The efficacy of perturbation training in nonoperative anterior cruciate ligament rehabilitation programs for physical active individuals

BACKGROUND AND PURPOSE: Treatment techniques involving perturbations of support surfaces may induce compensatory muscle activity that could improve knee stability and increase the likelihood of returning patients to high-level physical activity. The purpose of this study was to determine the efficacy of augmenting standard nonoperative anterior cruciate ligament (ACL) rehabilitation programs with a perturbation training program. SUBJECTS: Twenty-six patients with acute ACL injury or ruptures of ACL grafts participated in the study. Subjects had to have a unilateral ACL injury, be free of concomitant multiple ligament or meniscal damage requiring surgical repair, and pass a screening examination designed to identify patients who had the potential to return to high-level physical activity with nonoperative treatments. Subjects also had to be regular participants in level I activities (eg, soccer, football, basketball) or level II activities (eg, racquet sports, skiing, construction work). METHODS: Subjects were randomly assigned to either a group that received a standard rehabilitation program (standard group) or a group that received the standard program augmented with a perturbation training program (perturbation group). Treatment outcome was determined from scores on the Knee Outcome Survey's Activities of Daily Living Scale (ADLS) and Sports Activity Scale, a global rating of knee function, scores on a series of single-limb hop tests, measurements of maximum isometric quadriceps femoris muscle force output, and the group frequency of unsuccessful rehabilitation. Unsuccessful rehabilitation was defined as the occurrence of an episode of giving way of the knee or failure to maintain the functional status of a rehabilitation candidate on retesting. RESULTS: More subjects had unsuccessful rehabilitation in the standard group compared with the perturbation group. There was a within-group x time interaction for the ADLS, global rating of knee function, and crossover hop test scores. These scores decreased from posttraining to the 6-month follow-up for the standard group. CONCLUSION AND DISCUSSION: Although both the standard program and the perturbation training program may allow subjects to return to high-level physical activity, the perturbation training program appears to reduce the risk of continued episodes of giving way of the knee during athletic participation and allows subjects to maintain their functional status for longer periods.     

Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction

BACKGROUND AND PURPOSE: Although various hop tests have been proposed as performance-based outcome measures following anterior cruciate ligament (ACL) reconstruction, limited reports of their measurement properties exist. The purpose of this study was to investigate the reliability and longitudinal validity of data obtained from hop tests during rehabilitation after ACL reconstruction. SUBJECTS: Forty-two patients, 15 to 45 years of age, who had undergone ACL reconstruction participated in the study. METHODS AND MEASURES: The study design was prospective and observational with repeated measures. The subjects performed a series of 4 hop tests on 3 separate occasions within the 16th week following surgery and on a fourth occasion 6 weeks later. The tests were a single hop for distance, a 6-m timed hop, a triple hop for distance, and crossover hops for distance. Performance on the ACL-reconstructed limb was expressed as a percentage of the performance on the nonoperative limb, termed the "limb symmetry index." Subjects also completed the Lower Extremity Functional Scale and a global rating of change questionnaire. RESULTS: Intraclass correlation coefficients for limb symmetry index values ranged from .82 to .93. Standard errors of measurement were 3.04% to 5.59%. Minimal detectable changes, at the 90% confidence level, were 7.05% to 12.96%. Changes in hop test scores on the operative limb were statistically greater than changes on the nonoperative limb. Pearson correlations (r) between change in hop performances and self-reported measures ranged from .26 to .58. DISCUSSION AND CONCLUSION: The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction. These findings support the use and facilitate the interpretation of hop tests for research and clinical practice.     

Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial

ObjectiveTo compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction.MethodsThirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation.ResultsIG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17–23% vs. +5–9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test.ConclusionIsokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.     

Functional recovery after anterior cruciate ligament reconstruction: a longitudinal perspective

Hopper DM, Strauss GR, Boyle JJ, Bell J. Functional recovery after anterior cruciate ligament reconstruction: a longitudinal perspective.

Objective

To evaluate functional hop performance in subjects with an anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone graft during 12, 18, 26, 39, and 52 weeks.

Design

A longitudinal comparative study.

Setting

University research laboratory.

Participants

Patients (N=19) were evaluated at 12, 18, 26, 39, and 52 weeks after ACL reconstruction surgery.

Intervention

Testing on 5 separate occasions.

Main Outcome Measures

The Cincinnati Knee Rating System and analog scales, the 6-meter timed hop, crossover hop, stair hop, and vertical hop, and limb symmetry indices.

Results

The uninjured and injured legs and test order were randomized. There was a significant test occasion main effect for both the Cincinnati and analog scores (P=.001). Subjective rating scores improved over the 5 testing occasions. For all 4 hop tests, test occasion and limb main effects were significant (P=.001). Paired t test comparisons at each testing occasion indicated a significant difference between the reconstructed and uninjured limb (P<.05). Furthermore, significant test occasion main effects were noted for limb symmetry indices for the 4 hop tests (P=.001). Using a score of greater than or equal to 85% as a criterion for normative limb symmetry, normative scores were recorded in the 6-m timed hop at the week 18 test occasion, the stair hop and vertical hop at the week 26 test occasion, and the crossover hop at the week 39 test occasion.

Conclusions

These hop tests showed different levels of imposed demands on the knee that could be used to assess functional recovery and readiness to resume sport.     

Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial

BACKGROUND AND PURPOSE: Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause. SUBJECTS AND METHODS: The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs. RESULTS: One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking. DISCUSSION AND CONCLUSION: Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.     

关节镜下重建前交叉韧带:单隧道双束与单束隧道重建的比较

背景:膝关节内前交叉韧带损伤后多采用关节镜下单束单隧道重建及双束双隧道重建,目前单隧道双束重建也已应用于临床,但具体疗效尚不明确。目的:比较单隧道双束和单隧道单束重建前交叉韧带的临床疗效。方法:在2007-03/2009-06选择21例前交叉韧带完全断裂患者接受关节镜下单隧道双束重建前交叉韧带手术,同期18例前交叉韧带完全断裂患者接受关节镜下单隧道单束重建前交叉韧带手术。两组患者均采用异体胫前肌进行重建前交叉韧带手术。采用国际膝关节文献委员会分级及Lysholm评分等评估两组患者重建疗效。结果与结论:单隧道双束组随访12～25个月,平均(18.0±3.3)个月;单隧道单束组随访13～27个月,平均(19.8±3.6)个月。末次随访时单隧道双束组与单束组Lysholm评分平均分别为(87.0±2.2)分、(87.5±2.3)分,差异无显著性意义(P>0.05)。说明单隧道双束和单隧道单束重建前交叉韧带的临床疗效差异无显著性意义,单隧道双束重建前交叉韧带也是一种可靠的前交叉韧带重建方法。     

Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction

[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.     

Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Nondistally fixated (ie, what is often referred to as "open kinetic chain" [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called "closed kinetic chain" [CKC]) leg extensor training were compared for their effects on knee pain. SUBJECTS: Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16-54). METHODS: Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. RESULTS: No differences in knee pain were found between the treatment groups. DISCUSSION AND CONCLUSION: Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.     

单隧道四股半腱肌股薄肌肌腱重建前交叉韧带后的康复训练

【目的】探讨采用单隧道四股半腱肌股薄肌肌腱重建前交叉韧带后的康复训练方法,总结其近期康复效果。【方法】对49例前交叉韧带断裂的患者采用单隧道四股半腱肌股薄肌肌腱进行重建,术后进行1年以上系统的康复指导。包括支具制动及肌力、活动度、本体感受器训练和肌肉牵张训练等。观察其可行性和效果。【结果】术后3个月,患者膝关节的活动度均恢复正常。术后12个月,患肢的股四头肌和胭绳肌峰力矩比值超过正常侧的82％。术后6个月,膝关节Lanchman试验和轴移试验均为阴性。术后6个月,膝关节功能评分为与术前相比差异有显著性（P〈0．01）。【结论】对于前交叉韧带损伤患者,在采用单隧道四股半腱肌股薄肌肌腱进行重建后进行此康复训练是安全有效的。     

The Role of Fatigue in Return to Sport Testing Following Anterior Cruciate Ligament Reconstruction

BackgroundFatigue may play a role in anterior cruciate ligament (ACL) injury, but has not been incorporated into objective test batteries for return to sport decisions following ACL reconstruction (ACLR) surgery. The effect of fatigue on muscle function and performance following surgery and rehabilitation has been poorly studied.Purpose/HypothesisThe purpose of this study was to assess the effect of fatigue on performance of various hop tests used in clinical rehabilitation settings by examining LSI scores. The authors hypothesized that participants will have worse limb symmetry index scores following the fatigue protocol and that the operative limb (ACLR) will have a greater decline in function than the non-operative limb (CON).Study DesignCross-Sectional Study.MethodsParticipants (n=21 [Male = 15, Female = 6]; AGE = 24.6 ± 9.3) were at least six months post ACLR and in rehabilitation. Testing was performed over two separate sessions in either a non-fatigued (NFS) or fatigued state (FS). In the FS, individuals performed a series of exercises to exhaust muscular endurance, strength, and power systems, after which they performed as battery of seven hop tests (single hop for distance, triple hop for distance, crossover hop for distance, 6-meter timed hop, lateral rotation hop for distance, medial rotation hop for distance, and vertical jump for height). A 2(limb) x 2(time) ANOVA was used to compare limbs between each state.ResultsDifferences between limbs (CON vs ACLR) were observed for all hop tests in the NFS whereby the ACLR limb was observed to have reduced performance (↓5.4-9.1%, p <0.05). When tested in the FS, significant differences in performance between limbs remained for only the crossover (↓4.9%), medial rotation (↓7.1%), lateral rotation (↓5.5%), and vertical hop (↓10.0%)(p<0.05). When comparing the NFS and FS states, only the CON limb was observed to have significant decreases in performance of the Triple Hop (↓7.4%), Crossover (↓8.7%), and Lateral Rotation (↓5.2%)(p<0.05).ConclusionsFollowing ACL reconstruction, there appears to be a greater loss in jump performance in the CON limb in the FS. These findings suggest it may be crucial to consider and assess the endurance of both limbs rather than just the ACLR limb when determining readiness for return to play.Level of EvidenceLevel 3     

Effect of personality traits on rehabilitation effect after anterior cruciate ligament reconstruction: An observational study

BackgroundAnterior cruciate ligament (ACL) reconstruction requires an extended period of postoperative rehabilitation. Psychological factors can affect recovery after surgery. Study of psychological factors is still limited to self-motivation, fear and pain. Study of personality traits associated with early rehabilitation outcome after ACL reconstruction is scarce.ObjectiveWe aimed to explore the effect of personality traits on early rehabilitation after ACL reconstruction and provide a reference for clinicians in designing a personalized rehabilitation plan.MethodsThis prospective analysis investigated 155 patients at 3 and 6 months after ACL reconstruction. Follow-up involved administration of a general data questionnaire, the Chinese Big Five Personality Inventory Brief Version, the Tegner activity score, the International Knee Documentation Committee Subjective Knee Score, the Knee injury and Osteoarthritis Outcome Score, the Lysholm Score and a balance test.ResultsAmong the 155 patients included (124 males), Neuroticism was negatively correlated with subjective knee scores at 3 and 6 months after surgery (p<0.001). The odds of a poor balance test result was increased for each 1-point increase in Neuroticism score (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.28–2.36, p<0.001). We found a positive correlation between Conscientiousness score and subjective knee scores at 3 and 6 months after surgery (p<0.001). For every 1-point increase in Conscientiousness score, the odds of a poor balance test result were decreased (OR 0.29, 95% CI 0.16–0.54, p<0.001). Agreeableness and Openness to experience scores were positively correlated with subjective knee scores at 3 and 6 months after surgery (p<0.001). We found no correlation between Extraversion and subjective knee scores at 3 and 6 months after surgery (p>0.05) but a positive correlation with the Tegner activity score at 3 and 6 months after surgery (p<0.05).ConclusionWe found a significant correlation between the Big Five personality dimensions and the early rehabilitation effect after ACL reconstruction, which can provide a reference for clinicians in designing a personalized rehabilitation plan.     

Évaluation fonctionnelle isocinétique et neuromusculaire du genou,retour au sport après reconstruction du ligament croisé antérieur. Étude prospective d’une cohorte de 234 sportifs au recul moyen de 6 mois

Background

Ten percent or less reduction in isokinetic and functional test performance in comparison with the healthy side is generally considered to be a sign of satisfactory functional recovery after reconstruction of the anterior cruciate ligament (ACL). The main objective of this work was to assess postoperative functional recovery of the knee joint in a large cohort.

Sex differences in knee strength deficit 1?year after anterior cruciate ligament reconstruction

[Purpose] Little is known about the outcome differences between men and women after anterior cruciate ligament (ACL) reconstruction. Therefore, the present study aimed to compare knee muscle strength between men and women 1 year after ACL reconstruction. [Subjects and Methods] Retrospective and outcome study. Between 2012 and 2015, 35 males (mean age, 29.7 ± 010.7 years) and 35 females (mean age, 28.2 ± 11.3 years) who had undergone primary ACL reconstruction were recruited from Samsung medical centers. We assessed the strength deficit in the quadriceps (extensor) and hamstrings (flexor) at 60°/sec and 180°/sec with isokinetic testing equipment. Statistical analysis was conducted with a t-test to determine if sex differences existed in knee strength deficit. [Results] Significant differences were noted between men and women with respect to extensor muscle strength deficit. Women reported less extensor muscle strength than men did, at the angular velocities 60°/sec and 180°/sec. However, no significant sex differences were found at either velocity with respect to the strength deficit of the knee flexor muscles. [Conclusion] Compared to male patients, female patients reported significantly less extensor muscle strength and less improvement 1 year after reconstruction.Key words: Anterior cruciate ligament, Sex, Female     

Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes

OBJECTIVE: To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training. RESEARCH DESIGN AND METHODS: We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months. RESULTS: Compared with the WL group, HbA1c decreased significantly more in the RT&WL group (-0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months. CONCLUSIONS: In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.     

关节镜下重建前交叉韧带：单隧道双束与单束隧道重建的比较

背景：膝关节内前交叉韧带损伤后多采用关节镜下单束单隧道重建及双束双隧道重建,目前单隧道双束重建也已应用于临床,但具体疗效尚不明确。目的：比较单隧道双束和单隧道单束重建前交叉韧带的临床疗效。方法：在2007-03/2009-06选择21例前交叉韧带完全断裂患者接受关节镜下单隧道双束重建前交叉韧带手术,同期18例前交叉韧带完全断裂患者接受关节镜下单隧道单束重建前交叉韧带手术。两组患者均采用异体胫前肌进行重建前交叉韧带手术。采用国际膝关节文献委员会分级及Lysholm评分等评估两组患者重建疗效。结果与结论：单隧道双束组随访12～25个月,平均（18.0±3.3）个月;单隧道单束组随访13～27个月,平均（19.8±3.6）个月。末次随访时单隧道双束组与单束组Lysholm评分平均分别为（87.0±2.2）分、（87.5±2.3）分,差异无显著性意义（P〉0.05）。说明单隧道双束和单隧道单束重建前交叉韧带的临床疗效差异无显著性意义,单隧道双束重建前交叉韧带也是一种可靠的前交叉韧带重建方法。     

Relationship between age and measures of balance, strength and gait: linear and non-linear analyses

An age-related decline in balance, gait and lower-extremity muscle strength measures may lead to increased risk of falls and fractures. Previous studies have reported a possible non-linear age-related decline in these measures, but the choice of methodological approach has limited its interpretation. Healthy community-dwelling women (n=212) 21-82 years of age were evaluated for strength [Nicholas MMT (manual muscle tester)], gait [CSA (clinical stride analyser)], activity [HAP (human activity profile)] and static and dynamic balance [CBS (Chattecx balance system), LBT (Lord's balance test) and the ST (step test)]. A GAM (generalized additive model) was developed for each outcome variable to estimate the functional relationship, with age as a continuous variable. Performance was maintained until 45-55 years of age, depending on the outcome measure. Thereafter a decline in performance was evident with increasing age in all measures. Overall, a significant non-linear relationship with age was demonstrated for lower-extremity strength measures (MMT), velocity and double support duration of gait (CSA) and some clinical and laboratory balance tests [ST, LBT (eyes open) and the CBS]. Linear relationships were demonstrated by the LBT with eyes closed and activity measures. Balance, lower-extremity muscle strength and gait may decline non-linearly with age. Our study suggests possible threshold effects between age and balance, muscle strength and gait measures in women. Further research into these threshold effects may have implications for the optimal timing of exercise and other interventions to reduce the risk of falls and fractures.     

Psychological Patient-reported Outcomes Cannot Predict a Second Anterior Cruciate Ligament Injury in Patients who Return to Sports after an Anterior Cruciate Ligament Reconstruction

BackgroundPsychological patient-reported outcomes (PROs) are recommended for use in test batteries to aid in decision-making, regarding whether patients are well prepared to return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the values that should be regarded as “pass” or “fail” are still unclear.PurposeThis study aimed to identify cut-off values for three commonly used psychological PROs that could differentiate patients who suffer a second ACL injury from patients who do not within two years of RTS in patients after ACL reconstruction with respect to recovery of symmetrical quadriceps strength.Study designDiagnostic/prognostic studyMethodsDemographic data, isokinetic strength test data for quadriceps, as well as results for the ACL-Return to Sport after Injury scale (ACL-RSI), Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life, and Function in Sport and Recreation sub-scales, and the 18-item version of the Knee Self-Efficacy Scale (K-SES₁₈) were extracted from a registry. Receiver operating characteristic (ROC) curves were calculated for each PRO. Accuracy of the cut-offs was presented with two summary measures for the ROC: the area under the curve (AUC) and Youden index.ResultsIn total, 641 (355 men, 61%) patients (24.8 [SD 7.6] year old at ACL reconstruction) were included. The cut-off values were not able to differentiate patients who suffered a second ACL injury up to 24 months after RTS and ACL reconstruction from patients who did not. Additionally, achieving symmetrical quadriceps strength did not improve the cut-off psychometric properties.ConclusionSince cut-off values could not differentiate between patients who suffered a second ACL injury and those who did not, clinicians should not rely only on cut-off values or a single PRO of those analyzed in this study when making decisions on which patients are at risk of experiencing a second ACL injury when returning to sports after ACL reconstruction.Level of EvidenceLevel 3     

The effect of strength training on functional fitness in older patients with chronic lung disease enrolled in pulmonary rehabilitation.

The purpose of this study was to compare the effects of a strength training-enhanced program and a traditional pulmonary rehabilitation (PR) program on functional fitness (FF) in older patients with chronic obstructive pulmonary disease (COPD), using the Senior Fitness Test. Twenty patients were recruited from an outpatient PR program. After completing baseline measures, including muscular strength and the Senior Fitness Test, patients were randomly assigned to the strength training program (TR+ST, n = 10) or traditional PR program (TR, n = 10). Patients completed 16 exercise sessions that were conducted twice a week for 8-10 weeks, after which patients repeated outcome measurements. Independent t tests were conducted to determine whether groups differed between measures. Both the TR+ST and TR groups improved on all FF measures. Moderate effect sizes were found for two of the FF measures when the groups were compared. The addition of strength training to PR may have a favorable impact on FF in older patients with COPD.