Aerobic Workout Product
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Aerobic training causes changes in central factors such as the heart and blood volume, which result in a higher maximum oxygen uptake 57 . A significant number of peripheral adaptations also occur with this type of training 58 . The training leads to a proliferation of capillaries and an elevation of the content of mito-chondrial enzymes, as well as the activity of lactate dehydrogenase 1-2 isozymes (LDHj ). Furthermore, the mitochondrial volume and the capacity of one of the shuttle systems for NADH are elevated 59 . These changes cause marked alterations in muscle metabolism. The overall effects are an enhanced oxidation of lipids and sparing of glycogen, as well as a lowered lactate production, both at a given and at the same relative work-rate 58 . The recovery processes from intense exercise are related both to the oxidative potential and to the number of capillaries in the muscles 62 . Thus, aerobic training not only improves endurance performance of an athlete, but also appears...
Exercise, while discouraged when the patient is acutely decompensated to ease cardiac workload, is recommended when patients are stable. The heart is a muscle that requires activity to prevent atrophy. In addition, exercise improves peripheral muscle conditioning and efficiency, which may contribute to better exercise tolerance despite the low CO state. Regular, low-intensity aerobic exercise that includes walking, swimming, or riding a bike is encouraged, while heavy weight training is discouraged. The prescribed exercise regimen needs to be tailored to the individual's functional ability, and thus it is suggested that patients participate in cardiac rehabilitation programs, at least initially. It is important that patients not overexert themselves to fatigue or exertional dyspnea.
If surgery is performed, the athlete is transformed from an athletic person (with the healthy self-image associated with physical activity) to a bedridden, disabled patient. To counteract the negative aspects of this stage (from both a physical and psychological standpoint), it is necessary to initiate a program of rehabilitation goals. Providing an athlete with well-leg aerobic workouts following knee surgery encourages a goal-seeking attitude and helps the athlete maintain aerobic conditioning. In addition, setting appropriate goals for the injured area, for example, achieving a certain range of motion or level of exer-cise intensity, permits the patient to take an active part in treatment and assume a level of control over the postoperative environment.
Cardiovascular deconditioning develops secondary to inactivity in patients with chronic low back pain. Aerobic training to improve cardiovascular endurance is an extremely important part of rehabilitation of the low back. Heart-rate limitations for patients with known or suspected cardiac disease are based on stress testing. Aerobic training (i.e. treadmill, bike, stepper, arm and leg ergometer, walking, jogging, swimming) has multiple beneficial effects
The mainstay of physical therapy for this condition emphasizes flexion exercises, back strengthening, and aerobic conditioning. Aerobic conditioning can be somewhat problematic in this population, but exercises performed in flexion, such as stationary bicycle, enlarge the neural foramen and central canal, minimizing the symptoms of neurogenic claudication. Passive modalities such as ultrasound, massage, heat, and spinal manipulation are useful in that they may temporarily improve symptoms, but their efficacy has not been verified by prospective studies with long-term follow-up.10
Working-out, aerobics and similar activities are excellent, and often essential, rehabilitation methods and useful alternatives during rehabilitation of many injuries. Gym training, with a variety of fixed stations for weight training, has become popular recreational exercise. It is also used for basic pre-season training in almost every sport. There is no better way to learn functional anatomy than to work-out the muscle groups step by step in a gym.
The effects of exercise training on blood pressure show wide variation in different studies. A recent meta-analysis of 44 randomized controlled trials found that aerobic or endurance exercise on nor-motensive and hypertensive men and women resulted on average 3.4 2.4 mmHg net decrease in systolic and diastolic blood pressure, respectively, adjusted for control observations and for the number of trained participants 83 . The effect depends on the initial blood pressure being greater in hypertensive subjects. Another meta-analysis of 10 randomized controlled trials on the effect of aerobic exercise on blood pressure of normotensive and hypertensive women revealed a 2 1 mmHg decrease in systolic and diastolic blood pressure, respectively 84 . A comparable meta-analysis on the effect of progressive resistance exercise including 11 studies found an average 3 3 mmHg blood pressure decrease 85 . Hagberg et al. 86 reported in their updated review of all studies on the effect of exercise...
Cient magnitude (and this for older people requires more individual tailoring), then even in very late life, individuals are able to increase their aerobic power through training. For example Seals et al. 60 reported that 12 months of aerobic training in 60-70-year-old subjects resulted in a mean increase of 30 in Vo2max. In 70-79-year-old men and women 26 weeks of endurance training resulted in an increase in Vo2max of 22 27 . Two recent studies on the oldest old suggest that, as with positive adaptations to strength training, even very elderly people may adapt to aerobic-based physical training. Maltbut-Shannan et al. 61 reported a 15 increase in Vo2max in women aged 80-93 years of age following 24 weeks of progressive aerobic training however, no change was observed in the older men. In a second recent study on the oldest old, Puggaard et al. 62 reported a similar increase in Vo2 max of 18 in women, also over the age of 80 years, following 8 months of general training.
In an award-winning study, Mannion and her colleagues looked at the biomechanical effects of rehabilitation (Mannion et al 1999, 2001a, b, Kaser et al 2001). This was a randomized controlled trial of 148 patients with chronic low back pain. It compared active physiotherapy, muscle reconditioning on training devices, and low-impact aerobics. Pain intensity, frequency, and disability improved after all three treatments and these effects were maintained on 6-month follow-up. However, there was little difference between the three treatments.
What are aerobics If you think that aerobics are just jumping around to bad disco music, dust off your sneaks you're way behind the times. The term aerobic literally means with air.' Therefore, the exercises in which your muscles require an increased supply of air (more specifically, the oxygen within air) are termed aerobic. Aerobic activity is also known as cardiovascular activity (or cardio) because it most definitely challenges your heart and lungs. Think about this When you jog, the large muscles of your lower body are continuously working over an extended period of time and therefore require more than their usual supply of oxygen. Because your heart and lungs are the key players in retrieving and circulating oxygen, they go into overdrive to increase oxygen delivery. Therefore, in addition to working out the large exterior muscles, aerobic activity also provides one heck of a workout for your heart and lungs. Normally, aerobic exercise should last 20-60 minutes, depending upon...
Muscular dystrophies are today incurable inherited disorders characterized by progressive muscle degeneration. There is a great variability in the severity of symptoms and the rate of progression among the different disorders under this heading. Probably due to the diminished muscle mass and strength there is a restricted aerobic exercise capacity and lower power outputs in individuals with Duchenne dystrophy, the most severe type of muscular dystrophy.
If I have a cardiovascular disease and want to participate in aerobic exercise, is it safe Might the training have any positive effects Does regular exercise increase the exercise ability and make it possible to increase the ability to handle daily life The term exercise below generally refers to aerobic exercise, such as walking, swimming, jogging and running.
A Exercise in contraindicated as it may be harmful. b Moderate aerobic training is recommended. c Moderate aerobic training is recommended but only once a week. 5 Which (one or more) of the following statements is are correct about moderate aerobic exercise 6 weeks after uncomplicated acute myocardial infarction
Quired 'clinical bed rest' resulted in a decrease in the isometric strength of 5-15 35 , and in the isometric endurance of 13-18 36 in various major muscle groups tested shortly after the disappearance of clinical symptoms of disease, as compared to subsequent repeated individual baseline results when the patients were healthy. Furthermore, in both young male and young female adults, such infections caused a decrease in the aerobic exercise capacity, as determined from the heart rate response during submaximal exercise, by approximately 25 37 . The aerobic exercise capacity is dependent on central factors, such as the plasma volume, the total hemoglobin and the myocardial function, as well as on peripheral factors, i.e. the state of the skeletal muscles 38 . Potentially, all these factors may be negatively influenced by either the infection or the clinical bed rest that is part of the treatment, or both. In a group of healthy young adult males who served as controls in the studies...
Lifestyle modification should be employed in all patients at risk for OA and in those with established disease. Aerobic exercise and strength-training programs improve functional capacity in older adults with OA. Stretching and strengthening exercises should target affected and vulnerable joints. Isometric exercises performed three to four times weekly improve physicalfunctioning and decrease disability, pain, and analgesic use. Some patients have the misconception that increased activity will exacerbate joint symptoms, but controlled clinical trials have invalidated this belief.10 The American Geriatrics Society issued guidelines on the implementation of exercise in OA patients.11 In general, it is advisable to recommend performing low-impact exercise routinely.
The effect of exercise on body weight has been investigated in several studies. Wing systematically analysed investigations in which exercise without diet intervention had been studied in adults 17 . She found 10 randomized, controlled investigations which fulfilled the criteria set. Most of them included aerobic exercise (mostly walking). In six investigations statistically significant weight loss was observed, in four no change was seen. Thus, exercise without diet intervention seems to cause only minor weight loss, usually no more than 1-2 kg. The number of studies in children is too limited to evaluate the effect of exercise alone on weight reduction 18 . Weight reduction programs use a multidisciplinary approach. These include dietary counselling to decrease energy intake, exercise, and cognitive and behavioral therapy to promote permanent lifestyle changes. What are the effects of exercise in these programs In Wing's review 17 , 13 randomized, controlled trials addressing the...
This implies that preconceptions involving fixed pulse rate, specific types of exercise and whether the exercise is aerobic or not are not criteria of significance in the counselling of an obese individual about exercise. A client should be encouraged to select a type of exercise in which he or she is interested. Many obese people are not interested in formalized exercise programs and for them lifestyle activities are a useful alternative. Lifestyle activity includes taking the stairs instead of taking elevators or escalators, walking journeys of moderate distances instead of taking the car, using manual means to complete domestic tasks instead of using household machines, etc. In a randomized, controlled trial lifestyle activity has been shown to be as effective as aerobic exercise in weight maintenance after weight loss 23 .
In addition to the spectrum of physical therapy approaches, many TBI patients need ongoing encouragement and a structured program to maintain general fitness. An individualized aerobic training program can improve motor skills, decrease fatiguability, and improve mood.140 A randomized trial compared the addition of 3 months of aerobic exercise or of relaxation training to an outpatient therapy program that 142 patients entered a mean of 24 weeks after TBI. The investigators found a significant increase in exercise capacity for the exercise group, but no differences betweeen the two augmented interventions in FIM scores, walking speed or balance, or in report of depression, anxiety, or fatigue.141
Because golf is not an aerobic sport, aerobic conditioning should be included in any effective lower back rehabilitation program. Fairbank et al1 showed that higher aerobic fitness shows a strong negative correlation with the incidence of both lower back pain and disk herniation. Exercise results in increased aerobic metabolism in the outer annulus and the central portion of the nucleus pulposus, bringing about reduction of lactate concentration.26 Also, aerobic conditioning plays a significant role in muscle coordination during periods of fatigue. Fatigue can produce abnormal muscle function and overcompensation and thus resultant injury. Fatigue obviously can affect performance Unfortunately, some patients cannot tolerate certain types of aerobic conditioning that have high levels of loading to the spine, such as jogging. However, several types of aerobic conditioning exercises are highly effective without loading the spine (e.g., water exercises12 and the stair climber).
The effects of energetic arousal on mood and cognition may be the basis for the positive benefits attributed to exercise that are widely reported in the popular media. There is now a large body of books and articles that describe a panoply of psychological changes that presumably occur from running, aerobics, swimming, walking, and other kinds of exercise. Generally, these books do not contain references to scientific research concerning the effects of exercise on mood, but they usually reflect informal reports of experiences by the writers and exercise enthusiasts involved. These positive claims are not surprising one can hardly speak to a person involved in regular exercise without hearing accounts of beneficial mood changes believed to derive from that exercise. Serious scientists may tend to dismiss these accounts because they are not based on controlled studies, but the consistency of the reports of positive benefits at least suggests that exercise has a powerful influence on...
As expected, the exact ratio of carbohydrate and lipid utilized for muscle energy metabolism, a topic recently summarized in an editorial by Layzer, 3 reflects many variables, including the intensity of exertion and its duration, the blood concentration of free fatty acids and oxygen, the amount of blood flow to the muscle, the muscle glycogen concentration, and the muscle's capacity for oxidative metabolism. At rest and during light exercise, skeletal muscle tissue metabolism is aerobic, and consequently it aerobically metabolizes free fatty acids for its energy. As the degree of intensity increases, the supply of lipid-derived energy becomes unable to keep pace with the energy requirement. For this reason, a greater proportion of energy must be contributed by carbohydrate. In general, enough glycogen is available to work intensively for 3 to 4 hours. 4 Should effort continue after the glycogen supply is depleted, the slower rate of lipid metabolism immediately diminishes the...
Muscles that reduces cardiac preloading, and by impaired cardiovascular reflexes. Functional electrical stimulation-induced leg cycle er-gometry can improve both peripheral muscular and central cardiovascular fitness.173 Resistive voluntary arm activity has been combined with electrical stimulation of leg muscles to further enhance aerobic conditioning.174
To stop the inflammation of the spine in an injured athlete often requires rest and immobilization. We try to limit the rest and immobilization to the minimum. Bed rest produces stiffness and weakness, which causes the pain to persist. Stiffness and weakness are the antithesis of the body functions necessary for athletic performance. Every day of rest and immobilization may result in weeks of rehabilitation before the athlete is able to return to performance. As in motion treatment of lower extremity injuries, such as fracture bracing and postoperative continuous motion machines, rapid rehabilitation of lumbar injuries in athletes requires effective means of mobilizing the patient. Bed rest longer than 3 to 5 days is not of any benefit in the natural history of the disease. Rapid mobilization requires strong anti-inflammatory medications, ranging from epidural steroids, oral Medrol Dosepak (methylprednisolone), Indocin SR (indomethacin) to other...
Treatment of medial tibial syndrome is primarily non-surgical. In addition to reduction in the amount of impact activity, massage, stretching and aerobic training with cycling or rowing can have a positive effect on early medial tibial syndrome 1 . Insoles with an antipronation effect may also reduce symptoms. If these conservative measures fail, surgical intervention with fasciotomy is probably the best treatment. Fas-ciotomy for medial tibial syndrome was first done in 1971. The results have been excellent or good in 70-90 9,10,12 . During fasciotomy, the common crural fascia covering the deep posterior compartment should be opened, as well as the separate fascia of the posterior tibial muscle. The distal medial soleus muscle insertion can be freed from the medial tibial border at the same time and the soleus fascia opened proximal-ly 11 . Recovery time to full training is approximately 6 weeks, but there seems to be a longer recovery time and somewhat poorer results in female...
What is the most important component of an exercise program for the treatment of low back pain due to lumbar DDD
The most important component of a low back exercise program is to address fear-avoidance behavior of the patient by reassuring the patient that it is safe to exercise despite the chronic pain he or she may experience. The appropriate exercise program is a supervised active physical therapy program that uses progressive, non-pain contingent exercise (i.e. the patient is encouraged to exercise despite their pain) to increase strength and endurance. Successful outcomes may be achieved with a variety of exercise programs including core strengthening, McKenzie therapy, Pilates, and aerobic conditioning. It is counterproductive to tell patients, Let pain be your guide. Patients with lumbar DDD must be reassured that they will not do any damage to their spine, even if exercise is painful.
It makes sense to get the numbers working in your favor. The New England Journal of Medicine studied 34 formerly obese women who lost an average of 25 pounds. Moderate to sedentary women in one year gained back from 14 to 20 pounds. They also found a surprising exercise level necessary to loose weight, long term. The women who kept the weight off averaged 80 minutes per day of moderate activity, such as brisk walking, or 35 minutes per day of vigorous activity, such as aerobics or fast cycling.
Table 4.4.1 Effects of aerobic exercise training on glycemic control and other parameters in patients with type 2 diabetes. Table 4.4.1 Effects of aerobic exercise training on glycemic control and other parameters in patients with type 2 diabetes. 1.7 aerobics sessions week (Table 4.4.2). The mechanism underlying this change is, however, likely to be different from that of aerobic training. Data are limited regarding non-glycemic effects of physical training in type 2 diabetes. In many of the aerobic training studies, potentially beneficial effects in serum lipids (8 out of 14 studies, 57 ) and blood pressure (5 out of 7 studies, 71 ) were observed (Tables 4.4.1 & 4.4.2). Data are too sparse (no study with a control group) to allow conclusions to be made regarding the effects of resistive training on lipids and lipopro-teins in type 2 diabetic patients. In non-diabetic power athletes, serum triglycerides, HDL and low-density lipoprotein (LDL) cholesterol are comparable to those of...
Until recently, sports medicine has been primarily focused on the treatment of acute injuries or those injuries that occur in a single episode or event. These injuries most often occur during full-contact sports like football, soccer, and hockey. However, the focus on acute injuries is not as relevant as it once was. The recreational athlete of today is typically involved in repetitive sports such as running, aerobics, swimming, and or overhead sports. Athletes involved in these sports are less likely to experience an acute injury, yet are more susceptible to injury secondary to repetitive microtrauma. Younger athletes continue to involve themselves in organized year-round sports and are predisposed to similar overuse injuries.
Achieving rehabilitation goals requires several elements. First, the milestones should be challenging but realistic and should be designed by the physician, sports medicine therapist, and patient working together. Second, goals should stretch the limits of what the injured area can tolerate (without causing deformation or further injury) but should not extend beyond these limits. This requires a thorough understanding of the physiology and biomechanics of the injured area. Third, the patient should strengthen uninjured parts of the body in aerobic training, which helps prevent reinjury while providing more goal orientation. In the case of a leg injury, this training can include well-leg biking or swimming with or without a float. The positive psychological effects of aerobic training are an important aspect of treatment during this period.
There are important distinctions between the terms 'physical activity' and 'exercise'. Physical activity may be considered as any body movement produced by skeletal muscle that results in energy expenditure, and as such includes dressing, walking to the shops and gardening as well as participating in sport or attending an aerobics class. Exercise on the other hand might be considered one subset of physical activity defined as planned, structured and repetitive movement aimed at improving or maintaining one or more components of fitness. Participation in exercise involving a competitive element might be considered as sporting activity and as such is a further subdivision of physical activity 6 . The terminology has particular relevance for older people, many of whom may benefit from increasing their overall levels of physical activity even though this may not necessarily be considered preplanned exercise or participation in sport (Table 3.3.1).
The cause of muscle fatigue (i.e. inability to maintain a defined exercise intensity) is considered to be multifactorial. The classic hypothesis is that muscle fatigue is caused by failure of the energetic processes to generate ATP at a sufficient rate. The evidence for this hypothesis is that interventions which increase the power (i.e. aerobic training, hyperoxia, blood doping) or capacity (i.e. CHO loading, creatine supplementation, glucose supplementation) of the energetic processes result in increased performance and delayed onset of fatigue. Similarly, factors that impair the energetic processes (i.e. depletion of muscle glycogen, intracellular acidosis, hypoxic conditions, reduced muscle blood flow) have a negative influence on performance. The evidence is, however, circumstantial and a direct cause and effect relationship remains to be established.
One of the most debated substances lately has been creatine (Cr), and its performance-enhancing effects. Research indicates that Cr supplementation (initially 20 g day followed by 3-4 g day) can increase muscle PCr content in some individuals. Exercise performance involving short periods of extremely powerful activity can be enhanced, especially during repeated bouts of activity 15 , whereas performance in aerobic exercise is not influenced. Furthermore, it has been demonstrated that Cr results in increased improvement of muscle strength with strength training but the mechanism behind this has not been discovered 16 . So far there are no documented gastrointestinal, renal or muscle side-effects associated with Cr intake.
Bone remodeling is also affected by mechanical strain. The general trend is decreased bone degradation, possibly caused by reduced osteoclast recruitment as mentioned above. Young recruits subjected to military training display increased bone mass at the heel of 3 , but at the same time bone formation and resorption markers go down by 10-12 37 . The impact of physical activity on bone turnover may, however, depend on the kind of exercise performed. In dogs immobilization increases bone resorption 34 . Aerobic training causes changes compatible with reduced bone resorption activity, while anaerobic training seems to result in an overall accelerated bone turnover 38 .
Initial treatment options include a short period of bedrest (not to exceed 3 days), oral medications (nonsteroidal antiinflammatory drugs NSAIDs , aspirin, mild opioids), progressive ambulation, return to activity, and patient reassurance. Epidural injections can be considered. As acute pain subsides, physical therapy and aerobic conditioning are advised. If a patient fails to improve with 4 to 6 weeks of nonsurgical care, further evaluation is indicated. The optimal time for nonsurgical treatment ranges from a minimum of 4 weeks to a maximum of 6 months.
The practitioner can evaluate spinal impairment by quantifying spinal range of motion, assessing trunk strength and endurance, evaluating balance and motor control, and determining aerobic fitness. Techniques for measuring spinal range of motion include inclinometer, goniometer, modified Schober test, and finger-to-floor distance. There are three basic approaches for testing trunk extensor strength and lifting capacity isometric (velocity is zero), isokinetic (velocity is constant), and isoinertial (velocity is not constant, but the mass is held constant). Several high-tech machines can be used for testing and training patients (Med X, Cybex, Biodex, Isostation, LIDO, Kin-Com). One can also evaluate the
Look at each patient individually to determine an appropriate preventive regimen. Set realistic expectations. Emphasize a healthy lifestyle with aerobic exercise daily, good sleep hygiene, and limiting caffeine intake the equivalent of two 8 oz cups of coffee a day or less. Use the most efficacious drugs.
Aerobic exercise improves functional capacity and the higher the exercise intensity the higher the improvement in V . Patients with the lowest VO2 improve most with training programs but patients that at baseline have a preserved exercise capacity also improve with exercise. Patients with reduced LV function also improve their V02 with exercise 16 .
Both cross-sectional and longitudinal studies involving pharmacologic autonomic blockade and analysis of HRV indicate that increases in cardiac parasympathetic (vagal) tone make an important contribution to resting bradycardia 41,43 . The chronic increase in parasympathetic tone occurs within a few weeks after beginning regular training and this occurs independently of a lower intrinsic heart rate. In cross-sectional studies, aerobic fitness and or long-term aerobic training have been suggested to be associated with increased HRV, especially with vagally mediated respiratory sinus arrhythmia, at rest 44,45 . Some studies, however, have failed to show such an association 46,47 . The results from most longitudinal studies reveal decreased resting heart rate and increased vagal activity at rest after aerobic training 48,49 .
Physical therapy sessions are prescribed for children with ASDs to enhance their physical abilities. Impairments of movement can interfere with develop-mentally appropriate functioning. Some children with ASDs can have low muscle tone, as well as poor posture, balance, and coordination. Physical therapy sessions can treat these impairments by providing passive, active, resistive, or aerobic exercise as well as training in functional and developmental skills. Physical therapists implement procedures to increase endurance, motor control, and motor planning. They incorporate therapeutic exercises along with equipment such as weights, exercise balls, and BAPS boards (balance boards) to increase muscle strength and endurance and to facilitate body awareness and coordination. Aquatic, aerobic, and breathing exercises can also be part of your child's treatment. Physical therapy sessions are typically one-on-one and last 45 minutes. They can be administered in the therapist's office or in...
A 78-year-old woman with bilateral knee osteoarthritis and leg and back pain occurring only when walking and standing has been unable to tolerate land-based aerobic exercise. For this individual, her knee arthritis interferes with her ability to bear weight and train her spine on land. Evidence exists showing that aquatic exercises decrease pain from peripheral joint arthritis. The unloading effect that occurs in water allows for strength training and aerobic conditioning while in a supportive environment that protects from falls. Her history is suggestive of neuro-genic claudication from lumbar spinal stenosis, a condition where the patient often obtains relief while in positions of flexion. In water a flexion posture is achieved with less compressive force on the vertebral bodies, limiting the risk of an exercise-induced osteoporotic compression fracture or aggravation of mechanical low back pain. Eventually, this patient can try transitioning to a land-based program with the goal...
Before starting a moderate exercise program, clients should check with a physician. Most exercise programs appropriate for recovering addicts combine strength training with aerobics to increase metabolic rate, burn calories, and build muscle (Phillips, 1999). The National Standard recommends exercise at least four times a week for a minimum of 50 minutes. This should vary according to the client's age and fitness level. Among other benefits, exercise lowers blood pressure and increases the levels of mood-elevating neuro-chemicals such as endorphins, that enhance one's mental and physical well-being.
Routine aerobic exercise is recommended for all patients with PVD. The benefit of walking programs has been clearly established to increase time-to-claudication and maximal walking distance (Hiatt and Regensteiner, 1990 Hiatt et al., 1994). Regular exercise will have a strong impact on improving functional capacity and quality of life. A minimum of 30 to 60 minutes of exercise is recommended preferably daily, but at least three or four times a week. This should be supplemented by an increase in daily lifestyle activities, such as walking breaks at lunch, gardening, or household chores (Smith et al., 2001).
Community mobility, cooking and cleaning skills, leisure activities, social isolation, and support for caregivers often continue to be problematic for 2-year stroke survivors.108 The clinician ought to ask about instrumental ADLs or use an assessment that asks patients to rate the difficulty they perceive in carrying out these tasks,109 so an appropriate rehabilitation prescription may be ordered. A pulse of therapy carried out beyond 6 months poststroke, especially if focused on training specific skills such as walking speed or using the affected arm, often improves the practiced ADLs.110,111 The physician should recommend conditioning exercises and task-oriented practice. Muscle strengthening and aerobic training counteract many of the potentially debilitating physiologic changes associated with aging and with a sedentary lifestyle. At every follow-up visit, patients should be encouraged to walk more at home over ground or on a treadmill,112 set up a circuit training course,113 or...
Obesity is associated with elevated triglyceride (TG) levels, reduced high-density lipoprotein cholesterol (HDL-C), and an increase in the more atherogenic, small, dense LDL particles. Despite common belief, obesity causes only a small mean elevation in total and low-density lipoprotein cholesterol (LDL-C) values. There is strong evidence that weight loss through lifestyle measures will reduce TG and increase HDL-C levels. This weight loss is generally accompanied by a decrease in total cholesterol and LDL-C, in part because the same lifestyle changes in diet that decrease weight also decrease LDL-C. The favorable effect on lipids from aerobic exercise is most noticeable when accompanied by weight loss. NHLBI recommends weight loss to reduce elevated total cholesterol, LDL-C, and TG levels and to raise HDL-C in overweight obese persons.
Many studies show that successful rehabilitation and improved physical function are strongly associated with improvement in pain. One of the best is by Mannion et al (1999, 2001a, b), which we have already looked at in Chapter 9. The strongest link they found over the course of treatment was between reduction in pain and improvement in disability. This was equally true for physiotherapy, aerobic training, or muscle reconditioning. Improvement in pain was by far the strongest factor they could identify in successful rehabilitation. Strand et al (2001) showed that rehabilitation could influence this relationship. In patients who had usual care, return to work depended only on improvement in pain. In those who had a multidisciplinary rehab program, it depended on improvement in both pain and in physical function.
Inactive persons with paraplegia gained car-diorespiratory fitness by using arm crank training at 50 of peak oxygen intake on a schedule of 3 times a week for 40 minutes by 8-24 weeks.167 In the able-bodied, workloads for the upper extremities should be approximately 50 of those used for leg training. The target heart rate should be 10 beats per minute lower than what is prescribed for leg training. At a given submaximal workload, exercise of the arms is done at a greater energy cost, but maximal physiological responses including cardiac output and stroke volume are lower.168 Using these guidelines, a central conditioning effect can be achieved by able-bodied and neurolog-ically impaired people, especially in those who are initially unfit. Freewheeling gamefield exercises that included propelling a wheelchair over a rising power ramp and a ramp of uneven platforms and by performing chin-ups from the chair produced heart rates and oxygen uptakes from arm exercise alone that were...
Resistance exercise induces the gene expression that prevents atrophy and increases muscle fiber volume and force. Properly executed exercise also improves aerobic fitness and may reduce the common symptom of fatigability in patients with neuromuscular disorders. Small group and case studies have shown that selective muscle strengthening and general conditioning can be achieved by modest levels of exercise, almost regardless of the pathophysi-ology of the neurologic disease.8,9 The type, intensity, and duration of a muscle contraction and the frequency and duration of exercise sessions determine whether or not strength will increase. In healthy persons, strength improves significantly by isometric resistance against 60 of the person's maximum load for a single knee extension for example. Ten repetitions each done for 5 seconds must be performed 3 times a week for 6 weeks.10 Strengthening of atrophic muscles can be accomplished, however, by training with forces of only 20 -30 of the...
Aerobic training by arm-leg bicycle ergom-etry significantly decreased fatigue, depression, and anxiety and improved fitness in a controlled trial of ambulatory MS patients.129 Patients exercised for 30 minutes at 60 of their maximal aerobic capacity 4 times a week for 15 weeks. A fan helped cool them during exertion. Some neurologic symptoms worsened during and shortly after exercise, but no exacerbations
In fact, a six-part preseason and in-season prevention program has been proposed by some and includes recognition of injury mechanics, flexibility and strengthening exercises, aerobic conditioning, plyometrics, and agility drills (Table 8-3).51 These exercises should be incorporated into normal sport conditioning programs. Programs using these strategies or even those merely Aerobic conditioning Athletic pseudoanemia is a result of heavy aerobic training causing an increase in red blood cell mass and plasma volume. This dilutional effect is a physiologic adaptation to training and is not true anemia. No treatment is necessary, and the abnormalities should correct with elimination of the aerobic training.
In response to recent epidemiologic and clinical trial data, JNC-7 made a series of new recommendations for addressing the HTN epidemic, which now includes more than 73.6 million patients in the U.S. alone. Patients with SBP of 120 to 139 mm Hg and DBP of 80 to 89 mm Hg are defined as prehypertensive and warrant aggressive lifestyle modification to prevent progression to HTN. It must be assumed that even in this BP range, changes in vessel wall histology and physiology are inducing elevations in BP. Weight reduction, moderation of alcohol intake (2 drinks per day for men, 1 for women), reducing daily sodium intake to 2.4 g day, increasing aerobic exercise, and the Dietary Approaches to Stop Hypertension (DASH) regimen are all associated with significant reductions in BP (Chobanian et al., 2003). Thiazide diuretics such as hydrochlorothia-zide or chlorthalidone, alone or in combination with other antihypertensives, should be used to treat most patients with HTN. 4. Initiate lifestyle...
Tremendous extension forces occur at the hips and knees with the spine in a rigidly stable position. Success in this portion of the lift requires the body to generate tremendous rigid immobilization of the spine in the power position of slight flexion. To do a forward bent motion with the spine out of this position can be quite dangerous, resulting in tremendous shear forces across the spine. Lifting weights with the spine flexed at 90 degrees, whether they are lighter arm weights or weights across the upper back, generates tremendous lever arm effect forces. The weight times the distance to the spine result in tremendous shear forces across the lumbar spine, especially if weight is to be moved in this position. One cannot imagine muscles that must be strengthened in this dangerous and mechanically disadvantaged position. A dangerous time for weight lifters is the shift from spinal flexion to extension that occurs with lifting the weight over the head as in the...
Included stair-climbing, aerobics, skipping, jumping, dancing and jogging. More impact and loading is appropriate in primary prevention, but a less vigorous programme should be used in frailer groups. Programmes should be progressed in terms of intensity and impact, and maintained indefinitely, as the positive effects are reversed when regular exercise is stopped. Physiotherapy management and exercise guidelines have been reviewed in considerable detail (Bennell et a . 2000 Mitchell et al. 1999). Exercise therapy is complementary to but not a substitute for medical management, which includes hormone replacement therapy, calcium, vitamin D, calcitonin, biphosphonates and fluoride (Lane et al. 1996).
This condition is characterized by inflammation of the plantar fascia. The origin of the plantar fascia, the calcaneus, is the site most often affected. Activities such as running, prolonged standing or walking, dancing, and high-impact aerobics can cause repetitive microtrauma of the fascia leading to this condition. Other predisposing factors include a tight Achilles tendon, improper or new footwear, alterations in training intensity, pes planus, and pes cavus.
Anti-inflammatory medication. The athlete should possibly change activity from running to swimming or cycling. Group exercise (e.g. aerobics) is recommended in inactive patients to improve general flexibility, strength and endurance, and to reduce depressive symptoms. Analgesics (including opiates) may be indicated if sleep is disturbed by pain. The effectiveness of surgical treatment is uncertain in patients with back pain, but surgery is indicated in patients with progressive claudication and muscle weakness.
Subjects with mood disturbances have benefited by participating in physical activity programs 104,105 . Improvements in symptoms of anxiety 106 and depression 107 , and in patients with non-psychotic depression have been reported 108 . Most interventions have used aerobic exercise.
Pyruvate precedes the aerobic combustion of CHO in the mitochondrion and is therefore named aerobic gly-colysis. Pyruvate can be transferred to lactate, which is a dead-end metabolite. Glycolysis to lactate is named anaerobic glycolysis, since the process does not require oxygen. However, formation of lactate may also occur in the presence of oxygen. The mechanism of lactate formation during submaximal exercise has been extensively discussed over a number of years and remains a controversial issue. However, it is accepted that lac-tate is formed by a mass action effect through the near-equilibrium reaction catalyzed by lactate dehy-drogenase (LDH) and that increases in pyruvate, NADH NAD+ ratio or H+ are metabolic changes in the cytosol that will promote lactate formation. Activation of glycolysis in excess of pyruvate oxidation and NADH influx to mitochondria will cause cytosolic increases in pyruvate and NADH and will therefore also lead to lactate formation. Factors such as oxygen...