Fusun Ardic

The effects of aerobic and resistance exercises in obese women

Objective: To compare the effects of aerobic and resistance exercise on weight, muscle strength, cardiovascular fitness, blood pressure and mood in obese women who were not on an energy-restricted diet. Design: Randomized, prospective, controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Sixty obese women were assigned to one of three groups: aerobic exercise (n=20), resistance exercise (n=20) and control group (n=20). Interventions: The aerobic exercise group performed both walking and leg cycle exercise with increasing duration and frequency. The resistance exercise group performed progressive weight-resistance exercises for the upper and lower body. Main outcome measures: Before and after a 12-week period, all subjects were evaluated by anthropometric measurement, rating of mood, cardiorespiratory capacity and maximum strength of trained muscles. Results: After a 12-week training period, subjects in the resistance group showed significant improvement in one-repetition maximum test of hip abductors (7.95±3.58 kg), quadriceps (14±7.18 kg), biceps (3.37± 2.84 kg) and pectorals (8.75±5.09 kg) compared with those in the control group (P<0.001). VO2 max increased (0.51±0.40) and Beck Depression Scale scores decreased (-5.40±4.27) in the aerobic exercise group compared with the control group, significantly (P<0.001). Only in hip abductor muscle strength was there a significant increase in the resistance exercise group compared with the aerobic exercise group (P <0.05). Conclusion: Both aerobic exercise and resistance exercise resulted in improved performance and exercise capacity in obese women. While aerobic exercise appeared to be beneficial with regard to improving depressive symptoms and maximum oxygen consumption, resistance exercise was beneficial in increasing muscle strength.

Effects of resistance or aerobic exercises on metabolic parameters in obese women who are not on a diet

This longitudinal, controlled clinical study was conducted to compare the effects of resistance exercise (RE) and aerobic exercise (AE) on body mass index (BMI), weight, fat mass (FM), serum lipid profile, and insulin resistance in obese women who cannot adhere to energy-restricted diets. A total of 60 obese women with severe eating disorders were evaluated. Patients were randomly divided into 3 groups: control group with no exercise (n=20), group 1 with AE (n=20), and group 2 with RE (n=20). Demographic and anthropometric measurements were taken. Serum lipid fractions and fasting (FGlc) and postprandial glucose insulin (PGlc) levels were measured. Insulin resistance was calculated with use of homeostasis model assessment (HOMA-IR). Total body FM was measured by bioelectric impedance analysis. After 12 wk of exercise, significant decreases in BMI, waist and weight measurements, and FGlc, PGlc, triglyceride, and total cholesterol levels were noted in each of the study groups. Reduced low-density lipoprotein cholesterol level and FM and HOMA-IR measurements were observed only in group 1 (with AE). This study indicated that AE and RE training induces improvement in body fat composition and has a favorable metabolic effect in obese women with severe eating disorders.

Eficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction

Objective: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. Design: Prospective study. Setting: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. Subjects: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. Interventions: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. Main outcome measures: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). Results: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 ± 24.12 points to 21.21 ± 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 ± 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 ± 2.27 to 2.02 ± 1.75 (p < 0.001) at the end of second week, and to 1.51 ± 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. Conclusions: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.

Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial:

Objective: To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent — ultrasound — in patients with lumbar spinal stenosis. Design: Randomized, prospective, controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise — no treatment group (control group, n = 15). Interventions: Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm2 intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. Main outcome measures: Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. Results: Thirty-two of the participants were women and 13 were men, with an average age of 53.2 ± 12.68 years (range 25—82 years). After a three-week treatment period, leg pain decreased in group 1 (—1.47 ± 3.02) and group 2 (—2.47 ± 3.75) compared with the control group (P<0.05). Disability score decreased in group 1 (—3.94 ± 7.20) and group 2 (—7.80 ± 10.26) compared with control group (P<0.05). We did not find any statistically significant difference between groups 1 and 2 (P>0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P<0.05). Conclusion: The results of our study suggest that therapeutic exercises are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy lowers the analgesic intake substantially.

Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis

OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. DESIGN This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. RESULTS The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis.

Comparison of two different techniques of electrotherapy on myofascial pain

This study was designed to compare the effects of Transcutaneus Electrical Nerve Stimulation (TENS) and Electrical Muscle Stimulation (EMS) on myofascial trigger point (MTrP) of the upper trapezius muscle. A total of 40 patients were randomly divided into three groups. All patients had active MTrP in one side of the upper trapezius muscles. Group I was treated with TENS and trapezius-stretching exercises; Group II was treated with EMS and trapezius-stretching exercises and Group III, the control group, had only trapezius-stretching exercises. Subjective pain intensity with VAS, range of motion (ROM), and pain threshold (PT) were assessed before, immediately after two week treatment and 3 months after treatment. Group I had a statistically significant reduction in VAS (P<0.01), increase in PT and ROM (p<0.05) at end of the treatment when compared with the control group. Only VAS was significantly improved (p<0.05) in the Group II patients. At the end of the third month, both groups showed highly significant improvement (p<0.01) in VAS and PT (but not ROM). There was no statistical difference in none of parameters between EMS and TENS groups in any time (p>0.05). In conclusion, TENS seem to be more effective immediately after treatment but in long term evaluation there is no significant superiority of two electrotherapy techniques on each other.

Turkish Version of the painDETECT Questionnaire in the Assessment of Neuropathic Pain: A Validity and Reliability Study

OBJECTIVES The aim of this study was to develop a Turkish version of the painDETECT questionnaire (PD-Q) and assess its reliability and validity. METHODS Two hundred and forty patients who were diagnosed by expert pain physicians in daily clinical practice and classified as having either neuropathic, nociceptive, or mixed pain for at least 3 months were enrolled in this study. After the usual translation process, the Turkish version of the PD-Q was administered to each participant twice with an interval of 48 hours. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique en 4 questions (DN4) and a pain visual analog scale were assessed along with the PD-Q. Chronbachs α was calculated to evaluate internal consistency of the PD-Q. Intraclass correlation coefficient was calculated to examine test-retest reliability. Convergent validity was assessed by correlating the scale with LANSS and DN4. Discriminant statistics-sensitivity, specificity, Youden index, positive predictive value, negative predictive value-were also assessed. RESULTS A total of 240 patients with chronic pain, 80 patients in each neuropathic, nociceptive, and mixed pain group, were included in this study. Mean age of the patients was 54.1 years, and majority of the patients were female (52.9%). Chronbachs α of the Turkish version of the PD-Q was 0.81. The test-retest reliability of the Turkish version of the PD-Q was determined as 0.98 for the total score and ranged from 0.86 to 0.99 for individual items. The Turkish version of the PD-Q was possitively and significantly corralated with LANSS (r 0.89, P < 0.001) and DN4 (r 0.82, P < 0.001). When the two cutoff values in the original version were used, sensitivity was found 77.5% for a cutoff value ≤19, and specificity was 82.5%. Sensitivity and specificity were 90% and 67.5%, respectively, for the other cutoff value ≤12. Scores ≤12 represents a negative predictive value = 87%, and scores 19≤ represents a positive predictive value = 82%. When mixed pain patients were included in the neuropathic pain group, discriminant values were reduced as expected. CONCLUSIONS The Turkish version of the PD-Q is a reliable and valid scale to be used to determine neuropathic component of chronic pain in Turkish patients.

Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain

The study was designed to compare the efficacy of two different modalities of transcutaneous electrical nerve stimulation (conventional and low-frequency TENS) (C-TENS and Low-TENS) and percutaneous neuromodulation therapy (PNT) in the treatment of chronic low back pain. Sixty patients with chronic low back pain were randomly divided into four groups as placebo-TENS, C-TENS, Low-TENS, and PNT. Therapeutic modalities were administered for 2 weeks. The pre-treatment and post-treatment assessments were done by using the Visual Analog Scale for pain; Low Back Pain Outcome Scale and Oswestry Disability Index for functional disability; and Health Status Survey Short Form (SF-36) for quality of life. In placebo-TENS group only emotional role limitation score of SF-36 significantly decreased after the treatment. All measurements except emotional role limitation score of SF-36 significantly improved in C-TENS group after the treatment. In both of Low-TENS and PNT groups, all parameters were significantly improved by the treatment. TENS modalities and PNT were significantly more effective than the placebo-TENS. No significant difference was found between C-TENS and Low-TENS. PNT was significantly more effective than TENS in providing relief of activity pain and in improving general health, vitality and emotional role limitation scores of health quality.

Hemorheological responses to progressive resistance exercise training in healthy young males.

Summary Background This study aimed to explore the effects of progressive resistance exercise training (PRET) on hemorheology. Material/Methods Exercise sessions included 1–3 sets of 8–12 repetitions at 40–60% of 1-repetition maximum (1-RM) for 3 weeks and at 75–80% of 1-RM during weeks 4–12. Red blood cell (RBC) deformability and aggregation were determined by ektacytometry, plasma and whole blood viscosities (WBV) by rotational viscometry. Lactate concentration was evaluated by an analyzer and fibrinogen was evaluated by coagulometry. Plasma total oxidant/antioxidant status was measured by colorimetry. Results Following an acute increase after exercise on the first day, RBC deformability was elevated during weeks 3 and 4 (p=0.028; p=0.034, respectively). The last exercise protocol applied in week 12 again caused an acute increase in this parameter (p=0.034). RBC aggregation was increased acutely on the first day, but decreased after that throughout the protocol (p<0.05). At weeks 4 and 12 pre-exercise measurements of WBV at standard hematocrit and plasma viscosity were decreased (p=0.05; p=0.041, respectively), while post-exercise values were increased (p=0.005; p=0.04, respectively). Post-exercise WBV at autologous hematocrit measured at week 12 was increased (p=0.01). Lactate was elevated after each exercise session (p<0.05). Fibrinogen was decreased on the third week (p<0.01), while it was increased on the 4th week (p=0.005). Plasma antioxidant status was increased at week 3 (p=0.034) and oxidative stress index was decreased at week 4 (p=0.013) after exercise. Conclusions The results of this study indicate that PRET may have positive effects on hemorheological parameters.

Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial:

Objective: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. Design: Randomized, prospective, controlled single-blind trial. Setting: Department of physical medicine and rehabilitation, university hospital. Subjects: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. Interventions: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. Main measures: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion–extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. Results: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). Conclusions: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.