Gianni F. Maddalozzo

Tai Chi and Postural Stability in Patients with Parkinson's Disease

BACKGROUND Patients with Parkinsons disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. METHODS We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinsons disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinsons Disease Rating Scale, and number of falls. RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinsons disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.).

Concurrent Validity of the BOD POD and Dual Energy X-Ray Absorptiometry Techniques for Assessing Body Composition in Young Women

The purpose of this study was to determine the concurrent validity of the BOD POD (BP) (Life Measurement Instruments) and Dual Energy X-Ray Absorptiometry (DXA) Elite 4500A (Hologic, Inc.) techniques for assessing the body fat percentage of young women. The participants were forty-three white college-aged women (19.4 +/- 1.4 years) with a BMI of 23.4 +/- 2.3. Both body composition analyses were completed on the same day and were taken within 10 minutes of each other. Body fat percentage was estimated to be 24.3 (SE = 1.1) and 23.8 (SE = 0.8) using the BP and DXA techniques, respectively. Exact matches, in terms of body fat percentage, were obtained for 10 of the 43 participants (23.3%). In conclusion, our data supports the concurrent validity of the BP and DXA techniques for assessing body fat in young women.

Whole-body vibration slows the acquisition of fat in mature female rats.

Objective:To evaluate the effects of whole-body vibration on fat, bone, leptin and muscle mass.Methods/Design:Thirty 7-month-old female 344 Fischer rats were randomized by weight into three groups (baseline, vibration or control; n=8–10 per group). Rats in the vibration group were placed inside individual compartments attached to a Pneu-Vibe vibration platform (Pneumex, Sandpoint, ID, USA) and vibrated at 30–50 Hz (6 mm peak to peak) for 30 min per day, 5 days per week, for 12 weeks. The vibration intervention consisted of six 5-min cycles with a 1-min break between cycles.Results:There were significant body composition differences between the whole-body vibration and the control group. The whole-body vibration group weighed approximately 10% less (mean±s.d.; 207±10 vs 222±15 g, P<0.03) and had less body fat (20.8±3.8 vs 26.8±5.9 g, P<0.05), a lower percentage of body fat (10.2±1.7 vs 12±2.0%, P<0.05), and lower serum leptin levels (1.06±0.45 vs 2.27±0.57 ng ml−1, P<0.01) than the age-matched controls. No differences were observed for total lean mass, bone mineral content (BMC), bone mineral density (BMD), insulin-like growth factor-I (IGF-I) or soleus (SOL) and extensor digitorum longus (EDL) mass or function. Regional high-resolution dual-energy X-ray absoptiometry scans of the lumbar spine (L1-4) revealed that the whole-body vibration group had significantly greater BMC (0.33±0.05 vs 0.26±0.03 g, P<0.01) and BMD (0.21±0.01 vs 0.19±0.01 g cm−2, P<0.01) than the control group. No differences between the groups were observed in the amount of food consumed.Conclusion:These findings show that whole-body vibration reduced body fat accumulation and serum leptin without affecting whole body BMC, BMD or lean mass. However, the increase in vertebral BMC and BMD suggests that vibration may have resulted in local increases in bone mass and density. Also, whole-body vibration did not affect muscle function or food consumption.

Resistance Training Reduces Disability in Prostate Cancer Survivors on Androgen Deprivation Therapy: Evidence From a Randomized Controlled Trial

OBJECTIVES To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise. DESIGN Randomized controlled trial. SETTING Academic medical center. PARTICIPANTS PCS (N=51; mean age, 70.2y) on ADT. INTERVENTION PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year. MAIN OUTCOME MEASURES Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates. RESULTS Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05). CONCLUSIONS One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.

Skeletal Response to Resistance and Impact Training in Prostate Cancer Survivors

INTRODUCTION Androgen deprivation therapy (ADT) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors (PCS). We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density (BMD) among PCS on ADT. METHODS We randomized 51 PCS (mean age, 70.2 yr) currently prescribed ADT to participate in 1 yr of impact + resistance training (Prevent Osteoporosis with Impact + Resistance (POWIR)) or in an exercise placebo program of stretching exercise (FLEX). Outcomes were proximal femur (total hip, femoral neck, and greater trochanter) and spine (L1-L4) BMD (g·cm) and bone turnover markers (serum osteocalcin (ng·mL) and urinary deoxypyrodinoline cross-links (nmol·mmol Cr)). RESULTS Retention in the 1-yr study was 84% and median attendance to supervised classes was 84% in POWIR and 74% in FLEX. No study-related injuries were reported. There were no significant differences between groups for average L1-L4 BMD or for BMD at any hip site. When examining individual vertebrae, POWIR has a significant effect on preservation of BMD (-0.4%) at the L4 vertebrae compared with losses (-3.1%) in FLEX (P = 0.03). CONCLUSION Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT. Among our limited sample, POWIR did not appear to have a clinically meaningful effect on hip or spine BMD, but some evidence of skeletal adaptation to resistance + impact training in an androgen-deprived state was apparent. Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinically relevant sites.

Detrimental effects of reloading recovery on force, shortening velocity, and power of soleus muscles from hindlimb-unloaded rats

To better understand how atrophied muscles recover from prolonged nonweight-bearing, we studied soleus muscles (in vitro at optimal length) from female rats subjected to normal weight bearing (WB), 15 days of hindlimb unloading (HU), or 15 days HU followed by 9 days of weight bearing reloading (HU-R). HU reduced peak tetanic force (P(o)), increased maximal shortening velocity (V(max)), and lowered peak power/muscle volume. Nine days of reloading failed to improve P(o), while depressing V(max) and intrinsic power below WB levels. These functional changes appeared intracellular in origin as HU-induced reductions in soleus mass, fiber cross-sectional area, and physiological cross-sectional area were partially or completely restored by reloading. We calculated that HU-induced reductions in soleus fiber length were of sufficient magnitude to overextend sarcomeres onto the descending limb of their length-tension relationship upon the resumption of WB activity. In conclusion, the force, shortening velocity, and power deficits observed after 9 days of reloading are consistent with contraction-induced damage to the soleus. HU-induced reductions in fiber length indicate that sarcomere hyperextension upon the resumption of weight-bearing activity may be an important mechanism underlying this response.

Transitional shifts in exercise behavior among women with multiple sclerosis

BACKGROUND While physical activity is recommended to reduce symptomology associated with multiple sclerosis (MS) little has been done to explore the potential usefulness of theoretical models of exercise behavior change in individuals with MS. Based on the success of the transtheoretical model of exercise behavior change (TTM) in the general population and early promising results in those with MS, the TTM was tested in a sample of women with MS over a 1-year period, to examine its usefulness and the effect of TTM constructs on MS-related symptoms. METHODS This was a longitudinal study conducted over a 1-year period. Ambulatory women (N=86) with MS completed questionnaires assessing exercise behavior, TTM constructs, MS-related quality of life, pain, and fatigue at baseline and after 1 year. After categorization into transitional shift patterns reflecting naturally occurring exercise behavior change over the year, a series of mixed-design analyses of variance were conducted to examine TTM predictions and the relationship of the transitional shift patterns to MS-related quality of life, pain, and fatigue. RESULTS Significant interactions between transitional shift patterns and time (P < .05) indicated that changes in behavioral and cognitive processes of change and in self-efficacy were consistent with TTM predictions. Significant differences (P < .05) between the transitional shift groups in pain and fatigue in expected directions were also found. CONCLUSIONS Results supported the TTM proposed relationships, indicating the models potential for motivating individuals with MS to increase their physical activity. Findings also support the notion that physical activity is useful in reducing MS-related symptoms and that lifestyle types of physical activity may be as useful as structured exercise in bringing about these outcomes.

Dietary Intervention Restored Menses in Female Athletes with Exercise-Associated Menstrual Dysfunction with Limited Impact on Bone and Muscle Health

Exercise-related menstrual dysfunction (ExMD) is associated with low energy availability (EA), decreased bone mineral density (BMD), and increased risk of musculoskeletal injury. We investigated whether a 6-month carbohydrate-protein (CHO-PRO) supplement (360 kcal/day, 54 g CHO/day, 20 g PRO/day) intervention would improve energy status and musculoskeletal health and restore menses in female athletes (n = 8) with ExMD. At pre/post-intervention, reproductive and thyroid hormones, bone health (BMD, bone mineral content, bone markers), muscle strength/power and protein metabolism markers, profile of mood state (POMS), and energy intake (EI)/energy expenditure (7 day food/activity records) were measured. Eumenorrheic athlete controls with normal menses (Eumen); n = 10) were measured at baseline. Multiple linear regressions were used to evaluate differences between groups and pre/post-intervention blocking on participants. Improvements in EI (+382 kcal/day; p = 0.12), EA (+417 kcal/day; p = 0.17) and energy balance (EB; +466 kcal/day; p = 0.14) were observed with the intervention but were not statistically significant. ExMD resumed menses (2.6 ± 2.2-months to first menses; 3.5 ± 1.9 cycles); one remaining anovulatory with menses. Female athletes with ExMD for >8 months took longer to resume menses/ovulation and had lower BMD (low spine (ExMD = 3; Eumen = 1); low hip (ExMD = 2)) than those with ExMD for <8 months; for 2 ExMD the intervention improved spinal BMD. POMS fatigue scores were 15% lower in ExMD vs. Eumen (p = 0.17); POMS depression scores improved by 8% in ExMD (p = 0.12). EI, EA, and EB were similar between groups, but the intervention (+360 kcal/day) improved energy status enough to reverse ExMD despite no statistically significant changes in EI. Similar baseline EA and EB between groups suggests that some ExMD athletes are more sensitive to EA and EB fluctuations.

Resistance Exercise Reduces Body Fat and Insulin During Androgen-Deprivation Therapy for Prostate Cancer.

PURPOSE/OBJECTIVES To determine whether exercise could reduce biomarkers of cancer progression in prostate cancer survivors (PCSs) on androgen-deprivation therapy (ADT). DESIGN Randomized, controlled trial. SETTING Oregon Health and Science University School of Nursing. SAMPLE 51 PCSs randomized to one year of resistance and impact training or a stretching control group. METHODS The authors investigated changes in body composition and cancer-related biomarkers, and the influence of age and fat loss on changes in biomarkers. MAIN RESEARCH VARIABLES Body composition (total fat, trunk fat, and lean mass), insulin, insulin-like growth factor-1, and sex hormone-binding globulin. FINDINGS In the 36 PCSs with baseline and 12-month data, total fat (p = 0.02) and trunk fat (p = 0.06) mass decreased in the training group compared to gains in controls. Loss of total and trunk fat each mediated the relationship between groups and one-year change in insulin (p < 0.05). Age moderated the insulin response to exercise where insulin reductions were smaller with increasing age (p = 0.03). CONCLUSIONS Resistance and impact exercise may reduce body fat among PCSs undergoing ADT, in turn exerting an insulin-lowering effect. IMPLICATIONS FOR NURSING Nurses should counsel PCSs to exercise to reduce the risk of obesity and associated conditions, including cancer progression.

Active Women Before/After an Intervention Designed to Restore Menstrual Function: Resting Metabolic Rate and Comparison of Four Methods to Quantify Energy Expenditure and Energy Availability

UNLABELLED It is hypothesized that exercise-related menstrual dysfunction (ExMD) results from low energy availability (EA), defined as energy intake (EI)--exercise energy expenditure (EEE). When EI is too low, resting metabolic rate (RMR) may be reduced to conserve energy. PURPOSE To measure changes in RMR and EA, using four methods to quantify EEE, before/after a 6-month diet intervention aimed at restoring menses in women with ExMD; eumenorrheic (Eumen) active controls (n = 9) were also measured. METHODS Active women with ExMD (n = 8) consumed +360 kcal/d (supplement) for 6 months; RMR was measured 2 times at 0 months/6 months. EI and total energy expenditure (TEE) were estimated using 7-day diet/activity records, with EA assessed using four methods to quantify EEE. RESULTS At baseline, groups did not differ for age, gynecological age, body weight, lean/fat mass, VO₂max, EI and EA, but mean TEE was higher in ExMD (58.3 ± 4.4 kcal/ kgFFM/d; Eumen = 50.6 ± 2.4; p < .001) and energy balance (EB) more negative (-10.3 ± 6.9 kcal/kgFFM/d; Eumen=-3.0 ± 9.7; p = .049). RMR was higher in ExMD (31.3 ± 1.8 kcal/kgFFM/d) vs. Eumen (29.1 ± 1.9; p < .02). The intervention increased weight (1.6 ± 2.0 kg; p = .029), but there were no significant changes in EA (0-month range = 28.2-36.7 kcal/kgFFM/d; 6-month range = 30.0-45.4; p > .05), EB (6 months = -0.7 ± 15.1 kcal/kgFFM/d) or RMR (0 months = 1515 ± 142; 6 months = 1522 ± 134 kcal/d). Assessment of EA varied dramatically (~30%) by method used. CONCLUSIONS For the ExMD group, EI and weight increased with +360 kcal/d for 6 months, but there were no significant changes in EB, EA or RMR. No threshold EA value was associated with ExMD. Future research should include TEE, EB and clearly quantifying EEE (e.g.,>4 MET) if EA is measured.