Pelvic-Floor Rehabilitation, Part 2 : Pelvic-Floor Reeducation With Interferential Currents and Exercise in the Treatment of Genuine Stress Incontinence in Postpartum Women : A Cohort Study

Background and Purpose. This descriptive cohort study investigated a physical therapy program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine stress incontinence (GSI). Subjects. Eight female subjects with urodynamically established GSI persisting more than 3 months after delivery participated in the study. The subjects ranged in age from 24 to 37 years (X̅=32, SD=4.2). Methods. This was a descriptive multiple-subject cohort study. Each subject received a total of nine treatment sessions during 3 consecutive weeks, consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The treatment intervention was measured using three separate variables. Maximum muscle contractions (pretraining, during training, and posttraining) were measured indirectly as pressure, using perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-reported frequency of incontinence was recorded daily throughout the period of the study, using a diary. Data were analyzed using a one-way repeated measures analysis of variance (ANOVA), a Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. Results. The results indicated that maximum pressure generated by pelvic-floor contractions was greater and both the quantity of urine loss and the frequency of incontinence were lower following the implementation of the physical therapy program. Five subjects became continent, and three others improved. A follow-up survey 1 year later confirmed the consistency of these results. Conclusion and Discussion. The results suggest that the proposed physical therapy program may influence postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative physical therapy protocol.

Interactive processes link the multiple symptoms of fatigue in sport competition

Muscle physiologists often describe fatigue simply as a decline of muscle force and infer this causes an athlete to slow down. In contrast, exercise scientists describe fatigue during sport competition more holistically as an exercise-induced impairment of performance. The aim of this review is to reconcile the different views by evaluating the many performance symptoms/measures and mechanisms of fatigue. We describe how fatigue is assessed with muscle, exercise or competition performance measures. Muscle performance (single muscle test measures) declines due to peripheral fatigue (reduced muscle cell force) and/or central fatigue (reduced motor drive from the CNS). Peak muscle force seldom falls by >30% during sport but is often exacerbated during electrical stimulation and laboratory exercise tasks. Exercise performance (whole-body exercise test measures) reveals impaired physical/technical abilities and subjective fatigue sensations. Exercise intensity is initially sustained by recruitment of new motor units and help from synergistic muscles before it declines. Technique/motor skill execution deviates as exercise proceeds to maintain outcomes before they deteriorate, e.g. reduced accuracy or velocity. The sensation of fatigue incorporates an elevated rating of perceived exertion (RPE) during submaximal tasks, due to a combination of peripheral and higher CNS inputs. Competition performance (sport symptoms) is affected more by decision-making and psychological aspects, since there are opponents and a greater importance on the result. Laboratory based decision making is generally faster or unimpaired. Motivation, self-efficacy and anxiety can change during exercise to modify RPE and, hence, alter physical performance. Symptoms of fatigue during racing, team-game or racquet sports are largely anecdotal, but sometimes assessed with time-motion analysis. Fatigue during brief all-out racing is described biomechanically as a decline of peak velocity, along with altered kinematic components. Longer sport events involve pacing strategies, central and peripheral fatigue contributions and elevated RPE. During match play, the work rate can decline late in a match (or tournament) and/or transiently after intense exercise bursts. Repeated sprint ability, agility and leg strength become slightly impaired. Technique outcomes, such as velocity and accuracy for throwing, passing, hitting and kicking, can deteriorate. Physical and subjective changes are both less severe in real rather than simulated sport activities. Little objective evidence exists to support exercise-induced mental lapses during sport. A model depicting mind-body interactions during sport competition shows that the RPE centre-motor cortex-working muscle sequence drives overall performance levels and, hence, fatigue symptoms. The sporting outputs from this sequence can be modulated by interactions with muscle afferent and circulatory feedback, psychological and decision-making inputs. Importantly, compensatory processes exist at many levels to protect against performance decrements. Small changes of putative fatigue factors can also be protective. We show that individual fatigue factors including diminished carbohydrate availability, elevated serotonin, hypoxia, acidosis, hyperkalaemia, hyperthermia, dehydration and reactive oxygen species, each contribute to several fatigue symptoms. Thus, multiple symptoms of fatigue can occur simultaneously and the underlying mechanisms overlap and interact. Based on this understanding, we reinforce the proposal that fatigue is best described globally as an exercise-induced decline of performance as this is inclusive of all viewpoints.

Creatine supplementation reduces plasma levels of pro-inflammatory cytokines and PGE(2) after a half-ironman competition

Objective. The effect of creatine supplementation upon plasma levels of pro-inflammatory cytokines: Interleukin (IL) 1 beta and IL-6, Tumor Necrosis Factor alpha (TNF alpha), and Interferon alpha (INF alpha) and Prostaglandin E(2) (PGE(2)) after a half-ironman competition were investigated. Methods. Eleven triathletes, each with at least three years experience of participation in this sport were randomly divided between the control and experimental groups. During 5 days prior to competition, the control group (n = 6) was supplemented with carbohydrate (20g center dot d(-1)) whereas the experimental group (n = 5) received creatine (20 center dot d(-1)) in a double-blind trial. Blood samples were collected 48h before and 24 and 48h after competition and were used for the measurement of cytokines and PGE(2). Results. Forty-eight hours prior to competition there was no difference between groups in the plasma concentrations (pg center dot ml(-1), mean +/- SEM) of IL-6 (7.08 +/- 0.63), TNF alpha (76.50 +/- 5.60), INF alpha (18.32 +/- 1.20), IL-1 beta (23.42 +/- 5.52), and PGE(2) (39.71 +/- 3.8). Twenty-four and 48h after competition plasma levels of TNF alpha, INF alpha, IL-1 beta and PGE(2) were significantly increased (P < 0.05) in both groups. However, the increases in these were markedly reduced following creatine supplementation. An increase in plasma IL-6 was observed only after 24h and, in this case, there was no difference between the two groups. Conclusion. Creatine supplementation before a long distance triathlon competition may reduce the inflammatory response induced by this form of strenuous of exercise.

Treinamento muscular inspiratório para asma: revisão sistemática com metanálise

In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with open grip.

It was studied the trapezius muscle and serratus anterior muscle in 24 male volunteers using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes, during the execution of four different modalities of military press exercises with open grip. The results showed that TS acted significantly in the modalities standing and sitting press behind neck, while SI acted in all the modalities, i.e., standing and sitting press behind neck and forward, justifying their inclusion as basic exercises for physical conditioning programmes.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with middle grip

Electromyographic activity of the trapezius muscle and serratus anterior muscle was analysed in 24 male volunteers using a 2-channel TECA TE 4 electromyograp, during the execution of four different modalities of military press exercises with middle grip. The trapezius acted preferentially in the modalities standing press behind neck; and sitting forward and press behind neck, while SI did not show any significative difference among the modalities. The high levels of action potentials with which TS and SI acted justify the inclusion of these exercises in physical programmes.

Electromyographic validation of the trapezius and serratus anterior muscles in frontal-lateral cross, dumbbells exercises

Based on the lack of electromyographic researches on sport and programmes of physical conditioning, we can say that it is necessary to reexamine some exercises routinely used in the programmes of physical conditioning. Thus, the trapezius and serratus anterior muscles were studied electromyographically so that we could evaluate the validity in some ways of execution of the frontal-lateral cross, dumbbells exercises for the development of these muscles. We analyzed 24 male volunteers, 18 to 25 years old, using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes. For the execution of the exercise it was used a supine bench, a straight board and two bars of 40 cm made of light wood. The results showed that TS acted preferentially in standing modality and in the inclined supine modality, however with activity levels that do not justify its inclusion in physical fitness programmes.

Participation of the deltoid (anterior portion) and pectoralis major (clavicular portion) muscles in different modalities of supine and frontal elevation exercises with different grips

The muscles deltoid-anterior portion (DA) and pectoralis major-clavicular portion (PMC) were analysed to establish the muscular behavior and intensity patterns, as well to evaluate the connected participation of these muscles during supine and frontal elevation exercises. Twenty-four male volunteers were examined using a 2-channel TECA TE4 electromyograph and Hewlett Packard surface electrodes. Our results showed low levels of activity to PMC in frontal elevation exercises, whereas to DA the levels were very high. In the supine exercise, the action potential levels developed by the PMC were always lower than those presented by DA, however, with action simultaneity. Some suggestions to the use of the tested exercises are presented.

O limiar de esforço percebido (LEP) corresponde à potência crítica e a um indicador de máximo estado estável de consumo de oxigěnio

The perceived exertion has been a target of several investigations, many times with association with objective physiological indicators in exercise. Recently, the identification of the perceived exertion threshold (PET) was proposed in the water running, which presented no difference in relation to the critical velocity. Theoretically, both parameters would be indicators of the maximum steady state of variables such as V̇O2 and blood lactate. The objective of this work was to verify the coincidence between PET, critical power (PCrit) and an indicator of maximum V̇O2 steady state (PCrit') in cycle ergometer. Eight male participants were submitted to progressive effort test in order to determine V̇O2peak (46.7 ± 8.5 ml/kg/min) and to four rectangular tests until exhaustion for the estimation of the critical power model parameters, PET and PCrit'. The hyperbolic relation between mechanical power and time spent for the V̇O2peak to be reached in each test was used for the PCrit' estimation, considered as the asymptote in the power axis, and the portion of the anaerobic work capacity (CTAnaer) depleted up to the establishment of the V̇O2peak (CTAnaer'). In order to identify PET, the straight lines angular coefficients of the perceived exertion in time (ordinate) and the powers used (abscissa) were adjusted to a linear function that provided a point in the power axis in which the perceived exertion would be kept indefinitely stable. The parameters PCrit and CTAnaer were estimated by means of the power-time non-linear equation. In order to compare the estimations of PET, PCrit and PCrit', the analysis of variance ANOVA for repeated measurements was employed, and the associations were established through the Pearson correlation. CTAnaer and CTAnaer' were compared through the t test. PET (180 W ± 61 W), PCrit (174 W ± 43 W) and PCrit' (176 W ± 48 W) were not significantly different and the correlations were of 0.92-0.98. CTAnaer' (14,080 ± 5,219 J) was lower than CTAnaer (22,093 ± 9,042 J). One concludes that the PET predicts the intensity of PCrit and PCrit' with accuracy.

Electromyographic fatigue threshold of the biceps brachii: The effect of endurance time

Muscle fatigue can be a limiting factor to determine index as the electromyographic fatigue threshold (EMGFT) due the alterations in motivation and disconfots. This way, the purpose of this study was to identify the right biceps brachii and left biceps brachii obtained from repetitive elbow flexions at each 10% of total time. Nine healthy subjects performed the exercise named biceps curl until exhaustion with 25%, 35%, and 45% of one repetition maximum, in three different days. EMG amplitude (root mean square - RMS) was obtained for concentric contractions during these load levels and correlated with time to determine the slope values for each load and them detemine the EMGFT. The EMGFT was obtained within of each 10% of total time and they were compared by analysis of variance. The results showed a progressive increase in RMS with time, for both muscles in all loads, characterizing the muscle fatigue process, and for the EMGFT values ware not found predominantly significant differences between the execution time, as well as between muscles (right biceps × left biceps). This protocol allowed to identify the EMGFT to both muscles during the biceps curl, which was similar at different percentage of total time, indicating the possibility to reduce the length of the contraction test without the need to maintain the contraction until exhaustion. Further studies are needed to evaluate the applicability of this method to determining the effects on performance.

Electromyographic analysis of the arm muscles in back support exercises

This study aims at quantifying through electromyography the actions of the biceps brachii-BB (long head), tríceps brachii- TB (long head) and deltoideus-DA (clavicular portion) muscles, during the going (G) and return (R) phases in back support exercises. Surface electrodes were placed at the muscles, according to DELAGI (1981). It was used a specific software and a AID plate to take the signals. After being collected, the records were processed resulting in efficient values (RMS), were normalized by maximum isometric contraction (MVIC=100%) and statistically analysed using the Friedman, DSM and Wilcox non-parametric tests. All the muscles presented electromyographic activity of the movements. The triceps brachii was the muscle with higher activity in both phases of the movement. It was concluded that the exercise is indicated for the arm muscle strength development.

Electromyographic validation of the deltoideus (anterior portion) and pectoralis major (clavicular portion) muscles in pull-over exercises

The electromyographic activity of the deltoideus (anterior portion) and pectoralis major (clavicular portion) muscles was analyzed in 24 male volunteers in two different modalities of pull-over exercises. The PMC activity varied from weak to moderate in both modalities, while the DA activity was moderate in the pull-over and strong in the pull-over with bent arms exercises.

Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil

When looking at developing countries, the prolonged intensive medical and nursing care required by many patients places extra demands on an already stretched healthcare budget. The purpose of this study was to verify the effectiveness of a systematic rehabilitative program for swallowing and oral-motor movements in intensive care unit patients with the diagnosis of tetanus. Forty-five patients who were clinically diagnosed with tetanus were included in the study. Participants were divided in two groups: Cl - consisted of 18 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2002 to December 2005, prior to the existence of a systematic swallowing and oral-motor intervention: GII - consisted of 27 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2006 to December 2009 and were submitted to a specific rehabilitative management of swallowing and of the oral-motor movements. Results indicate that the proposed rehabilitative program reduced by approximately 50% the time patients remained in the ICU. The significant improvement observed in patients with tetanus who were submitted to the rehabilitative program for swallowing and oral-motor movements occurred in conjunction with a reduction in the amount of time necessary to reintroduce oral feeding, to decannulate and to remove the feeding tubes. In conclusion, swallowing/muscle exercise, in patients with severe/very severe tetanus, seem to promote the remission of muscle tension and seem to maximize functional swallowing. (C) 2012 Elsevier B.V. All rights reserved.

Oxygen consumption and muscle activation patterns during constant load exercise

The collective purpose of these two studies was to determine a link between the V02 slow component and the muscle activation patterns that occur during cycling. Six, male subjects performed an incremental cycle ergometer exercise test to determine asub-TvENT (i.e. 80% of TvENT) and supra-TvENT (TvENT + 0.75*(V02 max - TvENT) work load. These two constant work loads were subsequently performed on either three or four occasions for 8 mins each, with V02 captured on a breath-by-breath basis for every test, and EMO of eight major leg muscles collected on one occasion. EMG was collected for the first 10 s of every 30 s period, except for the very first 10 s period. The V02 data was interpolated, time aligned, averaged and smoothed for both intensities. Three models were then fitted to the V02 data to determine the kinetics responses. One of these models was mono-exponential, while the other two were biexponential. A second time delay parameter was the only difference between the two bi-exponential models. An F-test was used to determine significance between the biexponential models using the residual sum of squares term for each model. EMO was integrated to obtain one value for each 10 s period, per muscle. The EMG data was analysed by a two-way repeated measures ANOV A. A correlation was also used to determine significance between V02 and IEMG. The V02 data during the sub-TvENT intensity was best described by a mono-exponential response. In contrast, during supra-TvENT exercise the two bi-exponential models best described the V02 data. The resultant F-test revealed no significant difference between the two models and therefore demonstrated that the slow component was not delayed relative to the onset of the primary component. Furthermore, only two parameters were deemed to be significantly different based upon the two models. This is in contrast to other findings. The EMG data, for most muscles, appeared to follow the same pattern as V02 during both intensities of exercise. On most occasions, the correlation coefficient demonstrated significance. Although some muscles demonstrated the same relative increase in IEMO based upon increases in intensity and duration, it cannot be assumed that these muscles increase their contribution to V02 in a similar fashion. Larger muscles with a higher percentage of type II muscle fibres would have a larger increase in V02 over the same increase in intensity.