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Esther Suter, Walter Herzog and Robert Bray

This study assessed muscle inhibition in patients with chronic anterior cruciate ligament (ACL) deficiency or ACL reconstruction. A series of protocols were tested for their effectiveness in increasing activity of the individual knee extensor muscles and decreasing muscle inhibition of the whole quadriceps group. Quadriceps muscle inhibition was measured by superimposing an electrical twitch onto the quadriceps muscle during a maximal voluntary knee extension. The level of activation of the individual knee extensor and knee flexor muscles was assessed via electromyography (EMG). Patients with ACL pathologies showed strength deficits and muscle inhibition in the knee extensors of the involved leg and the contralateral leg. Muscle inhibition was statistically significantly greater in ACL-deficient patients compared to ACL-reconstructed patients. When a knee extension was performed in combination with a hip extension, there was a significant increase, p < 0.05, in activation of the vastus medialis and vastus lateralis muscles compared to isolated knee extension. The use of an anti-shear device, designed to help stabilize the ACL-deficient knee, resulted in increased inhibition in the quadriceps muscle. Furthermore, a relatively more complete activation of the vasti compared to the rectus femoris was achieved during a fatiguing isometric contraction. Based on the results of this study, it is concluded that performing knee extension in combination with hip extension, or performing fatiguing knee extensor contractions, may be more effective in fully activating the vasti muscles than an isolated knee extensor contraction. Training interventions are needed to establish whether these exercise protocols are more effective than traditional rehabilitation approaches in decreasing muscle inhibition and achieving better functional recovery, including equal muscle strength in the injured and the contralateral leg.

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Esther Suter, Walter Herzog, Kelly De Souza and Robert Bray

The present study was aimed at determining muscle inhibition (MI) and knee extensor moments in 42 subjects with unilateral anterior knee pain syndrome. The results were compared to a normal, healthy population with no history of knee injury. Also, the effects of 1 week of a nonsteroidal anti-inflammatory drug (NSAID) on MI and knee extensor moments were tested in a randomized controlled trial. At baseline, the involved leg showed significantly higher MI than the noninvolved leg. In both legs, MI was significantly higher and knee extensor moments lower than the corresponding values of the nonimpaired subjects. There was a direct relationship between knee pain during testing and the extent of MI. Higher MI, in turn, was associated with lower knee extensor moments. The study demonstrated significant MI in the quadriceps muscles of the involved and noninvolved legs of subjects with unilateral anterior knee pain syndrome. The results indicate that the noninvolved leg cannot be considered a normal control for a contralateral injury. NSAIDs did not affect MI or knee extensor moments, despite significantly reducing pain. This finding suggests that factors other than pain are responsible for the MI observed in this specific subject population, or that after removal of pain, more time is required to fully restore muscle function.

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Mollie G. DeLozier, Richard G. Israel, Kevin F. O’Brien, Robert A. Shaw and Walter J. Pories

This investigation quantified body composition and aerobic capacity and examined the interrelationships of these measures in 20 morbidly obese females (M age = 34.6 yrs) prior to gastric bypass surgery. Fifteen subjects were hydrostatically weighed at residual lung volume in order to determine body composition. Eighteen subjects performed a maximal modified progressive treadmill test to determine aerobic capacity. Results indicated that the 15 subjects who were weighed hydrostatically were heavier (M wt = 132.34 kg) and fatter (M % fat = 53.18) than any previously described individuals. Relative weight, which is used as a criterion to determine surgery eligibility, was not significantly (p > .05) correlated to percent body fat. Mean aerobic capacity (V̇O2 = 14.99 ml • kg-1 mir-1) was comparable to Class III cardiac patients and was limited by the individuals’ extreme body weight. Since relative weight was shown to be an insensitive measure of obesity, it is recommended that percent fat be measured and used as a means to determine eligibility for gastric bypass surgery. Further study of these individuals is warranted in order to determine what effects large weight loss following surgery will have on parameters of body composition and aerobic capacity. Understanding how large weight loss affects these parameters will aid in designing effective postsurgical exercise rehabilitative programs for future patients.

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Robert T. Floyd, Kurt R. Behrhorst and Stacey D. Walters

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Robert Beland, Walter Davis, Gary Kamen, Ruth Russell, Paul Surburg and Edward Tedrick

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Ricardo J.S. Costa, Robert Walters, James L.J. Bilzon and Neil P. Walsh

The purpose of the study was to determine the effects of carbohydrate (CHO) intake, with and without protein (PRO), immediately after prolonged strenuous exercise on circulating bacterially stimulated neutrophil degranulation. Twelve male runners completed 3 feeding interventions, 1 week apart, in randomized order after 2 hr of running at 75% VO2max. The feeding interventions included a placebo solution, a CHO solution equal to 1.2 g CHO~/kg body mass (BM), and a CHO-PRO solution equal to 1.2 g CHO/kg BM and 0.4 g PRO/kg BM (CHO+PRO) immediately postexercise. All solutions were flavor and water-volume equivalent (12 ml/kg BM). Circulating leukocyte counts, bacterially stimulated neutrophil degranulation, plasma insulin, and cortisol were determined from blood samples collected preexercise, immediately postexercise, and every 30 min until 180 min postexercise. The immediate postexercise circulating leukocytosis, neutrophilia, and lymphocytosis (p < .01 vs. preexercise) and the delayed lymphopenia (90 min postexercise, p < .05 vs. preexercise) were similar on all trials. Bacterially stimulated neutrophil degranulation decreased during recovery in control (23% at 180 min, p < .01 vs. preexercise) but remained above preexercise levels with CHO and CHO+PRO. In conclusion, CHO ingestion, with or without PRO, immediately after prolonged strenuous exercise prevented the decrease in bacterially stimulated neutrophil degranulation during recovery.

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Robert Beland, Walter Davis, Gary Kamen, Wendell Liemohn, Ruth Russell, Stuart J. Schleien, Paul Surburg and Edward Tedrick

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Stewart J. Laing, Samuel J. Oliver, Sally Wilson, Robert Walters, James L.J Bilzon and Neil P. Walsh

The aim was to investigate the effects of 48 hr of fluid, energy, or combined fluid and energy restriction on circulating leukocyte and lymphocyte subset counts (CD3+, CD4+, and CD8+) and bacterially stimulated neutrophil degranulation at rest and after exercise. Thirteen healthy men (M ± SEM age 21 ± 1 yr) participated in 4 randomized 48-hr trials. During control (CON) participants received their estimated energy (2,903 ± 17 kcal/day) and fluid (3,912 ± 140 ml/day) requirements. During fluid restriction (FR) they received their energy requirements and 193 ± 19 ml/day water to drink. During energy restriction (ER) they received their fluid requirements and 290 ± 6 kcal/day. Fluid and energy restriction (F+ER) was a combination of FR and ER. After 48 hr, participants performed a 30-min treadmill time trial (TT) followed by rehydration (0–2 hr) and refeeding (2–6 hr). Circulating leukocyte and lymphocyte counts remained unchanged for CON and FR. Circulating leukocyte, lymphocyte, CD3+, and CD4+ counts decreased by ~20% in ER and ~30% in F+ER by 48 hr (p < .01), returning to within 0-hr values by 6 hr post-TT. Circulating neutrophil count and degranulation were unaltered by dietary restriction at rest and after TT. In conclusion, a 48-hr period of ER and F+ER, but not FR, decreased circulating leukocyte, lymphocyte, CD3+, and CD4+ counts but not neutrophil count or degranulation. Circulating leukocyte and lymphocyte counts normalized on refeeding. Finally, dietary restriction did not alter circulating leukocyte, lymphocyte, and neutrophil responses to 30 min of maximal exercise.

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Ricardo J.S Costa, Samuel J. Oliver, Stewart J. Laing, Robert Walters, James L.J Bilzon and Neil P. Walsh

The aim of the study was to determine the influence of immediate and 1-hr-delayed carbohydrate (CHO) and protein (PRO) feeding after prolonged exercise on leukocyte trafficking, bacterially stimulated neutrophil degranulation, saliva secretory IgA (S-IgA) responses, and circulating stress hormones. In randomized order, separated by 1 wk, 9 male runners completed 3 feeding interventions after 2 hr of running at 75% VO2max. During control (CON), participants received water (12 ml/kg body mass [BM]) immediately and 1 hr postexercise. During immediate feeding (IF), participants received a CHO-PRO solution equal to 1.2 g CHO/kg BM and 0.4 g PRO/kg BM immediately postexercise and water 1 hr postexercise. During delayed feeding (DF), participants received water immediately postexercise and CHO-PRO solution 1 hr postexercise. Unstimulated saliva and venous blood samples were collected preexercise, immediately postexercise, and every 20 min until 140 min postexercise. No significant interactions were observed for circulating leukocytes and T-lymphocyte subset counts, S-IgA secretion rate, or plasma cortisol, epinephrine, or norepinephrine concentration. Bacterially stimulated neutrophil degranulation decreased during recovery on CON and DF (24% and 31%, respectively, at 140 min; p < .01) but not on IF. Compared with CON, neutrophil degranulation was higher on IF at 100 min postexercise and higher on IF than DF at 80 min and 100 min onward postexercise (p < .05). Ingestion of a CHO-PRO solution immediately after, but not 1 hr after, prolonged strenuous exercise prevented the decrease in neutrophil degranulation but did not alter circulating stress hormone, leukocyte trafficking, or S-IgA responses. Further research should identify the independent effect of different quantities of CHO and PRO ingestion during recovery on neutrophil responses and other aspects of immune function.

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Robert M. Beland, Mary Bopp, Andrea Brown, Rosemary Connell, Walter E. Davis, Gary Kamen, Wendell Liemohn, Ruth V. Russell, Stuart Schleien, Paul R. Surburg and Ted Tedrick