Andre Nyberg

Low‐load/high‐repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial

High‐repetitive resistance training (RT) is recommended to increase peripheral muscular endurance in healthy adults; however, the effects of RT with this design on exercise capacity and health‐related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD) is unknown. The study aimed to investigate if low‐load/high‐repetition elastic band RT could improve functional capacity, muscular function, endurance cycle capacity or HRQOL in patients with COPD.

Why and How Limb Muscle Mass and Function Should Be Measured in Patients with Chronic Obstructive Pulmonary Disease

Impaired limb muscle function is a common occurrence in patients with chronic obstructive pulmonary disease (COPD), and it negatively influences exercise tolerance, quality of life, and even survival. Assessment of limb muscle mass and function in COPD is highly encouraged; it should include the quadriceps muscle, but other lower and upper limb muscles may also be evaluated to provide valuable information. Quantification of muscle mass as well as assessment of muscle strength and endurance are suggested. Bioelectrical impedance and dual-energy X-ray absorption can be realistically used in the clinical environment to monitor body composition. Although sophisticated computerized dynamometers provide the most accurate assessment, simple exercise and testing equipment are valid alternatives and they should help in implementing limb muscle function assessment in clinical settings. Isometric measurements, using strain-gauges or hand-held dynamometers, should be favored for their simplicity, availability, and quality of information provided. This perspective provides a rationale for the evaluation of limb muscle mass and function in COPD in routine clinical practice. In addition, measurement techniques used to assess limb muscle mass, strength, endurance, and fatigue in various clinical settings are discussed.

Assessing the effect of high-repetitive single limb exercises (HRSLE) on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) : study protocol for randomized controlled trial

BackgroundSingle-limb knee extension exercises have been found to be effective at improving lower extremity exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Since the positive local physiological effects of exercise training only occur in the engaged muscle(s), should upper extremity muscles also be included to determine the effect of single limb exercises in COPD patients.Methods/designTrial design: a prospective, assessor-blind, block randomized controlled, parallel-group multicenter trial. Participants: stage II-IV COPD patients, > 40 years of age, ex-smokers, with stable medical treatment will be included starting May 2011. Recruitment at three locations in Sweden. Interventions: 1) high-repetitive single limb exercise (HRSLE) training with elastic bands, 60 minutes, three times/week for 8 weeks combined with four sessions of 60 minutes patient education, or 2) the same patient education alone. Outcomes: Primary: determine the effects of HRSLE on local muscle endurance capacity (measured as meters walked during 6-minute walk test and rings moved on 6-minute ring and pegboard test) and quality of life (measured as change on the Swedish version of the Chronic Respiratory Disease Questionnaire). Secondary: effects on maximal strength, muscular endurance, dyspnea, self-efficacy, anxiety and depression. The relationship between changes in health-related variables and changes in exercise capacity, sex-related differences in training effects, feasibility of the program, strategies to determine adequate starting resistance and provide accurate resistance for each involved movement and the relationship between muscle fatigue and dyspnea in the different exercise tests will also be analyzed. Randomization: performed by a person independent of the recruitment process and using a computer random number generator. Stratification by center and gender with a 1:1 allocation to the intervention or control using random block sizes. Blinding: all outcome assessors will be blinded to group assignment.DiscussionThe results of this project will contribute to increase the body of knowledge regarding COPD and HRSLE.Trial registrationClinicalTrials.gov Identifier: NCT01354067. Registration date: 2011-05-11. First participant randomized: 2011-09-02

Correlation between Limb Muscle Endurance, Strength, and Functional Capacity in People with Chronic Obstructive Pulmonary Disease

Purpose: To examine the correlation between limb muscle function (endurance and strength) and functional capacity in upper limbs (ULs) and lower limbs (LLs) of people with chronic obstructive pulmonary disease (COPD). Method: This article describes a secondary analysis of data from a randomized controlled trial. A stationary dynamometer was used to measure isokinetic muscle strength and endurance; the 6-minute walk test, the 6-minute pegboard and ring test, and the unsupported UL exercise test were used to measure functional capacity. Results: Participants were 44 adults with COPD. Muscle strength and endurance in ULs and LLs demonstrated a moderate to strong correlation with functional capacity. When controlling for muscle strength, muscle endurance was moderately correlated with functional capacity in ULs and LLs, but when controlling for muscle endurance, there was no positive and significant correlation between muscle strength and functional capacity for the ULs or LLs. Conclusions: Functional capacity seems to be more closely related to limb muscle endurance than to limb muscle strength in people with COPD.

Limited scientific evidence supports the use of conservative treatment interventions for pain and function in patients with subacromial impingement syndrome: randomized control trials

Abstract Background: Different conservative treatment interventions are often used to decrease pain and improve function in patients with subacromial impingement syndrome (SAIS). However, the current evidence to support the use of these interventions has not been established. Objectives: To determine the evidence for conservative treatment interventions regarding pain and function compared to any intervention for SAIS patients. Methods: A systematic review of randomized controlled trials, published in English between 1 January 1999 and 31 May 2010, was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and manual searching. The methodological quality (PEDro scale) and evidence grade (SBU) were rated. Eight studies were of high quality, four were medium quality, and eight were low quality. Various conservative treatment interventions were evaluated: acupuncture, electrotherapy modalities, exercises, mixed modalities, changing posture, and use of a functional brace. Results: Limited scientific evidence (LSE) indicates positive effects of exercise and mixed modalities regarding pain and function and high-intensity laser therapy (HILT) regarding pain in SAIS patients. LSE also indicate no effect of electrotherapy modalities, apart from HILT, as treatment for SAIS. Conclusions: The lack of high quality interventions limits the ability to draw conclusions regarding efficacy from several of the included studies. However, exercise may be as efficient as surgery, manual therapy in combination with exercise seems to be more effective than exercise alone and high-dose exercises seem to be more effective than low-dose exercises. Furthermore, there is contradictory evidence to support the use of acupuncture.

Acute Effects of Low-Load/High-Repetition Single-Limb Resistance Training in COPD.

Exercising small muscle groups at a time allows higher muscle specific workloads compared with whole body aerobic exercises in people with chronic obstructive pulmonary disease (COPD). Whether similar effects also occur with partitioning exercise during low load/high-repetition resistance exercises is uncertain. PURPOSE To investigate the acute effects of partitioning exercise on exercise workload, exertional symptoms and quadriceps muscle fatigue during low load/high-repetition resistance exercises in people with COPD and healthy controls. METHODS We compared the acute physiological effects of single-limb (SL) versus two-limb (TL) execution of isokinetic knee extension and of six low load/high-repetition elastic resistance exercises in 20 people with COPD (forced expiratory volume in 1 s = 38% predicted) and 15 healthy controls. RESULTS Among people with COPD, SL exercises resulted in higher exercise workloads during isokinetic knee extension (17% ± 31%, P < 0.05) and elastic exercises (rowing, 17% ± 23%; leg curl, 23% ± 21%; elbow flexion, 19% ± 26%; chest press, 14% ± 15%; shoulder flexion, 33% ± 24%; and knee extension, 24% ± 18%, all P < 0.05). Muscle fatigue ratings were similar during SL compared with TL exercises, whereas dyspnea ratings were similar between conditions during isokinetic exercises and lower during SL compared with TL elastic exercises (P < 0.05). In COPD, SL knee extension resulted in greater quadriceps fatigue than TL knee extension as evidenced by a greater fall in quadriceps potentiated twitch force after the former exercise (-24% ± 10% vs -16% ± 8%, P = 0.025). In healthy controls, partitioning exercise with SL exercise did not modify workload, quadriceps fatigue nor dyspnea achieved during the various exercises. CONCLUSIONS Partitioning exercise by exercising using an SL allowed higher muscle localized exercise workloads, larger amount of quadriceps muscle fatigue with lower, or similar level of exertional symptoms during low load/high-repetition resistance exercises in people with advanced COPD.

A Cohort Study to Evaluate the Feasibility of Low Load/High Repetition Elastic Band Resistance Training for People with Chronic Obstructive Pulmonary Disease

Background: Resistance training is an important component of pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD). A vast majority or resistance training studies in COPD have focused on increasing muscular strength with use of weight machines and has been found to be a feasible approach in COPD. However, regarding feasibility of resistance training equipment other than weight machines, such as elastic resistance equipment, information is scarce. In addition, little is known regarding other trainable muscle characteristics, such as peripheral muscular endurance in COPD. We therefore aim to evaluate the feasibility of a low load/high repetition elastic band Resistance Training (RT) regimen in people with moderate to severe COPD. We also aim to evaluate if the RT regimen is feasible for the physiotherapists, conducting the intervention. Methods: Twenty-two participants with moderate to severe COPD (mean forced expiratory volume in one second, and progression of exercise intensity, adverse events, participant and compliance (participant and physiotherapist) were collected for assessment of feasibility. Results: The mean (95% confidence interval) attendance rate was 94% (91-97) and mean exercise intensity was 79% (74-83) of the predicted maximum intensity. Furthermore, the median (interquartile range) compliance was 96% (94-96) and 100% (94-100) for the people with COPD and the physiotherapists respectively. Exercise intensity increased on all exercises and any recorded adverse events were considered minor and temporary Conclusions: Low load/high repetition elastic band resistance training appears to be feasible for both people with COPD and the physiotherapists performing the intervention. These results indicate that elastic bands could be a feasible alternative to weight machines in resistance training for people with COPD

Functional Tests in Chronic Obstructive Pulmonary Disease, Part 2: Measurement Properties

Abstract Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient‐centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity, and health‐related quality of life, but also of functional capacity in activities of daily life, are necessary. In Part 2 of this seminar series, we discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving, and climbing, as well as carrying, moving, and handling objects. We review the validity, reliability, and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences, and normative values for these functional tests.

The accuracy of using elastic resistance bands to evaluate muscular strength

Abstract Elastic resistance as a tool for evaluation of muscular strength has rarely been addressed even though it is commonly used in exercise and rehabilitation regimens involving the shoulder muscles. The aim was therefore to investigate the relationship and potential difference between development of force during maximal isokinetic (maximum peak force, maximum mean force and peak mean force) and elastic (one-repetition maximum (1 RM)) concentric shoulder flexion in healthy older adults. A total of 30 voluntary adults over the age of 50 (15 women, 15 men) were included. Intraclass correlation coefficient absolute agreement was 0.85, 0.43 and 0.48 for the isokinetic values respectively, when all subjects were analysed together. No difference was found between the isokinetic maximum peak force value and the elastic 1 RM for all participants (0.15 kg, p = 0.791), for men (0.80 kg, p = 0.121) or women (− 0.49 kg, p = 0.135). Variations at an individual level, i.e. 95% limits of agreement, were 3.3 kg for all participants, 2.8 kg for women and 3.2 kg for men. These results imply that elastic resistance could be used to evaluate shoulder flexion strength in both older men and women. However, the variation on an individual level and the lower agreement among women is important to consider.

Office-Cycling: A Promising Way to Raise Pain Thresholds and Increase Metabolism with Minimal Compromising of Work Performance

Aim Establishing the effects of low intensity cycling (LC), moderate intensity cycling (MC), and standing at a simulated office workstation on pain modulation, work performance, and metabolic expenditure. Methods 36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized 3 × 3 crossover trial with 75 minutes of LC on 20% of maximum aerobic power (MAP) output, 30 minutes of MC on 50% of MAP, and standing 30 minutes with 48-hour wash-out periods. Outcome measures were pain modulation (pressure pain threshold (PPT) and thermal pain threshold)), work performance (transcription, mouse pointing, and cognitive performance), and metabolic expenditure. Results PPTs increased in all conditions. PPT trapezius showed the highest increase after LC, 39.3 kilopascals (kPa) (15.6; 78.6), compared to MC, 17.0 kPa (2.8; 49.9), and standing, 16.8 kPa (−5.6; 39.4), p = 0.015. Transcription was reduced during LC and MC. Mouse pointing precision was best during standing and worst and slowest during MC. Cognitive performance did not differ between conditions. Metabolic expenditure rates were 1.4 (1.3; 1.7), 3.3 (2.3; 3.7), and 7.5 (5.8; 8.7) kcal/minute during standing, LC, and MC, respectively (p < 0.001). Conclusions LC seems to be the preferred option; it raised PPTs, more than doubled metabolic expenditure, whilst minimally influencing work performance.