Stephanie Enright

Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: is there imbalance and can taping change it?

OBJECTIVES To investigate (i) whether subacromial impingement symptoms (SIS) were associated with upper and lower trapezius muscle imbalance and (ii) the effect of a scapula taping technique on upper and lower trapezius muscle activity. DESIGN Cross-sectional study with nested within-subject intervention. SETTING University research laboratory. PARTICIPANTS Subjects who demonstrated SIS (n=16) on clinical testing and an age and gender matched group of asymptomatic subjects (n=32). MAIN OUTCOME MEASURES Surface electromyography (EMG) to measure activity in the upper (UFT) and lower (LFT) fibres of trapezius during repeated humeral elevation in the scapular plane. RESULTS Symptomatic subjects demonstrated a significantly (95% CI 2.13 to 4.17, p=0.019) higher ratio of UFT:LFT activity than the asymptomatic subjects (95% CI 1.35 to 2.25). With tape in situ the symptomatic subjects demonstrated a significant (95% CI -8.6% to -17.3%, p<0.001) reduction in UFT activity but no significant (95% CI +2.8% to -17.5%, p=0.145) change in activity of LFT. No relationship (r=- 0.116, p=0.669) was found between the degree of underlying muscle imbalance and the reduction in UFT under the taped condition for the symptomatic group. CONCLUSION Subacromial impingement symptoms are associated with altered upper and lower trapezius muscle activity which can be partially addressed by the application of tape.

Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD

BackgroundPatients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors.MethodsThirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation.ResultsOn commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP.ConclusionCardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.

Inspiratory Muscle Training Improves Shuttle Run Performance in Healthy Subjects

Summary Background Respiratory muscle training (RMT) has been extensively investigated over the past two decades. To date no method of ventilatory muscle training has fixed load throughout range in a manner consistent with the general principles of skeletal muscle training. The purpose of this study was to assess the use of computer-generated fixed-load incremental RMT produced by the performance of repeated sustained sub-maximal inspiratory efforts (80% of maximum, generated from RV to TLC; a full range of contraction/muscle shortening) with progressively reduced recovery times in healthy volunteers. Methods A ten-week controlled study of RMT was undertaken in healthy volunteers. Twenty-two subjects (mean age 26 years: 12 women) were randomly allocated to control or training groups. Each group performed the Test of Incremental Respiratory Endurance (TIRE) set at 80% of peak, three times weekly at weeks one and ten. The training group continued with the TIRE-based RMT over the intervening eight weeks. The control group ceased RMT at the end of week one and started training again only during the tenth week of the study. Before and at completion of the investigation each participant performed the multi-stage fitness test (shuttle run) and completed visual analogue scores of dyspnoea and perception of sports performance. Results Respiratory muscle strength (RMS) and endurance (RME) increased (P 2 max derived from the shuttle run also increased in this group (P Conclusions We conclude that TIRE-based RMT set at 80% of peak through range increases RMS, single-breath work capacity and RME and that these improvements result in reduced levels of breathlessness, an increase in predicted VO 2 max and a perceived improvement in sports performance.

Effect of inspiratory muscle training intensities on pulmonary function and work capacity in people who are healthy: a randomized controlled trial

Background Inspiratory muscle training (IMT) has been shown to improve inspiratory muscle function, lung volumes (vital capacity [VC] and total lung capacity [TLC]), work capacity, and power output in people who are healthy; however, no data exist that demonstrate the effect of varying intensities of IMT to produce these outcomes. Objectives The purpose of this study was to evaluate the impact of IMT at varying intensities on inspiratory muscle function, VC, TLC, work capacity, and power output in people who are healthy. Design This was a randomized controlled trial. Setting The study was conducted in a clinical laboratory. Participants Forty people who were healthy (mean age=21.7 years) were randomly assigned to 4 groups of 10 individuals. Interventions Three of the groups completed an 8-week program of IMT set at 80%, 60%, and 40% of sustained maximum inspiratory effort. Training was performed 3 days per week, with 24 hours separating training sessions. A control group did not participate in any form of training. Measurements Baseline and posttraining measurements of body composition, VC, TLC, inspiratory muscle function (including maximum inspiratory pressure [MIP] and sustained maximum inspiratory pressure [SMIP]), work capacity (minutes of exercise), and power output were obtained. Results The participants in the 80%, 60%, and 40% training groups demonstrated significant increases in MIP and SMIP, whereas those in the 80% and 60% training groups had increased work capacity and power output. Only the 80% group improved their VC and TLC. The control group demonstrated no change in any outcome measures. Limitations This study may have been underpowered to demonstrate improved work capacity and power output in individuals who trained at 40% of sustained maximum inspiratory effort. Conclusion High-intensity IMT set at 80% of maximal effort resulted in increased MIP and SMIP, lung volumes, work capacity, and power output in individuals who were healthy, whereas IMT at 60% of maximal effort increased work capacity and power output only. Inspiratory muscle training intensities lower than 40% of maximal effort do not translate into quantitative functional outcomes.

Systemic comorbidities in bronchiectasis.

Bronchiectasis is a chronic inflammatory lung disease, which has similarities to chronic obstructive pulmonary disease (COPD). Comorbidities of COPD include increased risk of cardiovascular (CV) disease, loss of bone mineral density (BMD) and loss of skeletal muscle mass and function, all linked to systemic inflammation. The potential for such comorbidities has not been explored in bronchiectasis. We hypothesised that patients with bronchiectasis would have similar increased comorbidities. A total of 20 patients with noncystic fibrosis bronchiectasis were compared to 20 controls similar in age, gender and smoking exposure. Assessments included aortic pulse wave velocity (PWV; (a measure of arterial stiffness and an independent predictor of CV risk), blood pressure (BP) as well as levels of interleukin-6 (IL-6), albumin, fasting glucose and lipids. Body composition (fat free mass index (FFMI)), BMD, the 6-min walk distance (6MWD) and self-reported physical activity were also determined. Patients with bronchiectasis had increased aortic PWV, 10.5 (3.0) m/second, when compared with controls, 8.8 (1.6) m/second (p < 0.05), despite similar central and peripheral BP and lipid profile. Patients also had increased IL-6 and reduced albumin and glucose. Although mean body mass index, FFMI and BMD were similar in patients and controls, only 20% of patients had a healthy BMD compared with 50% of controls. Patients had reduced 6MWD and reported less physical activity (p < 0.05). Patients with bronchiectasis had increased arterial stiffness (an indicator of increased CV risk), increased inflammation, reduced exercise capacity and bone thinning. These additional comorbidities require further evaluation for their management in these patients.

A pilot investigation of quality of life and lung function following choral singing in cancer survivors and their carers

Background: The diagnosis of cancer creates a wide range of social and emotional problems to patients and carers. However, delivering effective psychological, emotional, and social support remains a challenge. This pilot study evaluated quality of life (QoL) and lung function before and after three months of choral singing in cancer survivors and their carers. Methods: At baseline, 30 cancer survivors and their carers, mean (standard deviation) age 60 (10), completed questions about QoL (SF-36), anxiety and depression, and the multidimensional fatigue score. Lung function was measured by spirometry, and respiratory musclestrength (maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP) was also measured. Assessments were repeated after three months of singing in the choir, and 10 participants completed semi-structured interviews to explore their experience of the choir. Results: After three months of choral singing, 20 subjects repeated the assessments. Several domains of the SF-36 improved, including vitality, social functioning, mental health, and bodily pain. There was also a trend of reduced anxiety and depression, despite no change in fatigue. Spirometric measures of lung function were unchanged; however, there was a trend of increased MEP. Themes from the interviews revealed that the choir provided a focus, so the future participants felt uplifted and had greater confidence and self-esteem. Conclusions: This pilot project provides preliminary data which suggest choral singing may improve QoL and depression, despite no physiological change in cancer survivors and their carers. Choral groups offer a support mechanism applicable to cancer patients, carers, and supporters, and may be relevant to other chronic conditions. Further research examining the efficacy of this intervention in a larger controlled study is warranted.

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

BACKGROUND Respiratory failure and dysfunction are common problems in many neurodegenerative conditions. Although physiotherapists manage these problems, it is not known which treatments have been studied and their efficacy. OBJECTIVE To review evidence on the management of respiratory problems in people with neurodegenerative conditions using the PRISMA approach. DATA SOURCES Comprehensive searches were conducted using the following electronic databases from inception to May 2010: HUGEnet, SIGLE, British Library Direct, CINAHL, Medline, AMED and Web of Knowledge. Bibliographies of all studies and systematic reviews were searched by hand. STUDY SELECTION Studies were selected based on: self-ventilating participants with neurodegenerative conditions; interventions aimed at improving respiratory function; and any valid and reliable measures of respiratory function as outcomes. STUDY APPRAISAL Studies were appraised by one reviewer using the Critical Appraisal Skills Programme. Data were synthesised using a narrative approach. RESULTS Thirty-five studies were included in the review. The strongest evidence was for the use of non-invasive ventilation for people with amyotrophic lateral sclerosis, although this was weak. The evidence for the use of respiratory muscle training and methods to increase peak cough flow showed a positive effect, but was also weak. CONCLUSION There is weak evidence for the positive effects of physiotherapeutic interventions for respiratory problems in people with neurodegenerative conditions. Further work is necessary in specific neurodegenerative conditions to identify why respiratory problems occur, and larger scale studies should be undertaken to investigate management of these problems.

A mixed-method systematic review to investigate the effect of group singing on health related quality of life

OBJECTIVE To investigate the effect of group singing on health related quality of life (HRQoL) for adult, amateur singers with chronic health conditions. METHODS A literature search for experimental and observational studies and qualitative studies published before February 2014 was undertaken using the following databases: ASSIA (Proquest), CINAHL (Ebsco), EMBASE (OVID), HMIC (OVID), MEDLINE (OVID), MEDLINE in Process (OVID), OpenGrey, PsycINFO (OVID) and PubMed for Epub ahead of print studies. Social Science searches included: Web of Science, Proquest, and Scopus (Elsevier). The records were screened independently by two reviewers. Studies were critiqued using Critical Appraisal Skills Programme tools. RESULTS The literature search identified 573 papers, from which 18 were included (5 quantitative, 5 qualitative, 8 mixed-methods studies). These included a variety of patient populations including chronic respiratory disease, neurological conditions and mental health. The quantitative studies lacked consistency: two of the seven controlled studies demonstrated additional HRQoL benefits with singing compared to controls, while three of six uncontrolled studies showed improved HRQoL. Qualitative methods were recorded in variable depth. The qualitative data presented a range of benefits of group singing including increased confidence, increased mood and social support. Few negative effects of singing were reported. CONCLUSION This systematic review indicates that group singing interventions may have beneficial effects on HRQoL, anxiety, depression and mood. Studies were heterogeneous with significant methodological limitations, allowing only a weak recommendation for group singing as an intervention for adults with chronic health problems. The undertaking of larger controlled and in-depth qualitative studies is warranted.

Reproducibility of measurements of inspiratory work capacity in cystic fibrosis patients.

The evaluation of respiratory muscle endurance (RME) is regarded as being clinically relevant to the assessment of respiratory muscle function. The reproducibility of a non-invasive measure of assessing RME was determined by measuring inspiratory work capacity (IWC) (using a computerised system). Measurements were obtained on two occasions in 20 adult cystic fibrosis (CF) patients (22.7+/-3.4 years, mean+/-S.D.) and 20 age (23.4+/-4.4 years) and gender (10 male, 10 female in each group) matched healthy controls. The coefficients of reliability (CR), intra-class correlation coefficients (ICC) and limits of agreement (bias+/-2 S.D.) were determined. CR values for the CF patients and controls were above 90% and with ICC of 0.99 in both CF patients and controls. The differences in IWC between study days were within +/-2 S.D. of the mean difference in all but one CF and one control subject. These data suggest that measures of IWC may be considered reliable when used to assess RM function in both controls and in patients with CF.

A simple and rapid test of physical performance in chronic obstructive pulmonary disease

Impaired physical performance is common in chronic obstructive pulmonary disease (COPD), but its assessment can be difficult in routine clinical practice. We compared the timed up and go (TUG) test and other easily applied assessments of physical performance with the 6-minute walk distance (6MWD). In a longitudinal study of comorbidities in COPD, submaximal physical performance was determined in 520 patients and 150 controls using the TUG test and 6MWD. Spirometry, body composition, handgrip strength, the COPD assessment test, St George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council dyspnoea scale were also determined. Patients and controls were similar in age, body mass index, and sex proportions. The TUG in the patients was greater than that in the control group, P=0.001, and was inversely related to 6MWD (r=−0.71, P<0.001) and forced expiratory volume in one second predicted (r=−0.19, P<0.01) and was directly related to the SGRQ activity (r=0.39, P<0.001), SGRQ total (r=0.37, P<0.001), and total COPD assessment test scores (r=0.37, P<0.001). The TUG identified the difference in physical performance between patients and controls. The TUG test and validated questionnaires provide a measure of physical performance, which is rapid and could be used in clinical practice.