Nicolas Tordi

Effects of a wheelchair ergometer training programme on spinal cord-injured persons

Study design: Before and after investigation of the effects of a wheelchair ergometer Training programme.Objective: To investigate the effects of an original interval-training programme on work capacity and cardiorespiratory variables with spinal cord-injured persons (SCIPs) on a wheelchair-specific ergometer.Setting: BESANCON, FRANCE.Methods: Seven SCIPs (male) performed 45 min of wheelchair ergometry three times per week, for 6 weeks. Training effects on maximal dynamic performance and endurance capacity were studied by comparison of performance and cardiorespiratory responses observed during both a maximal progressive test (10 W/2 min) and the same training session performed before and after training.Results: Training induced significant improvements in maximal tolerated power (+19.6%), in peak oxygen consumption (V O2+16%), and in oxygen pulse (O2p,+18.7%).At ventilatory threshold, significant improvements were also observed in power output (+63%), V O2VT(+ 34.1), ventilation V EVT(+ 37.1%), and V 2pVT(+ 19.9% ). Heart rate and ventilation were significantly lower (−11 and −14.6%, respectively) after training at the same work rate, while V O2 was unchanged. Between the first and the last training session, the total physical work was improved by 24.7%, whereas heart rate was unchanged.Conclusion: An interval-training programme individualised to each paraplegic subject using a wheelchair ergometer can significantly improve the fitness level and endurance capacity.

Interval training program on a wheelchair ergometer for paraplegic subjects

Background: Various combinations of training intensity, duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness. However, no consensus about a specific training program has been reached for such a population.Objective: This study investigated the effects of a short interval training program specifically designed for patients with spinal cord injuries.Methods: Paraplegic men performed 30-min wheelchair ergometry three times per week, for 4 weeks. Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test (10 W/2 min) until volitional fatigue and a constant work rate test, respectively. Cardiorespiratory responses were continuously studied during each of these tests.Results: Training induced significant improvement in maximal tolerated power (+27.9%), and in peak oxygen consumption ([Vdot ]O2, +18.5%). After training the subjects were able to maintain the load applied during the constant test (total mechanical work +210.7%), for a significantly longer time. The heart rate, [Vdot ]O2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher (+10%, +10%, +40% respectively) than those obtained after a similar time period during the second constant load test which was performed after the training program.Conclusion: After this short training period, with an appropriate combination of different types of training, duration, intensity and frequency exercises, we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects.Spinal Cord (2001) 39, 532–537.

Cryotherapy in inflammatory rheumatic diseases: a systematic review

The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.

Autonomic recovery following sprint interval exercise

The autonomic nervous activity was assessed following supramaximal exercise through heart rate (HR) and blood pressure (BP) variability (HRV and BPV) and baroreflex sensitivity (BRS). The beat‐to‐beat HR and BP were recorded during the supine and standing states before (PRE) and at 60 (R60) and 120 min (R120) following single (one Wingate, 1W) and multiple sprint intervals (four Wingates interspersed with 4 min of light cycling, 4W). The supine low frequency (LF) component was increased (P<0.001) and the high frequency (HF) was reduced (P<0.01) at R60 (LF, 178.1 ± 11.0; HF, 74.8 ± 10.5) compared with PRE (LF, 140.2 ± 7.4; HF, 110.4 ± 7.2) after both exercises. Supine systolic BPV LF:HF was higher at R60 (4.6 ± 1.4) compared with PRE (6.8 ± 2.4) only after 4W (P=0.035). Supine BRS was lower (P<0.001) at R60 (6.8 ± 1.1) than at PRE (15.3 ± 1.8) and R120 (11.3 ± 1.3). BRS at R120 remained lower after 4W (P=0.02). Standing BRS was less (P<0.001) at R60 (2.3 ± 0.5) than at PRE (5.6 ± 0.8) or R120 (3.7 ± 0.6) and returned to PRE values only after 1W. We concluded that (a) autonomic balance is shifted to a greater sympathetic and less parasympathetic activation following both types of exercise, (b) it takes longer than 1 h to recover following supramaximal exercise and (c) the recovery is longer after 4W than 1W.

Perceived exertion and rehabilitation with wheelchair ergometer: comparison between patients with spinal cord injury and healthy subjects

Objectives: The purpose of this study was to compare the effects of a rehabilitation program on the perceived exertion (PE) and the cardioventilatory responses during exercise in healthy people and paraplegics.Methods: A group of seven healthy persons (age 26.6 SD 6.2 years) and one of seven paraplegics (age 42 SD 15.9 years) participated in a rehabilitation program composed of Square Wave Exercise Tests (SWEET) during six weeks. The maximal oxygen uptake, the power output (PO), heart rate (HR) and measures of PE using the Borg CR 10 scale were investigated during a maximal graded test performed before and after the rehabilitation program. During the first SWEET session (SWEET 1) measures of PE and HR (base and peak) were also investigated and compared to the last session (SWEET 2) of the same absolute workload after the 6 weeks.Results: Statistical analysis revealed no significant difference in both groups for PE between the two maximal graded tests. However, a significant decrease in the PE values (P<0.01) was observed in both groups during the SWEET 2. There was no significant difference in maximal HR between the two graded tests, but a significant decrease in HR (P<0.0001 for base HR and P<0.001 for peak HR) was observed in SWEET 2 compared to 1. The maximal tolerated power (MTP) and the peak oxygen uptake increased significantly in both healthy and paraplegic groups (P<0.0001 and P<0.05 respectively) after the 6 weeks of rehabilitation exercise.Conclusion: The results of the present study suggest that PE could be used to control the exercise intensity during a rehabilitation training program for paraplegics, similar to healthy subjects. The increase in the peak oxygen uptake and MTP demonstrates the positive effects of the rehabilitation program on the physical fitness of the subjects.

A SPECIFIC ARM-INTERVAL EXERCISE PROGRAM COULD IMPROVE THE HEALTH STATUS AND WALKING ABILITY OF ELDERLY PATIENTS AFTER TOTAL HIP ARTHROPLASTY: A PILOT STUDY

OBJECTIVE To investigate the influence of an arm-interval exercise program for the upper limbs on health status and walking ability in elderly patients after total hip arthroplasty. DESIGN A randomized controlled investigation. After surgery, a control group started a general rehabilitation program, and a training group combined it with an arm-interval exercise program. SUBJECTS Fourteen patients (age 75.1 +/- 4.8 years) were randomly assigned to the control group (n = 7) and the training group (n = 7). METHODS A Western Ontario and MacMaster University (WOMAC) Osteoarthritis Index was completed and an incremental exercise test on an arm crank ergometer was also performed 1 month before (T(-1)) and 2 months after surgery (T2). Moreover, a 6-minute walk test was performed at T2. RESULTS Both groups significantly improved all dimensions of WOMAC, except in WOMAC physical function subscale in the control group. The training group covered a significantly longer distance in the walking test than the control group and also presented significantly higher VO2 peak value at T2. Correlation analyses indicate that VO2 peak value and the distance covered in the 6-minute walking test were significantly associated with functional status. After calculating the ratio distance covered/score at WOMAC physical function, we observed a significantly higher ratio value in the training group than in the control group. CONCLUSION Preliminary results indicate that the improvement in physical fitness and functional status of the training group seems to be associated with better health status.

Two-Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional myocardial abnormalities remains largely unknown, potentially because of its frequent association with other cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function. We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in youths with isolated severe obesity. Thirty‐seven asymptomatic severely obese adolescents free of diabetes and hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate (SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (−24%) and systolic and early diastolic SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ± 0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic—diastolic coupling, an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part related to alterations in relaxation and contractility properties of subendocardial fibers.

Perceived exertion and rehabilitation with arm crank in elderly patients after total hip arthroplasty: a preliminary study.

This preliminary study examined, in a restricted randomized trial, the effects of a 6-week arm-crank rehabilitation training program in elderly osteoarthrosis patients after total hip arthroplasty, first on physiological and perceptual responses and second on physical function. Two groups of patients were studied: a training group (N = 7, mean age = 74.9 yr, standard deviation [SD] = 5.0 yr) who followed a training program in addition to traditional rehabilitation, and a control group who followed traditional rehabilitation only (N = 7 mean age = 75.4 yr, SD = 5.1 yr). At the beginning of the training program, the heart rate and the perceived exertion were not significantly correlated during the exercise session. However, at the end of the training program, five patients had a significant heart rate/perceived exertion relationship (p < 0.05). Furthermore, positive effects of the arm-crank rehabilitation training program were observed on cardioventilatory and functional responses in the training group compared with the control group. These results suggest that after an habituation period, most of our elderly osteoarthrosis patients experienced physical sensations that were connected to physiological responses. Therefore, perceived exertion could be useful in these patients to regulate exercise intensity, especially at the end of and after the rehabilitation period.

Physical activity in patients with rheumatoid arthritis.

INTRODUCTION Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease and is associated with an excess risk of cardiovascular disease. For the general population, the World Health Organization has issued detailed recommendations on the type of physical activity appropriate for decreasing the cardiovascular risk. The objective of this work is to review available data on the effects of physical activity in patients with RA. RESULTS RA is responsible for a marked decrease in physical activity. Physical activity significantly diminishes both the cardiovascular risk and the DAS 28. Vascular benefits from physical activity include improved endothelial function and slowing of the atherosclerotic process. Physical activity also has favorable effects on bone, slowing radiographic disease progression in small joints and increasing bone mineral density at the femoral neck, although these effects are not statistically significant. Finally, engaging in physical activity increases self-esteem, alleviates symptoms of depression, improves sleep quality, and decreases pain perception. Aerobic exercise is the most commonly advocated type of physical activity. Most interventions were of short duration (4 weeks) and involved aerobic activity (running or cycling) for 60minutes a day 5 days a week. Resistance training has been shown to decrease systemic inflammation and increase muscle strength. The main obstacles to physical activity in patients with RA are related to both the patients, who lack both motivation and knowledge, and the rheumatologists, who also lack knowledge and place insufficient emphasis on promoting physical activity. CONCLUSION Physical activity provides many benefits in patients with RA and should be widely performed. Promoting physical activity should be among the objectives of therapeutic patient education for RA.

The Perceived Exertion to Regulate a Training Program in Young Women

Grange-Faivre Céline, C, Monnier-Benoit, P, Groslambert, A, Tordi, N, Perrey, S, and Rouillon, JD. The perceived exertion to regulate a training program in young women. J Strength Cond Res 25(1): 220-224, 2011-The aim of this study was to compare the heart rate (HR) and the perceived exertion (PE) regulation of a training program in women and their effects on the cardiorespiratory responses. Twenty-seven women (mean age 22.4 ± 2.7 years) were randomly assigned to a control group (CG, n = 9), a heart rate group (HRG, n = 9), or a perceptive group (PG, n = 9). All subjects performed a maximal graded test (MGT) on a cycle ergometer before and after 6 weeks. The HR, &OV0312;O2peak, maximal tolerated power (MTP), and PE were recorded during both MGTs. A 6-week interval training program was performed by both the HRG and PG. HR targets were used for the HRG and PE for the PG to readjust the power output. The results show that the &OV0312;O2peak and the MTP increased significantly (p < 0.05) for both training groups, whereas the CG obtained no changes. As a consequence, PE could be a valuable tool to readjust the training load during an interval training program.