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Robert M. Kaplan, Alison K. Herrmann, James T. Morrison, Laura F. DeFina and James R. Morrow Jr.

Background:

Despite benefits of physical activity (PA), exercise is also associated with risks. Musculoskeletal injury (MSI) risk increases with exercise frequency/intensity. MSI is associated with costs including medical care and time lost from work.

Purpose:

To evaluate the economic costs associated with PA-related MSIs in community-dwelling women.

Method:

Participants included 909 women in the Women’s Injury Study reporting PA behaviors and MSI incidence weekly via the Internet for up to 3 years (mean follow-up 1.89 years). Participants provided consent to obtain health records. Costs were estimated by medical records and self-reports of medical care. Components included physician visits, medical facility contacts, medication costs, and missed work.

Results:

Of 909 participants, 243 reported 323 episodes of expenditure or contact with the health care system associated with PA. Total costs of episodes ranged from $0–$18,934. Modal cost was $0 (mean = $433 ± $1670). Costs were positively skewed with nearly all participants reporting no or very low costs.

Conclusions:

About 1 in 4 community-dwelling women who are physically active experienced a PA-related MSI. The majority of injuries were minor, and large expenses associated with MSI were rare. The long-term health benefits and costs savings resulting from PA likely outweigh the minor costs associated with MSI from a physically-active lifestyle.

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Ann L. Smiley-Oyen, Sonja A. Hall, Kristin A. Lowry and John P. Kerr

We investigated the effects of extensive practice of rapid aiming on bradykinesia and, more specifically, generation of peak velocity, in discrete rapid aiming and in transfer to reach-to-grasp. Twenty-one participants (seven young adults, seven older adults, and seven adults with mild to moderate Parkinson’s disease (PD) while on medication) engaged in eight practice periods per week for three weeks (> 700 trials), with changes in performance measured weekly. Retention was measured weekly for three weeks postpractice. Movement time decreased with one week of practice, primarily due to a decrease in time-to-peak velocity. With practice and after retention, the PD group generated peak velocity as consistently as both neurologically healthy groups, but remained more variable in time-to-peak velocity. Transfer was observed in the neurologically healthy groups, but not in the PD group. We concluded that short-term practice (one week in our paradigm) is sufficient for decreasing movement time, but more extensive practice is needed to improve consistency of rapid aiming performance for people with mild to moderate PD.

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Jennifer M. Yentes, Jessie M. Huisinga, Sara A. Myers, Iraklis I. Pipinos, Jason M. Johanning and Nicholas Stergiou

Peripheral arterial disease (PAD) is a manifestation of atherosclerosis resulting in intermittent claudication (IC) or leg pain during physical activity. Two drugs (cilostazol and pentoxifylline) are approved for treatment of IC. Our previous work has reported no significant differences in gait biomechanics before and after drug interventions when PAD patients walked without pain. However, it is possible that the drugs are more efficacious during gait with pain. Our aim was to use advanced biomechanical analysis to evaluate the effectiveness of these drugs while walking with pain. Initial and absolute claudication distances, joint kinematics, torques, powers, and gait velocity during the presence of pain were measured from 24 patients before and after 12 weeks of treatment with either cilostazol or pentoxifylline. We found no significant improvements after 12 weeks of treatment with either cilostazol or pentoxifylline on the gait biomechanics of PAD patients during pain. Our findings indicate that the medications cilostazol and pentoxifylline have reduced relevance in the care of gait dysfunction even during pain in patients with PAD.

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Cristina Jácome, Joana Cruz, Raquel Gabriel, Daniela Figueiredo and Alda Marques

This study assessed functional balance among older adults at all grades of chronic obstructive pulmonary disease (COPD) and explored balance impairment predictors. A cross-sectional study with outpatients with COPD (N = 160; M = 72.2 years, SD = 7.9; mean forced expiratory volume in 1 s = 63.8% predicted, SD = 23.7) was conducted. The Timed Up and Go (TUG) test was used to assess functional balance. Functional balance impairment was defined as a TUG score exceeding the upper limit of the confidence intervals of normative values for healthy older adults. Participants performed the TUG test in 11.0 s (SD = 4.8 s). Functional balance impairment was present in 44.4% of the participants and was significantly more frequent in severe to very severe COPD (62.5%). Body mass index (odds ratio [OR] = 1.12), number of medications (OR = 1.20), restriction in recreational activities (OR = 1.66), and depression score (OR = 1.14) were multivariate predictors of functional balance impairment. Functional balance impairment is present in early COPD, although more evident at advanced grades. These findings highlight the importance of balance assessment in older patients at all COPD grades.

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Joanna Kostka, Tomasz Kostka and Ewa Borowiak

Background:

The goal of this study was to assess the physical activity (PA) and its determinants of older people living in the 3 different environments.

Methods:

Three equal (n = 693 each) groups of individuals aged ≥65 years living in urban, rural and institutional environments took part in this study. PA was measured by the Seven Day Recall PA Questionnaire (energy expenditure—PA-EE) and the Stanford Usual Activity Questionnaire (health-related behaviors—PA-HRB).

Results:

PA-EE was highest in the rural environment and lowest in nursing homes. PA-HRB were most common in urban area. Older age, lower education level, several concomitant diseases and the number of systematically used medications were consistently related to lower PA-EE and PA-HRB. Smoking habit, presence of hypertension, musculoskeletal and gastrointestinal disorders had different association to PA-EE and PA-HRB in the 3 environments.

Conclusions:

Subpopulations of older people differ from the general population with regard to their level of PA and its association with sociodemographic data and concomitant diseases. Concomitant serious diseases significantly decrease the level of PA of older subjects. The relationship between PA and nondebilitating disorders may vary depending on the living environment or PA assessment methodology.

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Fuzhong Li, Peter Harmer, K. John Fisher, Junheng Xu, Kathleen Fitzgerald and Naruepon Vongjaturapat

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson’s disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71.51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < .05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation.

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Jason S. Scibek and Christopher R. Carcia

Background:

The efficacy of a variety of noninvasive, conservative management techniques for calcific tendinopathy has been investigated and established for improving pain and function and/or facilitating a decrease in the size or presence of calcium deposits. Surprisingly, few have reported on the use of traditional therapeutic exercise and rehabilitation alone in the management of this condition, given the often spontaneous resorptive nature of calcium deposits. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes.

Case Description:

The patient was a self-referred 41-y-old man with complaints of acute right-shoulder pain and difficulty sleeping. Imaging studies revealed liquefied calcium deposits in the right supraspinatus. The patient reported constant pain at rest (9/10) and tenderness in the area of the greater tuberosity. He exhibited a decrease in all shoulder motions and had reduced strength. The simple shoulder test (SST) revealed limited function (0/12). Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic and glenohumeral range-of-motion (ROM) and strengthening exercises.

Outcomes:

At discharge, pain levels decreased to 0/10 and SST scores increased to 12/12. ROM was full in all planes, and resisted motion was strong and pain free. The patient was able to engage in endurance activities and continue practicing as a health care provider.

Discussion:

The outcomes with respect to pain, function, and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy. Successful management of calcific tendinopathy requires attention to outcomes and an understanding of the pathophysiology, prognostic factors, and physical interventions based on the current stage of the calcium deposits and the patient’s status in the healing continuum.

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Mindi Fisher, Ryan Tierney, Anne Russ and Jamie Mansell

Athletes with ADHD: Examining Differences Based on Medication Use Mild Traumatic Brain Injury and Attention-Deficit Hyperactivity Disorder in Young Student Athletes Study Participants 4,238 male football players from 15 US colleges from 1999–2001; 3,961 high school student athletes from southeastern

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Irfan A. Khan and Kelley D. Henderson

corticosteroid injections, hyaluronic acid injections, or medication changes in 6 months Exclusion criteria : Patients with gait-altering disease; patients with surgical indication Inclusion criteria : Isolated medial knee OA Exclusion criteria : Kellgren and Lawrence stage II or higher lateral or patellofemoral

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Casey Mace Firebaugh, Simon Moyes, Santosh Jatrana, Anna Rolleston and Ngaire Kerse

& Young, 2001 ). This scale is based on a 22-point scoring system, with 22 being the highest score representing higher independence and function. Gender and age were ascertained; number of medications and Charlson Index were established. Comorbidities were identified from questions answered in the