High intensity knee extensor training, in patients with chronic heart failure: Major skeletal muscle improvement

Skeletal muscle adaptations to high intensity knee extensorstrength and/or endurance training in patients with chronicheart failure were investigated. Eleven patients with chronicheart failure were randomized into two groups and exercisedthe m. quadriceps femoris 3 days/week for 8 weeks. After training,the maximal exercise intensity tolerated on the ergometer cyclewas raised from 99 (32) to 114 (40) watts (W, P<0·05)for all 11 patients. Peak dynamic knee extensor work rate showedthe greatest increase after endurance training (40%, P<0·01).Maximal dynamic and isometric strength were elevated by 40–45%(P<0·05) after strength training. The cross-sectionalarea of m. quadriceps femoris was increased in the strength-trainedlegs (9%, P<0·05), and the capillary per fibre ratioof m. vastus lateralis was raised by 47 and 58% in the endurance-trainedlegs (P<0·05). The oxidative enzyme activity in m.vastus lateralis was significantly raised above 50% after endurancetraining, whereas glycolytic enzyme activity was unaltered.The peripheral skeletal musculature in patients with chronicheart failure adapts fairly quickly to high intensity knee extensortraining. This results in a marked rise in local, and a smallrise in total work capacity, indicating maintained plasticityof skeletal muscle in chronic heart failure patients.     

Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density.

OBJECTIVE: To assess the effects of 12 months' dynamic strength training on muscle strength and bone mineral density (BMD) at the lumbar spine and femoral neck in patients with early rheumatoid arthritis (RA). METHODS: Thirty-two subjects in the training group (EG) and 33 in the control group (CG) completed the study. EG carried out strength training 2 times a week with moderate loads of 50-70% of repetition maximum. They were also encouraged to do recreational physical activities. CG performed recreational physical activities and range of motion exercises. Maximal strength of the knee extensors, trunk extensors and flexors, and grip strength were recorded with dynamometers. BMD was measured using dual x-ray absorptiometry. Modified Disease Activity Score, erythrocyte sedimentation rate, and pain were used for the estimation of disease activity, and Stanford Health Assessment Questionnaire to measure functional disability. RESULTS: The 12 month resistance training in EG led to statistically significant mean increases of 22-35% in all muscle groups examined. CG patients were also able to increase their strength to some degree (3-24%), but at the end of the study strengths in CG were significantly lower than in EG. By the end of the study lumbar spine BMD had changed by +0.19% (4.24) in EG and by -1.14% (4.36) in CG. The corresponding changes of femoral BMD were +1.10% (3.71) and -0.03% (3.58). The changes in BMD were minor and statistically not significant in both groups. However, femoral BMD was found to be decreased among those patients treated periodically with oral glucocorticoids (n = 15, 3 subjects from EG and 12 from CG) compared with changes in BMD among those not treated with systemic glucocorticoids (n = 50). CONCLUSION: Minimally supervised strength training resulted in significant improvements in muscle strength without detrimental effects on disease activity. The detected annual changes in central BMD were minor and statistically insignificant in both groups. Special attention should be focused on those patients with RA with high disease activity and concomitant glucocorticoid treatment.     

Hip muscle weakness in individuals with medial knee osteoarthritis

Objective

To compare the strength of the hip musculature in people with symptomatic medial knee osteoarthritis (OA) with asymptomatic controls.

Methods

Eighty‐nine people with knee OA and 23 controls age >50 years were recruited from the community. The maximal isometric strength (torque relative to body mass) of the hip abductors, adductors, flexors, extensors, and internal and external rotators was evaluated using hand‐held dynamometry or a customized force transducer apparatus. Univariate linear models with age and sex included as covariates were used to compare muscle strength between groups.

Results

In people with knee OA, significant strength deficits were evident for all hip muscle groups evaluated (P < 0.05). Compared with controls, strength deficits ranged from 16% (hip extensors) to 27% (hip external rotators) after accounting for differences in sex and age between groups.

Conclusion

People with knee OA demonstrate significant weakness of the hip musculature compared with asymptomatic controls. It is not clear if hip muscle weakness precedes the onset of knee OA or occurs as a consequence of disease. Findings from this study support the inclusion of hip strengthening exercises in rehabilitation programs.     

Effects of high-speed power training on functional capacity and muscle performance in older women

The purpose of the study was to examine the effects of 12 weeks high-speed power training on isometric contraction (handgrip strength), maximal strength (1RM), muscle power (walking velocity, counter movement jump and ball throwing) and functional tasks of the arm and leg muscles (sit-to-stand and get-up and go). Fifty-six older women were divided into an experimental group and a control group [EG, n=28, 62.5 (5.4) years; CG: n=28, 62.5 (4.3) years]. The EG was submitted to a high-speed power training that consisted of 40% of one repetition maximum (1相似文献   

An investigation of the association between grip strength and hip and knee joint moments in older adults

Grip strength is a predictor of health outcomes but with differing rates of age-related decline in muscle strength, it is unclear whether handgrip is a reliable indicator of lower limb moments. This study investigated the relationship between grip strength and lower extremity moments in community-dwelling older adults. Eighty-two healthy volunteers aged 60-82 years (mean age 73.2 years) performed maximal voluntary contractions of knee and hip extensors and flexors at three positions and at neutral position for hip abductors and adductors using a custom-built dynamometer. Grip strength was measured using an electronic Jamar dynamometer. The relative reduction in muscle strength of 80s age category compared to 60-year-olds ranged from 14% for grip strength to 27% for hip abductors. Peak torque of flexors and extensors of the knee and hip joints were significantly correlated with grip strength and Pearson's correlation coefficients ranged from 0.56 to 0.78 with the highest correlations observed between knee moments and grip strength. "Good" correlation was found but only 31-60% of the variation in grip strength could be related to changes in joint torques. Hence the assumption that grip strength is an indicator of strength in the lower limb would seem unjustified in the healthy older adult.     

Age-related differences in the force generation capabilities and tendon extensibilities of knee extensors and plantar flexors in men

BACKGROUND: Recently, the number of elderly individuals who participate in sports has increased, thus injuries from overuse are now becoming recognized in the elderly population. Therefore, it is important to determine which muscle groups and tendons are most affected with aging to plan appropriate exercise interventions for elderly individuals. In particular, muscles and tendons in knee extensors and plantar flexors play an important role during locomotion. The purpose of this study was to compare the knee extensor and plantar flexor muscles and tendons. METHODS: Young (n = 19) and elderly (n = 17) men performed isometric voluntary knee extension and plantar flexion contractions. Muscle thickness and elongation of tendon structures in knee extensors and plantar flexors were measured by ultrasonography. RESULTS: Relative muscle thickness (to limb length) in the elderly group was significantly lower than that in the young group in knee extensors (p <.001), although no significant difference was found between the two groups in plantar flexors (p =.063). Relative muscle strength (to body mass) in the elderly group was significantly lower than that in the young group in both sites (all p <.001). Ratio of muscle strength to muscle thickness in the elderly group was significantly lower than that in the young group in plantar flexors, but not in knee extensors. The elderly group had significantly lower maximal elongation and strain of tendon structures in both sites than the young group had. CONCLUSION: These results suggest that the age-related weakness in knee extensors may be attributed to muscle atrophy, whereas that in plantar flexors is not, and that elderly persons have less extensible tendon structures in both sites.     

THE EFFECT OF A LONG-TERM EXERCISE PROGRAMME ON THE RHEUMATOID HAND

Forty-four female patients with sero-positive active RA participatedin a 48-month trial to assess the effect of simple hand exercises.Twenty-two patients in the test group were given a daily exerciseregime of six exercises. The control group were not given anyexercises. At the end of 48 months there was a statisticallysignificant improvement in grip strength (P<0.0001) and pincergrip strength (P<0.0005) in the test group. There was a significantdeterioration in the control group (P<0.0000). A simple exerciseprogramme is beneficial for the rheumatoid hand as far as gripand pincer grip strength are concerned. KEY WORDS: Rheumatoid hand, Exercise, Grip strength, Pincer grip strength, Metacarpophalangeal joints, Proximal inter-phalangeal joints     

Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS)

BACKGROUND: Growing evidence indicates that physical exercise can prevent at least some of the negative effects on health associated with early menopause. Here we determine the effects of intense exercise on physical fitness, bone mineral density (BMD), back pain, and blood lipids in early postmenopausal women. METHODS: The study population comprised 50 fully compliant women, with no medication or illness affecting bone metabolism, who exercised over 26 months (exercise group [EG]), and 33 women who served as a nontraining control group (CG). Two group training sessions per week and 2 home training sessions per week were performed in the EG. Both groups were individually supplemented with calcium and cholecalciferol. Physical fitness was determined by maximum strength and cardiovascular performance. Bone mineral density was measured at the lumbar spine (dual-energy x-ray absorptiometry [DXA] and quantitative computed tomography [QCT]), the proximal femur (DXA), and the forearm (DXA). In serum samples taken from a subset of the study participants, we determined bone formation (serum osteocalcin) and resorption (serum cross-links) markers as well as blood lipid levels. Vasomotor symptoms related to menopause and pain were also assessed. RESULTS: After 26 months, significant exercise effects determined as percentage changes compared with baseline were observed for physical fitness (isometric strength: trunk extensors [EG +36.5% vs CG +1.7%], trunk flexors [EG +39.3% vs CG -0.4%], and maximum oxygen consumption [EG +12.4% vs CG -2.3%]); BMD (lumbar spine [DXA L1-L4, EG +0.7% vs CG -2.3%], QCT L1-L3 trabecular region of interest [EG +0.4% vs CG -6.6%], QCT L1-L3 cortical region of interest [EG +3.1% vs CG -1.7%], and total hip [DXA, EG -0.3% vs CG -1.7%]); serum levels (total cholesterol [EG -5.0% vs CG +4.1%] and triglycerides [EG -14.2% vs CG +23.2%]); and pain indexes at the spine. CONCLUSION: General purpose exercise programs with special emphasis on bone density can significantly improve strength and endurance and reduce bone loss, back pain, and lipid levels in osteopenic women in their critical early postmenopausal years.     

Proprioception,dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects

Background: Osteoarthritis (OA) is one of the most common musculoskeletal complaints worldwide. The knee is the most frequently involved joint of the lower limb in OA. Knee joint proprioception, dynamic balance and maximal quadriceps strength may be impaired in patients with knee OA. Objective: To investigate whether females with knee OA have reduced knee joint proprioception, balance responses and quadriceps strength compared with normal controls. Methods: We undertook a cross‐sectional study of 30 females with knee OA and 30 controls. Knee joint proprioception was measured using electrogoniometer. Dynamic balance response was determined using a step test. Quadriceps strength was measured isometrically using a modified Tornvall chair. Results: Subjects with OA had greater mean error, poorer dynamic balance and less quadriceps strength than non‐symptomatic ones (P < 0.001). Increasing age was associated with a decline in proprioceptive acuity for both controls and patients (r = 0.40, P < 0.001). In subjects with knee OA, decreased dynamic balance was associated with increasing weight (r = 0.30, P < 0.001) and reduced quadriceps strength (r = –0.37, P = 0.002). Conclusion: Compared with age and sex‐matched controls, females with symptomatic knee OA have reduced knee proprioception, balance responses and quadriceps strength.     

Age related differences in maximal and rapid torque characteristics of the leg extensors and flexors in young,middle-aged and old men

The decline in maximal and rapid isometric torque characteristics may compromise functional living abilities in aging adults while loco-motor muscle groups, such as the leg extensors and flexors, may exhibit different torque–time age related decreases. The purpose of the present study was to examine the age-related differences in maximal and rapid torque characteristics of the leg extensor and flexor muscle groups in young, middle-aged, and old men. Sixty-five healthy men were categorized by age as young (n = 25; mean ± SD age = 24.9 ± 3.0 years), middle-aged (n = 22; age = 50.6 ± 4.0 years), and old (n = 18; age = 66.8 ± 4.5 years). Participants performed maximal voluntary contractions (MVCs) of the leg extensors and flexors and an estimated thigh cross sectional area (eThighCSA) assessment. Peak torque (PT), peak rate of torque development (RTDpeak), absolute RTD and the contractile impulse (IMPULSE) were calculated at time intervals of 30, 50, 100 and 200 ms from the torque–time curve. Relative RTD was calculated at 10, 20, 30, 40 and 50% of MVC from the normalized torque–time curves. PT, RTDpeak and later rapid torque variables (RTD100, RTD200, and IMPULSE200) were greater (P ≤ 0.05) in the young and middle-aged when compared to the old men for both muscle groups. Early (RTD30,50; IMPULSE30,50) and late (IMPULSE100) rapid torque variables were greater (P ≤ 0.05) for the young and middle-aged than the old men for the leg extensors but not the leg flexors, except for RTD30, in which there was no difference between young and old. There were no differences for all relative RTD variables between age groups (P > 0.05). eThighCSA was lower in the old compared to the young (P = 0.001) and middle-aged (P = 0.016) men. Maximal and rapid torque characteristics were preserved in middle-aged men but greatly reduced in older men with differential effects at early and late portions of the torque–time curve between the leg extensors and flexors. Significant decreases in absolute maximal and rapid torque production with no change in relative RTD across age groups and lower eThighCSA in old men may suggest that the loss of rapid torque producing capacities observed in older men may be largely a function of mechanisms associated with loss of muscle strength and muscle mass.     

Effects of functional training on pain,leg strength,and balance in women with fibromyalgia

Aim: The aim of this study was to analyze the effect of 18-week functional training (FT) program consisting in two sessions a week of in-water exercise and one of on-land exercise on pain, strength, and balance in women with fibromyalgia.

Methods: A sample consisting of 36 fibromyalgia patients was included in the study. The patients were allocated randomly into the experimental group (EG, n = 20), and control group (CG, n = 16). Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand and handgrip strength) and agility/dynamic balance and static balance. Fibromyalgia impact and pain were analyzed by Fibromyalgia Impact Questionnaire (FIQ), tender points (TPs), visual analog scale (VAS).

Results: We observed a significant reduction in the FIQ (p = 0.042), the algometer scale of TP (p = 0.008), TP (p < 0.001), and VAS (p < 0.001) in the EG. The EG shows better results in leg strength (p < 0.001), handgrip strength (p = 0.025), agility/dynamic balance (p = 0.032) and balance (p = 0.006).

Conclusions: An 18-week intervention consisting in two sessions of in-water exercise and one session of on-land exercise of FT reduces pain and improves functional capacity in FM patients. These results suggested that FT could play an important role in maintaining an independent lifestyle in patients with FM.     

Age modify the associations of obesity,physical activity,vision and grip strength with functional mobility in Irish aged 50 and older

ObjectiveTo estimate whether the associations of obesity, physical activity, vision and grip strength with functional mobility were modified by age.MethodsData from The Irish Longitudinal Study on Ageing (2009–2012) were analyzed and 5001 individuals were included in this study. Mobility was assessed by the timed up and go test (TUG-test). Main exposure variables were obesity, physical activity, visual acuity and grip strength at baseline. Multiple linear regression models were fitted to assess the associations of baseline main exposure variables with 2-year follow-up functional mobility and potential confounders were adjusted. Stratified analyses by age were used to assess the interaction between main exposures and age on functional mobility.ResultsMultiple linear regression models identified significant interactions of obesity (P < 0.001), vigorous physical activity (P = 0.001), vision (P < 0.001) and grip strength (P < 0.001) with age on functional mobility. Stratified analyses suggested that the risk effect of obesity on functional mobility was greater in middle-aged group (β = 0.025, P < 0.001) than in older group (β = 0.016, P = 0.017). The protective effects of high level of physical activity and grip strength on functional mobility were stronger in older group (β = −0.023, P = 0.004 for physical activity; β = −0.002, P < 0.001 for grip strength) than in middle-aged group (β = −0.012, P = 0.008 for physical activity; β = −0.0015, P < 0.001 for grip strength). The benefit of better vision on functional mobility was observed in middle-aged group only (β = −0.032, P = 0.002).ConclusionNon-obesity, higher level of physical activity, vision and grip strength at baseline were associated with better mobility performance among middle-aged and older Irish. And these associations were modified by age.     

Strength prior to endurance intra-session exercise sequence optimizes neuromuscular and cardiovascular gains in elderly men

This study investigated the effects of different intra-session exercise sequences in the cardiovascular and neuromuscular adaptations induced by concurrent training in elderly. Twenty-six healthy elderly men (64.7±4.1years), were randomly placed into two concurrent training groups: strength training prior to (SE, n=13) or after (ES, n=13) endurance training. Subjects trained strength and endurance training 3 times per week performing both exercise types in the same training session. The peak oxygen uptake (VO(2peak)), maximum aerobic workload (W(máx)), absolute (VT(1) and VT(2)) and relative (VT(1)% and VT(2)%) ventilatory thresholds, as well as workloads at VT(1) and VT(2) (W(VT1) and W(VT2)) were evaluated during a maximal incremental test on a cycle ergometer before and after the training. In addition, muscle quality (MQ) was evaluated by the quotient between maximal dynamic strength (one repetition maximum test) of the knee extensors and the quadriceps femoris muscle thickness determined by ultrasonography. There were no modifications after training in the VT(1), VT(2), VT(1)%, and VT(2)%. There was significant increase in the W(VT1) only in SE (P<0.05), as well as significant increase in the W(VT2) in both groups (P<0.001). There was significant increase in the VO(2peak), with both groups showing increases (P<0.001), with no difference between groups; as well significant increase in the W(máx) (P<0.001) with no difference between SE and ES. The force per unit of muscle mass of knee extensors increased in both groups (P<0.001), but the increase was significantly higher in SE than in ES (27.5±12.7 vs. 15.2±10.3%, P<0.02). Hence, the intra-session exercise sequence had no influence in the maximal endurance power adaptations to concurrent training, but had influence in the magnitude of the muscle quality enhancements.     

The effect of age and joint angle on the proportionality of extensor and flexor strength at the knee joint

Functional movements require concerted actions of monoarticular and biarticular agonists and antagonists. Understanding age-related changes of muscle function on performance requires insight in the contributions of different muscles to joint moments. Young and elderly participants performed isometric knee extensions and flexions at combinations of knee and hip joint angles. This approach allowed assessing changes in contribution of monoarticular and biarticular knee joint flexors and extensors. Reduced moments were found for elderly persons (flexors: -43%; extensors: -33%). In the flexor group, this reduction was mainly caused by retardation of the biarticular muscles; in the extensors, by reduced strength of the monoarticular muscles. This age-related reduction of joint moments occurred to be joint angle dependent for the extensors. In the flexor group, the reduction was almost invariant. Due to this difference in joint angle dependence, the proportionality between extensors and flexors varied over joint angles and differed with age. It has been discussed how this is related to changes in performances occurring with age.     

SERUM YKL-40 LEVELS IN HEALTHY CHILDREN AND ADULTS. COMPARISON WITH SERUM AND SYNOVIAL FLUID LEVELS OF YKL-40 IN PATIENTS WITH OSTEOARTHRITIS OR TRAUMA OF THE KNEE JOINT

YKL-40 is a recently discovered human glycoprotein which isrelated in amino acid sequence to the chitinase protein family.YKL-40 is a major secretory protein of human chondrocytes andsynoviocytes, and could play a role in tissue remodelling. Theaim of the study was to establish the serum YKL-40 level innormal subjects and to evaluate serum YKL-40 as a marker forosteoarthritis. Serum YKL-40 was 80 µg/1 in healthy children(n = 476) and 102 µg/1 in healthy adults (n = 260). Noage or sex differences were found in serum YKL-40 in subjectsyounger than 70 yr, but thereafter serum YKL-40 increased significantly.Patients with late-stage osteoarthritis of the knee (n = 37)had significantly higher serum YKL-40 (1.5-fold; P < 0.01)compared to healthy age-matched subjects, whereas patients withearly-stage osteoarthritis of the knee or recent torn cruciateligaments or menisci did not have elevated serum YKL-40. Thelevel of YKL-40 in serum and synovial fluid correlated significantly,and 10-fold higher values were found in synovial fluid. YKL-40levels in serum and synovial fluid of patients with acute severesynovial inflammation were significantly higher (P < 0.05-P0.001) than those in patients with no, light or moderate synovitisof the knee joint. Furthermore, YKL-40 correlated significantly(P < 0.01) with the amino-terminal propeptide of type IIIprocollagen, but not with serum C-reactive protein. Our dataindicate that YKL-40 in synovial fluid and serum may reflecthuman articular cartilage degradation and the degree of synovialinflammation in the knee joint. KEY WORDS: Osteoarthritis, Biochemical markers     

Effect of voluntary exercise on number and volume of cardiomyocytes and their mitochondria in the mouse left ventricle

Voluntary exercise (VE) has a beneficial influence on the heart and mean lifespan. The present study evaluates structural adaptations of cardiomyocytes and their mitochondria due to VE by new, unbiased stereological methods. Female, 7–9-week-old mice were randomly assigned to a control (CG, n = 7) or VE group (EG, n = 7). EG animals were housed in cages with free access to a running wheel and had a mean running distance of 6.7 (1.8) km per day. After 4 weeks, the hearts of all mice were processed for light and electron microscopy. We estimated the number and volume of cardiomyocytes by the disector method and the number and volume of mitochondria by estimation of the Euler number. In comparison to CG, VE did not have an effect on the myocardial volume of the left ventricle (CG: 93 (10), EG: 103 (17) (mm³)), the number of cardiomyocytes (CG: 2.81 (0.27), EG: 2.82 (0.43) (×10⁶)) and their number-weighted mean volume. However, the composition of the cardiomyocytes changed due to VE. The total volume of mitochondria (CG: 21.8 (4.9), EG: 32.2 (4.3) (mm³), P < 0.01) and the total number (CG: 3.76 (0.44), EG: 7.02 (1.13) (×10¹⁰), P < 0.001) were significantly higher in EG than in CG. The mean number-weighted mitochondrial volume was smaller in EG than in CG (P < 0.05). In summary, VE does not alter ventricular volume nor cardiomyocyte volume or number but the oxidative capacity of cardiomyocytes by an increased mitochondrial number and total volume in the left ventricle. These structural changes may participate in the beneficial effects of VE. Returned for 1. revision: 12 January 2007 1. Revision received: 17 January 2007 Returned for 2. revision: 12 February 2007 2. Revision received: 27 September 2007     

Short-term strength training improves muscle quality and functional capacity of elderly women

To assess effects of a short-term strength training (ST) program on muscle quality (MQ) and functional capacity, 36 sedentary elderly women (age = 66.0 ± 8 year, height = 159.1 ± 9.2 cm, body mass = 68.3 ± 12.1 kg, body fat = 37.0 ± 4.2 %) were randomly divided into an experimental group (EG; n = 19) or a control group (CG; n = 17). The EG performed two to three sets of 12–15 repeats of leg press, knee extension, and knee flexion exercises, 2 days/week for 6 weeks. Before and after training, lower body one repetition maximum (1RM), functional performance tests, quadriceps femoris muscle thickness (MT), and muscle quality (MQ) (1RM and quadriceps MT quotient) were assessed. After training, only the EG showed significant improvements in 1RM (p < 0.05), 30-s sit-to-stand (p < 0.001), and 8 foot up-and-go (p < 0.001). In addition, only in the EG, significant increases in all quadriceps femoris MT measurements (vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris) (p ≤ 0.05), and MQ (p < 0.001) were demonstrated. No changes were observed in the CG. Furthermore, there were significant associations between individual changes in MQ and corresponding changes in 30-s sit-to-stand (r = 0.62, p < 0.001), and 8 foot up-and-go (r = −0.71, p < 0.001). In conclusion, a ST program of only 6 weeks was sufficient to enhance MQ of the knee extensors in elderly women, which resulted in beneficial changes in functional capacity.     

Neuromuscular adaptations to water-based concurrent training in postmenopausal women: effects of intrasession exercise sequence

This study investigated the effects of different exercise sequences on the neuromuscular adaptations induced by water-based concurrent training in postmenopausal women. Twenty-one healthy postmenopausal women (57.14 ± 2.43 years) were randomly placed into two water-based concurrent training groups: resistance training prior to (RA, n = 10) or after (AR, n = 11) aerobic training. Subjects performed resistance and aerobic training twice a week over 12 weeks, performing both exercise types in the same training session. Upper (elbow flexors) and lower-body (knee extensors) one-repetition maximal test (1RM) and peak torque (PT) (knee extensors) were evaluated. The muscle thickness (MT) of upper (biceps brachii) and lower-body (vastus lateralis) was determined by ultrasonography. Moreover, the maximal and submaximal (neuromuscular economy) electromyographic activity (EMG) of lower-body (vastus lateralis and rectus femoris) was measured. Both RA and AR groups increased the upper- and lower-body 1RM and PT, while the lower-body 1RM increases observed in the RA was greater than AR (34.62 ± 13.51 vs. 14.16 ± 13.68 %). RA and AR showed similar MT increases in upper- and lower-body muscles evaluated. In addition, significant improvements in the maximal and submaximal EMG of lower-body muscles in both RA and AR were found, with no differences between groups. Both exercise sequences in water-based concurrent training presented relevant improvements to promote health and physical fitness in postmenopausal women. However, the exercise sequence resistance–aerobic optimizes the strength gains in lower limbs.     

ALTERED LEVELS OF SOLUBLE ADHESION MOLECULES IN RHEUMATOID ARTHRITIS, VASCULITIS AND SYSTEMIC SCLEROSIS

We compared the levels of soluble adhesion molecules E-selectin(sE-selectin), intercellular adhesion molecule-1 (sICAM-1) andvascular cell adhesion molecule-1 (sVCAM-1) alongside von Willebrandfactor (vWf), CRP and rheumatoid factor in 40 patients withRA, 38 with systemic sclerosis (SSc), 35 with vasculitis andin 80 asymptomatic controls. Adhesion molecules were measuredin serum by ELISA, rheumatoid factor by sheep red blood cellagglutination and CRP by immunonephelometry. Compared to controls,increased sE-selectin was found in patients with RA (P = 0.0015),vasculitis (P = 0.0003) and SSc (P = 0.0126), whilst raisedsICAM-1 was found in RA (P < 0.0003), vasculitis (P <0.0003) and SSc (P < 0.0378). sVCAM was lower in RA thanin controls (P = 0.0102), but was unchanged in vasculitis orin SSc. vWf was raised in RA (P = 0.0102), vasculitis (P <0.0003) and SSc (P < 0.0003). In a Spearman's rank analysisof all the data, vWf correlated with sVCAM-1 and sICAM-1 (bothP < 0.001), sE-selectin with sICAM-1 (P < 0.001) and sVCAMwith sICAM-1 (P < 0.005). Levels of rheumatoid factor correlatedwith those of sE-selectin (P = 0.003) and sVCAM-1 (P < 0.012),but there were no correlations between any index and CRP. Thestrongest correlations within the RA group were between sICAMand sVCAM (P = 0.001), in vasculitis it was between sE-selectinand sICAM (P < 0.001), and in SSc it was between sE-selectinand sVCAM (P = 0.019). These data suggest that the differinglevels of vWf, sE-selectin and sICAM-1 in the inflammatory vasculitidesmay be useful in establishing a rolefor leucocyte/endothelialadhesion in these diseases. KEY WORDS: Vasculitis, Rheumatoid arthritis, Systemic sclerosis, von Willebrand factor, Soluble E-selectin, Soluble ICAM-1, Soluble VCAM-1     

A randomized two‐year study of the effects of dynamic strength training on muscle strength,disease activity,functional capacity,and bone mineral density in early rheumatoid arthritis

Objective

To evaluate the impact of a 2‐year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent‐onset (<2 years) rheumatoid arthritis (RA).

Methods

In this prospective trial, 70 RA patients were randomly assigned to perform either strength training (all major muscle groups of the lower and upper extremities and trunk, with loads of 50–70% of repetition maximum) or range of motion exercises (without resistance) twice a week; all were encouraged to engage in recreational activities 2–3 times a week. All patients completed training diaries (evaluated bimonthly) and were examined at 6‐month intervals. All were treated with medications to achieve disease remission. Maximum strength of the knee extensors, trunk flexors and extensors, and grip strength was measured with dynamometers. BMD was measured at the femoral neck and lumbar spine by dual x‐ray densitometry. Disease activity was determined by the Disease Activity Score, the extent of joint damage by the Larsen score, and functional capacity by the Health Assessment Questionnaire (HAQ); walking speed was also measured.

Results

Sixty‐two patients (31 per group) completed the study. Strength training compliance averaged 1.4–1.5 times/week. The maximum strength of all muscle groups examined increased significantly (19–59%) in the strength‐training group, with statistically significant improvements in clinical disease activity parameters, HAQ scores, and walking speed. While muscle strength, disease activity parameters, and physical function also improved significantly in the control group, the changes were not as great as those in the strength‐training group. BMD in the femoral neck and spine increased by a mean ± SD of 0.51 ± 1.64% and by 1.17 ± 5.34%, respectively, in the strength‐training group, but decreased by 0.70 ± 2.25% and 0.91 ± 4.07% in the controls. Femoral neck BMD in the 17 patients with high initial disease activity (and subsequent use of oral glucocorticoids) remained constantly at a statistically significantly lower level than that in the other 45 patients.

Conclusion

Regular dynamic strength training combined with endurance‐type physical activities improves muscle strength and physical function, but not BMD, in patients with early RA, without detrimental effects on disease activity.