Sirkka-Liisa Karppi

Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis: a randomized controlled trial

Objective: To investigate the effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in subjects with multiple sclerosis (MS). Design: A randomized controlled trial. Setting: At Masku Neurological Rehabilitation Centre, Masku, and the Social Insurance Institution, Research Department, Turku, Finland. Subjects: Ninety-five MS patients with mild to moderate disability were randomized into exercise group (n = 47) and a control group (n = 48). Intervention: Participants in the exercise group attended in a supervised exercise period of three weeks, which was followed by a home exercise programme lasting for 23 weeks. Patients in the control group continued with their normal living. Outcome measures: Motor fatigue of knee flexor and extensor muscles was measured during a static 30-s maximal sustained muscle contraction. The decline in force (Nm) during the 30 s was recorded, and a fatigue index (FI) was calculated. Subjective fatigue was measured by using the Fatigue Severity Scale (FSS). The Ambulatory Fatigue Index (AFI) was calculated on the basis of a 500-m walking test. Assessment took place at baseline, at the third week (not for the control group) and at the 26th week. All outcome variables were analysed, men and women together, and some interesting contrasts were analysed by gender. Results: Associations were observed with changes in extension FI and Expanded Disability Status Scale (EDSS) score and mean extension torque (Nm), but not with changes in FI and aerobic or strength exercise activity, mean AFI, mean FSS or in mean knee flexion torque. AFI was decreased in all subject groups (p = 0.007). Motor fatigue was reduced in knee flexion (p = 0.0014) and extension (ns) among female but not in male exercisers after six months of exercise. The exercise activity of women was 25% higher than that of the men. Conclusions: Six months of exercise reduced motor fatigue in women, but not in men.

Effect of long‐term neck muscle training on pressure pain threshold: A randomized controlled trial

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short‐term results have been reported so far. The aim of the present study was to evaluate the long‐term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain.

EFFECTS OF NECK MUSCLE TRAINING IN WOMEN WITH CHRONIC NECK PAIN: ONE-YEAR FOLLOW-UP STUDY

Exercises are commonly recommended for chronic neck pain, but evidence-based guidelines do not explain what types of exercise. The aim of this randomized study was to evaluate the rate of change in neck strength following high- and low-intensity neck muscle training and their effects on pain and disability. One hundred eighty women with chronic neck pain were randomized into a high-intensity strength training group (STG), local muscle endurance training group (ETG), or control group (CG). The neck training consisted of isometric exercises in the STG and dynamic exercises in the ETG. Both groups performed dynamic exercises for the upper extremities. Strength tests, neck pain, and disability indices were evaluated at the baseline, at the follow-ups after 2 and 6 months in the training groups, and after 12 months in all groups. In both groups the greatest gains in neck strength, as well as decrease in neck pain and disability, were achieved during the first 2 months. However, the improvements continued up to 12 months. The STG achieved the greatest strength gains at all follow-ups. The CG showed only minor changes, and significant differences were found in favor of the training groups in all measures. The change in neck pain and disability indices correlated with the isometric neck strength (r = −0.22 [-0.36 to - 0.08] to −0.36 [-0.49 to −0.23]). Neck and shoulder muscle training was shown to be an effective therapy for chronic neck pain, resulting in early improvement in both the strength tests and subjective measures. The results can be maintained and even improved with long-term training.

The meanings older people give to their rehabilitation experience

Promoting older peoples ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older peoples autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

Adherence to a power-type strength training programme in sedentary, middle-aged men and women

The purpose of the study was to investigate the adherence to a supervised, 22-week power-type strength training programme in middle-aged sedentary men and women. Another objective was to examine and evaluate the reasons for dropping out. A total of 226 voluntary, healthy men and women were recruited to the study. Prior to the intervention, all participants’ health status was examined by a physician, and they were qualified to exercise. Data about employment status, smoking, musculoskeletal symptoms, previous and present physical exercise activity, physical leisure activities, perceived health and fitness, and motives for exercising were collected by using a questionnaire. After the intervention, the subjects were also asked about the main reason for dropping out. Dropping out correlated strongly with unemployment. Smoking predicted low adherence in women. Women aged 50 or over showed a higher exercise attendance rate than women aged under 40 years. Of the unemployed subjects, those who completed the training valued their fitness better than those who dropped out. In women, employment, non-smoking behaviour and older age were associated with high adherence to the training programme. Lack of motivation, lack of time and exercise-induced injuries were given as causes for dropping out. Among the unemployed, good perceived fitness was associated with adherence to the training programme.

Feasibility of power-type strength training for middle aged men and women: self perception, musculoskeletal symptoms, and injury rates

Objectives: To examine the feasibility of a power-type strength training programme for middle aged men and women, the impact of the training programme on perceived health and fitness and on knee and low back symptoms, and the rate of exercise induced injuries. Methods: A total of 154 voluntary, healthy, sedentary men and women participated in a training programme lasting about four months. The explosive force of leg extensor muscles was measured by means of standing long jumps and vertical squat jumps. Perceived health, perceived fitness, and low back and knee symptoms were assessed before and after the intervention by using a questionnaire. Musculoskeletal disorders and exercise induced injuries were reported during the training programme. Results: Perceived fitness improved in both men (p<0.01) and women (p<0.0001), but perceived health only in women (p<0.01). Men with increased explosive force in squat jumping also showed better perceived health (p<0.05), and women with increased explosive force in standing long jump showed better perceived fitness (p<0.05). Exercising men who had increased knee symptoms had significantly higher body mass index than the other exercising men (p<0.05). The exercise induced injury rate was 19% in men and 6% in women. Conclusions: Successful completion of the exercise programme, together with the increased physical activity and relatively low injury rate, may have contributed to the participants finding the exercise programme positive and stimulating and believing that their health and fitness had improved. The low rate of musculoskeletal injury suggests that this type of supervised exercise programme is feasible for untrained middle aged people.

A New Agility Test for Adults: Its Test-Retest Reliability and Minimal Detectable Change in Untrained Women and Men Aged 28-55.

Abstract Manderoos, SA, Vaara, ME, Mäki, PJ, Mälkiä, EA, Aunola, SK, and Karppi, S-L. A new agility test for adults: its test–retest reliability and minimal detectable change in untrained women and men aged 28−55. J Strength Cond Res 30(8): 2226–2234, 2016—The aims of this study were to present a new Agility Test for Adults (ATA), to investigate its test–retest reliability and to quantify minimal detectable change at the 95% confidence interval (MDC95). Both the relative and absolute reliabilities were evaluated. Altogether 52 healthy untrained volunteers (25 women: age 43.3 ± 6.6 years; 27 men: age 42.8 ± 7.2 years) were recruited into the study. The subjects performed 3 ATA tests repeated after 2 different intervals: the first test session was baseline, session 2 was a week later, and session 3 was half an hour after session 2. The intraclass correlation coefficient and the SEM of the performance time of ATA were 0.91 and 0.27 seconds (same day), 0.94 and 0.20 seconds (1 week) for women, and 0.95, 0.13 seconds, and 0.94, 0.19 seconds for men, respectively. MDC95 was 0.76 seconds (same day) and 0.56 seconds (1 week) for women, and respectively 0.37 and 0.51 seconds for men. The results showed that ATA is stable and reliable when evaluating agility characteristics in untrained adults. The properties of ATA make it appropriate for screening people to find early signs of declined agility and allow possibility to clinicians and physical trainers to monitor true changes in performance time at agility test by applying the knowledge of MDC95 coefficient. Furthermore, ATA can give tips for planning appropriate exercise programes to prevent clumsiness and falls with more serious consequences among aging people.

Interaction between clients and physiotherapists in group exercise classes in geriatric rehabilitation

The aim of this paper is to explore how older people construct their interaction in group exercise classes in geriatric rehabilitation and what is their contribution to the interaction. Discourse analysis was employed and data, consisting of seven videotaped group-based exercise sessions, were collected from 52 older people (aged 66–93 years) and nine rehabilitation professionals in seven rehabilitation centres. Four discourse categories were found. In “taciturn exercising”, older people remained verbally silent but physically active. In “submissive disagreeing”, older people opposed the professionals’ agenda by displaying reluctant consent to proposals. In “resilient endeavouring”, older adults persisted on their course of action, regardless of the disapproval of the professionals. In “lay helping”, older people initiated spontaneous encouragement, but also gave verbal and physical assistance to their peers. Older peoples meaningful contribution to interaction, whilst it may challenge the institutional flow of activities, can constitute an integral part of the re-ablement process of rehabilitation.

Effect of Power-Type Strength Training on Lumbar Extension and Flexion Velocity

The aim of our study was to investigate the effects of 22 weeks of power-type strength training on isometric peak torque (Nm), dynamic peak torque (Nm), and angular peak velocity (deg/s) of lumbar spine flexion and extension. Subjects (n=125) were sedentary, middle-aged volunteers, of whom 25 women and 28 men were classified in the highly trained group and 35 women and 37 men in the low trained group (=moderately trained, low trained, and nontraining control groups). Isometric peak torque, dynamic peak torque, and angular peak velocity of the lumbar spine in flexion and extension were measured before and after the intervention by using an isoresistive dynamometer. The effects of power-type strength training were mainly manifested in the progress of velocity. With a training frequency of at least twice a week, significant increases were observed in peak flexion and extension velocities in both genders, whereas no such changes were found in isometric or dynamic torque. A training frequency of at least twice a week is apparently needed for improved velocity in lumbar spine extension and flexion in middle-aged, sedentary men and women.