Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC

Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / N/A

Two studies were conducted. A longitudinal study (12 months) was designed to describe the physiological and psychological recovery patterns in a group of pediatric patients who were recently treated for a malignancy. An intervention program (12 week rehabilitation exercise program), was used to separate the effects of deconditioning from the disease and/or its treatment in children who had been out of treatment for a malignancy for at least one year. In the twelve month study, 10 pediatric patients recently out of treatment and 10 healthy controls were tested at 0, 6, 12 weeks and 6 and 12 months. In the twelve week study, 18 patients and 52 healthy controls were assigned to an exercise or no exercise group and were tested at 0, 6 and 12 weeks. At each test session, all subjects were tested for measures of height, weight, sum of skin folds, blood pressure, and pulmonary function. Each subject completed a 30s Wingate test on a cycle ergometer, for measures of anaerobic capacity, and a maximal oxygen consumption test (15 or 20 W/min, ramp protocol) to volitional fatigue for measures of aerobic fitness. A measurement of self-esteem and self-confidence were tested using the Harter scale Self-Perception Profile for Children and Adolescents. All subjects were also evaluated at 0 and 12 weeks (again at 6 and 12 months in the 12 month study) using Doppler and M-mode echocardiography to note cardiovascular changes during semi-supine exercise. Results of both studies show no significant differences between the patients and the healthy controls in any of the physiology, psychology, or cardiology measures. The patients did demonstrate a similar response to exercise in many measures but their values were reduced in magnitude. The patients consistently performed below both the healthy controls in all physiological and cardiology measures but these trends were not statistically significant. It would appear that the majority of children and adolescent patients who were followed in this study are functioning remarkably well both physically and psychologically compared to their healthy controls.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban University of Technology, 2009 / Objectives: When we consider the body position of a field hockey player, the lumbar spine is always in a flexed position, which combined with rotational movements during various hitting and pushing techniques, increases the strain upon the spine and surrounding muscles, thus leading to low back pain. To determine the relationship between core strength and trunk extensor endurance relating to the incidence of acute low back pain in field hockey players. Project Design: The research project was in the form of a quantitative cross-sectional study, using human subjects. Setting: The research project occurred during the field hockey season (2008) with players who had acute low back pain. The players were clinically assessed and subdivided into necessary groups at the Chiropractic Day Clinic at the Durban Institute of Technology. Subjects: Adult, male patients, aged between 18 and 30 years of age, playing premier field hockey. Out of the thirty players, 12 players have played in the National u/21 squad, 7 players have played in a Junior National team and 11 players have played senior provincial field hockey. Outcome measure: This included three tests. Firstly, the absolute difference of pressure from the reference value of 70mmHg (prone) and 40mmHg (supine) was used as the outcome measure on a Pressure Biofeedback Unit and length of time (in seconds), a correct contraction of the core stability muscles was maintained. Secondly, the length of time (in seconds) for Trunk Extensor Endurance. Thirdly, repeated measures for NRS-101 and Quebec Back Pain Disability Scale for the duration of the research period. v Results: It was found that there was no statistical evidence or convincing trend to show that the training programmes (core stability and trunk extensor endurance) increased the subjects’ core strength or trunk extensor endurance in the time allocated, although there seemed to be a placebo effect in the Trunk Extensor Group, which showed improvement in some of the core stability outcomes. There was statistical evidence that the intervention (training programmes) reduced pain, according to the Quebec Back Pain Disability Scale (Quebec) score over time, and a non-significant trend suggested this according to the Numerical Rating Scale-101 (NRS). Since both groups’ NRS and Quebec scores were not significantly different at baseline, the difference can be attributed to the effect of the intervention. Conclusions: The results of this study found that the Trunk Extensor Endurance Group, that performed the trunk extensor endurance training programme, yielded better results in core stability and trunk extensor endurance. However, the Core Stability Group, that performed the core stability training programme, showed a quicker reduction in pain levels during the three week intervention period. Therefore, by combining both training programmes, future rehabilitation of athletes suffering from acute low back pain will be more successful. Sport performance of the athletes (field hockey players), through the proponents of swiss ball training, will also improve.

The primary purpose of this study was to determine the ratio of activation between the VMO and the VL during an open chain knee exercise (dynamic knee extension) and a closed chain knee exercise (lateral step-up). A secondary purpose of this study was to compare muscle activation during the concentric and eccentric phase of the exercises. The data obtained during the knee extension exercise was further analyzed to compare the activity of the VMO and VL during three ranges of knee flexion: 0° - 30°, 30° - 60°, and 60° - 90°. Electromyographic (EMG) data was collected while 20 Ball State University students, who were asymptomatic for Patellofemoral Pain Syndrome, performed the two selected exercises. A one way ANOVA showed no statistically significant difference between the VMO: VL ratio of the two exercises, but the lateral step-up did produce a ratio greater than 1.0. A one-way ANOVA indicated a significant difference between the RMS values of the VL for the concentric and eccentric phase of the knee extension exercise. Based on the results of this study, the lateral stepup and eccentric training could be used to selectively strengthen the VMO for the treatment of PFPS. / School of Physical Education

Physical activity (PA) is related to prevention and rehabilitation (rehab) of oncology patients, however little is known about PA habits of patients with cancer. Purpose. The purpose of this study was to assess and characterize PA habits, fatigue, and mood states of cancer survivors from before participation in an exercise rehab program to the final week of a 16 session exercise rehab program. Methods. Eleven subjects (9 women, 2 men, with an average age 60.9±1 0.1 years) wore an Actigraph GT1M accelerometer and New Lifestyle series pedometer a week before beginning an exercise rehab program (baseline), the first week (week 1) and the final week of exercise rehab (week 8). Intensity counts/minute and steps were measured by the GT1M and steps were calculated by the pedometer. Results. Ten subjects were classified under the sedentary step index, walking <5,500 steps/day and further grouped under the subcategory for chronic diseased individuals proposed by Tudor-Locke and Myers of 3,500-5,500 steps/day. One subject was recorded by the accelerometer to meet the Surgeon General, American College of Sports Medicine/Center for Disease Control and Prevention, the American Cancer Society, and 10,000 step/day PA guidelines throughout the study. The accelerometer underestimated rehab activity of 4 subjects who exercised on the Nu-step during rehab. PA habits of steps and intensity varied at baseline, week 1, and week 8 and on rehab and non-rehab days. There were no patterns seen determined by diagnosis, treatment, or staging of cancer. Five subjects increased their 6 minute walk distance, 6 subjects decreased in total mood disturbance, and 4 subjects lowered their perception of fatigue. Conclusion. The intervention, exercise, with 11 cancer survivors maintained PA habits, functional ability, fatigue, and mood states over time and on rehab and non-rehab days. / School of Physical Education, Sport, and Exercise Science

A learning effect has been shown to be present in the repeated performance of the six-minute walk test and contributes to the variability of walk distance up to the third walk test. The purpose of this study was to see if education about the performance of the walk test could minimize the learning effect. It was hypothesized that education about the learning effect would decrease the learning effect. There were a total of 18 subjects (5 female and 13 male) with a mean age of 63.7+12.1 years that completed three standardized six-minute walk tests. The subjects were randomly assigned to either a Learning Effect Education (LEE) group or a Usual Care (UC) group. The LEE group was provided with education material about the learning effect approximately two days prior to their first walk test, with additional instruction immediately prior to their first walk test. The mean walk distances for the LEE group over the three walk tests were 1,248±297.4, 1,361.9±275.7, and 1,355.1+291.7 feet, respectively. Mean walk distances for the UC group over the three walk tests were 1,149.6+392.3, 1,123.6+427.5, and 1,209.9±368.7 feet, respectively. The hypothesis was tested and the repeated measures ANOVA showed a significant (p=0.033) interaction between the groups with respect to six-minute walk distance. A Bonferroni's post hoc analysis showed that mean walk distance (113.9+42.3 feet) increased significantly (p=0.048) from test one to test two in the LEE group. There was no significant difference between mean walk distance from test two and test three (6.8+31.1 feet) in the LEE group. In the UC group, there was no significant increase in mean walk distance from test one to test two (-26+42.3 feet), while there was a significant (p=0.04) increase in mean walk distance from test two to test three (86.3+31.1 feet). There was a significant difference between walk tests (p=0.011) with no significant difference between groups (p=0.333). In conclusion, the results from this study suggest that education may reduce the number of familiarization trials needed prior obtaining an accurate baseline six-minute walk test distance. / School of Physical Education

The purpose of this study was to assess the effect of BWSTT on paretic limb function using the outcome measures of overground walking velocity, paretic leg propulsion, and the mechanical work produced by the hip, knee, and ankle of the paretic limb. Thirteen participants with chronic stroke, ranging in age from 40 to 80 years, completed 24 sessions of BWSTT over eight weeks. Overground walking velocity and bilateral kinematics and kinetics were collected prior to and following completion of the BWSTT intervention. All participants exhibited statistically significant increases in overground walking velocity post BWSTT. Neither the propulsive impulse of the paretic limb, relative to total propulsive impulse, nor the relative contribution of the paretic hip, knee, and ankle to total positive work significantly changed post BWSTT. The results suggest that paretic limb function remains unchanged following BWSTT, despite improvements in overground walking velocity. / School of Physical Education, Sport, and Exercise Science

This study was conducted to determine if improvements in glucose tolerance could be demonstrated following an acute bout of progressive resistance exercises. Fourteen individuals, not currently weight training, were assigned to two groups using the guidelines established by the WHO for NIDDM and normal (CON), based on the results of a three hour 75 g (-1.2M) load oral glucose tolerance test (OGTT). Eight blood samples were collected during the OGTT and assayed for glucose, insulin, and C-peptide. Each subject from the NIDDM (n=7) and CON (n=7) groups participated in a familiarization period, including a IRM, with eight different Nautilus selectorized exercise machines utilizing both the upper and lower body. A 3 set x 10 repetition exercise protocol based on the IRM was conducted and followed 18 hours later by another OGTT. Two day diets were replicated from the prior OGTT. Analysis of variance failed to demonstrate significant differences in the total responses or at any specific sampling points from pre to postprotocol for glucose (p=0.53), C-peptide (p=0.07) or the C-peptide:insulin ratio (p=0.16) in either group. Blood insulin levels from pre to postprotocol were significantly reduced (p=0.001) by 24% and 22% for the NIDDM and CON groups, respectively. These data suggest that a single series of progressive resistance exercises improve insulin uptake by the tissues without augmenting glucose disposal. / School of Physical Education

Background: Altered muscular function of the deep abdominal and back muscles has been implicated as a factor in the development and continuation of low back pain (LBP) and small-scale studies, on specific subgroups of LBP patients, have reported favourable outcomes when these dysfunctions are addressed using specific exercise training. However, these techniques are increasingly being incorporated into treatment packages for non-specific LBP in the UK despite little evidence of their effectiveness in this patient group. A multi-centered, pragmatic, randomized clinical trial, with 12-month follow-up, was therefore designed to investigate the effectiveness of incorporating specific spinal stabilisation exercises within a physiotherapy treatment package in the management of recurrent LBP patients. Methods: Following ethical approval, consenting patients with recurrent LBP, without significant levels of distress (as measured by the distress risk assessment method {DRAM}), were randomized to two groups; 'conventional' physiotherapy and the provision of an advice booklet (Cl) and 'conventional' physiotherapy, the provision of an advice booklet with the addition of specific spinal stabilisation exercises (SSSE). Randomisation was stratified for laterality, duration of symptoms and initial functional disability level {Roland Morris Disability Questionnaire—RMDQ} using a minimization procedure. Functional disability (RMDQ) was the main outcome, and generic, disease-specific and psychological measures were also collected. The trial was powered to detect a 5-point difference between groups using 90% power. A total of 221 patients were screened for entry into the trial and 97 were recruited from three metropolitan physiotherapy departments within the UK between May 1999 and September 2000. Results: All patients were between the ages of 19 and 60 years (mean 38.6, SD: 10.5) and had an average duration of symptoms of 8.7 (8.1) months. Over 30% of the patients screened for entry to the trial were excluded as they showed evidence of psychological distress. Both groups demonstrated improved functioning, reduced pain intensity and an improvement in the physical component of quality of life. Mean change (95% Cl) for RMDQ scores between baseline to 12-month follow-up were —4.5 (-6.2 to —3.6) for the SSSE group and -5.2 (-6.7 to —3.6) for the CT group. No statistically significant differences between the two groups were demonstrated for any of the outcome variables. Patients in the spinal stabilisation group received a slightly greater mean number of treatment sessions over a longer period than the conventional physiotherapy treatment group (7.5 (2.5) over 11 weeks compared to 5.9 (2.3) over 8 weeks respectively). Exploration of the content of each treatment package revealed a combination of treatments was used, most frequently active exercise and manual therapy, with little use of electrotherapy or mechanical lumbar traction. Discussion and Conclusion: This trial represents the largest to date investigating the effects of specific spinal stabilisation exercises, and the first examining their use in a recurrent LBP population. Results indicate that physiotherapy is effective in reducing functional disability and to a lesser extent pain intensity, with improvements maintained at one year following completion of treatment, but that the addition of spinal stabilisation exercises to conventional physiotherapy and an advice booklet, does not provide any obvious additional benefit in terms of functional disability or pain intensity. These findings are of importance as they support the ongoing use of physiotherapy treatment packages in the management of recurrent LBP patients, without significant levels of distress, but challenge the assumption that stabilisation training provides an additional benefit in this particular group of LBP patients.