Merih Özgen

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 balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients

The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome (FMS) and to determine if balneotherapy influences serum levels of inflammation markers, IL-1, PGE2 and LTB4. 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study. Their ages ranged between 33 and 55xa0years. FMS patients were randomly assigned in two groups as, group 1 (nxa0=xa012) and group 2 (nxa0=xa012). Group 1 received 20-min bathing, once in a day for five days per week. Patients participated in the study for 3xa0weeks (total of 15 sessions) in Denizli. Group 2 did not receive balneotherapy. FMS patients were evaluated by tenderness measurements (tender point count and algometry), Visual Analogue Scale, Beck’s Depression Index, Fibromyalgia Impact Questionnaire. Ten healthy women recruited group three as the controls. Serum PGE2, LTB4 and IL1-α levels were measured in all three groups. The biochemical measurements and clinical assessments were performed before and at the end of general period of therapy. Statistically significant alterations in algometric score, Visual Analogue score, Beck’s Depression Index and PGE2 levels (Pxa0<xa00.001), numbers of tender points (Pxa0<xa00.01) and Fibromyalgia Impact Questionnaire score (Pxa0<xa00.05) were found after the balneotherapy between group 1 and 2. Mean PGE2 level of FMS patients were higher compared to healthy control group (Pxa0<xa00.0001) and decreased after the treatment period, only in group 1 (Pxa0<xa00.05). As in the group 2 and 3, detectable IL-1 and LTB4 measurements were insufficient, statistical analysis was performed, only in group 1. After balneotherapy IL-1 and LTB4 significantly decreased in group 1 (Pxa0<xa00.05). In conclusion, balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms, and possibly influencing the inflammatory mediators.

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

OBJECTIVEnThe objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis.nnnDESIGNnThis 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.nnnRESULTSnThe 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.nnnCONCLUSIONnMud 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 the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial.

To compare the efficacy of electromyography (EMG)-triggered (active) neuromuscular electrical stimulation (NMES) and passive NMES in enhancing the upper extremity (UE) motor and functional recovery of subacute and chronic stage stroke patients. Thirty-one hemiplegic patients were randomly assigned to active NMES (n=11), passive NMES (n=10), and control (sham stimulation) (n=10) groups. Each treatment regimen was applied five times per week for 45 min for 3 weeks. All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks. Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment (UE-FMA), the self-care component of the Functional Independence Measure (self-care FIM), the Motor Activity Log (MAL), goniometric measurements of active wrist and metacarpophalangeal joint extension, surface EMG potentials, grip strength, and the modified Ashworth scale in a blinded manner. Data were obtained before and at the end of the treatment. Participants were similar in all clinical and demographic features (P>0.05). All groups were comparable with respect to UE-FMA, MAL, self-care FIM, wrist and finger flexor spasticity, active range of motion (ROM), grip strength, and surface EMG potentials before treatment (P>0.05). The active ROM, grip strength, FMA, FIM, surface EMG potentials, and MAL: amount of use were significantly improved in the EMG-triggered NMES group compared with the controls (P<0.05). The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls (P<0.05). There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment (P>0.05). Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors. Vergleich der Wirksamkeit der elektromyographisch (EMG)-getriggerten (aktiven) neuromuskulären Elektrostimulation (NMES) und passiven NMES zur Verbesserung der motorischen und funktionellen Erholung der oberen Extremitäten bei Schlaganfallpatienten in der subakuten und chronischen Phase. Insgesamt 31 einseitig gelähmte Patienten wurden randomisiert den aktiven NMES- (n=11), passiven NMES- (n=10) und Kontrollgruppen (Sham-Stimulation) (n=10) zugeordnet. Jede Therapie wurde fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg angewandt. Alle Patienten unterzogen sich fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg dem gleichen neurophysiologischen Übungsprogramm. Die Beurteilung der Patienten erfolgte anhand der Komponente “obere Extremitäten” des motorischen Funktionstests nach Fugl-Meyer (UE-FMA), der Selbstversorgungskomponente des funktionalen Selbständigkeitsindexes (Selbstversorgung FIM), des Motor Activity Log (MAL), der goniometrischen Messung der aktiven Handgelenk- und Fingergrundgelenkextension, der Oberflächen-EMG-Potenziale, der Griffstärke und der modifizierten Ashworth-Skala in verblindeter Form. Daten wurden vor und nach Abschluss der Behandlung erfasst. Die Teilnehmer schnitten bei allen klinischen und demographischen Merkmalen ähnlich ab (P<0.05). Alle Gruppen waren vergleichbar hinsichtlich UE-FMA, MAL, Selbstversorgungs-FIM, Spastizität der Handgelenks- und Fingerbeuger, aktiver Bewegungsamplitude (ROM), Griffstärke und Oberflächen-EMG-Potenziale vor der Behandlung (P>0.05). Aktive ROM, Griffstärke, FMA, FIM, Oberflächen-EMG-Potenziale und MAL: Das Ausmaß der Anwendung war in der EMG-getriggerten NMES-Gruppe verglichen mit den Teilnehmern der Kontrollgruppe signifikant verbessert (P<0.05). Die ROM- und FMA-Scores der aktiven Handgelenkextension waren in der passiven NMES-Gruppe verglichen mit der Kontrollgruppe signifikant verbessert (P<0.05). Es lagen keine statistisch signifikanten Unterschiede zwischen den aktiven und passiven NMES-Gruppen bei den zu Ende der Behandlung beurteilten Parametern vor (P>0.05). Die aktive und passive NMES als Begleittherapie des neurophysiologischen Übungsprogramms verbesserte die motorische und funktionelle Genesung der oberen Extremitäten von Überlebenden eines Schlaganfalls effektiv. El objetivo de este estudio fue comparar la eficacia de la estimulación eléctrica neuromuscular (EENM) (activa) mediante electromiografía (EMG) y EENM pasiva con respecto a la mejora de la recuperación motora y funcional de las extremidades superiores (ES) en pacientes con accidente cerebrovascular subagudo y crónico. Treinta y un pacientes hemiplégicos fueron asignados de forma aleatoria al grupo de EENM activa (n=11), al grupo de EENM pasiva (n=10) y al grupo control (estímulo falso) (n=10). Cada uno de los tratamientos se aplicó cinco veces a la semana durante 45 minutos, durante 3 semanas. Todos los pacientes fueron sometidos al mismo programa de ejercicios neurofisiológicos, con una duración de 45 minutos, cinco veces a la semana durante 3 semanas. Los pacientes fueron analizados mediante el componente de extremidades superiores de la puntuación de Fugl-Meyer (FM-ES), el componente de cuidado personal de la Medida de Independencia Funcional (MIF-CP), el Registro de Actividad Motora (MAL, por sus siglas en inglés), las medidas goniométricas de la extensión articular activa metacarpofalángica y de la muñeca, los potenciales de EMG de superficie, la fuerza de prensión y la escala modificada de Ashworth con enmascaramiento. Se recopilaron datos previamente y posteriormente al tratamiento. Los participantes poseían características clínicas y demográficas similares (P<0.05). Todos los grupos eran comparables con respecto a FM-ES, MAL, MIF-CP, la espasticidad flexora de la muñeca y el dedo, el rango activo de movimiento (RM), la fuerza de prensión y los potenciales de EMG de superficie antes de comenzar el tratamiento (P>0.05). El RM activo, la fuerza de prensión, la puntuación de FM, MIF, los potenciales de EMG de superficie y MAL mejoraron significativamente en el grupo de EENM mediante EMG en comparación con el grupo control (P<0.05). Las puntuaciones de FM y RM activo de la extensión de la muñeca mejoraron significativamente en el grupo de EENM pasiva en comparación con el grupo control (P<0.05). No se observaron diferencias estadísticamente significativas entre los grupos de EENM activa y pasiva en ninguno de los parámetros evaluados al finalizar el tratamiento (P>0.05). Tanto la EENM activa como la EENM pasiva, como tratamientos adyuvantes dentro del programa de ejercicios neurofisiológicos, mejoraron efectivamente la recuperación motora y funcional de los supervivientes de accidente cerebrovascular. Comparer l’efficacité de la stimulation électrique neuromusculaire (NMES) déclenchée par électromyographie (EMG) (active) et de la NMES passive dans l’amélioration de la récupération motrice et fonctionnelle des extrémités supérieures (UE) chez les patients victimes d’AVC en phase subaiguë et chronique. Trente et un patients hémiplégiques ont été assignés de manière aléatoire à des groupes de NMES active (n=11), passive (n=10) et de contrôle (stimulation leurre) (n=10). Chaque traitement a été appliqué cinq fois par semaine pendant 45 min pendant 3 semaines. Tous les patients ont suivi le même programme d’exercice neurophysiologique pendant 45 min, cinq fois par semaine, pendant 3 semaines. Les patients ont été évalués en aveugle par la composante UE de lévaluation motrice de Fugl-Meyer (UE-FMA), la composante de soins auto-administrés de la mesure d’indépendance fonctionnelle (FIM soins auto-administrés), le Motor Activity Log (MAL), les mesures goniométriques du poignet actif et de l’extension de l’articulation métacarpophalangienne, les potentiels EMG de surface, la force de préhension et léchelle Ashworth modifiée. Les données ont été recueillies avant et à la fin du traitement. Les participants présentaient des caractéristiques cliniques et démographiques semblables (P<0.05). Tous les groupes étaient comparables en ce qui concerne les paramètres UE-FMA, MAL, FIM soins auto-administrés, spasticité des fléchisseurs du poignet et des doigts, amplitude active des mouvements (ROM), force de préhension et potentiels EMG de surface avant le traitement (P>0.05). ROM active, force de préhension, FMA, FIM, potentiels EMG de surface et MAL : volume d’utilisation significativement amélioré chez le groupe NMES déclenchée par EMG par rapport au groupe témoin (P<0.05). Les scores ROM et FMA d’extension du poignet actif ont été considérablement améliorés chez le groupe NMES passive par rapport au groupe témoin (P<0,05). Il n’a été constaté aucune différence statistiquement significative entre les groupes NMES active et passive dans les paramètres évalués à la fin du traitement (P>0.05). La NMES active ou passive comme thérapie adjuvante dans le programme d’exercice neurophysiologique a efficacement amélioré la récupération motrice et fonctionnelle UE des patients ayant survécu à un AVC.

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.

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 8.3u2009±u20098.0, 1.5u2009±u20092.5 and 4.5u2009±u20095.5 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 (Pu2009<u20090.017). 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 (Pu2009<u20090.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (Pu2009<u20090.017). 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 (Pu2009<u20090.017). Conclusions: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Comparison of the symptomatic and chondroprotective effects of glucosamine sulphate and exercise treatments in patients with knee osteoarthritis

OBJECTIVESnThe aim of the present study was to evaluate the symptomatic effects of glucosamine sulphate (GS) in comparison to the exercise therapy, as well effects on Magnetic Resonance Imaging (MRI) findings of cartilage loss in patients with knee osteoarthritis (OA).nnnMATERIALS AND METHODSnSeventy patients with a diagnosis of knee OA were randomly divided into two groups. First group of patients (n=40) were treated with 1500 mg/day oral glucosamine sulphate and the second group (n=30) performed a home exercise program for a period of 6 months.nnnRESULTSnCompared with baseline, significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index and 20-min walking time in both groups (p< 0.001); there were no significant differences between the two treatment groups. Upon the evaluation of joint cartilage thickness by MRI, an improvement was evident in only in the area of medial femoral condyle of patients who had performed a home exercise program (p< 0.05).nnnCONCLUSIONnThe results of the present study suggest that both oral GS treatment and exercise therapy are efficient in the symptomatic treatment of patients with knee OA. However, exercise therapy found to have a better chondroprotective effect than oral GS treatment in this patient population.

Effects of Native Type II Collagen Treatment on Knee Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVEnThe aim of this randomized controlled study was to evaluate the efficacy of oral native type II collagen treatment on the symptoms and biological markers of cartilage degradation, when given concomitantly with acetaminophen in patients with knee osteoarthritis.nnnMATERIALS AND METHODSnThirty-nine patients diagnosed with knee osteoarthritis were included and randomly distributed into two groups: one treated with 1500 mg/day of acetaminophen (group AC; n=19) and the other treated with 1500 mg/day of acetaminophen plus 10 mg/day of native type II collagen (group AC+CII; n=20) for 3 months. Visual Analogue Scale (VAS) at rest and during walking, Western Ontario McMaster (WOMAC) pain, WOMAC function, and Short Form-36 (SF-36) scores, were recorded. Coll2-1, Coll2-1NO2 and Fibulin-3 levels were quantified in urine as biomarkers of disease progression. ClinicalTrials.gov: NCT02237989.nnnRESULTSnAfter 3 months of treatment, significant improvements compared to baseline were reported in joint pain (VAS walking), function (WOMAC) and quality of life (SF-36) in the AC+CII group, while only improvements in some subscales of the SF-36 survey and VAS walking were detected in the AC group. Comparisons between the groups revealed a significant difference in VAS walking score in favour of the AC+CII group as compared to AC group. Biochemical markers of cartilage degradation in urine did not significantly improve in any of the groups.nnnCONCLUSIONnAll in all, these results suggest that native type II collagen treatment combined with acetaminophen is superior to only acetaminophen for symptomatic treatment of patients with knee osteoarthritis.