Clinical Scenario: Reduced bone mineral density (BMD) is a serious condition in older adults. The mild form, osteopenia, is often a precursor of osteoporosis. Osteoporosis is a pathological condition and a global health problem as it is one of the most common diseases in developed countries. Finding solutions for prevention and therapy should be prioritized. Therefore, the critically appraised topic focuses on strength training as a treatment to counteract a further decline in BMD in older adults. Clinical Question: Is strength training beneficial in increasing BMD in older people with osteopenia or osteoporosis? Summary of Key Findings: Four of the 5 reviewed studies with the highest evidence showed a significant increase in lumbar spine BMD after strength training interventions in comparison with control groups. The fifth study confirmed the maintenance of lumbar spine density due to conducted exercises. Moreover, 3 reviewed studies revealed increasing BMD at the femoral neck after strength training when compared with controls, which appeared significant in 2 of them. Clinical Bottom Line: The findings indicate that strength training has a significant positive influence on BMD in older women (ie, postmenopausal) with osteoporosis or osteopenia. However, it is not recommended to only rely on strength training as the increase of BMD may not appear fast enough to reach the minimal desired values. A combination of strength training and supplements/medication seems most adequate. Generalization of the findings to older men with reduced BMD should be done with caution due to the lack of studies. Strength of Recommendation: There is grade B of recommendation to support the validity of strength training for older women in postmenopausal phase with reduced BMD.
Maja Zamoscinska, Irene R. Faber and Dirk Büsch
Nikolai Gantchev, François Viallet, Roselyne Aurenty and Jean Massion
The primary purpose of this paper was to compare the effect of reversing the direction of step initiation in Parkinson's disease. Forward (FDS) and backward (BDS) oriented stepping initiation analyses were conducted on combined kinematic and kinetic data recorded on Parkinsonian patients (PD) and healthy age-matched subjects. Two successive phases were examined: a postural phase from T1 (onset of the center of pressure [CP] displacement) to T2 (onset of the malleolus displacement), which was followed by a stepping phase from T2 to T3 (end of the malleolus displacement; i.e., the end of the step). In healthy subjects, the duration of the postural phase remained unchanged regardless of the direction in which the step was initiated. The stepping phase duration and the first step length were reduced in BDS in comparison with FDS. In both tasks, the absolute value of the horizontal force in sagittal plane (Fx) remained unchanged. The maximal velocity of the iliac crest marker (estimated whole body center of gravity [CG]) in the sagittal plane (Vmax CG) remained within the same range regardless of direction of stepping. In Parkinsonian patients, the duration of the postural phase was markedly prolonged in both tasks in comparison with healthy subjects. The mean duration of stepping phase was approximately the same as in normal subjects, but the first step length was considerably reduced, as were horizontal force (Fx) and Vmax CG. This impairment, which was due to a decrease in the propulsive forces, was significantly more pronounced in BDS that in FDS.
Ram Haddas, Steven F. Sawyer, Phillip S. Sizer, Toby Brooks, Ming-Chien Chyu and C. Roger James
Recurrent lower back pain (rLBP) and neuromuscular fatigue are independently thought to increase the risk of lower extremity (LE) injury. Volitional preemptive abdominal contraction (VPAC) is thought to improve lumbar spine and pelvis control in individuals with rLBP. The effects of VPAC on fatigued landing performance in individuals with rLBP are unknown.
To determine the effects of VPAC and LE fatigue on landing performance in a rLBP population.
Cross-sectional pretest-posttest cohort control design.
A clinical biomechanics laboratory.
32 rLBP (age 21.2 ± 2.7 y) but without current symptoms and 33 healthy (age 20.9 ± 2.3 y) subjects.
(i) Volitional preemptive abdominal contraction using abdominal bracing and (ii) fatigue using submaximal free-weight squat protocol with 15% body weight until task failure was achieved.
Main Outcome Measure(s):
Knee and ankle angles, moments, electromyographic measurements from semitendinosus and vastus medialis muscles, and ground reaction force (GRF) were collected during 0.30 m drop-jump landings.
The VPAC resulted in significantly earlier muscle onsets across all muscles with and without fatigue in both groups (mean ± SD, 0.063 ± 0.016 s earlier; P ≤ .001). Fatigue significantly delayed semitendinosus muscle onsets (0.033 ± 0.024 s later; P ≤ .001), decreased GRF (P ≤ .001), and altered landing kinematics in a variety of ways. The rLBP group exhibited delayed semitendinosus and vastus medialis muscle onsets (0.031 ± 0.028 s later; P ≤ .001) and 1.8° less knee flexion at initial contact (P ≤ .008).
The VPAC decreases some of the detrimental effects of fatigue on landing biomechanics and thus may reduce LE injury risk in a rLBP population.
Beatriz H. Thames and Stacey L. Gorniak
fingertips in a type II diabetes patient cohort previously evaluated by our lab. As such, the working hypothesis of the study is that type II diabetes patients will exhibit μ changes at the fingertips as compared to healthy age- and sex-matched controls. Methods Study Participants Ten (10) individuals with
Brian D. Street and William Gage
ability remain post-TKR compared with healthy age-matched controls. 1 , 6 Notably, asymmetrical gait patterns, such as sagittal plane knee kinematics and vertical loading at toe-off, have been observed in patients with OA, and this altered gait pattern is often retained after TKR. 7 – 10 It has been
Harsh H. Buddhadev, Daniel L. Crisafulli, David N. Suprak and Jun G. San Juan
OA compared with healthy controls. We hypothesize that (1) individuals with knee OA would demonstrate interlimb asymmetry in crank power output, generating greater power with their less affected compared with their more affected leg. We also hypothesize that individuals in the healthy age- and sex
Anne Sofie B. Malling, Bo M. Morberg, Lene Wermuth, Ole Gredal, Per Bech and Bente R. Jensen
depends on the task complexity and changes with both healthy aging and PD ( Maidan et al., 2016 ; Seidler et al., 2010 ). A recent functional magnetic resonance imaging study indicated a reorganization of the cortical activity during complex finger tapping in PD compared to healthy peers. The authors
Timothy A. Kulpa, Jamie Mansell, Anne Russ and Ryan Tierney
sustained on treadmill testing once per day, 5–6 days per week, until symptoms were no longer exacerbated upon exercise. 12 subjects (4 male, 8 female; ages 17–52). Three groups: (a) PCS controlled exercise (n = 4); (b) PCS placebo stretching (n = 4); (c) healthy age/gender-matched control group (n = 4
Etem Curuk, Yunju Lee and Alexander S. Aruin
with stroke. Methods Participants Nine individuals with stroke and five healthy age-matched adults participated in the study. The stroke diagnosis was established by attending neurologists based on clinical presentation, the neurological findings, and imaging studies. A pool of prospective subjects
Mark A. Sutherlin, L. Colby Mangum, Jay Hertel, Susan A. Saliba and Joseph M. Hart
individuals did not complete USI based on the inclusion and exclusion screening criteria, and one participant did not have complete anthropometric data and was subsequently removed. A total of 34 healthy (age: 22 ± 7 years) and 24 H×LBP individuals (age: 24 ± 9 years) were used in the final analysis (Table 2