants were randomly divided into 4 groups, namely, low-frequency (LG: 20Hz x 720s), medium-frequency (MG: 40Hz x 360s), high-frequency (HG: 60Hz x 240s) and control (CG: no extra training) for 12 weeks of whole body vibration training and 12 weeks of follow-up.
Main measures:
Assessments were done at baseline, mid-intervention, post-intervention, mid-follow-up, and final follow-up for five-repetition sit-to-stand, 10-meter walking test with self-preferred speed and timed-up-and-go test.
Results:
There was significant time × group interaction effect in timed-up-and-go test (F12, 304 = 3.333, effect size = 0.116, p < 0.001). Between-group differences in percentage change from baseline were significant between medium-frequency group and control group on all outcome variables after 12-week whole body vibration training (Five-repetition sit-to-stand test: 10.46 ± 2.28 (–16.12%), p = 0.008; 10-meter walking test: 1.05 ± 0.16 (11.18%), p = 0.04; Timed-up-and-go test: 11.32 ± 1.72 (–15.08%), p = 0.001).
Conclusion:
With the total number of vibrations controlled, the combination of 40Hz and 360s of whole body vibration has the best outcome on physical performance of people with sarcopenia.
Whole body vibration was an effective training for improving muscle performance. The purpose of this study was to explore the effects of 12-week whole-body vibration training program on voluntary ...activation of quadriceps muscles of older people with age-related muscle loss (sarcopenia).
Twelve community dwelling seniors with age-related muscle loss were randomly allocated into whole body vibration training group and control group. The training lasted for 12 weeks. Twitch interpolation were conducted to examine the voluntary activation of quadriceps at pre- and post-intervention.
Although there was no significant difference between whole body vibration training group and control group on the absolute values of the interpolated twitch ratio after 12 weeks of training. The changed values of ratio (Post minus Pre) were significantly different between the two groups (p = 0.044).
The voluntary activation of quadriceps muscles of older people with age-related muscle loss was facilitated after 12 weeks of WBV training with 40 Hz × 4 mm × 360 s. Considering the small sample size of this study, it may only provide a piece of evidence that WBV is effective for facilitating the central motor drive in seniors with age-related muscle loss. More subjects are needed to confirm the present finding.
ISRCTN63583948 , registered on 16th January 2017, retrospectively registered.
Aim
To determine the optimal combination of frequency and exposure time of a whole‐body vibration (WBV) training program for improving muscle performance of older people with age‐related muscle loss.
...Methods
A total of 80 community‐dwelling older adults with age‐related muscle loss were randomly divided into four equal groups, namely, low‐frequency long duration (20 Hz × 720 s), medium‐frequency medium duration (40 Hz × 360 s), high‐frequency short duration (60 Hz × 240 s) and control (no training) for 12‐week WBV training and 12‐week follow up. Assessments were carried out at baseline, mid‐intervention, post‐intervention, mid‐follow up, follow up for the cross‐sectional area of the vastus medialis, isometric knee extension strength at 90°, and isokinetic knee extension at 60°/s and 180°/s.
Results
There was a significant time × group interaction effect in isokinetic knee extension at 180°/s. Significant time effects were found in all muscle strength outcome variables. Group differences in percentage change from baseline were significant between medium‐frequency medium duration and control on isokinetic knee extension at 180°/s and 60°/s. No changes were found in the cross‐sectional area of the vastus medialis.
Conclusions
With the total number of vibrations controlled, the combination of 40 Hz and 360 s of WBV exercise had the best outcome among all other combinations tested. The improvements in knee extension performance can be maintained for 12 weeks after cessation of WBV training. Geriatr Gerontol Int 2017; 17: 1412–1420.
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