Vigdis Schnell Husby

Early Maximal Strength Training Is an Efficient Treatment for Patients Operated With Total Hip Arthroplasty

UNLABELLED Husby VS, Helgerud J, Bjørgen S, Husby OS, Benum P, Hoff J. Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty. OBJECTIVE To compare muscle strength, work efficiency, gait patterns, and quality of life in patients undergoing total hip arthroplasty (THA) randomly assigned to either maximal strength training or a conventional rehabilitation program. DESIGN A randomized controlled study. SETTING Research laboratory, rehabilitation center, and physical therapy clinic. PARTICIPANTS Patients (N=24) with osteoarthritis as the main reason for THA were randomly assigned to perform maximal strength training (n=12) or conventional rehabilitation (n=12). INTERVENTIONS The maximal strength training group (STG) performed maximal strength training in leg press and abduction with the operated leg only 5 times a week for 4 weeks in addition to the conventional rehabilitation program. The conventional rehabilitation group (CRG) received supervised physical therapy 3 to 5 times a week for 4 weeks. MAIN OUTCOME MEASURES 1-repetition maximum (1RM) leg press strength, 1RM abduction strength, rate of force development (RFD), work efficiency, gait patterns, and quality of life. RESULTS 1RM increased in the bilateral leg press (P<.002) and in the operated leg separately (P<.002) in the STG compared with the CRG. 1RM abduction strength in the operated leg (P<.002) and the healthy leg (P<.002) increased in the STG compared with the CRG. RFD increased in the STG compared with the CRG (P(g)=.030), followed by a trend towards increased peak force in the STG (P(g)=.053) (P(g) = probability for differences between groups). Work efficiency tended to improve in the STG compared with the CRG (P=.065). No differences in gait patterns were revealed between the groups after the training intervention. CONCLUSIONS Early maximal strength training 1 week postoperatively is feasible and an efficient treatment to regain muscular strength for patients who have undergone THA, demonstrated by a significantly larger increase in muscular strength and a trend towards a better work efficiency in the STG compared with the CRG.

Early postoperative maximal strength training improves work efficiency 6-12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years.

Husby VS, Helgerud J, Bjørgen S, Husby OS, Benum P, Hoff J: Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis induced total hip arthroplasty in patients younger than 60 years. Objective:To assess physical outcome of early maximal strength training after total hip arthroplasty. Design:Six- and 12-mo follow-up of 24 (22) total hip arthroplasty patients randomly assigned to 4 wks of maximal strength training and conventional rehabilitation and to conventional rehabilitation only was conducted. After the intervention period, all patients attended conventional rehabilitation. Outcome measures were hip abduction and leg press strength, gait patterns, work efficiency, maximal oxygen consumption, and health-related quality of life. Results:Work efficiency was significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation–only group after 6 and 12 mos by 29% and 30%, respectively. Leg press for the healthy leg and rate of force development for the operated leg were significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation–only group 12 mos postoperatively by 36% and 74%, respectively. Conclusions:This study demonstrates higher work efficiency after 6 and 12 mos and improved rate of force development after 12 mos in total hip arthroplasty patients who performed early maximal strength training combined with conventional rehabilitation after total hip arthroplasty surgery compared with total hip arthroplasty patients receiving conventional rehabilitation only. However, the study indicates that a prolonged maximal strength training program and aerobic endurance training are required to fully recover total hip arthroplasty patients.

Hyperoxic interval training in chronic obstructive pulmonary disease patients with oxygen desaturation at peak exercise

High‐intensity work might not be preserved in chronic obstructive pulmonary disease (COPD) during whole‐body exercise due to ventilatory limitations that exceed metabolic limitations, resulting in reduced training adaptations. The purpose of the present study was to address the hyperoxic effect during training and testing in COPD patients with hypoxemia at peak exercise. Six COPD and eight coronary artery disease (CAD) patients completed 24 aerobic high‐intensity interval training sessions, 4 × 4 min in hyperoxia at 85–95% of the peak heart rate and peak exercise tested in normoxia and hyperoxia pre‐ and post‐training. VO2peak increased in the COPD group by 19% (13–31%) and in the CAD group by 15% (7–29%), [0.98(0.68–1.52)–1.17(0.89–1.78) and 2.11(1.57–2.64)–2.44(1.92–3.39) L/min], respectively. VO2peak was higher in hyperoxia at pre‐ and post‐test (1.22(0.80–1.87) and 1.37(1.01–1.94) L/min) in the COPD group. Work economy improved by 10% in both groups. Quality of life improved in the COPD group in terms of physical and mental health status by 24% and 35%. Hyperoxic aerobic high‐intensity interval training in COPD patients with hypoxemia at peak exercise increases VO2peak, peak workload, work economy and quality of life. Acute hyperoxia increases VO2peak, peak workload at pre‐ and post‐test compared with normoxia in the COPD patients, indicating an oxygen supply limitation to VO2peak.

Muscular strength after total hip arthroplasty: A prospective comparison of 3 surgical approaches

Background and purpose — Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. Patients and methods — In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. Results — Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. Interpretation — The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

Aerobic High Intensity One-Legged Interval Cycling Improves Peak Oxygen Uptake in Chronic Obstructive Pulmonary Disease Patients; No Additional Effect from Hyperoxia

The aim of the present study was to investigate whether hyperoxic aerobic high intensity one-legged interval cycling improves peak oxygen uptake (V O (2peak)) compared to normoxic training in patients with severe chronic obstructive pulmonary disease, and to evaluate the acute effect of hyperoxia during one- and two-legged peak exercise testing. Twelve COPD patients were recruited to perform 3 training sessions per week for 8 weeks in hyperoxia (n=7) or normoxia (n=5). Each leg was trained 4x4 min at 85-95% of the one-legged peak heart rate. One-legged V O (2peak) increased in the hyperoxia and normoxia training groups by 24 and 15% (16.1(13.2)-20.0(11.3) and 17.4(15.1)-20.0(6.7) mL.kg (-1).min (-1)) respectively. The corresponding increases in V O (2peak) during two-legged testing were 14% in both groups (20.1(11.5)-22.9(10.6) and 18.8(8.5)-21.4(7.3) mL.kg (-1).min (-1)). There were no differences between groups from pre- to post-training. Nor were there any differences between acute hyperoxia and normoxia at the pre- or post-peak exercise test. One-legged aerobic high intensity interval cycling significantly increases V O (2peak) in COPD patients. However, breathing supplemental oxygen during training or testing does not appear to improve V O (2peak) above the level attained by breathing ambient air.

Daily Physical Activity in Total Hip Arthroplasty Patients Undergoing Different Surgical Approaches: A Cohort Study.

Objective Muscle weakness due to trauma from the surgical approach is anticipated to affect the ability of the patient to undertake daily physical activity early after total hip arthroplasty (THA). The objective of this study was to compare daily physical activity on days 1 to 4 after discharge, in patients following THA performed by 1 of 3 surgical approaches. Design A cohort study included 60 hip osteoarthritis patients, scheduled for THA, allocated to direct lateral approach, posterior approach, or anterior approach. Daily physical activity was measured by an accelerometer, with upright time per 24 hours as primary outcome and walking time, number of steps, and number of upright events per 24 hours as secondary outcomes. Results There were no statistically significant group differences in any of the measures of daily physical activity (P > 0.290) or between days of follow-up (P > 0.155). Overall, the median participant had 3.50 hours (interquartile range, 2.85–4.81 hours) of upright time, and participants showed wide variation in all outcomes of daily physical activity. Conclusions There were no differences in daily physical activity between THA patients undergoing different surgical approaches. The surgical approach may not be a limiting factor for daily physical activity early after surgery in a fast-track treatment course.

A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty: Implementing maximal strength training into clinical practice

Background and purpose — Total hip arthroplasty (THA) patients have reduced muscle strength after rehabilitation. In a previous efficacy trial, 4 weeks’ early supervised maximal strength training (MST) increased muscle strength in unilateral THA patients <65 years. We have now evaluated muscle strength in an MST and in a conventional physiotherapy (CP) group after rehabilitation in regular clinical practice. Patients and methods — 60 primary THA patients were randomized to MST or CP between August 2015 and February 2016. The MST group trained at 85–90% of their maximal capacity in leg press and abduction of the operated leg (4 × 5 repetitions), 3 times a week at a municipal physiotherapy institute up to 3 months postoperatively. The CP group followed a training program designed by their respective physiotherapist, mainly exercises performed with low or no external loads. Patients were tested pre- 3, 6, and 12 months postoperatively. Primary outcomes were abduction and leg press strength at 3 months. Other parameters evaluated were pain, 6-min walk test, Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) Physical Function Short-form score. Results — 27 patients in each group completed the intervention. MST patients were substantially stronger in leg press and abduction than CP patients 3 (43 kg and 3 kg respectively) and 6 months (30 kg and 3 kg respectively) postoperatively (p ≤ 0.002). 1 year postoperatively, no intergroup differences were found. No other statistically significant intergroup differences were found. Interpretation — MST increases muscle strength more than CP in THA patients up to 6 months postoperatively, after 3 months’ rehabilitation in clinical practice. It was well tolerated by the THA patients and seems feasible to conduct within regular clinical practice.