Deniz Bayraktar

Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: A pilot study

BACKGROUND Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited. OBJECTIVE The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS. METHODS Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale. RESULTS Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p < 0.05), but no significant differences in any outcome measures were observed in the control group (p > 0.05) after the intervention. CONCLUSIONS According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS.

Relationship between lower extremity isometric muscle strength and standing balance in patients with multiple sclerosis.

BACKGROUND Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). OBJECTIVE The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. METHODS Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. RESULTS Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. CONCLUSIONS Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.

Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis.

[Purpose] This study describes the cultural adaptation, validation, and reliability of the Turkish version of the Pain Catastrophizing Scale in patients with ankylosing spondylitis. [Methods] The validity of the Turkish version of the Pain Catastrophizing Scale was assessed by evaluating data quality (missing data and floor and ceiling effects), principal components analysis, internal consistency (Cronbach’s alpha), and construct validity (Spearman’s rho). Reproducibility analyses included standard measurement error, minimum detectable change, limits of agreement, and intraclass correlation coefficients. [Results] Sixty-four adult patients with ankylosing spondylitis with a mean age of 42.2 years completed the study. Factor analysis revealed that all questionnaire items could be grouped into two factors. Excellent internal consistency was found, with a Chronbach’s alpha value of 0.95. Reliability analyses showed an intraclass correlation coefficient (95% confidence interval) of 0.96 for the total score. There was a low correlation coefficient between the Turkish version of the Pain Catastrophizing Scale and body mass index, pain levels at rest and during activity, health-related quality of life, and fear and avoidance behaviors. [Conclusion] The results of this study indicate that the Turkish version of the Pain Catastrophizing Scale is a valid and reliable clinical and research tool for patients with ankylosing spondylitis.

A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study

Abstract Purpose: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. Method: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age–sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. Results: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). Conclusion: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. Implications for Rehabilitation An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.

AB0837-HPR Core stability exercises: in water or on land? comparison of the effects of two different core stabilization trainings

Background Core stabilization exercises have a theoretical basis and are used in the treatment of low back pain. But the effects of core stability exercises performed in water are unknown. Objectives To determine and compare the effects of Core stability exercise programs performed in different environments in low back pain (LBP) patients. Methods Twenty-three patients (47.78±13.20 years) and fifteen age-sex matched healthy controls (46.67±13.69) were included to the study. Patients were randomly divided into 2 groups as Core Stabilization (CS) or Water Specific Therapy (WST). Both groups underwent 8-weeks (3 times a week) core stabilization exercises in different environments. The assessments for pain, static endurance of trunk muscles, functional status and quality of life were performed before and after the treatment. Results Level of static endurance of trunk muscles was found lower in the patients compared to the controls at baseline (p<0.05). Both groups showed significant improvements in all outcomes (p<0.05) after 8-weeks intervention. When two groups were compared, no differences were found in the amount of change after the intervention (p>0.05). After the treatment static endurance of trunk muscles of LBP patients became similar to controls (p>0.05). Conclusions According to these results, core stabilization exercisetrainings performed on land or in water both could be beneficial in LBP patients and there is no difference between environments. References Hayden JA, van Tulder MW, MalmivaaraA et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005 Jul 20;(3):CD000335. Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. ClinRehabil 2009 Jan;23(1): 3-14. Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, Part 1. Am J Phys Med Rehabil 2005 Jun;84(6):473-80. Disclosure of Interest None Declared

Are the alterations in body posture related to decreased trunk muscle endurance in healthy young adults

BACKGROUND Trunk muscle endurance exercises are commonly used for correcting the postural alterations. However, there is no study investigating the relationship between postural alignment and trunk muscle endurance in healthy young adults. OBJECTIVE The aim of this study was to examine whether the three-dimensional (3D) body posture is related to trunk muscle endurance in healthy young adults. METHODS Forty-two healthy young adults enrolled in this study. For 3D evaluation of the body posture, an internet-based postural assessment system was used. Alterations in posture (head, ribcage, and pelvis) were evaluated by using the Posture Index which represents the total score of postural displacements. The higher Posture Index scores indicate more severe displacements in the posture. Trunk muscle endurance measurements included side bridge, trunk flexors and trunk extensors endurance tests. Spearmans rho was used to evaluate the associations between measured parameters. RESULTS The median age of the participants were 22 (IQR: 21.0-23.0) years. The only significant correlation was detected between the side bridge endurance test and the total Posture Index score (rho =⁣-0.402, p= 0.008). CONCLUSIONS These results indicated that the alterations of the body posture was significantly related to lower lateral trunk muscle endurance scores. These findings support the importance of trunk muscles, especially lateral trunk musculature to have a better body posture.

Fatigue perception and related factors in patients with advanced sarcoidosis and COPD patients

Aim: To compare the fatigue symptom, which is related to pulmonary functions strongly, in two distinct lung diseases (Sarcoidosis and COPD) with different etiologies. Methods: Seventeen patients (mean age= 55.82±6.54) with sarcoidosis in stage 3-4 and 31 patients (mean age= 65.52±10.50) with stage 3-4 COPD were included. Perceived fatigue level (Fatigue Severity Scale), dyspnea severity (modified Medical Research Council scale (MMRCS) and Modified Borg Scale (MBS)), pulmonary function tests (spirometer), functional level (6-minute walking test), Health-related quality of life-HRQOL (St. George Quality of Life questionnaire and Short Form-36 (SF-36)), and depression and anxiety (Hospital Anxiety and Depression Scale (HAD)) were assessed. Results: Mean perceived fatigue severity scores were 48.32±10.62 in COPD and 37.82±13.61 in sarcoidosis group (p=0.25). Six-minute walking distance, dyspnea severity, and anxiety and depression were found similar between groups (p>0.05). Sarcoidosis patients showed lower St. George Quality of Life scores, but higher SF-36 scores in comparison to COPD patients. Pulmonary functions were found more diminished in COPD group (p= 0.04). Fatigue severity was found related to MMRCS, MBS, %FEV1 value, HAD, HRQOL scores in COPD group and MMRCS, MBS, walking distance, body-mass index, HRQOL scores in sarcoidosis group (p Conclusion: We believe that while the fatigue severity which was found higher in COPD patients was affected by lower pulmonary functions and poor quality of life, in sarcoidosis patients fatigue symptom along with the dyspnea limits the exercise capacity of patients and affects the quality of life negatively.

SAT0751-HPR The relationship between anaerobic exercise capacity and isometric lower extremity muscle strength in children with juvenile idiopathic arthritis

Background Juvenile idiopathic arthritis (JIA) is a chronic disease that occurs before the age of 16 years. It was shown that anaerobic exercise capacity, which is important for most daily activities in children such as jumping, hoping and climbing was diminished in JIA. Previous studies showed that anaerobic exercise capacity was related to well-being level, functional status, and aerobic exercise capacity in JIA. However, no data is available about the relationship between lower extremity muscle power and anaerobic exercise capacity in children with JIA. Objectives To determine the possible relationships between lower extremity muscle strength and anaerobic capacity. Methods Forty-six children with JIA (14 F, 32 M), with a mean age of 13.74±2.29 years (min-max: 9–17 years) were included in the study. Isometric lower extremity muscle strength was assessed with a hand-held dynamometer at the end points of knee flexion, knee extension, hip flexion and hip extension movements, which are generated from gross lower extremity muscles and important for anaerobic power. All the muscle testing was performed on the right leg. Anaerobic exercise capacity was measured performing a 30-second Wingate test. Both absolute and per kilogram values for peak power and average power were noted. The relationships between the parameters were determined with Pearsons correlation coefficient. (Relationship levels were interpreted as 0.05–0.30: low correlation; 0.30–0.40: low-moderate correlation; 0.40–0.60: moderate correlation; 0.60–0.75: good correlation; 0.75–1.00: good-excellent correlation. Results All children completed the assessments without any adverse effects. Demographics, average isometric lower extremity muscle strengths and parameters related to the anaerobic exercise capacity testing were shown at Table 1. Moderate to good correlations were determined between isometric muscle strength and anaerobic exercise capacity parameters p<0.001 (Table 2).Table 1. Demographics, isometric lower extremity muscle strength and anaerobic exercise capacity parameters Mean±SD Age (years) 13.74±2.29 Height (cm) 159.72±11.08 Weight (kg) 53.76±14.95 BMI (kg/m2) 20.76±3.92 Hip Flexion (kg) 16.81±5.47 Hip Extension (kg) 13.57±4.50 Knee Flexion (kg) 17.72±5.83 Knee Extension (kg) 22.08±6.94 Peak Power (W) 386.26±184.08 Peak Power (W/kg) 6.99±2.33 Average Power (W) 287.69±129.53 Average Power (W/kg) 5.22±1.60 SD: Standard Deviation; cm: centimeters; kg: kilogram; m: meter; W: watt; W/kg: watt/kilogram.Table 2. The relationships between isometric muscle strength and anaerobic exercise capacity parameters Peak Power Peak Power ) Average Power Average Power (W) (W/kg) (W) (W/kg) Hip Flexion (kg) 0.688* 0.629* 0.636* 0.552* Hip Extension (kg) 0.618* 0.532* 0.581* 0.458* Knee Flexion (kg) 0.642* 0.530* 0.630* 0.494* Knee Extension (kg) 0.647* 0.465* 0.670* 0.469* Pearson Correlation Test; kg: kilogram; W: watt; W/kg: watt/kilogram. *Significance at level <0.001. Conclusions The results of this study suggested that lower extremity muscle strength might influence the anaerobic exercise capacity. Exercise regimes including lower extremity strengthening might help improving anaerobic exercise capacity in children with JIA. Disclosure of Interest None declared

OP0009-HPR The effect of an 8-week water exercise program on anaerobic exercise capacity in children with juvenile idiopathic arthritis

Background Anaerobic exercise capacity was reported to be lower in children with juvenile idiopathic arthritis (JIA) than healthy children. However, to our knowledge, there is no study focusing on improving anaerobic exercise capacity in JIA. Objectives To investigate the effect of an 8-week water exercise program, which was performed at the weekends, on anaerobic exercise capacity in children with JIA. Methods Forty-two children with JIA were divided into two groups as exercise and control. Prior to the study, anaerobic exercise capacity was measured performing a 30-second Wingate test. Deep water running was employed as the progressive water exercise program for the exercise group. Control group did not receive any additional treatment other than their usual care. Weekends were chosen for the exercise sessions considering the educational program of the children. Exercise intensity was set as moderate. Exercise intensity was determined with a wearable heart rate tracking system during the exercises. All children were reassessed regarding to anaerobic exercise capacity two months after the first assessment. Results All children completed the study without any adverse effects. Twenty-one children were in the exercise group, others were assessed as controls. No significant differences were determined between groups prior the study regarding to age, disease duration, height, weight, body-mass index, and anaerobic exercise capacity related parameters (p<0.05). While all anaerobic exercise capacity parameters improved in the exercise group, no improvement were seen in the control group. The in-group comparisons were shown at Table 1. The comparison of the changes between groups after 8 weeks were demonstrated at Table 2.Table 1. In-group comparison before and after the study Before After p Median (IQR 25/75) Median (IQR 25/75) Exercise Group (n=21)  Peak Power (W) 354.73 (267.59/471.55) 441.3 (295.2/636.9) 0.002*  Peak Power (W/kg) 6.74 (5.44/8.94) 7.7 (6.4/9.7) 0.001*  Average Power (W) 291.5 (188.78/359.61) 360.0 (220.4/446.4) 0.001*  Average Power (W/kg) 5.54 (4.07/6.88) 6.0 (4.8/7.4) 0.002* Control Group (n=21)  Peak Power (W) 355.57 (225.43/463.62) 366.7 (236.3/447.8) 0.259  Peak Power (W/kg) 6.69 (5.80/7.83) 7.3 (6.1/8.1) 0.232  Average Power (W) 261.04 (181.68/351.27) 284.8 (187.8/373.0) 0.050  Average Power (W/kg) 5.29 (4.75/5.85) 5.5 (5.0/6.1) 0.076 Wilcoxon Test. IQR: Interquartile Range; W: watt; W/kg: watt/kilogram; *p<0.05.Table 2. The differences in the groups after 8 weeks Exercise Group (n=21) Control Group (n=21) p Median (IQR 25/75) Median (IQR 25/75) ΔPeak Power (W) 65.1 (23.8/107.1) 24.5 (-15.6/39.4) 0.009* ΔPeak Power (W/kg) 0.9 (0.3/1.6) 0.3 (-0.3/0.6) 0.007* ΔAverage Power (W) 41.4 (9.9/78.7) 17.3 (5/31.3) 0.019* ΔAverage Power (W/kg) 0.6 (0.3/1.3) 0.2 (-0.1/0.5) 0.024* Mann-Whitney U Test. IQR: Interquartile Range; Δ: Delta; W: watt; W/kg: watt/kilogram; *p<0.05. Conclusions The present study is the first study focusing on improving anaerobic capacity in children with JIA. According to our results, an 8-week water exercise program which is performed at the weekends might be beneficial to improve anaerobic exercise capacity in children with JIA. Disclosure of Interest None declared

The relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults

BACKGROUND Despite the popularity of core stabilization, there is limited evidence as to the relationship between performance on tests of isometric trunk muscle endurance and physical activity levels in adults. OBJECTIVE To investigate the relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults. METHODS A total of 51 participants (24 female) participated in the study. Median age and body mass index were; 22 years (Min-max: 18-26 years) and 21.8 kg/m2 (Min-Max: 18.59-28.98 kg/m2), respectively. Participants completed the International Physical Activity Questionnaire. Isometric trunk muscle endurance was assessed with holding times of isometric trunk flexor, extensor, and lateral side bridge tests. Collected data were summarized based on median and interquartile ranges. The Spearmans correlation test was used to ascertain the relationship between isometric trunk muscle endurance and physical activity related energy expenditure. RESULTS There were no gender differences in holding times of the trunk flexor and trunk extensor endurance tests (p> 0.05). Males showed higher endurance scores for side bridge test than females (p< 0.001). No difference was found in physical activity related energy expenditure between males and females. No correlation was observed between isometric trunk muscle endurance and physical activity related energy expenditure for either females or males (p> 0.05). CONCLUSIONS According to our findings, trunk muscle endurance is not related to physical activity related energy expenditure in healthy young adults.