Peter Douris

The Effect of Land and Aquatic Exercise on Balance Scores in Older Adults

Background and Purpose: Lower body exercises are an important intervention in retraining balance. The aquatic environment has been identified as an appropriate medium to perform these exercises. The purpose of this research was to determine if aquatic exercise was more effective than land‐based exercise when training balance. Study Design: The study involved a 2‐group pretest‐post‐test design. The Berg Balance Scale (BBS) scores served as the outcome measure. Methods: Eleven subjects completed this study. Five subjects were from an assisted living facility (age 83.2 ± 8.1 years) and 6 subjects were from an outpatient facility (age 75.0 ± 3.6 years). Each group did a comparable set of lower body exercises (2 times per week for 6 weeks), but one group exercised in the pool, and the other exercised on land. The data was analyzed using a mixed model 2x2 analysis of variance. Results: There was a significant main effect of time (p <.001) but not group on BBS scores.There was no significant interaction between group and time. Conclusions: Regardless of the treatment medium, significant improvements were evidenced on the BBS between pretest and post‐test. The utilization of lower body exercise, whether in water or on land, was accompanied by improved balance. Neither medium however was superior for retraining balance in the older adult.

The Effect of Thoracic Spine Mobilization On Lower Trapezius Strength Testing

Abstract Evidence has shown that muscle strength and function become altered due to motion restrictions. Strengthening muscles with traditional therapeutic exercise will not be completely successful unless inhibition is removed by restoring normal joint mechanics. This study investigated the effect of Grade-IV thoracic spine mobilizations on lower trapezius strength testing in normal subjects. The mobilization for the treatment group (n=20) consisted of posterior-anterior (P-A) oscillations performed from T6-T12 at each segments end range (Grade-IV). This technique is aimed at restoring normal joint play. The control group (n=20) received a Grade-I mobilization consisting of P-A oscillations performed at the beginning of the joints range, which is not expected to have articular reflexogenic effects. Before and after the mobilizations, isometric muscle strength of the lower trapezius was measured using a Nicholas Manual Muscle Tester. An independent group t-test comparing the groups demonstrated a statistically significant effect of thoracic spine mobilization on lower trapezius strength testing (P<.05).

A Meta-analysis of the Efficacy of Phototherapy in Tissue Repair

OBJECTIVE The effect of phototherapy on tissue repair was determined by aggregating the literature and using statistical meta-analysis to analyze pertinent studies published between 2000 and 2007. BACKGROUND DATA Phototherapy has been used for more than 40 y; however, its efficacy on tissue repair remains contentious. METHOD Related original studies were gathered from every available source. The papers were then screened and coded; those meeting pre-established inclusion criterion were subjected to meta-analysis, using Cohens d statistic to determine treatment effect size. RESULTS Seventy effect sizes were computed from the 23 papers that met the inclusion criteria. The overall mean effect obtained was highly significant, d = +1.94 (95% confidence interval = 0.58-2.50). Further analyses revealed a similarly positive effect of phototherapy on tissue repair in experimental animal studies, d = +2.60, and a small to moderately positive effect in human cases of tissue repair, d = +0.34. The fail-safe number associated with the overall effect was 869; i.e., the number of additional studies in which phototherapy has negative or no effect on wound healing needed to negate the overall large effect size of + 1.94. The corresponding fail-safe numbers for experimental animal and human tissue repair studies were 612 and 64, respectively. CONCLUSION These findings indicate that phototherapy is a highly effective form of treatment for tissue repair, with stronger supporting evidence resulting from experimental animal studies than human studies.

Static stretching does not impair performance in active middle-aged adults.

Handrakis, JP, Southard, VN, Abreu, JM, Aloisa, M, Doyen, MR, Echevarria, LM, Hwang, H, Samuels, C, Venegas, SA, and Douris, PC. Static stretching does not impair performance in active middle-aged adults. J Strength Cond Res 24(3): 825-830, 2010-Recent investigations with young, healthy adult subjects suggest that static stretching before activity decreases performance and should, therefore, be avoided. The purpose of this study was to assess the effects of an acute static stretching protocol on balance and jump/hop performance in active middle-aged adults. Ten subjects (6 men and 4 women aged 40-60 yr) from a martial arts school volunteered to take part in this research study. This was a repeated measures design. Subjects who stretched for 10 minutes using a 30-second hold during 1 session sat quietly for 10 minutes during the alternate session. Sessions were randomly assigned. The following dependent variables were compared: Dynamic Stability Index (DSI) for single-leg dynamic balance (smaller DSI = improved balance); distances for broad jump, single hop, triple hop, and crossover hop; elapsed time for a 6-m timed hop. Group means for balance were significantly different between the stretch and no-stretch conditions (3.5 ± 0.7 vs. 4.3 ± 1.4 DSI, respectively; p < 0.05). No significant differences were found between the group means of the stretch and no-stretch conditions for the dependent measures of broad jump, single hop, triple hop, crossover hop, and 6-m timed hop performance. Ten minutes of acute static stretching enhances dynamic balance and does not affect jump/hop performance in active middle-aged adults. Static stretching should be included before competition and before exercise in fitness programs of active middle-aged adults.

The relationship between maximal repetition performance and muscle fiber type as estimated by noninvasive technique in the quadriceps of untrained women.

The purpose of this investigation was to establish a relationship between the number of repetitions an individual can complete at a predetermined load and their percentage of type II muscle fibers in their quadriceps. Subjects included 22 untrained women between the ages of 18 and 35. Day 1 consisted of noninvasive anthropologic testing, 1 repetition maximum (1RM) testing, and recording repetition performance at 70% 1RM. Day 2 consisted of isokinetic dynamometry to determine muscle fiber composition. Results were obtained and analyzed using the Pearson product correlation coefficient (r). The results demonstrated a fair-to-moderate relationship (Pearson r = −0.48, p = 0.02) that individuals with greater percentages of type II muscle fibers performed fewer repetitions at 70% 1RM. The results of this study demonstrate that muscle fiber type composition is an important variable to consider when designing training or rehabilitation programs.

Fatiguing upper body aerobic exercise impairs balance.

Douris, PC, Handrakis, JP, Gendy, J, Salama, M, Kwon, D, Brooks, R, Salama, N, and Southard, V. Fatiguing upper body aerobic exercise impairs balance. J Strength Cond Res 25(12): 3299–3305, 2011—There are many studies that have examined the effects of selectively fatiguing lower extremity muscle groups with various protocols, and they have all shown to impair balance. There is limited research regarding the effect of fatiguing upper extremity exercise on balance. Muscle fiber–type recruitment patterns may be responsible for the difference between balance impairments because of fatiguing aerobic and anaerobic exercise. The purpose of our study was to investigate the effect that aerobic vs. anaerobic fatigue, upper vs. lower body fatigue will have on balance, and if so, which combination will affect balance to a greater degree. Fourteen healthy subjects, 7 men and 7 women (mean age 23.5 ± 1.7 years) took part in this study. Their mean body mass index was 23.6 ± 3.2. The study used a repeated-measures design. The effect on balance was documented after the 4 fatiguing conditions: aerobic lower body (ALB), aerobic upper body (AUB), anaerobic lower body, anaerobic upper body (WUB). The aerobic conditions used an incremental protocol performed to fatigue, and the anaerobic used the Wingate protocol. Balance was measured as a single-leg stance stability score using the Biodex Balance System. A stability score for each subject was recorded immediately after each of the 4 conditions. A repeated-measures analysis of variance with the pretest score as a covariate was used to analyze the effects of the 4 fatiguing conditions on balance. There were significant differences between the 4 conditions (p = 0.001). Post hoc analysis revealed that there were significant differences between the AUB, mean score 4.98 ± 1.83, and the WUB, mean score 4.09 ± 1.42 (p = 0.014) and between AUB and ALB mean scores 4.33 ± 1.40 (p = 0.029). Normative data for single-leg stability testing for this age group are 3.9 ± 1.9. Higher scores reflect greater balance deficits. The AUB condition produced the greatest balance deficit. Our data provide evidence of the important role of the upper body in maintaining unilateral standing balance and supports its inclusion as part of rehabilitation and training protocols designed to improve balance.

Martial art training enhances the glutathione antioxidant system in middle-aged adults.

Douris, PC, Elokda, AS, Handrakis, JP, Principal, S, Rondo, E, Bovell, J, Coughlin, WP, Mastroianni, CN, Wong, MJ, and Zimmerman, T. Martial art training enhances the glutathione antioxidant system in middle-aged adults. J Strength Cond Res. 23(5):1518-1523, 2009-The purpose of this study was to compare the antioxidant capacity of physically active middle-aged martial artists to age-matched sedentary controls. Nine sedentary subjects (mean age 52.9 yr) and 9 martial artists (mean age 51.8 yr) who practice Soo Bahk Do, a Korean martial art and were age- and sex-matched performed a graded exercise test (GXT) using a modified Bruce protocol. Ages ranged from 41 to 58 years. A GXT has been shown to be an effective technique for inducing oxidative stress. Glutathione (GSH) is the bodys most highly concentrated antioxidant, is the central component of the antioxidant system, and plays an essential role in protecting tissues against oxidative stress. Free radical oxidation leads to the transformation of GSH to glutathione disulfide (GSSG). Venous blood samples for GSH and GSSG were collected before and immediately after the GXT. Repeated measures analysis of variance were performed on the resting baseline values and immediate post-GXT values of GSH, GSSG, and GSH:GSSG to compare groups. The blood GSH, GSSG, and GSH:GSSG levels were significantly different (p < 0.001) between the 2 groups at rest and after the GXT. The Soo Bahk Do practitioners had higher resting levels of GSH and lower levels of GSSG and responded more effectively to acute oxidative stress than the age-matched sedentary controls. Soo Bahk Do appears to enhance the antioxidant defense system and may be an effective intervention for improving overall health by protecting against the adverse effects of oxidative stress that is associated with the free radical theory of aging. Health professionals should be aware of alternative methods of training, conditioning, and exercise that can improve the general adaptation response to oxidative stress.

Use of the Occivator for the Correction of Forward Head Posture, and the Implications for Temporomandibular Disorders: A Pilot Study

Abstract Numerous studies suggest that temporomandibular disorders may be associated with forward head posture. The current study presents a need for an intervention that will effectively facilitate an ideal postural alignment of the head. The Occivator (Posteocentric Systems, Mastic Beach, NY) is an intervention speculated to improve forward head posture (FHP). However there has not been a randomized study to correlate use of the Occivator with improvement of FHP. The purpose of this study was to evaluate the effectiveness of the Occivator as a therapeutic intervention for the correction of FHP. Using a plumb line, twenty-nine (29) subjects were selected on the basis of having FHP. The CROM (cervical range of motion) device was used to determine measurement of forward head position for each group, pre and post an eight week period. The experimental group followed a specific protocol of 20 minutes of stretches and exercises on the Occivator, two times a week for eight weeks. The control group did not receive any intervention. The experimental group as compared to the control group, demonstrated significant improvement for forward head posture (p=.02). Further research is needed to evaluate the effectiveness of the Occivator.

Martial Art Training and Cognitive Performance in Middle-Aged Adults.

Abstract Cognitive performance includes the processes of attention, memory, processing speed, and executive functioning, which typically declines with aging. Previous research has demonstrated that aerobic and resistance exercise improves cognitive performance immediately following exercise. However, there is limited research examining the effect that a cognitively complex exercise such as martial art training has on these cognitive processes. Our study compared the acute effects of 2 types of martial art training to aerobic exercise on cognitive performance in middle-aged adults. We utilized a repeated measures design with the order of the 3 exercise conditions randomly assigned and counterbalanced. Ten recreational middle-aged martial artists (mean age = 53.5 ± 8.6 years) participated in 3 treatment conditions: a typical martial art class, an atypical martial art class, and a one-hour walk at a self-selected speed. Cognitive performance was assessed by the Stroop Color and Word test. While all 3 exercise conditions improved attention and processing speed, only the 2 martial art conditions improved the highest order of cognitive performance, executive function. The effect of the 2 martial art conditions on executive function was not different. The improvement in executive function may be due to the increased cortical demand required by the more complex, coordinated motor tasks of martial art exercise compared to the more repetitive actions of walking.

The Effect of the PostureJac on Deep Cervical Flexor Endurance: Implications in the Management of Cervicogenic Headache and Mechanical Neck Pain

Abstract The convergence of cervical and trigeminal afferents on second-order neurons in the trigeminocervical nucleus may refer pain from the upper cervical spine into the head and face. Furthermore, “bi-directional interactions” between trigeminal and upper cervical afferents may also explain neck symptoms of trigeminal origin (e.g., migraine). It is known that cervicogenic headache sufferers present with several musculoskeletal changes including poor endurance of the deep cervical flexor muscles. These intrinsic muscles of the neck contribute to stabilization and protection of the cervical spine and are critical for the control of both intervertebral motion and the cervical lordosis. The purpose of this study was to determine whether the use of the PostureJac (SomatoCentric Systems, Inc., Toronto, Ontario, Canada), a posture support and exercise jacket, was effective in enhancing deep cervical muscle endurance. Forty-five (45) female subjects, between the ages of 18 and 40 years, were randomly assigned to three groups consisting of the no-treatment control, the treatment-control (table stabilization), and the experimental (PostureJac) group. The outcome measure of deep cervical flexor muscle endurance was based on the Flexor Endurance Test and was recorded in seconds. The results indicated that the PostureJac group was superior to the no-treatment control (p=.001) and the treatmentcontrol (p=.004) groups in terms of increasing endurance of the deep cervical flexors. Consequently, the PostureJac may be a useful therapeutic tool in the management of cervicogenic headache and mechanical neck pain.