William S. Quillen

The Impact of Obesity on Back and Core Muscular Endurance in Firefighters

The purpose of this study was to assess the relationships between obesity and measures of back and core muscular endurance in firefighters. Methods. A cross-sectional study was conducted in career firefighters without low back pain. Obesity measures included body mass index (BMI) and body fat percentage assessed with air displacement plethysmography. Muscular endurance was assessed with the Modified Biering Sorensen (back) and Plank (core) tests. Relationships were explored using t-tests and regression analyses. Results. Of the 83 participants enrolled, 24 (29%) were obese (BMI ≥ 30). Back and core muscular endurance was 27% lower for obese participants. Significant negative correlations were observed for BMI and body fat percentage with back and core endurance (r = −0.42 to −0.52). Stepwise regression models including one obesity measure (BMI, body fat percentage, and fat mass/fat-free mass), along with age and self-reported physical exercise, accounted for 17–19% of the variance in back muscular endurance and 29–37% of the variance in core muscular endurance. Conclusions. Obesity is associated with reduced back and core muscular endurance in firefighters, which may increase the risk of musculoskeletal injuries. Obesity should be considered along with back and core muscular endurance when designing exercise programs for back pain prevention in firefighters.

STAIR ASCENT AND RAMP GAIT TRAINING WITH THE GENIUM KNEE

Accepted May 1, 2013. Address correspondence to M. Jason Highsmith, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4799, USA. Tel: +1-813-974-3806 (office); Fax: +1-813-974-8915; E-mail: mhighsmi@health.usf.edu Technology and Innovation, Vol. 15, pp. 349–358, 2014 1949-8241/14

Impact of a Supervised Worksite Exercise Program on Back and Core Muscular Endurance in Firefighters

90.00 + .00 Printed in the USA. All rights reserved. DOI: http://dx.doi.org/10.3727/194982413X13844488879267 Copyright  2014 Cognizant Comm. Corp. E-ISSN 1949-825X www.cognizantcommunication.com

Perceived differences Between the Genium and the c-LeG m icro Processor Prosthetic Knees in Prosthetic-reLated function and QuaLity of Life

Purpose. Low back pain is a leading cause of disability in firefighters and is related to poor muscular endurance. This study examined the impact of supervised worksite exercise on back and core muscular endurance in firefighters. Design. A cluster randomized controlled trial was used for this study Setting. The study occurred in fire stations of a municipal fire department (Tampa, Florida). Subjects. Subjects were 96 full-duty career firefighters who were randomly assigned by fire station to exercise (n = 54) or control (n = 42) groups. Intervention. Exercise group participants completed a supervised exercise targeting the back and core muscles while on duty, two times per week for 24 weeks, in addition to their usual fitness regimen. Control group participants continued their usual fitness regimen. Measures. Back and core muscular endurance was assessed with the Biering-Sorensen test and plank test, respectively. Analysis. Changes in back and core muscular endurance from baseline to 24 weeks were compared between groups using analysis of covariance and linear mixed effects models. Results. After 24 weeks, the exercise group had 12% greater (p = .021) back muscular endurance and 21% greater (p= .0006) core muscular endurance than did the control group. The exercise intervention did not disrupt operations or job performance. Conclusion. A supervised worksite exercise program was safe and effective in improving back and core muscular endurance in firefighters, which could protect against future low back pain.

Metabolic Demands of Rock Climbing in Transfemoral Amputees

Microprocessor knees (MPKs) are a viable option for persons with transfemoral amputation (TFA). Studies have assessed biomechanics and physical function to quantify MPK functional performance. However, it is also essential to assess patient perception as part of evidence-based practice using valid and reliable measures. The Prosthesis Evaluation Questionnaire (PEQ) evaluates prosthetic-related function and quality of life. The PEQ has been used in MPK literature to compare perceptive response between C-Leg and non-microprocessor-controlled knee mechanisms. The Genium, a new MPK, has not been assessed for differences in perceived function. The purpose of this project was to report perceived differences in prosthetic function and quality of life following accommodation with a Genium compared with a C-Leg. Twenty people with TFA participated in this randomized crossover study. C-Leg users randomized to test first with their own C-Leg or a Genium then crossed over into the other condition for repeated testing. Nonknee prosthetic attributes were held constant. Participants completed the PEQ for each knee condition to compare perceived differences in prosthetic function and quality of life. Genium use resulted in significant improvements (p ≤ 0.05) in the following scales — Perceived Response, Social Burden, Utility, and WellBeing — as well as in individual items related to improved standing comfort, satisfaction with walking ability, and improved gait in tight spaces, hills, and slippery surfaces (p < 0.025). As a result of using the Genium, patients perceive improvements in prosthetic-related quality of life and function. Further, patients perceive improvements in very specific mobility functions related to ambulation on complex settings.

Correlations between residual limb length and joint moments during sitting and standing movements in transfemoral amputees

This pilot study compared the energy expenditure required to climb an indoor rock wall, in amputees utilizing five prosthetic configurations. Three experienced climbers (1M age 21 yr, 2F ages 30 and 49 yr) with unilateral transfemoral amputation climbed a 9.14 m indoor rock wall, 5.9 Yosemite Decimal Scale rating, using the following prosthetic configurations: 1. no prosthesis; 2. stubby prosthesis-foot forward; 3. stubby prosthesis-foot backward; 4. articulated prosthesis-knee unlocked; 5. articulated prosthesis-knee locked. Subjects climbed three times with each configuration resulting in 15 climbs per subject. Metabolic data was collected using the COSMED K4b(2) system. VO(2) was 15, 18 and 20% greater in the articulated unlocked condition (mean+/-SE: 20.5+/-0.8 ml.kg (-1).min (-1)), and 11, 13 and 15% greater in the articulated locked condition (19.7+/-0.9 ml.kg (-1).min (-1)), compared to the no prosthesis (17.8+/-0.7 ml.kg (-1).min (-1)), stubby backward (17.4+/-0.7 ml.kg (-1).min (-1)) and stubby forward (17.1+/-0.9 ml.kg (-1).min (-1)) conditions. Participants expended 11-20% more energy using the articulated prostheses than with the stubby and no prosthesis conditions. In persons with transfemoral amputation, use of an articulated prosthesis in indoor rock climbing may be a disadvantage in many aspects including competition, training, rehabilitation and satisfaction with the activity.

Spatiotemporal Parameters and Step Activity of a Specialized Stepping Pattern Used by a Transtibial Amputee During a Denali Mountaineering Expedition

Background and aim: Longer residual limb lengths provide an increased lever arm. Longer residual limbs may produce increased joint moments; the two may be correlated. These correlations have not been evaluated in transfemoral amputees during transitional movements. Correlations between residual limb length and involved side joint moment could contribute to justification supporting maximal residual limb length preservation. This study investigated possible correlations between hip or knee moment and residual limb length. Technique: Hip and knee joint moments were determined while 21 transfemoral amputees performed sitting and standing movements and then evaluated for correlation with residual limb length. Discussion: Residual limb length was not correlated with either knee or involved side hip moments during sit to stand or stand to sit. Conversely, weak inverse correlations (p < 0.05) existed between sound hip moment magnitude and residual limb length. These correlations suggest that in community ambulating transfemoral amputees, longer residual limb length could decrease sound hip kinetic burden during transitional movement. Beyond correlations between residual limb length and sound hip transitional movement kinetics, there are other considerations in determining residual limb length during amputation. Clinical relevance This study examines relationships between lower limb joint moments and residual limb length related to sit-to-stand and stand-to-sit activities. The results have implications for amputation surgery and rehabilitation.

Effect of Lumbar Progressive Resistance Exercise on Lumbar Muscular Strength and Core Muscular Endurance in Soldiers

ABSTRACT Specialized mountaineering stepping patterns have not been studied in persons with transtibial amputation (TTA). The purpose of this report was to describe spatiotemporal differences between the specialized French technique and traditional stepping in an individual with TTA and report his step activity during a climbing expedition in Denali, AK, USA. A 51-year-old old man with TTA recorded step count and activities during a summit attempt on Mt. McKinley (Denali). After the climb, the subject traversed a GAITRite walkway simulating French and traditional stepping to compare spatiotemporal differences between stepping patterns. The climber completed 8 days on the trail, with a total step count of 62,421 and average daily count of 10,404. Approximately 27% of the steps were taken using the French technique. Five total events were logged: one dermatologic, three musculoskeletal events, and the culminating event was cardiovascular in nature, where the climber reported overheating and exertion requiring climb cessation and evacuation. For velocity, the French technique was slower than traditional stepping. Stride, step, and double support times were greater in the French technique compared with traditional stepping. Spatially, stride and step lengths were greater in the traditional compared with the French technique. The base of support width was wider in the French than in the traditional stepping. Musculoskeletal rather than dermatologic issues predominated in the event log. Fatigue ultimately concluded the climb, warranting further investigation into balancing component durability and mass in terms of prosthetic foot selection. As altitude increased, the French technique was selected as the preferred stepping strategy. The French technique is ultimately a slower stepping technique favoring stability over mobility.

Concurrent Validity of the Continuous Scale-physical Functional Peformance-10 (CS-PFP-10) Test In Transfemoral Amputees

OBJECTIVES Low back pain is common, costly, and disabling for active duty military personnel and veterans. The evidence is unclear on which management approaches are most effective. The purpose of this study was to assess the effectiveness of lumbar extensor high-intensity progressive resistance exercise (HIPRE) training versus control on improving lumbar extension muscular strength and core muscular endurance in soldiers. METHODS A randomized controlled trial was conducted with active duty U.S. Army Soldiers (n = 582) in combat medic training at Fort Sam Houston, Texas. Soldiers were randomized by platoon to receive the experimental intervention (lumbar extensor HIPRE training, n = 298) or control intervention (core stabilization exercise training, n = 284) at one set, one time per week, for 11 weeks. Lumbar extension muscular strength and core muscular endurance were assessed before and after the intervention period. RESULTS At 11-week follow-up, lumbar extension muscular strength was 9.7% greater (p = 0.001) for HIPRE compared with control. No improvements in core muscular endurance were observed for HIPRE or control. CONCLUSIONS Lumbar extensor HIPRE training is effective to improve isometric lumbar extension muscular strength in U.S. Army Soldiers. Research is needed to explore the clinical relevance of these gains.

Functional performance differences between the Genium and C-Leg prosthetic knees and intact knees.

The Continuous Scale-Physical Functional Performance-10 (CS-PFP-10) test consists of 10 standardized daily living tasks that evaluate overall physical functional performance and performance in five individual functional domains: upper body strength (UBS), upper body flexibility (UBF), lower body strength (LBS), balance and coordination (BAL), and endurance (END). This study sought to determine the concurrent validity of the CS-PFP-10 test and its functional domains that involve the lower extremities (LBS, BAL, or END) in comparison to measures that have established validity for use in persons with transfemoral amputation (TFA). Ten TFA patients functioning at K3 or higher (Medicare Functional Classification Level) completed the study. Participants were assessed performing the CS-PFP-10, Amputee Mobility Predictor (AMP), 75 m self-selected walking speed (75 m SSWS) test, timed down stair walking (DN stair time), and the limits of stability (LOS) balance test. Concurrent validity was assessed using correlation analysis. The AMP, 75 m SSWS, LOS, and the DN stair time tests were strongly correlated (r = ± 0.76 to 0.86) with their paired CS-PFP-10 domain score (LBS, BAL, or END) and CS-PFP-10 total score. These findings indicate that the lower limb and balance domains of the CS-PFP-10 are valid measures to assess the physical functional performance of TFA patients.