Supervised walking exercise therapy improves gait biomechanics in patients with peripheral artery disease
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Head-down bed rest was used to simulate weightlessness in an experiment that examined variations in dose, time, and frequency of +Gz stimuli countermeasures. Results indicate that 4 hr. standing was most effective for orthostatic intolerance, walking was most effective in achieving peak oxygen consumption, 4 hr. of standing or walking had the best effect on plasma volume, and 4 hr. of walking was most effective in maintaining urinary calcium excretion.
Constant-value weight-relieving apparatus, which moves on rollers on overhead track, supports weight of walking, stooping, squatting, or standing patient with combination of multiple pulleys and spring clusters. Individually preselected support force is constant for all movements.
Several years of stress, smoking, increased alcohol use, and weight gain accompanied hypertension in a young man with an ominous family history. Aided by short-term drug therapy, he changed his ways and reduced his blood pressure for the long term.
The recent biomedical investigations conducted on the Space Shuttle and Spacelab have provided a wealth of biomedical information, including the ability to test the efficacy of proposed countermeasures. This achievement was made possible by the ability to conduct mechanistic and control-interventive studies simultaneously with a large number of individuals over a relatively brief period and to compare these data with results obtained from the Skylab missions. Comparisons between short- and long-duration results were limited to establishing trends or extrapolating from short-duration missions. To date, we have evaluated several protocols involving the lower-body negative pressure (LBNP) device, the bicycle-ergometer, the treadmill and preparations for body-fluid replenishment. In many instances, the traditional means of applying these protocols were not sufficient to protect against space-related deconditioning. This paper will review current countermeasures and compare their efficacy to that of existing protocols. Results from in-flight and ground-based experiments will be presented to illuminate the recommended protocols and procedures.
A review of the existing literature regarding the effects of different types of physical activities on the gene expression of adult skeletal muscles leads us to conclude that each type of exercise training program has, as a result, a different phenotype, which means that there are multiple mechanisms, each producing a unique phenotype. A portion of the facts which support this position is presented and interpreted here. [Abstract translated from the original French by NASA].
Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional decline during bed- or chair-bound hospital stays.
Reduction of exercise capacity with confinement to bed rest is well recognized. Underlying physiological mechanisms include dramatic reductions in maximal stroke volume, cardiac output, and oxygen uptake. However, bed rest by itself does not appear to contribute to cardiac dysfunction. Increased muscle fatigue is associated with reduced muscle blood flow, red cell volume, capillarization and oxidative enzymes. Loss of muscle mass and bone density may be reflected by reduced muscle strength and higher risk for injury to bones and joints. The resultant deconditioning caused by bed rest can be independent of the primary disease and physically debilitating in patients who attempt to reambulate to normal active living and working. A challenge to clinicians and health care specialists has been the identification of appropriate and effective methods to restore physical capacity of patients during or after restricted physical activity associated with prolonged bed rest. The examination of physiological responses to bed rest deconditioning and exercise training in healthy subjects has provided significant information to develop effective rehabilitation treatments. The successful application of acute exercise to enhance orthostatic stability, daily endurance exercise to maintain aerobic capacity, or specific resistance exercises to maintain musculoskeletal integrity rather than the use of surgical, pharmacological, and other medical treatments for clinical conditions has been enhanced by investigation and understanding of underlying mechanisms that distinguish physical deconditioning from the disease. This symposium presents an overview of cardiovascular and musculoskeletal deconditioning associated with reduced physical work capacity following prolonged bed rest and exercise training regimens that have proven successful in ameliorating or reversing these adverse effects.
There are two major problems here that are not independent. One is the more practically oriented problem of determining the effect of various modes of exercise training on gravitational tolerances, i.e., the point of syncope (unconsciousness) usually estimated from the time of appearance of presyncopal signs and symptoms. The other is more theoretical and concerns the mechanism of blood pressure failure that results in syncope. In many experimental designs these two problems or purposes have been intermingled, with equivocal results.
The MyoMonitor EMG system was developed by Delsys, Inc. under SBIR funding from Johnson Space Center. It is a wearable four-channel device that can monitor muscle performance. Presently, its application include rehabilitative therapy, injury prevention, sports medicine, exercise training, and various other muscle monitoring activities. The MyoMonitor uses a two-bar single differential electrode. Due to the electrode-skin interface in traditional EMG equipment, during rigorous muscular activity, the movement of the skin causes the electrode detection surfaces to become compromised. The MyoMonitor eliminates this problem, enabling a wide array of applications and experiments during intense muscular activity. The ability to make such recordings, for example, enables novel experiments aboard the International Space Station for investigating the effect of microgravity on muscle performance. Product still commercially available as of March 2002.
Fatigue is a common adverse effect of cancer and its therapy. However, the specific mechanisms underlying cancer fatigue are unclear. One physiologic mechanism may involve changes in skeletal muscle protein stores or metabolite concentration. A reduction in skeletal muscle protein stores may result from endogenous tumor necrosis factor (TNF) or from TNF administered as antineoplastic therapy. This muscle wasting would require patients to exert an unusually high amount of effort to generate adequate contractile force during exercise performance or during extended periods of sitting or standing. This additional effort could result in the onset of fatigue. Additionally, cancer fatigue may develop or become exacerbated during exercise as a consequence of changes in the concentration of skeletal muscle metabolites. These biochemical alterations may interfere with force that is produced by the muscle contractile proteins. These physiologic changes may play a role in the decision to include exercise in the rehabilitation plans of patients with cancer. They also may affect ideas about fatigue.
INTRODUCTION: The development of Motion Sickness (MS) symptoms is correlated with increased sympathetic influence and irregular patterns of vagal activity. Such autonomic actions can be characterized by indices of heart rate variability (HRV), which reflect autonomic balance through neurocardiac function. Nonpharmacological interventions aimed at attenuating MS symptoms may therefore produce an effect on HRV. One such intervention that has been shown to mitigate MS symptoms is Autogenic Feedback Training Exercise (AFTE), which combines principles of autogenic therapy and biofeedback. AFTE teaches individuals to manipulate various physiological parameters in provocative environments and shows promise as a potential MS intervention in military aviators. The effects of AFTE on HRV have not previously been examined. Understanding HRV changes following AFTE may help to elucidate its indirect effects and inform its implementation for MS mitigation. METHODS: Twenty-four subjects received 2 hours of AFTE over 4 days. Pre- and post-AFTE rotating chair tests, which included stationary periods of baseline data, were conducted to evaluate the effects of AFTE. HRV data were recorded by SOMNOtouch™ NIBP. Post hoc analysis of pre- and post-AFTE short-term HRV (RMSSD, LF, HF, LF/HF) was performed. RESULTS: RMSSD, HF, and LF/HF were not significantly changed following AFTE. However, LF showed a statistically significant (p=0.015) decrease following AFTE. DISCUSSION: AFTE prescribes a respiratory rate of 15 breaths per minute (BPM), which is typically faster than participants’ pre-AFTE BPM (M=12.65). Healthy individuals can increase respiratory sinus arrhythmia (RSA) by slow, deep breathing. However, increasing the respiratory rate to 15 BPM may decrease RSA and subsequently HF. Increasing RSA potentially negates any influence of AFTE on HF, resulting in no significant change. RMSSD is correlated with HF power and was likewise not affected by AFTE. LF power, however, decreased significantly following AFTE, potentially indicating a lower sympathetic response in the post-AFTE measurement.
A general review is presented of data on bone loss with references to countermeasures for use during spaceflight and bedrest. The two primary countermeasures against skeletal atrophy are skeletal loading such as centrifugation and exercise and/or the administration of drugs designed to alter the rate of bone remodeling. Bone loss is argued to be unavoidable in long-duration spaceflight in spite of countermeasures utilized, but a combination of exercise, biochemical treatments, and post-flight therapy is considered the optimal solution.
The reduction of gravity-related forces on the skeleton creates a type of osteoporosis that is unique because its severity is dependent on the mechanical stress bearing function of the skeleton as well as the length of time that the forces are absent or reduced. Bones that bear weight under normal conditions are more affected than bones that normally do not bear weight. The cytokine environment and the cells in the affected bones are altered in time so that stem cells produce fewer new cells and the differentiated cells tend to be less active. These alterations in the local environment of the affected parts appear to resemble those of age- and disease-associated systemic forms of osteoporosis. The osteoporosis produced as a result of the loss of normal activity however, appears to be at least partially reversible through remobilization, strenuous exercise, and--possibly in the future--cytokine therapy.
Adjustable apparatus which simulates partial to zero gravity partially supports the weight of convalescing patients in rehabilitation exercises. This device is an ideal tool for physical therapy.
Motion sickness is a common physiological reaction to provocative motion and is characterized by a constellation of symptoms, including stomach awareness, nausea, emesis, pallor, sweating, hypersalivation, and fatigue. The emergence of these symptoms can pose a significant threat to safety, particularly in the context of aviation. Given its prevalence among aviators and its detrimental impact on performance, researchers have endeavored to identify effective countermeasures for motion sickness. Currently, many of the existing interventions are pharmacological in nature and while effective, they present a problem due to their associated adverse side effects. A modified two-hour version of Autogenic Feedback Training Exercise (AFTE) could be an effective countermeasure to motion sickness without adverse side effects. AFTE combines principles of autogenic therapy, biofeedback, and learning to teach individuals to control their own internal physiological reactions through a series of relaxation and arousal exercises. AFTE was administered over six days. On the first day, participants were exposed to provocative motion via a rotating chair test to collect baseline physiological data. AFTE sessions were conducted on four consecutive days and lasted approximately 30 minutes each session. Participants were exposed to the rotating chair again on the 6th day. Results: Participants (n = 16) were evaluated on the number of rotations experienced and cumulative minutes spun in the chair. Participants tended to ride longer (M = 21.0 min, SD = 16.56) and tolerated more rotations (M = 244.8 rotations, SD = 310.62) on their second rotating chair test compared to baseline (M = 14.0 min, SD = 9.35; M = 125.8 rotations, SD = 124.08; t(15) = 2.21, p = .02). A moderate effect size was recorded (Hedges’s g = 0.44). A modified two-hour version of the AFTE is effective at increasing tolerance of symptoms associated with motion sickness.
Wearable robots can potentially offer their users enhanced stability and strength. These augmentations are ideally designed to actuate harmoniously with the users movements and provide extra force as needed. The creation of such robots, however, is particularly challenging due to the complexity of the underlying human body. In this paper, we present a compliant, robotic exosuit for upper-extremities called CRUX. This exosuit, inspired by tensegrity models of the human arm, features a lightweight (1.3 kg), flexible design for portability. We also show how CRUX maintains full flexibility of the upper-extremities for its users while providing multi- DoF augmentative strength to the major muscles of the arm, as evident by tracking the heart rate of an individual exercising said arm. Exosuits such as CRUX may be useful in physical therapy and in extreme environments where users are expected to exert their bodies to the fullest extent.