Bruce Paton

Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis

Background and objective Low-load exercise training with blood flow restriction (BFR) can increase muscle strength and may offer an effective clinical musculoskeletal (MSK) rehabilitation tool. The aim of this review was to systematically analyse the evidence regarding the effectiveness of this novel training modality in clinical MSK rehabilitation. Design This is a systematic review and meta-analysis of peer-reviewed literature examining BFR training in clinical MSK rehabilitation (Research Registry; researchregistry91). Data sources A literature search was conducted across SPORTDiscus (EBSCO), PubMed and Science Direct databases, including the reference lists of relevant papers. Two independent reviewers extracted study characteristics and MSK and functional outcome measures. Study quality and reporting was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise. Eligibility Search results were limited to exercise training studies investigating BFR training in clinical MSK rehabilitation, published in a scientific peer-reviewed journal in English. Results Twenty studies were eligible, including ACL reconstruction (n=3), knee osteoarthritis (n=3), older adults at risk of sarcopenia (n=13) and patients with sporadic inclusion body myositis (n=1). Analysis of pooled data indicated low-load BFR training had a moderate effect on increasing strength (Hedges’ g=0.523, 95% CI 0.263 to 0.784, p<0.001), but was less effective than heavy-load training (Hedges’ g=0.674, 95% CI 0.296 to 1.052, p<0.001). Conclusion Compared with low-load training, low-load BFR training is more effective, tolerable and therefore a potential clinical rehabilitation tool. There is a need for the development of an individualised approach to training prescription to minimise patient risk and increase effectiveness.

Multiple myeloma and physical activity: a scoping review.

Objectives Multiple myeloma is the second most common haematological cancer. A growing body of literature is emerging that investigates the role physical activity plays in all stages of multiple myeloma (prevention and survivorship) and to date no attempt has been made to collate and understand this literature. Therefore, this scoping review aims to (1) outline what is already known about physical activity in all stages of multiple myeloma (2) map the literature on physical activity and multiple myeloma and (3) identify future directions for research. Design Scoping Review. Data Sources Searches were carried out in May 2015. Searchers were conducted in PubMed, Web of Science, SPORTdiscus and MEDLINE. Eligibility criteria for selecting studies To be included studies had to report original data, investigate physical activity per se or physical activity correlates and multiple myeloma or smouldering multiple myeloma. Results A total of 19 papers received full screening, 5 of these papers were excluded. This review identified three journal articles relating to the role of physical activity in the prevention of multiple myeloma, nine papers were identified in the treatment of multiple myeloma and two on smouldering multiple myeloma. Conclusions The search identified that the literature surrounding multiple myeloma and physical activity is very limited. We encourage those designing new cohort studies to allow for future assessment of associations between physical activity and onset of multiple myeloma and smouldering multiple myeloma, as well as the potential role that physical activity plays in the progression from smouldering multiple myeloma to multiple myeloma. Second, we encourage the design and investigation of gender and treatment-specific physical activity interventions in patients with multiple myeloma. Finally, we highlight the need for more randomised controlled trials to evaluate the impact of different types, frequencies and intensities of physical activity on various health parameters in multiple myeloma survivors.

Influence and reliability of lower-limb arterial occlusion pressure at different body positions

Background Total arterial occlusive pressure (AOP) is used to prescribe pressures for surgery, blood flow restriction exercise (BFRE) and ischemic preconditioning (IPC). AOP is often measured in a supine position; however, the influence of body position on AOP measurement is unknown and may influence level of occlusion in different positions during BFR and IPC. The aim of this study was therefore to investigate the influence of body position on AOP. Methods Fifty healthy individuals (age = 29 ± 6 y) underwent AOP measurements on the dominant lower-limb in supine, seated and standing positions in a randomised order. AOP was measured automatically using the Delfi Personalised Tourniquet System device, with each measurement separated by 5 min of rest. Results Arterial occlusive pressure was significantly lower in the supine position compared to the seated position (187.00 ± 32.5 vs 204.00 ± 28.5 mmHg, p < 0.001) and standing position (187.00 ± 32.5 vs 241.50 ± 49.3 mmHg, p < 0.001). AOP was significantly higher in the standing position compared to the seated position (241.50 ± 49.3 vs 204.00 ± 28.5 mmHg, p < 0.001). Discussion Arterial occlusive pressure measurement is body position dependent, thus for accurate prescription of occlusion pressure during surgery, BFR and IPC, AOP should be measured in the position intended for subsequent application of occlusion.

New lower-limb gait biomechanical characteristics in individuals with Achilles tendinopathy: A systematic review update

BACKGROUND Variations in lower-limb biomechanics have recurrently been associated as aetiological factors for Achilles tendinopathy. OBJECTIVE To update a previous systematic review examining lower-limb gait biomechanics in Achilles tendinopathy. DESIGN Systematic Review. DATA SOURCES MEDLINE, EMBASE, CINAHL PLUS, SPORTDiscus and PUBMED databases searched from inception to May 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies investigating adults with Achilles tendinopathy and lower-limb gait biomechanics including kinematics, kinetics, dynamic plantar-pressures, temporospatial parameters and muscle activity. RESULTS Fourteen studies were identified, involving 836 participants. Three were prospective studies and 11 were case-control designs. Selection and performance bias were high for all studies except the prospective studies, reporting bias was unclear for all studies. Significant effect size reductions in gait speed (d = -0.80), stride length (d = -0.84) and step length (d = -0.80) were calculated in runners with Achilles tendinopathy. Increased effect sizes for ankle eversion (d = 1.08), time to maximum pronation (d = -1.72), calcaneal inversion (d = -1.82) and ankle and hip joint moments were also established. Significant differences in plantar pressures and timing of ground reaction forces were calculated. Individuals with Achilles tendinopathy demonstrated differences in amplitude and timing of several lower-limb muscles, notably reductions in the onset of activity (d = 2.02) and duration of activation (d = 2.11) in the Gluteus Medius of subjects with Achilles tendinopathy. CONCLUSION Eighteen new biomechanical characteristics in individuals with Achilles tendinopathy have been established. This review highlights a topic rich in quantity, but generally weak in quality, consequently results should be interpreted cautiously. High powered prospective studies are required to determine causality.

Protocol for a 1-year prospective, longitudinal cohort study of patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy: the BARI-LIFESTYLE observational study

Introduction Roux-en-Y gastric bypass and sleeve gastrectomy are the two most common bariatric surgery performed in the UK that result in comparable weight loss and remission of obesity-associated comorbidities. However, there is a paucity of studies examining the impact of these procedures on body composition, physical activity levels, sedentary behaviour, physical function and strength, dietary intake, health-related quality of life and costs. Methods and analysis The BARI-LIFESTYLE observational study is a 1-year prospective, longitudinal cohort study within a real-world routine clinical care setting aiming to recruit 100 patients with severe obesity undergoing either primary Roux-en-Y gastric bypass or sleeve gastrectomy from two bariatric centres in London, UK. Participants will be followed up four times during the study period; presurgery baseline (T0) and at 3 (T1), 6 (T2) and 12 months (T3) postsurgery. In addition to the standard follow-up investigations, assessments including dual-energy X-ray absorptiometry scan, bioelectric impedance analysis, 6 min walk test, sit-to-stand test and handgrip test will be undertaken together with completion of questionnaires. Physical activity levels and sedentary behaviour will be assessed using accelerometer, and dietary intake will be recorded using a 3-day food diary. Outcome measures will include body weight, body fat mass, lean muscle mass, bone mineral density, physical activity levels, sedentary behaviour, physical function and strength, dietary intake, health-related quality of life, remission of comorbidities, healthcare resource utilisation and costs. Ethics and dissemination This study has been reviewed and given a favourable ethical opinion by London-Dulwich Research Ethics Committee (17/LO/0950). The results will be presented to stakeholder groups locally, nationally and internationally and published in peer-reviewed medical journals. The lay-person summary of the findings will be published on the Centre for Obesity Research, University College London website (http://www.ucl.ac.uk/obesity).

FOOT POSTURE AND ITS RELATIONSHIP WITH KNEE KINEMATICS IN BAREFOOT RUNNING OF THE HEALTHY ADULT

Background Abnormal dynamic knee moments and variations of static foot posture are risk factors for chronic lower limb injury development. However, relationships between the two have yet to be established in the running gait. Objective The primary aim was to investigate the correlation between variations in static foot posture and maximum knee adduction. Secondary aims investigated the correlation of static foot posture with variables that affected dynamic knee motion. Design A single-group prospective exploratory study design was implemented. Setting Laboratory-based study setting. Participants 23 volunteers from University College London social media network(n=3119) recruited in June 2016 met entry criteria of healthy adult 18–59 years) with no lower limb musculoskeletal injury in the last 6 months, history of biomechanical abnormality(including use of prosthesis) or lower limb surgery. All participated and completed study but only 14 sets of data were included due to data-corruption. An a priori sample size calculation determined that 9–14 participants were required to demonstrate significantly different correlations(α=0.05, β=0.20). Assessment of Risk Factors Foot Posture Index scores of each participants dominant foot was an independent variable during a 13 minute barefoot treadmill gait analysis. Main Outcome Measurements Maximum knee adductor moments, knee tri-planar kinematics, hip tri-planar kinematics, maximum loading force and foot-strike pattern were measured at 3 instances(1.39 m/s; 3.6 m/s; self-selected running speed) as determined prior to data-collection. Results No significant correlation (p<0.05) was found between static foot posture measurements and all outcome variables once confounders were accounted for. When comparing maximum knee adductor moments between the 3 speeds, significant correlations were observed (r=0.66–0.71, p<0.01). Conclusions In the healthy population, static foot posture and dynamic knee motion demonstrate a poor and insignificant relationship. Dynamic motion should be assessed independently in predicting future injury where more evidence is needed to account for variations in knee adductor moments.