Dynamic Medicine - Latest Articles

A portable system for collecting anatomical joint angles during stair ascent: a comparison with an optical tracking device

Jeroen Bergmann — 2009-04-23T00:00:00Z

Background: Assessments of stair climbing in real-life situations using an optical tracking system are lacking, as it is difficult to adapt the system for use in and around full flights of stairs. Alternatively, a portable system that consists of inertial measurement units (IMUs) can be used to collect anatomical joint angles during stair ascent. The purpose of this study was to compare the anatomical joint angles obtained by IMUs to those calculated from position data of an optical tracking device. Methods: Anatomical joint angles of the thigh, knee and ankle, obtained using IMUs and an optical tracking device, were compared for fourteen healthy subjects. Joint kinematics obtained with the two measurement devices were evaluated by calculating the root mean square error (RMSE) and by calculating a two-tailed Pearson product-moment correlation coefficient (r) between the two signals. Results: Strong mean correlations (range 0.93 to 0.99) were found for the angles between the two measurement devices, as well as an average root mean square error (RMSE) of 4 degrees over all the joint angles, showing that the IMUs are a satisfactory system for measuring anatomical joint angles. Conclusion: These highly portable body-worn inertial sensors can be used by clinicians and researchers alike, to accurately collect data during stair climbing in complex real-life situations.

Local increase in trapezius muscle oxygenation during and after acupuncture

Masaki Ohkubo — 2009-03-16T00:00:00Z

PurposeThis study aimed to compare the trapezius muscle blood volume and oxygenation in the stimulation region and in a distant region in the same muscle during acupuncture stimulation (AS). We hypothesized that AS provokes a localized increase in muscle blood volume and oxygenation in the stimulation region. Methods: Two sets of near-infrared spectrometer (NIRS) probes, with 40-mm light-source detector spacing, were placed on the right trapezius muscle, with a 50-mm distance between the probes. Changes in muscle oxygenation (oxy-Hb) and blood volume (t-Hb) in stimulation and distant regions (50 mm away from the stimulation point) were measured using NIRS. Nine healthy acupuncture-experienced subjects were chosen as the experimental (AS) group, and 10 healthy acupuncture-experienced subjects were chosen for the control (no AS) group. Measurements began with a 3-min rest period, followed by "Jakutaku" (AS) for 2 min, and recovery after stimulation. Results: There was a significant increase in oxy-Hb (60.7 μM at maximum) and t-Hb (48.1 μM at maximum) in the stimulation region compared to the distant region. In the stimulation region, a significant increase in oxy-Hb and t-Hb compared with the pre-stimulation level was first noted at 58.5 s and 13.5 s, respectively, after the onset of stimulation. Conclusion: In conclusion, oxygenation and blood volume increased, indicating elevated blood flow to the small vessels, not in the distant region used in this study, but in the stimulation region of the trapezius muscle during and after a 2-min AS.

Acute exercise and oxidative stress: a 30 year history

Kelsey Fisher-Wellman — 2009-01-13T00:00:00Z

The topic of exercise-induced oxidative stress has received considerable attention in recent years, with close to 300 original investigations published since the early work of Dillard and colleagues in 1978. Single bouts of aerobic and anaerobic exercise can induce an acute state of oxidative stress. This is indicated by an increased presence of oxidized molecules in a variety of tissues. Exercise mode, intensity, and duration, as well as the subject population tested, all can impact the extent of oxidation. Moreover, the use of antioxidant supplements can impact the findings. Although a single bout of exercise often leads to an acute oxidative stress, in accordance with the principle of hormesis, such an increase appears necessary to allow for an up-regulation in endogenous antioxidant defenses. This review presents a comprehensive summary of original investigations focused on exercise-induced oxidative stress. This should provide the reader with a well-documented account of the research done within this area of science over the past 30 years.

Expressing gait-line symmetry in able-bodied gait

Piotr Jelen — 2008-12-19T00:00:00Z

Background: Gait-lines, or the co-ordinates of the progression of the point of application of the vertical ground reaction force, are a commonly reported parameter in most in-sole measuring systems. However, little is known about what is considered a "normal" or "abnormal" gait-line pattern or level of asymmetry. Furthermore, no reference databases on healthy young populations are available for this parameter. Thus the aim of this study is to provide such reference data in order to allow this tool to be better used in gait analysis. Methods: Vertical ground reaction force data during several continuous gait cycles were collected using a Computer Dyno Graphy in-sole system® for 77 healthy young able-bodied subjects. A curve (termed gait-line) was obtained from the co-ordinates of the progression of the point of application of the force. An Asymmetry Coefficient Curve (AsC) was calculated between the mean gait-lines for the left and right foot for each subject. AsC limits of ± 1.96 and 3 standard deviations (SD) from the mean were then calculated. Gait-line data from 5 individual subjects displaying pathological gait due to disorders relating to the discopathy of the lumbar spine (three with considerable plantarflexor weakness, two with considerable dorsiflexor weakness) were compared to the AsC results from the able-bodied group. Results: The ± 1.96 SD limit suggested that non-pathological gait falls within 12–16% asymmetry for gait-lines. Those exhibiting pathological gait fell outside both the ± 1.96 and ± 3SD limits at several points during stance. The subjects exhibiting considerable plantarflexor weakness all fell outside the ± 1.96SD limit from 30–50% of foot length to toe-off while those exhibiting considerable dorsiflexor weakness fell outside the ± 1.96SD limit between initial contact to 25–40% of foot length, and then surpassed the ± 3SD limit after 55–80% of foot length. Conclusion: This analysis of gait-line asymmetry provides a reference database for young, healthy able-bodied subject populations for both further research and clinical gait analysis. This information is used to suggest non-pathological gait-line asymmetry pattern limits, and limits where detailed case analysis is warranted.

Modeling transitions in body composition: the approach to steady state for anthropometric measures and physiological functions in the Minnesota human starvation study

James Hargrove — 2008-10-07T00:00:00Z

Background: This study evaluated whether the changes in several anthropometric and functional measures during caloric restriction combined with walking and treadmill exercise would fit a simple model of approach to steady state (a plateau) that can be solved using spreadsheet software (Microsoft Excel®). We hypothesized that transitions in waist girth and several body compartments would fit a simple exponential model that approaches a stable steady-state. Methods: The model (an equation) was applied to outcomes reported in the Minnesota starvation experiment using Microsoft Excel's Solver® function to derive rate parameters (k) and projected steady state values. However, data for most end-points were available only at t = 0, 12 and 24 weeks of caloric restriction. Therefore, we derived 2 new equations that enable model solutions to be calculated from 3 equally spaced data points. Results: For the group of male subjects in the Minnesota study, body mass declined with a first order rate constant of about 0.079 wk-1. The fractional rate of loss of fat free mass, which includes components that remained almost constant during starvation, was 0.064 wk-1, compared to a rate of loss of fat mass of 0.103 wk-1. The rate of loss of abdominal fat, as exemplified by the change in the waist girth, was 0.213 wk-1.On average, 0.77 kg was lost per cm of waist girth. Other girths showed rates of loss between 0.085 and 0.131 wk-1. Resting energy expenditure (REE) declined at 0.131 wk-1. Changes in heart volume, hand strength, work capacity and N excretion showed rates of loss in the same range. The group of 32 subjects was close to steady state or had already reached steady state for the variables under consideration at the end of semi-starvation. Conclusion: When energy intake is changed to new, relatively constant levels, while physical activity is maintained, changes in several anthropometric and physiological measures can be modeled as an exponential approach to steady state using software that is widely available. The 3 point method for parameter estimation provides a criterion for testing whether change in a variable can be usefully modelled with exponential kinetics within the time range for which data are available.

The relationships among endurance performance measures as estimated from VO2PEAK, ventilatory threshold, and electromyographic fatigue threshold: a relationship design

Jennifer Graef — 2008-09-10T00:00:00Z

Background: The use of surface electromyography has been accepted as a valid, non-invasive measure of neuromuscular fatigue. In particular, the electromyographic fatigue threshold test (EMGFT) is a reliable submaximal tool to identify the onset of fatigue. This study examined the metabolic relationship between VO2PEAK, ventilatory threshold (VT), and the EMGFT, as well as compared the power output at VO2PEAK, VT, and EMGFT. Methods: Thirty-eight college-aged males (mean ± SD = 22.5 ± 3.5 yrs) performed an incremental test to exhaustion on an electronically-braked cycle ergometer for the determination of VO2PEAK and VT. Each subject also performed a discontinuous incremental cycle ergometer test to determine their EMGFT value, determined from bipolar surface electrodes placed on the longitudinal axis of the vastus lateralis of the right thigh. Subjects completed a total of four, 2-minute work bouts (ranging from 75–325 W). Adequate rest was given between bouts to allow for subjects' heart rate to drop within 10 beats of their resting heart rate. The EMG amplitude was averaged over 10-second intervals and plotted over the 2-minute work bout. The resulting slopes from each successive work bout were used to calculate EMGFT. Results: Power outputs and VO2 values from each subject's incremental test to exhaustion were regressed. The linear equations were used to compute the VO2 value that corresponded to each fatigue threshold. Two separate one-way repeated measure ANOVAs indicated significant differences (p < 0.05) among metabolic parameters and power outputs. However, the mean metabolic values for VT (1.90 ± 0.50 l·min-1) and EMGFTVO2(1.84 ± 0.53 l·min-1) were not significantly different (p > 0.05) and were highly correlated (r = 0.750). Furthermore, the mean workload at VT was 130.7 ± 37.8 W compared with 134.1 ± 43.5 W at EMGFT (p > 0.05) with a strong correlation between the two variables (r = 0.766). Conclusion: Metabolic measurements, as well as the power outputs at VT and EMGFT, were strongly correlated. The significant relationship between VT and EMGFT suggests that both procedures may reflect similar physiological factors associated with the onset of fatigue. As a result of these findings, the EMGFT test may provide an attractive alternative to estimating VT.

Bioelectrical phase angles values in a clinical sample of ambulatory rehabilitation patients.

Simon Gunn — 2008-09-10T00:00:00Z

Background: Phase angle (PhA) is derived from the resistance and reactance measurements obtained from bioelectric impedance analysis (BIA) and is considered indicative of cellular health and membrane integrity. This study measured PhA values of rehabilitation patients and compared them to reference values, measures of functional ability and serum C-reactive protein (CRP) levels to explore their utility as a clinical tool to monitor disease progression and treatment efficacy. Methods: This cross-sectional observational study was conducted on 215 ambulatory rehabilitation patients aged 20 – 94 years. All participants had been hospitalised for a stroke, orthopaedic or other condition resulting in a functional limitation. PhA was derived from BIA analysis and functional ability characterised using the Functional Independence Measure (FIM), timed up and go (TUG) and maximal quadriceps strength (MQS). Serum levels of CRP were also collected. Results: Stroke patients had the highest PhA (5.3°) followed by elective orthopaedic surgery (5.0°) with the other group (4.3°) significantly lower than both previous categories (p < 0.001). Ambulatory rehabilitation patients' PhA values were dependent on age and sex (p < 0.001), lower than published age matched healthy reference values (p ≤ 0.05) and similar to other hospitalised or sick groups, but also higher than values reported in critically ill patients. Patients with CRP values less than 10 mg.L-1 had significantly (p = 0.005) higher mean PhA values. Furthermore, the highest functional status quartiles had significantly higher PhAs (p ≤ 0.04) for the FIM, MQS and TUG measures. Conclusion: The results suggest that the phase angles of rehabilitation patients are between those of healthy individuals and seriously ill patients, thereby supporting claims that PhA is indicative of general health status. Phase angles are a potentially useful indicator of functional status in patients commencing an ambulatory rehabilitation program with a normal hydration status.

Femoral artery remodeling after aerobic exercise training without weight loss in women

Manning Sabatier — 2008-09-08T00:00:00Z

Background: It is currently unclear whether reductions in adiposity mediate the improvements in vascular health that occur with aerobic exercise. The purpose of this longitudinal study of 13 healthy women (33 ± 4 years old) was to determine whether 14 weeks of aerobic exercise would alter functional measures of vascular health, namely resting aortic pulse wave velocity (aPWV, an index of arterial stiffness), femoral artery diameter (DFA), and femoral artery blood flow (BFFA) independent of changes in adiposity. Methods: Aerobic fitness was assessed as VO2peak normalized to fat-free mass, and adiposity (percent body fat) was determined by dual energy x-ray absorptiometry. Serum concentrations of proteins associated with risk for cardiovascular disease, including C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), and leptin, were also measured. Subjects cycled for 50 minutes, 3 times per week. Results: Aerobic fitness normalized to fat-free mass increased 6% (P = 0.03) whereas adiposity did not change. Resting DFA increased 12% (P < 0.001) and resting shear rate decreased 28% (P = 0.007). Aortic PWV, and serum sICAM-1, CRP and leptin did not change with training. Conclusion: Significant reductions in adiposity were not necessary for aerobic exercise training to bring about improvements in aerobic fitness and arterial remodeling. Peripheral arterial remodeling occurred without changes in central arterial stiffness or markers of inflammation.

Biomechanical Effects Of A Single- Versus Multi-Radius Total Knee Arthroplasty Design On Bilateral Arthoplasty Patients During the Sit-To-Stand

He Wang — 2008-08-13T00:00:00Z

Background: Compared to the design of a traditional multi-radius (MR) total knee arthroplasty (TKA), the single-radius (SR) implant investigated has a fixed flexion/extension center of rotation. The biomechanical effectiveness of an SR for functional daily activities, i.e., sit-to-stand, is not well understood. The purpose of the study was to compare the biomechanics underlying functional performance of the sit-to-stand (STS) movement between the limbs containing an MR and an SR TKA of bilateral TKA participants. Methods: Sagittal plane kinematics and kinetics, and EMG data for selected knee flexor and extensor muscles were analyzed for eight bilateral TKA patients, each with an SR and an MR TKA implant. Results: Compared to the MR limb, the SR limb demonstrated greater peak antero-posterior (AP) ground reaction force, higher AP ground reaction impulse, less vastus lateralis and semitendinosus EMG during the forward-thrust phase of the STS movement. No significant difference of knee extensor moment was found between the two knees. Conclusion: Some GRF and EMG differences were evident between the MR and SR limbs during STS movement. Compensatory adaptations may be used to perform the STS.

The oxygen delivery response to acute hypoxia during incremental knee extension exercise differs in active and trained males.

Michael Kennedy — 2008-08-12T00:00:00Z

Background: It is well known that hypoxic exercise in healthy individuals increases limb blood flow, leg oxygen extraction and limb vascular conductance during knee extension exercise. However, the effect of hypoxia on cardiac output, and total vascular conductance is less clear. Furthermore, the oxygen delivery response to hypoxic exercise in well trained individuals is not well known. Therefore our aim was to determine the cardiac output (Doppler echocardiography), vascular conductance, limb blood flow (Doppler echocardiography) and muscle oxygenation response during hypoxic knee extension in normally active and endurance-trained males. Methods: Ten normally active and nine endurance-trained males (VO2max = 46.1 and 65.5 mL/kg/min, respectively) performed 2 leg knee extension at 25, 50, 75 and 100% of their maximum intensity in both normoxic and hypoxic conditions (FIO2 = 15%; randomized order). Results were analyzed with a 2-way mixed model ANOVA (group × intensity). Results: The main finding was that in normally active individuals hypoxic sub-maximal exercise (25 – 75% of maximum intensity) brought about a 3 fold increase in limb blood flow but decreased stroke volume compared to normoxia. In the trained group there were no significant changes in stroke volume, cardiac output and limb blood flow at sub-maximal intensities (compared to normoxia). During maximal intensity hypoxic exercise limb blood flow increased approximately 300 mL/min compared to maximal intensity normoxic exercise. Conclusion: Cardiorespiratory fitness likely influences the oxygen delivery response to hypoxic exercise both at a systemic and limb level. The increase in limb blood flow during maximal exercise in hypoxia (both active and trained individuals) suggests a hypoxic stimulus that is not present in normoxic conditions.