Terry Nicola

Exercise training in a predominantly African-American group of stroke survivors.

PURPOSE The purpose of this study was to determine the effects of a 12-wk exercise training program in a predominantly African-American group of stroke survivors with multiple comorbidities. METHODS A lag-control group design was employed to provide training to all participants (N = 35). Two 12-wk training iterations were arranged. Participants trained 3 d x wk(-1) for 60 min x d(-1) (cardiovascular, 30 min; strength, 20 min; flexibility, 10 min). Outcome measures included peak VO2 (mL x min(-1), mL x kg(-1) x min(-1), maximal workload (MW), time to exhaustion (TTE), 10 RM on two LifeFitness strength machines, grip strength (GS), body weight (BW), total skinfolds (TS), waist to hip ratio (WHR), hamstring/low back flexibility (HLBF), and shoulder flexibility (SF). RESULTS Compared with controls, the exercise group showed significant gains in peak VO2 (P < 0.01), strength (P < 0.01), HLBF (P < 0.01), and body composition (BW and BMI, P < 0.05; TS, P < 0.01). There was no significant difference between exercise and controls on WHR, SF, and GS. DISCUSSION A supervised exercise training program for stroke survivors with multiple comorbidities was highly effective in improving overall fitness, potentially reducing the risk of further disease and disability. Greater effort must be made on the part of the public health community to increase access to community-based physical activity programs for persons with stroke.

A Preliminary Study to Examine the Effects of Aerobic and Therapeutic (Nonaerobic) Exercise on Cardiorespiratory Fitness and Coronary Risk Reduction in Stroke Survivors

OBJECTIVES To compare the effects of 3 different exercise training regimens on cardiorespiratory fitness and coronary risk factor reduction in subjects with unilateral stroke. DESIGN A cluster assignment by residential location repeated-measures design. SETTING University-based medical center. PARTICIPANTS Fifty-five subjects with unilateral ischemic stroke were assigned to the following groups: intensity (n=18), duration (n=19), and therapeutic exercise (n=18). INTERVENTION A 14-week intervention with subjects randomized to 1 of 3 interventions: (1) moderate intensity, shorter duration (MISD) exercise (gradually increasing exercise intensity while keeping exercise duration constant at 30 min), (2) low-intensity, longer duration (LILD) exercise (gradually increasing duration to 60 min while keeping exercise intensity constant), or (3) conventional therapeutic exercise (TE) consisting mainly of strength, balance, and range of motion activities. All groups exercised 3 days per week. MAIN OUTCOME MEASURES Peak oxygen consumption (VO2peak), submaximal oxygen consumption (VO2), lipid panel, and resting blood pressure. RESULTS The MISD group attained more favorable effects on systolic (P<.04) and diastolic blood pressure (P<.002) and total cholesterol (TC) (P<.036) compared with LILD and TE groups. Both MISD (P<.029) and LILD (P<.045) showed significant reductions in triglycerides compared with TE (P<.029). There was no significant change in VO2peak and submaximal VO2 in any of the groups. CONCLUSIONS Overall, both MISD and LILD conditions achieved greater clinical and significant gains in coronary risk reduction compared with TE.

Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors.

BACKGROUND The study examined the effects of a 12-week health promotion intervention for a predominantly urban African-American population of stroke survivors. DESIGN A pre-test/post-test lag control group design was employed. PARTICIPANTS/SETTING Participants were 35 stroke survivors (9 male, 26 female) recruited from local area hospitals and clinics. MAIN OUTCOME MEASURES Biomedical, fitness, nutritional, and psychosocial measures were employed to assess program outcomes. RESULTS Treatment group made significant gains over lag controls in the following areas: (1) reduced total cholesterol, (2) reduced weight, (3) increased cardiovascular fitness, (4) increased strength, (5) increased flexibility, (6) increased life satisfaction and ability to manage self-care needs, and (7) decreased social isolation. CONCLUSION A short-term health promotion intervention for predominantly African-American stroke survivors was effective in improving several physiological and psychological health outcomes.

Outcomes of a Home-Based Walking Program for African-American Women

Purpose. As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks. Design. Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers. Setting. The centers were in predominately African-American communities. Participants. Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center. Intervention. Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks. Methods. Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition. Results. Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments. Conclusion. Findings suggest the potential impact of workshop group support on adherence in African-American women.

Exercise training for African Americans with disabilities residing in difficult social environments.

OBJECTIVE To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments. METHODS A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO(2) (mL min(-1), mL kg(-1) min(-1)); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF). RESULTS Compared to the control group, the exercise group showed significant gains in peak VO(2) (p < 0.01); strength (p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants x 36 sessions), 87% of the sessions were attended. CONCLUSIONS A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.

Rehabilitation of running injuries.

Rehabilitating the injured runner involves a thorough evaluation of the runner. The running history is at least as critical as the physical examination to determine the risk factors for injury and goals for rehabilitation. The medical assessment should include an office situation in which the runner can be seen walking and running to ensure that the rehabilitation program is complete and successful.

Rehabilitation of the Patellofemoral Joint

Nonsurgical care by a specialist in physical medicine and rehabilitation is typically a multifaceted approach, which can include modalities, bracing, medication, injection, proprioceptive techniques, restoration of normal movement patterns, and overall conditioning. There is evidence that physical therapy interventions have significant beneficial effect on pain and function compared with no treatment.

Poster 167 Ovarian Cyst Rupture as an Unusual Etiology for Hip Pain in a Young Female Runner: A Case Report

Disclosures: Suzanne Gutierrez Teissonniere: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Four patients, aged between 28 and 39, presented for evaluation of swelling, tightness, weakness and tenderness in bilateral upper or lower extremities at least a day after completing an endurance exercise. Two female patients had bilateral arm symptoms after completing CrossFit. The third female presented with bilateral hamstrings and calves symptoms, along with dark urine, after completing NYC marathon. The male patient presented with bilateral thigh symptoms and dark urination, after a spinning class. The latter patient did not exercise regularly; the other three exercised regularly. Setting: Outpatient Office. Results: All patients were referred for immediate rhabdomyolysis workup. One female CrossFit patient with creatine kinase (CK) of 6540 received aggressive oral hydration. The female runner with CK of 5000 received 3 liters of intravenous fluids (IVF). The other female CrossFit patient was hospitalized with CK of 33,000, and completed IVF management. The male spinning patient was hospitalized with CK of 94,000, and was started on IVF with bicarbonate drips. All patients had normal renal function, and recovered fully with hydration and rest. Discussion: Acute Exertional Rhabdomyolysis (AER) is a result of skeletal muscle injury from strenuous exercise. Patients usually present with delayed-onset pain, soreness and swelling of the affected muscles. This is associated with the release of different proteins, including CK, lactate dehydrogenase and myoglobin, into circulation system. AER has been reported in endurance athletes, or jobs that require extreme physical work. Eccentric exercises tend to have the highest risk for muscle injury. Both CrossFit and spinning have been linked with several cases. Conclusions: Early diagnosis of AER is important to prevent severe complications, including electrolyte abnormalities, dehydration, renal failure, compartment syndrome, disseminated intravascular coagulation, and death. Adequate fluid replacement is an essential management. Furosemide and Mannitol are used in the presence of renal failure. Physicians have to educate athletes about proper prevention techniques. Level of Evidence: Level V