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A-39 Exercise is Medicine/Poster - Exercise is Medicine - Special Populations

Medicine & Science in Sports & Exercise: May 2013 - Volume 45 - Issue 5S - p 49–52
doi: 10.1249/01.mss.0000433614.59050.a5

May 29, 2013, 7:30 AM - 12:30 PM

Room: Hall C

247 Board #99 May 29, 11:00 AM - 12:30 PM

Nurse-led Group Exercise Program For Cancer Survivors In The Community

Joy Kiviat. University of Arizona, Tucson, AZ.

(No relationships reported)

PURPOSE: The value of exercise in enhancing recovery and quality of life after cancer treatment has been firmly established. The ACS and ACSM published guidelines that support exercise as an important component of survivorship care planning. However, recent studies document that many cancer survivors do not exercise. A group exercise program, led by an oncology certified RN, was implemented to engage cancer survivors in regular exercise to promote physical and emotional recovery, while monitoring well-being and safety and educating participants about healthy living.

METHODS: A weekly group exercise class for cancer survivors, incorporating stretching, aerobics, and resistance training, was implemented at a location near oncology clinics. Promotional efforts included emails and flyers distributed to oncologists, local media reports, and a video on the College of Nursing website. The instructor determined each enrollee’s goals and readiness to exercise. Participants completed a survey of physical and emotional well-being prior to starting the class, and again six weeks and one year after starting or upon discontinuing. Participants were also asked to maintain a log of physical activity outside of class. An additional class was intiated in the second year at a senior community center.

RESULTS: A total of seven cancer survivors enrolled the first year. After one year, five of the original participants continue to attend class regularly. The surveys showed that participants achieved their exercise goals and described increased strength and endurance and improved mood as a result of the class. In addition, the participants demonstrated compassion and support for one another. Enrollment at the second location is currently in progress.

CONCLUSIONS: The results highlight the importance of engaging the community and cancer survivors’ physicians. Cancer survivors face many barriers to exercise participation, including lack of knowledge about safety, fatigue and pain, concerns about body image, and lack of physician recommendations to exercise. The nurse-led group exercise class piloted here offers guidance on overcoming these barriers and engaging cancer survivors in a fun, safe, supportive environment while directing them to meet established activity guidelines.

248 Board #100 May 29, 11:00 AM - 12:30 PM

Preliminary Results From a Cancer Survivor Rehabilitation Program

Timothy R. Burnham1, Hillary Conner2, Katie Kemble3, Amanda Esmond3, Mary Gunkel3, Tamara Wells3, Jamey Peters1, Katie Justice1. 1Central Washington University, Ellensburg, WA. 2Wenatchee Valley YMCA, Wenatchee, WA. 3Wenatchee Valley Medical Center, Wenatchee, WA.

(No relationships reported)

Cancer survivors in the U.S. now total over 12 million. The symptoms remaining post-treatment may lead to a decrease in quality of life. Often patients are left without guidance to rehabilitate themselves back to prior physical, emotional and psychosocial status. Rehabilitation for patients with cancer should be no different from rehabilitation for other diagnostic conditions, including both educational and functional components.

PURPOSE:To measure the effectiveness of a cancer survivor rehabilitation program.

METHODS: Twenty-five post-treatment cancer survivors, (21 breast, 3 colon, 1 lung, 2 men, 23 women, ages 35-77 years) were subjects in a one group pre-post quasi-experimental design. Subjects were cleared for exercise by their primary oncologist. If the subjects were surviving breast cancer, they were evaluated by an occupational therapist for lymphedema. The program consisted of two 90 minutes sessions a week for 12 weeks. Each meeting was divided into 3 sections: an educational activity, cardiovascular endurance training, and a strength and flexibility session. The dependent measures included: aerobic capacity (VO2max), body fat %, blood pressure, lower body flexibility, handgrip strength, quality of life, Schwartz fatigue scale, and the LASA scale (fatigue, anxiety, confusion, depression, energy and anger). A paired t-test was used for pre-post measures.

RESULTS: Aerobic capacity increased 21% (p = .0001), body fat decreased by 1.76 % (p = .001), lower body flexibility improved 16% (p = .02), and handgrip strength increased 12% (p = .01). Fatigue measured by the Schwartz scale decreased 32% (p = .001), LASA scale

RESULTS: fatigue decreased 64% (p = .001), depression decreased 68% (p = .001), confusion decreased 62% (p = .008), energy increased 62% (p = .001) and anger decreased 61% (p = .03). Quality of life increased 15% (p = .008).

CONCLUSIONS: This program gave the participants the tools to change their lifestyles for the better. They developed a fundamental knowledge of the physiological and psychological changes that can occur with lifestyle choices and they had a support system with other participants. This combination of tools acquired in the cancer rehabilitation program proved effective at reducing symptoms often seen in post-treatment cancer survivors and improving overall quality of life.

249 Board #101 May 29, 11:00 AM - 12:30 PM

Physical Activity Associates with Lower Limb Lymphedema Among Uterine Cancer Survivors

Justin C. Brown1, Gabriella M. John2, Saya Segal1, Christina S. Chu1, Kathryn H. Schmitz, FACSM1. 1University of Pennsylvania, Philadelphia, PA. 2Columbia University, New York, NY.

(No relationships reported)

PURPOSE: Physical activity (PA) is known to provide physical and mental health benefits to uterine cancer survivors. However, it is unknown if PA associates with lower limb lymphedema (LLL), an accumulation of protein-rich fluid in the lower limbs. Therefore, we sought to examine the association between PA, and LLL in uterine cancer survivors, with a focus on walking.

METHODS: We conducted a cross-sectional study using mailed surveys among uterine cancer survivors who received care at a university-based cancer center. We asked about PA, walking, and LLL symptoms using validated self-report questionnaires. PA was calculated using metabolic equivalent hours per week (MET-hrs/wk), and walking was calculated using blocks per day (blocks/d).

RESULTS: The response rate to our survey was 43%. Among the 213 uterine cancer survivors in our survey, 36% were classified as having LLL. Compared with participants who reported <3 MET-hrs/wk of PA, participants who reported ≥18.0 MET-hrs/wk of PA had an odds ratio of LLL of 0.35 (95% CI: 0.18-0.70; Ptrend = .002). Compared with participants who reported <4.0 blocks/d of walking, participants who reported ≥12 blocks/d of walking had an odds ratio of LLL of 0.25 (95% CI: 0.12-0.50; Ptrend < .0001).

CONCLUSIONS: These results suggest PA, walking, and LLL are associated. Additional research is needed to elucidate the causal effects of increasing PA or walking and LLL outcomes among uterine cancer survivors.

250 Board #102 May 29, 11:00 AM - 12:30 PM

The Immediate Antihypertensive Effects of Acute Aerobic Exercise: A Meta-Analysis

TaShauna U. Goldsby1, Hayley V. MacDonald2, Tania B. Huedo-Medina2, Blair T. Johnson2, Linda S. Pescatello, FACSM2. 1The Hospital of Central Connecticut, New Britain, CT. 2University of Connecticut, Storrs Mansfield, CT.

(No relationships reported)

Introduction: Aerobic exercise (AE) is recommended as antihypertensive therapy because of its short (i.e., acute or post exercise hypotension [PEH]) and long-term (i.e., training) BP reductions of 5-7 mmHg.

PURPOSE: To explore the efficacy of PEH as an antihypertensive therapy.

METHODS: PEH trials were retrieved from PubMed with the following inclusion criteria: adults 19y+; non-exercise, non-diet control group; pre- and post-BP for the control and AE groups; and Frequency, Intensity, Time and Type of AE. Excluded were diet or drug trials or samples with non-cardiovascular related diseases. Analyses followed random-effects assumptions.

RESULTS: 48 qualifying studies evaluated 101 AE interventions. Participants were middle–aged (39.1±3.5y), overweight (26.8±2.8kg/m2) men (59%) and women (41%), with prehypertension (systolic BP [SBP] 131.2±15.7/diastolic BP [DBP] 81.7±9.4mmHg). AE bouts were performed at moderate-vigorous intensity (6.0 2.3METs) for 32.110.4minsession-1. The post-exercise observation period was 68.529.1min in the lab and 10.32.3h under daytime ambulatory conditions. PEH resulted in small reductions (SBP d=-.25, 1.7mmHg; DBP d=.36, 3.5mmHg) in the lab, and small-moderate reductions (SBP d=-.43, 4.0mmHg; DBP d=.28, 3.5mmHg) under ambulatory conditions; moderators qualified these reductions. In the lab, DBP was reduced to greater levels among samples with higher resting DBP (β= -.24, p=.05); 0.5 mmHg for normal BP and prehypertension and 2.0 mmHg for hypertension; and SBP with AE interventions of greater intensity (β=0.23, p=.04); 4.8 mmHg for >6METs, 1.3 mmHg 3-6METs, and +0.8mmHg for <3METs. Under ambulatory conditions, SBP was reduced to greater levels among samples with higher resting SBP (β=-.54, p=.01); +3.5mmHg for normal BP, 0.7mmHg for prehypertension; and 10.4 mmHg for hypertension; and older samples (β= -.56, p=.001); 9.7mmHg for >69y, 1.8mmHg for 39-69y, and +3.6mmHg for 19-<39y.

CONCLUSION: This meta-analysis is the first to show PEH results in overall BP reductions that rival the magnitude of those from training and are sustained throughout the day under ambulatory conditions. PEH was more pronounced among samples with higher resting BP under both conditions, AE interventions of higher intensity in the lab, and older samples under ambulatory conditions.

251 Board #103 May 29, 11:00 AM - 12:30 PM

Post-exercise Hypotensive Responses Following A Single-bout Of Aquatic And Overground Treadmill Exercise In People Post-stroke

Byron Lai, Yumi Kim, Brenda Jeng, Mai Narasaki-Jara, Konstantinos Vrongistinos, Taeyou Jung. California State University Northridge, Northridge, CA.

(No relationships reported)

Post-exercise hypotension (PEH) has been well documented. Aquatic treadmill exercise (ATE) has shown greater immediate reductions in blood pressure (BP) after exercise compared to overground treadmill exercise (OTE) in healthy adults. Limited studies have examined PEH responses in people post-stroke and none investigated such responses following ATE in this population.

PURPOSE: To compare PEH responses following a single bout of aquatic and overground treadmill walking in people post-stroke.

METHODS: A total of 14 individuals post-stroke (mean age 58.5± 6.7; 8 males, 6 females; average 8.5 ± 4.3 years post-stroke) completed a single-bout of ATE and OTE on separate visits while their BPs were continuously measured. After 20 minutes of seated rest each participant performed either ATE or OTE for 15 minutes at 70% of the predicted VO2max with a 5-minute warm-up and cool-down. Each participant’s BP was measured by an ambulatory BP monitor before, during, and after exercise up to 8 hours. A separate day was assigned to collect their BP measures from a no exercise control day.

RESULTS: ANOVA revealed significantly lower systolic BP during ATE than OTE while no difference was found during the seated rest (p< .05). In addition, ATE showed significantly lower BP during earlier hours following exercise (1-4 hours post exercise) as compared to OTE (p< .05). When compared to BP measures from the no exercise control day, both ATE and OTE demonstrated lower BP after exercise that was sustained up to 8 hours. However, the onset of the PEH was earlier (1 hour post exercise) on the ATE day as compared to that of OTE (4 hours post exercise).

CONCLUSION: Our findings suggest that both aquatic and overground exercise can elicit PEH in people post-stroke. The results demonstrate that aquatic exercise can show greater reductions in BP during exercise and after exercise, particularly in the immediate few hours post-exercise in the stroke population, when compared to overground exercise. These outcomes may help rehabilitation professionals advance their understanding of PEH to provide non-pharmaceutical interventions for the management of BP in people post-stroke.

252 Board #104 May 29, 11:00 AM - 12:30 PM

The Implementation of a Neuromuscular Training Program with Two Adolescent Fibromyalgia Patients: A Case Report

Staci Thomas, Soumitri Sil, Dan Strotman, Tracy V. Ting, Chris DiCesare, Susmita Kashikar-Zuck, Gregory D. Myer, FACSM. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

(No relationships reported)

PURPOSE:Patients with juvenile fibromyalgia experience chronic widespread musculoskeletal pain and significant physical impairments. Although exercise is a beneficial treatment to manage pain, few patients with fibromyalgia actually fulfill the prescribed recommendations for engaging in physical activity. Patients with fibromyalgia can improve their exercise tolerance by addressing condition-specific deficits that may put them at an increased risk of pain and even injury with exercise. We hypothesized that the implementation of a directed neuromuscular training program will reduce functional deficits in both strength and dynamic stability in patients with fibromyalgia.

METHODS:Two adolescent female patients (mean ± SD age 17.8 ± 1.2 years) with fibromyalgia were pre and post tested to measure the effect of an 8-week modified neuromuscular training program, which occurred 2x per week and consisted of core strengthening, postural control, and resistance training exercises. Testing measures included isokinetic knee extension and flexion strength, isokinetic hip abduction strength, and the Star Excursion Balance Test (SEBT).

RESULTS:Subject 1 showed improvements in the following measures: Knee extension strength - LEFT (Pre-test Values, % change) 0.74 ftlbs/kg, +3.1%, hip abduction strength - LEFT 0.35 ftlbs/kg, +70.1%, SEBT Composite score RIGHT 67.3%, +24.5%, LEFT 68.5%, +8.2%. Subject 2 showed improvements in the following measures: Knee extension strength - LEFT 0.65 ftlbs/kg, +19.3%, hip abduction strength - LEFT 0.49 ftlbs/kg, +22.5%, SEBT Composite score RIGHT 75.13%, +17.1%, LEFT 81.1%, +17.1%. Improvements were not seen with knee flexion strength in either subject.

CONCLUSIONS:These results indicate that implementing a modified neuromuscular training program with adolescent fibromyalgia patients may improve deficits in knee strength, hip strength, and dynamic stability as measured in this report. Improvement in these measures may help to prepare patients with fibromyalgia for participation in physical activity by possibly lowering their risk for pain flare-ups as well as potentially decreasing the risk of sustaining a physical activity related injury.

253 Board #105 May 29, 11:00 AM - 12:30 PM

Oxandrolone, Propranolol, And Exercise Effects On Muscle Mass And Function In Hispanic Children With Burns

Marshall Gillette, Leybi Ramirez, David N. Herndon, Ronald P. Mlcak, Oscar E. Suman, FACSM. University of Texas Medical Branch, Galveston, TX.

(No relationships reported)

Previous studies report that a disproportionally large number of Hispanic children are burned every year. After a burn that covers ≥30% of total body surface area, resting heart rate and metabolism increase significantly, resulting in a hypermetabolic, muscle wasting state that persists for up to two years. Low testosterone and inactivity cause a further decrease in muscle mass, strength, and function.

PURPOSE: This study tested the hypothesis that oxandrolone, a testosterone analogue, paired with propranolol (OxProp) and combined with a 6-week exercise program would attenuate hypermetabolism muscle wasting and improve functional outcomes.

METHODS: Hispanic pediatric burn patients ages 7 to 17(n=20) were randomly chosen to receive OxProp (n=10) or placebo (PLA; n=10). Oxandrolone was given at a dose of 0.1 mg/kg/bid and propranolol was given at a dose titrated to achieve a 20% decrease in resting heart rate. Patients began drug treatment on admission after parents gave informed consent and child assent if applicable. When discharged from acute care (95% healed) patients underwent baseline testing consisting of: Dual Energy X-ray Absorptiometry to assess lean mass (LM), isokinetic dynamometry to assess leg strength (LS), and a treadmill test to assess cardiopulmonary function (peak oxygen consumption; VO2peak). Tests were repeated at the completion of a 6-weeks exercise program. Results were analyzed using a paired t-test within groups and an unpaired t-test between groups, with significance set at p < 0.05.

RESULTS: OxProp and PLA groups significantly improved in LM (6.42% p=0.05 v. 7.07% p<0.01 respectively), in LS (36.20% p<0.01 v. 47.80% p<0.01 respectively) and in VO2peak (32.30% p<0.01 v. 20.63% p=0.01). However, both groups improved similarly in all outcomes (p > 0.05).

CONCLUSIONS: Exercise ameliorated loss of LM, LS, and VO2peak. However, OxProp did not appear to have an additional effect when combined with exercise. We advocate the continued use of exercise. OxProp may need to be given for a longer period to ameliorate post burn sequelae. This project was supported by grants from the National Institute for Disability and Rehabilitation Research (H133A070026, H133A70019), the National Institutes of Health (P50-GM60338, R01-HD049471), and Shriners Hospitals for Children (84080 and 71009).

254 Board #106 May 29, 11:00 AM - 12:30 PM

Comparison of the Effects of Varying Exercise Intensities vs. Albuterol on Pulmonary Function in Patients with Cystic Fibrosis

Courtney M. Wheatley1, Mary A. Morgan1, Sarah E. Baker1, Eric C. Wong1, Marina Martinez1, Wayne J. Morgan1, Eric M. Snyder2. 1University of Arizona, Tucson, AZ. 2University of Minnesota, Minneapolis, MN.

(No relationships reported)

PURPOSE:Exercise has become a vital component of the therapy prescribed to cystic fibrosis (CF) patients due to its systemic benefits such as increased sputum expectoration, attenuation of the 2-3% expected annual decline in pulmonary function, and extended life expectancy. However, exercise is not viewed to be as beneficial as pharmacological treatments by many CF patients and can be intimidating. As such, we sought to investigate the intensity of exercise necessary for increases in pulmonary function comparable to albuterol.

METHODS:We recruited 12 patients with CF (age=20±8years, ht=165±18cm. wt=60±12kg, BMI=22±2kg/m2, VO2peak=79±17%pred., FVC=98±32%pred. , FEV1=86±29%pred., FEF25-75=64±31%pred.) to complete three visits. First, a VO2 max test was completed. On the two subsequent visits, subjects completed maximal expiratory flow-volume and diffusing capacity of the lungs for nitric oxide (DLNO) maneuvers either at baseline, 30, and 60 minutes post-albuterol administration or at baseline and the midway point of three separate 15 min exercise bouts at low, moderate and high intensity (25, 50and 75% of the maximum workload, respectively).

RESULTS:Moderate intensity exercise mediated greater improvements in DLNO and similar levels of bronchodilation, forced expiratory flow at 25-75% of the FVC (FEF25-75), compared to 60 minutes post-albuterol administration in CF patients. There was a decline in forced vital capacity (FVC) with exercise that did not occur with albuterol (DLNO=11±11, 17±22, 17±22, 41±31*, 53±29%*; FEF25-75=22±13, 23±22, 9±23, 34±4, 15±42%; FVC=5±4, 4±4, -5±8*, -7±6*, -15±20*%; percent change from baseline for 30min post, 60min post albuterol, 25%, 50% and 75% exercise respectively,*p<0.05 vs. 60min post). As expected, epinephrine (EPI) release increased with exercise intensity (EPI= 30±35, 51±46, 156±114, percent change for 25, 50, 75% respectively).

CONCLUSIONS:Our results suggest that moderate intensity exercise is the best dose for CF patients, as low intensity does not mediate sufficient epinephrine release and high intensity is working CF patients too hard that airflow is restricted. Although the duration of the beneficial effect is uncertain, exercise can promote greater improvements in gas diffusion and comparable bronchodilation to albuterol administration.

255 Board #107 May 29, 11:00 AM - 12:30 PM

Cardio-respiratory Fitness Improvement In Obese Pregnant Women Following A 12 Week Exercise Program: Pilot Study

Michèle Bisson1, Natalie Alméras2, Sébastien Dufresne1, Emmanuel Bujold1, Caroline Rhéaume2, Jérôme Frenette1, Angelo Tremblay2, Isabelle Marc1. 1Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, QC, Canada. 2Research Centre of the Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, QC, Canada.

(No relationships reported)

Although exercise is safe during pregnancy, most obese pregnant women are inactive. Inactivity in obese pregnant women before and during pregnancy contributes to a non-optimal fetal environment that may have consequences on mother’s and child’s health. However, little data objectively documents the potential of an exercise intervention for improving fitness in obese women during pregnancy.

PURPOSE: To evaluate the impact of a supervised 12 week exercise program on maternal cardio-respiratory and muscular fitness.

METHODS: Obese pregnant women (BMI≥30 kg/m2) were recruited and randomly assigned at 15 weeks of pregnancy to either a 12 week individually supervised exercise program in a hospital-based setting, or to a non-exercising control group. The prescribed exercise training consisted of 3 sessions of 1h each per week, including aerobic exercise at 70% of maximal heart rate and muscular conditioning. Adherence to the intervention was determined as the number of sessions attended by the women divided by the total of prescribed sessions. Fitness assessments before randomization and at 28 weeks of gestation (post-intervention) included cardio-respiratory peak exercise testing on a treadmill, lower and upper limbs muscle function with an isokinetic dynamometer, anthropometric measurement, physical activity assessment by accelerometry and questionnaire, and nutritional evaluation.

RESULTS: While submaximal VO2 at the anaerobic threshold decreased in non-exercising obese pregnant women, cardo-respiratory fitness parameters were maintained or improved in those engaged in an exercise training program (-9.5±6% in control group versus 0.5±7.5% in exercise group, punilateral=0.03, n=10). Adherence to the training sessions was 55% (n=13).

CONCLUSIONS: Supervised exercise training in obese, pregnant women is effective in maintaining or improving maternal fitness. Further investigations are needed to understand all benefits of an exercise program on obese mothers and possibly newborns.

256 Board #108 May 29, 11:00 AM - 12:30 PM

High-Intensity Interval Training on an Aquatic Treadmill: A Promising Treatment Approach for Adults with Osteoarthritis

Eadric Bressel1, Jessica Wing1, Andrew Miller2, Dennis Dolny1. 1Utah State University, Logan, UT. 2Arizona State University, Tempe, AZ.

(No relationships reported)

Although aquatic exercise is considered a potentially effective intervention for people with lower extremity osteoarthritis (OA), previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity. With aquatic treadmills water depth can be adjusted to control joint loading, and jet intensities and belt speeds can be adjusted to incrementally control exercise intensity. However, the efficacy of aquatic treadmill exercise for people with OA is lacking.

PURPOSE: To quantify the efficacy of a six-week aquatic treadmill exercise program on measures of pain, balance, function, and mobility in patients with OA.

METHODS: Nineteen participants (age = 64.5 ± 10.2) with predominate knee OA participated in a crossover study design completing a non-exercise control period followed by a six-week exercise period. Outcome measures were examined before and after the control and exercise periods using visual analog scales for pain, posturography for balance, sit to stand test for function, and a 10 m walk test for mobility. The exercise protocol included balance training and high-intensity interval training (HIT) with an aquatic treadmill using water jets to destabilize the participant while standing and elicit high ratings of perceived exertion (16-19) while walking.

RESULTS: In comparison to pretests, the exercise program resulted in significant (p = 0.03-0.001) reductions in joint pain (pre = 50.3 ± 24.8 mm versus post = 15.8 ± 10.6 mm), improved balance (equilibrium pre = 66.6 ± 11.0 versus post = 73.5 ± 7.1), function (rising index pre = 0.49 ± 0.19% versus post = 0.33 ± 0.11%), and mobility (walk pre = 8.6 ± 1.4 s versus post = 7.8 ± 1.1 s). No changes in outcome measures were observed after the non-exercise control period.

CONCLUSION: Adherence to the exercise protocol was exceptional (100%) and no participants reported adverse effects, suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by OA patients and appears to be effective at managing symptoms of OA.

Supported by a National Swimming Pool Foundation Grant

257 Board #109 May 29, 11:00 AM - 12:30 PM

Strength Gain and Progression Following Concentrically or Eccentrically Focused Resistance Exercise in Knee Osteoarthritis

Cindy Montero, Heather K. Vincent, Amanda N. Seay, Kevin R. Vincent. University of Florida, Gainesville, FL.

(No relationships reported)

PURPOSE: Knee osteoarthritis (OA) adversely affects leg muscle strength and perceived knee function. Traditional, concentrically focused resistance exercise (CONC RX) can improve strength and perception of knee function in this population. By emphasizing eccentric phases of muscle contraction, there is strong potential for eccentrically focused RX (ECC RX) to improve strength in knee OA. We examined whether or not a progressive ECC RX program was safe, tolerable and feasible in knee OA compared to traditional CONC RX.

METHODS: A randomized, controlled study was performed to compare RX programs in older adults with knee OA (N=49, 68±6 yrs). Participants completed 16 weeks (7 machines) of CONC RX, ECC RX, or standard care control (CONT). ECC RX program goals were to attain training weight of 100% ECC 1RM by 8 weeks; CONC RX program goals were to train at 50% 1RM. Repetitions and resistance were structured to match workloads between groups. Strength was assessed using one repetition maximum (1RM). Weekly progression, attrition, adverse events and pain symptoms were monitored.

RESULTS: There was a faster weekly progression with CONC RX versus ECC RX in leg press (CONC: 9.8±5.3 Nm/wk, ECC: 2.9±2.1 Nm/wk; p<.001) and leg curl (CONC: 6.8±4.1 Nm/wk, ECC: 2.9±2.1 Nm/wk, p=.001), but not leg extension (CONC: 5.9±3.1 Nm/wk, ECC: 4.7±3.5 Nm/wk, p=.317). Adjusted regression models showed that weekly progression predicted absolute change in strength for each exercise with a 20-38% variance (r range = 0.203-0.386; p<.001). Attrition rates remained the same for all groups (∼33%). Adverse events were higher with ECC RX when compared to CONC RX and were related to musculoskeletal discomforts and pain (CONC=2, ECC=8).

CONCLUSIONS: Both RX modes were safe (no serious adverse events), but the ECC RX was related with a slower progression of strength gain. The ECC RX group could not achieve progression goals and this progression structure was not feasible. Group differences might be due to musculoskeletal discomforts in ECC RX, machine design and familiarity, stresses on the knee joint and muscle soreness. Future studies using ECC RX should consider less aggressive progression for knee OA.

258 Board #110 May 29, 11:00 AM - 12:30 PM

Effects of Resistance Exercise Training on Pain Severity and Physical Function in Obese Older Adults with Chronic Low Back Pain

Heather K. Vincent, Amanda N. Seay, Kevin R. Vincent, Cindy Montero, Bryan P. Conrad, Robert W. Hurley. University of Florida, Gainesville, FL.

Supported by H.K. Vincent: Contracted Research - Including Principle Investigator; NIH NIAMS.

Strength deficits in the trunk extensor muscles relate to chronic low back pain (LBP) and functional and mobility impairments. Obesity also contributes to LBP and functional decline, and this is exacerbated in older adults. Resistance exercise training (RX) has strong, but untested potential to increase lumbar strength, decrease LBP and improve mobility and function in obese, older adults.

PURPOSE: To determine whether either of two four-month RX programs (isolated lumbar exercise, total RX) improves pain severity and functional mobility compared to standard care in obese, older adults with chronic LBP.

METHODS: This study examined whether there is differential efficacy in two RX programs compared to a non-exercise control. Older adults (N=48; 68±7 yrs; 33±5 kg/m2) trained for 4 months using isolated lumbar extension (LE) or lumbar extension+total body exercise (TOT), or were controls (CON). Walking endurance, ambulatory LBP severity, chair rise, stair climb and gait parameters were assessed at baseline and month 4. Oswestry disability index (ODI) survey scores, an index of perceived disability due to back pain, were also collected.

RESULTS: Lumbar extensor strength increased 5%, 8% and 14% in the LE, CON and TOT groups, respectively. Walking endurance time increased by 10% (TOT) and 9% (LE) and decreased by 3% in CON. Ambulatory LBP decreased 50-67% in the training groups, compared to 13% in the CON. Chair rise time decreased 0.27-0.30 sec in the trained groups but increased 0.1 sec in CON. Stair climb time decreased by 11% in TOT, but did not change in the other two groups. Pain severity during the chair rise decreased by 43%, did not change in the LE, and increased by 4% in CON. Stair climb pain severity decreased in all groups by month 4. Walking velocity increased from 112 to 120 cm/sec in TOT by month 4. ODI scores decreased by 19% and 30% in LE and TOT compared to 3% in CON. Regression analyses revealed ODI score change was a significant predictor of the change in walking endurance (R2 .086; p=.044).

CONCLUSIONS: Both RX protocols elicited improvements in mobility and pain compared to CON. RX may improve lumbar strength and perceived disability due to LBP, both of which may be mechanisms underlying performance change with these RX programs.

Supported by NIH Grant RO3 AR057552.

259 Board #111 May 29, 11:00 AM - 12:30 PM

Effects of Neck Strengthening or Upright training on Balance in Patients with Chronic Neck Pain

Yi-Jia Lin1, Cheng-Hsiu Lai2, Chia-Hua Kuo2, Shih-Wei Chou3, Alice May-kuen Wong3. 1National Sports Training Center, Taipei, Taiwan. 2Taipei Physical Education College, Taipei, Taiwan. 3Chang Gung Memorial Hospital, Tao-yuan, Taiwan.

(No relationships reported)

The mechanoreceptors and their connections to the somatosensory system in the cervical region, being responsible for head and body control, may alter in the patients with chronic neck pain and result in balance disturbance. Different types of neck training may improve neck function and balance through different mechanisms.

PURPOSE: The purpose of this study was to compare the effects of neck muscle strengthening and neck upright stability training on balance performance in the patients with chronic neck pain.

METHODS: Thirty six patients, complaining chronic neck pain with the radiographs of non-specific spondylosis, were randomly assigned into two groups: group 1, neck strengthening (the NS group; age: 54.8±4.5years); or group 2, upright stability training (the US group; age: 57.3±5.0years). Either training program consists of 12 sessions in 4 weeks. The SMART Balance Master was employed to acquire equilibrium scores of SOT under 6 conditions, including eyes open & fixed support (EO), eyes closed & fixed support (EC), sway-referenced vision & fixed support (SV), eyes open & sway-referenced support (SS), eyes closed & sway-referenced support (ECSS), and sway-referenced vision & support (SVSS). The visual analog scale (VAS) of neck pain, neck fitness as well as SOT variables were measured and compared using 2-by-2 mixed-model analysis of variance with one between-subject factor (groups: NS vs. US) and one within-subject factor (time interval: pre- vs. post-training).

RESULTS: Group differences in all the SOT variables (p<0.05) were significant except the SV condition. After training, all the SOT variables (Pre vs. Post EO: 94.4±1.2 vs. 95.5±1.1; EOSS: 80.4±15.1 vs. 88.6±3.2; ECSS: 56.8±15.9 vs. 68.1±5.7; SVSS: 56.7±18.2 vs. 70.7±9.3) were significantly improved in NS group except the conditions EC and SV, while none of these variables were changed significantly in the US group.

CONCLUSION: The training in NS group emphasizing the enhancement of neck fitness produced much greater improvements in balance performance than the training in US group emphasizing facilitation of neck righting reflex. Neck fitness training seems to be more effective in the improvement of neck fitness and balance performance in patients with chronic neck pain.

© 2013 American College of Sports Medicine