Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training. Caffeines enhancement of maximal voluntary strength and activation in uninjured but not injured muscle. Reduced physical activity increases intermuscular adipose tissue in healthy young adults. The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. Relationship Between Intensity of Quadriceps Muscle Neuromuscular Electrical Stimulation and Strength Recovery After Total Knee Arthroplasty Injuries during the one repetition maximum assessment in the elderly. Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters. The Influence of Prophylactic Orthoses on Abdominal Strength and Low Back Injury in the Workplace The value of strength training for older adults. Risk Factors for Shoulder and Elbow Injuries in High School Baseball Pitchers Selective strength loss and decreased muscle activity in hamstring injury. Atrophy and impaired muscle protein synthesis during prolonged inactivity and stress. Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Low-Load Very High-Repetition Resistance Training Attenuates Bone Loss at the Lumbar Spine in Active Post-menopausal Women Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. Response of males and females to high-force eccentric exercise Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation Effects of cold water immersion on the symptoms of exercise-induced muscle damage. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. Motor and sensory recovery following complete tetraplegia. Effect of transcutaneous electrical nerve stimulation, cold, and a combination treatment on pain, decreased range of motion, and strength loss associated with delayed onset muscle soreness. 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. The effects of whey protein with or without carbohydrates on resistance training adaptations Sensory level electrical muscle stimulation: effect on markers of muscle injury Relationship Between Isokinetic Strength and Tibiofemoral Joint Space Width Changes After Anterior Cruciate Ligament Reconstruction Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise. Loss of motion after anterior cruciate ligament reconstruction Changes in postpartum perineal muscle function in women with and without episiotomies. A double-blind placebo-controlled clinical trial of subcutaneous recombinant human ciliary neurotrophic factor (rHCNTF) in amyotrophic lateral sclerosis. ALS CNTF Treatment Study Group. Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth The relationship of joint symptoms with exercise performance in older adults. Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia. Strength versus muscle power-specific resistance training in community-dwelling older adults. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Knee strength maintained despite loss of lean body mass during weight loss in older obese adults with knee osteoarthritis. Efficacy of nonloading exercises in prevention of vertebral bone loss in postmenopausal women: a controlled trial. Effects of supplementation with a combination of β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee arthroplasty. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial. Strength Inhibition Following An Acute Stretch Is Not Limited To Novice Stretchers Effects of weight management program on postural stability and neuromuscular function among obese children: study protocol for a randomized controlled trial Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss—a population-based approach Effects of a submaximal exercise protocol to recondition the pelvic floor musculature. Sports Massage after Eccentric Exercise Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Effects of hip extensor fatigue on lower extremity kinematics during a jump-landing task in women: a controlled laboratory study. Resistance exercise and supraphysiologic androgen therapy in eugonadal men with HIV-related weight loss: a randomized controlled trial. Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation. Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage Predictors of time loss after back injury in nurses. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Eccentric hamstring strength and hamstring injury risk in Australian footballers. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. Effect of valproate on hemostatic function in patients with traumatic brain injury Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis. Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial A trial of testosterone therapy for HIV‐associated weight loss
BACKGROUND Functional loss of respiratory muscles in persons with spinal cord injury leads to impaired pulmonary function and respiratory complications . In addition , respiratory complications are responsible for 50 - 67 % of the morbidity in this population . OBJECTIVE To investigate the effects of normocapnic hyperpnoea training in acute spinal cord injury . PATIENTS AND METHODS Fourteen patients were r and omized between control ( sham ) and an experimental normocapnic hyperpnoea training group .  Vital capacity , maximal voluntary ventilation , respiratory muscle strength and endurance , respiratory complications and symptoms were evaluated before , after 4 and 8 weeks of training and after 8 weeks follow-up . RESULTS Maximal voluntary ventilation , respiratory muscle strength and endurance improved significantly in the experimental group compared with the control group ( p < 0.05 ) . Improvements in vital capacity tended to be different from the control group at 8 weeks of training . The Index of Pulmonary Dysfunction decreased after 4 weeks of training and respiratory complications were reported less frequently in the experimental group compared with the control group . CONCLUSION Normocapnic hyperpnoea training in patients with spinal cord injury improved respiratory muscle strength and endurance . Respiratory complications occurred less frequently after training The study 's objective was to determine whether orally ingested caffeine could help overcome excitation-contraction-coupling failure , which has been suggested to explain part of the strength loss associated with eccentric-contraction-induced muscle injury . A sample of 13 college students ( 4 men and 9 women ) was used in a double-blind , repeated- measures experimental design . Each participant performed 2 experimental trials , 1 with each leg , with each trial lasting 4 consecutive days . On a given day , each participant was r and omly assigned to ingest a capsule containing 6 mg/kg of either caffeine or flour ( placebo ) . On the day of and the first 2 days after a bout of 50 injurious eccentric contractions done by the knee extensors , the interpolated-twitch technique was used to assess electrically evoked strength , maximal voluntary isometric contraction ( MVIC ) strength , and percent muscle activation during MVIC both before and after capsule ingestion . These variables were also measured before and after capsule ingestion the day before the eccentric-contraction bout -- when the muscle was uninjured . In injured muscle , caffeine had no effect on any variable . In uninjured muscle , caffeine also had no effect on electrically evoked strength but increased MVIC strength by 10.4 % compared with placebo ( p = .00002 ) , and this was attributed to an increase in muscle activation ( 6.2 % ; p = .01 ) . In conclusion , the data provide no evidence that caffeine ingestion can help overcome excitation-contraction-coupling failure , if it exists , in injured human muscle . The data do indicate that caffeine ingestion can increase MVIC strength and activation in uninjured muscle but not in injured muscle BACKGROUND Recent findings suggest that higher levels of intermuscular adipose tissue ( IMAT ) are associated with glucose dysregulation , lower levels of muscle strength , and a heightened risk of disability . Although several studies have described adaptations in muscle after reduced physical activity , the change in IMAT in healthy young adults is unknown . OBJECTIVE The objective was to determine whether reduced lower limb activity alters IMAT in healthy young adults and to assess whether this change affects muscle strength loss . DESIGN The subjects ( 6 men and 12 women aged 19 - 28 y ) underwent a 4-wk control period , which was followed by 4 wk of unilateral lower limb suspension . Volumes of whole muscle , subcutaneous adipose tissue , and IMAT were assessed by using magnetic resonance imaging in the thigh and calf . Muscle strength was assessed during maximal voluntary isometric contractions . RESULTS No changes were observed in the control period . Reduced physical activity decreased thigh and calf muscle volumes by 7.4 % and 7.9 % ( P < 0.001 ) , respectively ; no significant change in subcutaneous adipose tissue was observed . Additionally , IMAT increased in both regions ; the increase was larger in the calf ( 20 % ) than in the thigh ( 14.5 % ) ( P < or= 0.005 ) and was partially explained by the loss in muscle ( R(2 ) = 26 % ) . The loss in strength was greater in the thigh ( 20.4 % ) than in the calf ( 15 % ) . Strength loss was associated with increases in IMAT ( P = 0.039 ) after adjustment for the loss in muscle , initial strength , initial IMAT , and initial muscle volume . CONCLUSIONS IMAT accumulates markedly after reduced activity in healthy young adults . Increases in IMAT may contribute to losses in muscle strength associated with reduced physical activity , but the mechanism responsible is yet to be determined Purpose Hamstring strain injury is a frequent and serious injury in competitive and recreational sports . While Nordic hamstring ( NH ) eccentric strength training is an effective hamstring injury-prevention method , the protective mechanism of this exercise is not understood . Strength training increases muscle strength , but also alters muscle architecture and stiffness ; all three factors may be associated with reducing muscle injuries . The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture , stiffness , and strength . Methods Twenty healthy participants were r and omly assigned to an eccentric training group or control group . Control participants performed static stretching , while experimental participants performed static stretching and NH training for 6 weeks . Pre- and post-intervention measurements included : hamstring muscle architecture and stiffness using ultrasound imaging and elastography , and maximal hamstring strength measured on a dynamometer . Results The experimental group , but not the control group , increased volume ( 131.5 vs. 145.2 cm3 , p < 0.001 ) and physiological cross-sectional area ( 16.1 vs. 18.1 cm2 , p = 0.032 ) . There were no significant changes to muscle fascicle length , stiffness , or eccentric hamstring strength . Conclusions The NH intervention was an effective training method for muscle hypertrophy , but , contrary to common literature findings for other modes of eccentric training , did not increase fascicle length . The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length . Future research is , therefore , warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk BACKGROUND Aging is associated with greater susceptibility to muscle injury and soreness after exercise . Although elderly persons regularly consume nonsteroidal anti-inflammatory drugs ( NSAIDs ) , it is not clear that NSAIDs alleviate muscle dysfunction and /or inflammation following injurious exercise . METHODS In this double-blind crossover study , 10 men and 5 women ( aged 60 + /- 2 years , mean + /- SE ) consumed naproxen sodium or placebo for 10 days after performing 64 unilateral eccentric ( ECC ) knee extensions using 75 % of the ECC 1-repetition maximum .  Strength was measured before , 3 days after , and 10 days after each bout . Injury and soreness were assessed using magnetic resonance images of m. quadriceps femoris ( QF ) and a visual analog scale . RESULTS Three days after exercise , concentric strength loss was greater for placebo ( -32 + /- 9 % ) than NSAID ( -6 + /- 8 % ; p = .0064 ) . Likewise , isometric strength declined less for NSAID than placebo ( -12 + /- 7 % vs -24 + /- 4 % ; p = .0213 ) , and thigh soreness while rising from a chair was greater for placebo ( p < or = .0393 ) than NSAID ( 43 + /- 7 mm vs 26 + /- 7 mm ) . QF cross-sectional area ( cm(2 ) ) showing elevated T(2 ) was 27 % and 35 % greater ( p < or = .0096 ) for placebo on Days 3 and 10 , respectively . CONCLUSIONS Naproxen sodium attenuated muscle injury , strength loss , and soreness following ECC exercise in older individuals and may be beneficial during the early stages of increased physical activity Background Neuromuscular electrical stimulation ( NMES ) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty ( TKA ) , yet the optimal intensity ( dosage ) of NMES and its effect on strength after TKA have yet to be determined . Objective The primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA . A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions . Design This study was an observational experimental investigation . Methods Data were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA . These people participated in a r and omized controlled trial in which they received either st and ard rehabilitation or st and ard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss . For the NMES intervention group , NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA . Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 3.5 and 6.5 weeks after TKA . Results At 3.5 weeks , there was a significant association between NMES training intensity and a change in quadriceps muscle strength ( R2=.68 ) and activation ( R2=.22 ) . At 6.5 weeks , NMES training intensity was related to a change in strength ( R2=.25 ) but not to a change in activation ( R2=.00 ) . Furthermore , quadriceps muscle fatigue occurred during NMES sessions at 3.5 and 6.5 weeks , whereas quadriceps muscle activation did not change . Limitations Some participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation . Conclusions Higher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA PURPOSE A decrease in strength , and its associated loss of functional ability is common among the elderly . Although resistance training can reverse this decline , associated injuries with frequently used strength assessment s may present a greater risk . METHODS To evaluate the injuries associated with maximal strength evaluations , 83 relatively healthy elderly subjects ( 40 men and 43 women , 65.8 + /- 6.2 years ) with and without prior weight training experience performed 1 repetition maximum testing ( 1 RM ) involving 5 different exercises : chest press , leg extension , abdominal curl , arm curl , and seated calf raise . Subjects were separated into three groups depending on weight training experience , Group 1 had no weight training experience ( n = 32 ) , Group 2 had < 6 months of training ( n = 24 ) , and Group 3 had > 6 months of training ( n = 27 ) . Injury assessment was made 30 minutes , 2 days , and 7 days posttesting . RESULTS Two Group 1 subjects sustained an injury ( 2.4 % of total subjects , 8 % of Group 1 ) . Eighty-one subjects safely completed the 1 RM assessment without injury ( 97.6 % of total ) . Forty-eight of the 83 subjects complained of muscle soreness after testing ( 58 % of total ) . This complaint alone was not sufficient to be categorized as an injury . CONCLUSIONS These results indicate that 1 RM testing is an acceptable tool in strength evaluations in the elderly . Additional pre caution s may be needed in inexperienced , elderly individuals to prevent injury STUDY DESIGN Prospect i ve cohort study . OBJECTIVES In this prospect i ve cohort study of elite sprinters , muscle strength of the hip extensors , as well as of the knee extensors and flexors , was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing . The method used for testing muscle strength simulated the specific muscle action during late swing and early contact phases when sprinting . BACKGROUND There have been no prospect i ve studies in elite sprinters that examine the concentric and eccentric isokinetic strength of the hip extensors and the quadriceps and hamstring muscles in a manner that reflects their actions in late swing or early contact phases of sprinting . Consequently , the causal relationship between hip and thigh muscle strength and hamstring injury in elite sprinters may not be fully understood . METHODS AND MEASURES Isokinetic testing was performed on 30 male elite sprinters to assess hip extensors , quadriceps , and hamstring muscle strength . The occurrence of hamstring injury among the subjects was determined during the year following the muscle strength measurements . The strength of the hip extensors , quadriceps , and hamstring muscles , as well as the hamstrings-quadriceps and hip extensors- quadriceps ratios were compared . RESULTS Hamstring injury occurred in 6 subjects during the 1-year period . Isokinetic testing at a speed of 60 degrees /s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors . When performing a side-to-side comparison for the injured sprinters , the hamstring injury always occurred on the weaker side . Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs , and this was attributable to deficits in hamstring strength . CONCLUSION Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of the hip extensors , but only when tested at the slower speed of 60 degrees /s This study was design ed to determine the effect of multimodal intervention and the prevention of back injury , and to evaluate the adverse side effects of using a lumbosacral corset in the workplace . Subjects were 90 male warehouse workers r and omly selected from over 800 employees at a grocery distribution center . Subjects were assigned to three groups : true controls , no back school , no brace orthoses ; back school only ; and back school plus wearing a custom molded lumbosacral orthosis . Comparisons of pre-testing and 6-month follow-up posttesting for abdominal strength , cognitive data , work injury incidence and productivity and use of health care services were evaluated . Controls and training-only group showed no changes in strength productivity or lost time . Orthoses and training-group showed no changes in strength productivity or accident rate ; however , they showed substantially less lost time . This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss . It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries Health in older adults can best be measured in terms of functional status . Skeletal muscle strength has been reported to be a determinant of functional status in older individuals . Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity . Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries , physical frailty , and disability .  Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living , which are important indicators of independence Background : Shoulder strength and motion deficits in high school baseball pitchers have been implicated in injury risk . Purpose /Hypothesis : To prospect ively determine if preseason strength and range of motion ( ROM ) are predictive of injury in high school baseball pitchers . It was hypothesized that ROM asymmetries and weakness would be predictive of injury . Study Design : Case-control study ; Level of evidence , 3 . Methods : Preseason strength and ROM measurements  were made on 101 pitchers from 4 different high schools over 4 seasons ( total 166 pitcher-seasons : 25 freshman , 46 junior varsity , and 95 varsity player-seasons ) .  Glenohumeral internal rotation ( IR ) , glenohumeral external rotation , and posterior shoulder ROM  were measured bilaterally . Strength in IR , external rotation , supraspinatus ( empty-can test ) , and scapular retraction  was measured bilaterally ( h and held dynamometer ) . Injury incidence ( injuries per 1000 pitches ) was computed for players categorized as above normal ( ≥1 SD above the mean ) , normal ( within 1 st and ard deviation of the mean ) , and below normal ( ≤1 SD below the mean ) for each potential risk factor . Injury was defined as a missed game or practice because of shoulder or elbow problem . Results : There were 28 upper extremity injuries ( 19 shoulder , 9 elbow ; incidence , 0.58 injuries/1000 pitches ) . There was a trend for supraspinatus weakness to be associated with increased injury risk ( relative risk [ RR ] , 3.60 ; 95 % CI , 0.75 - 17.32 ; P = .09 ) . When analyzing major injuries only ( > 3 missed games ) , preseason supraspinatus weakness was significantly associated with increased injury risk ( RR , 4.58 ; 95 % CI , 1.40 - 15.01 ; P = .02 ) . Paradoxically , pitchers with no IR loss were at increased risk compared with pitchers with ≥20 ° loss ( RR , 4.85 ; 95 % CI , 1.01 - 23.29 ; P = .04 ) . Other ROM and strength measures were unrelated to injury risk . Conclusion : Although excessive loss of IR ROM is thought to be a risk factor for injury , the opposite was the case in this study . The absence of IR ROM loss  in high school pitchers may indicate inadequate prior exposure to pitching , result ing in increased injury risk . Preseason supraspinatus weakness was associated with increased risk for a major injury , and preventative supraspinatus strengthening may be beneficial STUDY DESIGN Cross-sectional , controlled laboratory study . OBJECTIVES To determine whether thigh muscle isokinetic torque patterns and activity , measured by electromyography ( EMG ) , of individuals with hamstring injury differ from control individuals . BACKGROUND Neuromuscular control during thigh muscle strength assessment following hamstring injuries has not been reported . METHODS Fifteen athletes with prior hamstring injury ( hamstring-injured group [ HG ] ) were compared to 15 uninjured athletes ( control group [ CG ] ) . The injuries were incurred 6 weeks to 12 months prior to participation , and all injured athletes had returned to at least partial training . Participants performed 5 isokinetic concentric extensor , concentric flexor , and eccentric flexor torque tests at 60 ° /s in the seated position . Peak torque was determined for each contraction type , as well as average torque for each of 4 time-based movement quartiles . EMG root-mean-squares were calculated in these movement quartiles for the biceps femoris and medial hamstrings . RESULTS No significant differences were found for peak torque for all contractions , when comparing HG injured and uninjured sides to CG bilateral averages . The HG injured limb eccentric flexor torque was significantly lower in the fourth quartile ( approximately 25 ° to 5 ° knee flexion , hamstring lengthened range ) compared to the CG bilateral average ( P = .025 ) . Eccentric flexor biceps femoris and hamstrings EMG root-mean-squares of the HG injured and the uninjured sides were significantly lower in the second to fourth quartiles ( towards the lengthened range ) , compared to the CG bilateral averages ( P<.05 ) . CONCLUSION Decreased strength and EMG activation in a lengthened hamstrings range for the athletes with prior hamstring injury suggested a change in neuromuscular control . Lengthened range assessment of isokinetic eccentric flexor torque may be useful for the assessment of athletes with a prior injury ; however , results should be confirmed with prospect i ve studies CONTEXT We recently demonstrated that 28-d bed rest in healthy volunteers results in a moderate loss of lean leg mass and strength . OBJECTIVE The objective of this study was to quantify changes in muscle protein kinetics , body composition , and strength during a clinical bed rest model reflecting both physical inactivity and the hormonal stress response to injury or illness . DESIGN Muscle protein kinetics were calculated during a primed , continuous infusion ( 0.08 micromol/kg.min ) of 13C6-phenylalanine on d 1 and 28 of bed rest . SETTING The setting for this study was the General Clinical Research Center at the University of Texas Medical Branch . PARTICIPANTS Participants were healthy male volunteers ( n = 6 , 28 + /- 2 yr , 84 + /- 4 kg , 178 + /- 3 cm ) . INTERVENTION During bed rest , hydrocortisone sodium succinate was administered iv ( d 1 and 28 ) and orally ( d 2 - 27 ) to reproduce plasma cortisol concentrations consistent with trauma or illness ( approximately 22 microg/dl ) . MAIN OUTCOME MEASURES We hypothesized that inactivity and hypercortisolemia would reduce lean muscle mass , leg extension strength , and muscle protein synthesis .  RESULTS Volunteers experienced a 28.4 + /- 4.4 % loss of leg extension strength ( P = 0.012 ) and a 3-fold greater loss of lean leg mass ( 1.4 + /- 0.1 kg ) ( P = 0.004 ) compared with our previous bed rest-only model . Net protein catabolism was primarily due to a reduction in muscle protein synthesis [ fractional synthesis rate , 0.081 + /- 0.004 ( d 1 ) vs. 0.054 + /- 0.007%/h ( d 28 ) ; P = 0.023 ] . There was no change in muscle protein breakdown . CONCLUSION Prolonged inactivity and hypercortisolemia represents a persistent catabolic stimulus that exacerbates strength and lean muscle loss via a chronic reduction in muscle protein synthesis BACKGROUND Hamstring strain injuries are among the most common injuries seen in sports . Management is made difficult by the high recurrence rates . Typical time to return to sport varies but can be prolonged with recurrence . Eccentric strength deficits remain post-injury , contributing to reinjury . Eccentric training has shown to be an effective method at prevention of hamstring injury in multiple systematic review s and prospect i ve RCTs but limited prospect i ve rehabilitation literature . Functional dry needling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains , but there is limited published literature on its effects on rehabilitation or recurrence of injury . PURPOSE The purpose of this case report is to present the management and outcomes of a patient with hamstring strain , treated with functional dry needling and eccentric exercise . CASE DESCRIPTION The subject was an 18-year-old collegiate pole-vaulter who presented to physical therapy with an acute hamstring strain and history of multiple strains on uninvolved extremity . He was treated in Physical Therapy three times per week for 3 weeks with progressive eccentric training and 3 sessions of functional dry needling . OUTCOMES By day 12 , his eccentric strength on the involved extremity was greater than the uninvolved extremity and he reported clinical ly meaningful improvement in outcome scores . By Day 20 , he was able to return to full sports participation without pain or lingering strength deficits . DISCUSSION The patient in this case report was able to return to sport within 20 days and without recurrence . He demonstrated significant decreases in pain and dysfunction with dry needling . He had greater strength on the injured extremity compared to contra-lateral previously injured extremity . CONCLUSIONS This case illustrates the use of functional dry needling and eccentric exercise leading to a favorable outcome in a patient with hamstring strain . LEVEL OF EVIDENCE Level 4 OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls Abstract This study determined the effect of 6 months of low-load very high-repetition resistance training on bone mineral density ( BMD ) and body composition in nonosteoporotic middle-aged and older women . Fifty healthy , active community-dwelling women aged 56–75 years took part in the two-group , repeated- measures r and omized controlled trial . Participants either undertook 6 months of low-load very high-repetition resistance training in the form of BodyPump ™ or served as control participants . Outcome measures included BMD at the lumbar spine , hip , and total body ; total fat mass ; fat-free soft tissue mass and maximal isotonic strength . Significant group-by-time interactions were found for lumbar spine BMD and maximal strength in favor of the BodyPump ™ group . No favorable effects were found for hip BMD , total body BMD , total fat mass , or fat-free soft tissue mass . Three participants withdrew from the intervention group due to injury or fear of injury associated with training . Under the conditions used in this research , low-load very high-repetition resistance training is effective at attenuating losses in lumbar spine BMD compared to controls in healthy , active women aged over 55 years but did not influence hip and total body BMD or fat mass and fat-free soft tissue mass INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic The posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness , which persist despite st and ard rehabilitation programs of occupational and physical therapy . We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury . We assessed the changes in leg muscle strength and lean body mass in severely burned children with > 40 % total body surface area burned . Patients were r and omized to a 12-wk st and ard hospital rehabilitation program supplemented with an exercise training program ( n = 19 ) or to a home-based rehabilitation program without exercise ( n = 16 ) . Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150 degrees /s . Lean body mass was assessed using dual-energy X-ray absorptiometry . We found that the participation in a resistance exercise program results in a significant improvement in muscle strength , power , and lean body mass relative to a st and ard rehabilitation program without exercise QUESTION Does inspiratory muscle training improve respiratory muscle strength , functional capacity , lung function and quality of life of patients with chronic kidney disease ? Does inspiratory muscle training improve these outcomes more than breathing exercises ? DESIGN Systematic review and meta- analysis of r and omised trials . PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment . OUTCOME MEASURES The primary outcomes were : maximal inspiratory pressure , maximal expiratory pressure , and distance covered on the 6-minute walk test . The secondary outcomes were : forced vital capacity , forced expiratory volume in the first second ( FEV1 ) , and quality of life . RESULTS The search identified four eligible studies . The sample consisted of 110 participants . The inspiratory muscle training used a Threshold ® or PowerBreathe ® device , with a load ranging from 30 to 60 % of the maximal inspiratory pressure and lasting from 6 weeks to 6 months . The studies showed moderate to high risk of bias , and the quality of the evidence was rated low or very low , due to the studies ' method ological limitations . The meta- analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure ( MD 23 cmH2O , 95 % CI 16 to 29 ) and the 6-minute walk test distance ( MD 80 m , 95 % CI 41 to 119 ) when compared with controls . Significant benefits in lung function and quality of life were also identified . When compared to breathing exercises , significant benefits were identified in maximal expiratory pressure ( MD 6 cmH2O , 95 % CI 2 to 10 ) and FEV1 ( MD 0.24litres 95 % CI 0.14 to 0.34 ) , but not maximal inspiratory pressure or forced vital capacity . CONCLUSION In patients with chronic renal failure on dialysis  , inspiratory muscle training with a fixed load significantly improves respiratory muscle strength , functional capacity , lung function and quality of life . The evidence for these benefits may be influenced by some sources of bias . REGISTRATION PROSPERO ( CRD 42015029986 ) . [ de Medeiros AIC , Fuzari HKB , Rattesa C , Br and ão DC , de Melo Marinho PÉ ( 2017 ) Inspiratory muscle training  improves respiratory muscle strength , functional capacity and quality of life in patients with chronic kidney disease : a systematic review . Journal of Physiotherapy 63 : 76 - 83 ] It has previously been shown that females incur less muscle damage than males after strenuous exercise , but limited data are available for humans . To determine possible differences between the sexes in humans , the response to high-force eccentric exercise was examined in a large sample of women ( n = 83 ) and men ( n = 82 ) . The participants performed a bout of eccentric exercise of the elbow flexors consisting of 70 maximal repetitions .  Isometric strength , resting elbow angle and muscle soreness were measured before , immediately after ( except soreness ) and then daily for 7 days after exercise . There was a significant loss in strength among both groups ( 69 % for women and 63 % for men ) ( P≪0.01 ) immediately after exercise ; at 168 h post-exercise , women still had a 27 % strength loss and men had a 24 % strength loss . No significant difference in strength loss or recovery rate was found between men and women . Soreness reached peak values 32 - 48 h post-exercise ( P≪0.01 ) , with no significant difference between men and women . Range of motion decreased significantly until 3 days after exercise ( 14.6 ° or 0.255 rad loss for women ; 12.2 ° or 0.213 rad loss for men ) ( P≪0.01 ) ; at 168 h post-exercise , the women and men still showed a loss of 4.8 ° ( 0.084 rad ) and 4.0 ° ( 0.07 rad ) , respectively . There was a significant interaction of sex x time ( P≪0.01 ) ; a post-hoc test indicated that the women experienced a greater loss in range of motion at 72 h than men and this difference was maintained to 168 h post-exercise ( P≪0.01 ) . Thus , our results do not support the contention that women have a lower response to eccentric exercise than men Severe muscle atrophy occurs rapidly following traumatic spinal cord injury ( SCI ) . Previous research shows that neuromuscular or ‘ functional ’ electrical stimulation ( FES ) , particularly FES-cycle ergometry ( FES-CE ) can cause muscle hypertrophy in individuals with chronic SCI ( > 1 year post-injury ) . However , the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI . It is not known whether FES treatments are effective when used to prevent , rather than reverse , muscle atrophy in individuals with acute SCI . This study explored whether unloaded isometric FES contractions ( FES-IC ) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI ( <3 months post-injury ) . Twenty-six subjects , 14–15 weeks post-traumatic SCI , were assigned to control , FES-IC , or FES-CE against progessively increasing resistance . Subjects were involved in the study for 3 or 6 months . Total body lean body mass ( TB-LBM ) , lower limb lean body mass ( LL-LBM ) , and gluteal lean body mass ( G-LBM ) were determined before the study , and at 3 and 6 months using dual energy X-ray absorptiometry ( DEXA ) . Controls lost an average of 6.1 % , 10.1 % , 12.4 % , after 3 months and 9.5 % , 21.4 % , 26.8 % after 6 months in TB-LBM , LL-LBM and G-LBM respectively . Subjects in the FES-IC group consistently lost less lean body mass than controls , however , only 6 month G-LBM loss was significantly attenuated in this group relative to the controls . In the FES-CE group , LL-LBM and G-LBM loss were prevented at both 3 and 6 months , and TB-LBM loss was prevented at 6 months . In addition , FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels . Within the control group , there was no significant relationship between LL-LBM loss ( 3 and 6 months ) and the number of days between injury and baseline measurement . In summary , this study shows that FES-CE , but not FES-IC , training prevents muscle atrophy in acute SCI after 3 months of training , and causes significant hypertrophy after 6 months . The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs Cryotherapy is an effective treatment for acute sports injury to soft tissue , although the effect of cryotherapy on exercise-induced muscle damage is unclear . The aim of this study was to assess the effects of cold water immersion on the symptoms of exercise-induced muscle damage following strenuous eccentric exercise . After performing a bout of damage-inducing eccentric exercise ( eight sets of five maximal reciprocal contractions at 0.58 rad x s(-1 ) ) of the elbow flexors on an isokinetic dynamometer , 15 females aged 22.0+/-2.0 years ( mean + /- s ) were allocated to a control group ( no treatment , n = 7 ) or a cryotherapy group ( n = 8) . Subjects in the cryotherapy group immersed their exercised arm in cold water ( 15 degrees C ) for 15 min immediately after eccentric exercise and then every 12 h for 15 min for a total of seven sessions . Muscle tenderness , plasma creatine kinase activity , relaxed elbow angle , isometric strength and swelling ( upper arm circumference ) were measured immediately before and for 3 days after eccentric exercise . Analysis of variance revealed significant ( P < 0.05 ) main effects for time for all variables , with increases in muscle tenderness , creatine kinase activity and upper arm circumference , and decreases in isometric strength and relaxed elbow angle . There were significant interactions ( P<0.05 ) of group x time for relaxed elbow angle and creatine kinase activity . Relaxed elbow angle was greater and creatine kinase activity lower for the cryotherapy group than the controls on days 2 and 3 following the eccentric exercise . We conclude that although cold water immersion may reduce muscle stiffness and the amount of post-exercise damage after strenuous eccentric activity , there appears to be no effect on the perception of tenderness and strength loss , which is characteristic after this form of activity STUDY DESIGN Prospect i ve cohort study without a control group . OBJECTIVES Firstly , to present our 5-week progressive exercise therapy program in the early stage after anterior cruciate ligament ( ACL ) injury . Secondly , to evaluate changes in knee function after completion of the program for patients with ACL injury in general and also when classified as potential copers or noncopers , and , finally , to examine potential adverse events . BACKGROUND Few studies concerning early-stage ACL rehabilitation protocol s exist . Consequently , little is known about the tolerance for , and outcomes from , short-term exercise therapy programs in the early stage after injury . METHODS One-hundred patients were included in a 5-week progressive exercise therapy program , within 3 months after injury . Knee function before and after completion of the program was evaluated from isokinetic quadriceps and hamstrings muscle strength tests , 4 single-leg hop tests , 2 different self- assessment question naires , and a global rating of knee function . A 2-way mixed-model analysis of variance was conducted to evaluate changes from pretest to posttest for the limb symmetry index for muscle strength and single-leg hop tests , and the change in scores for the patient-reported question naires . In addition , absolute values and the st and ardized response mean for muscle strength and single-leg hop tests were calculated at pretest and posttest for the injured and uninjured limb . Adverse events during the 5-week period were recorded . RESULTS The progressive 5-week exercise therapy program led to significant improvements ( P<.05 ) in knee function from pretest to posttest both for patients classified as potential copers and noncopers . St and ardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong ( 0.49 - 0.84 ) , indicating the observed improvements to be clinical ly relevant . Adverse events occurred in 3.9 % of the patients . CONCLUSION Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation , either to improve knee function before ACL reconstruction or as a first step in further nonoperative management . LEVEL OF EVIDENCE Therapy , level 2b Sixty-one individuals admitted for rehabilitation with a diagnosis of complete tetraplegia due to traumatic spinal cord injury underwent prospect i ve examinations for motor and sensory recovery . The amount of motor , light touch and sharp/dull ( pin prick ) sensory recovery was independent of the initial neurologic level of injury between C4 and C8 . In the interval between one month and one year following injury , the American Spinal Injury Association Motor Score increased an average of 8.6 + /- 4.7 . However , the rate of motor recovery rapidly declined in the first six months and then approached plateau . Ninety-seven percent of muscles with Grade 1/5 ( " Trace " ) or 2/5 ( " Poor " ) strength one month after injury recovered to > or = 3/5 ( " Fair " ) strength by the time of first annual follow-up . Muscles with 0/5 strength one month after injury and located one neurological level below the most caudal level having motor function regained > or = 3/5 strength in only 27 percent of cases at one year follow-up and at two levels below in only 1 % of cases Athletic trainers have a variety of therapeutic agents at their disposal to treat musculoskeletal pain , but little objective evidence exists of the efficacy of the modalities they use . In this study ,  delayed onset muscle soreness  ( DOMS ) served as a model for musculoskeletal injury in order to : ( 1 ) compare the changes in perceived pain , elbow extension range of motion , and strength loss in subjects experiencing DOMS in the elbow flexor muscle group following a single treatment with either transcutaneous electrical nerve stimulation ( TENS ) , cold , a combination of TENS and cold , sham TENS , or 20 minutes of rest ; ( 2 ) compare the effects of combining static stretching with these treatments ; and ( 3 ) determine if decreased pain is accompanied by a restoration of strength . DOMS was induced in the non-dominant elbow flexor muscle group in 40 females ( age = 22.0 + /- 4.3 yr ) with repeated eccentric contractions . Forty-eight hours following exercise , all subjects presented with pain , decreased elbow extension range of motion , and decreased strength consistent with DOMS . Subjects were r and omly assigned to 20-minute treatments followed by static stretching . Cold , TENS , and the combined treatment result ed in significant decreases in perceived pain . Treatments with cold result ed in a significant increase in elbow extension range of motion . Static stretching also significantly reduced perceived pain . Only small , nonsignificant changes in muscle strength were observed following treatment or stretching , regardless of the treatment group . These results suggest that the muscle weakness associated with DOMS is not the result of inhibition caused by pain . The results suggest that these modalities are effective in treating the pain and muscle spasm associated with DOMS , and that decreased pain may not be an accurate indicator of the recovery of muscle strength An unexplained loss of muscle strength occurs with aging . Vitamin D deficiency can cause myopathy and administration of 1,25-dihydroxyvitamin D3 [ 1,25-(OH2)D3 ] to persons with low serum concentrations can improve strength . To test the hypothesis that the weakness associated with aging is in part due to inadequate serum concentrations of [ 1,25-(OH2)D3 ] , we conducted a r and omized , controlled , double blinded trial in 98 men and women volunteers over 69 yr old . Treatment consisted of 0.25 micrograms 1,25-(OH)2D3 , orally , twice per day or identical placebo for 6 months .  Leg muscle strength of the quadriceps was measured with an isokinetic dynamometer . There was no difference between the two groups at 1 week , 1 month , or 6 months of treatment in any of the measures of muscle strength . We conclude that oral administration of 0.5 micrograms 1,25-(OH)2D3/day does not improve muscle strength in older persons . Further research is needed to determine the etiology of the decline in muscle strength associated with aging Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin , New Zeal and The benefit was most noticeable in elderly people who fell OBJECTIVE The authors set out to determine whether immediate enteral feeding minimizes early postoperative decreases in h and grip and respiratory muscle strength . SUMMARY BACKGROUND DATA Muscle strength decreases considerably after major surgical procedures . Enteral feeding has been shown to restore strength rapidly in other clinical setting s. METHODS A r and omized , controlled , nonblinded clinical trial was conducted in patients undergoing esophagectomy or pancreatoduodenectomy who received immediate postoperative enteral feeding via jejunostomy ( fed , n = 13 ) , or no enteral feeding during the first 6 postoperative days ( unfed , n = 15 ) .  H and grip strength , vital capacity , forced expiratory volume in one second ( FEV1 ) , and maximal inspiratory pressure ( MIP ) were measured before surgery and on postoperative days 2 , 4 , and 6 . Fatigue and vigor were evaluated before surgery and on postoperative day 6 . Mobility was assessed daily after surgery using a st and ardized descriptive scale . Postoperative urine biochemistry was evaluated in daily 24-hour collection s. RESULTS Postoperative vital capacity ( p < 0.05 ) and FEV1 ( p = 0.07 ) were consistently lower ( 18%-29 % ) in the fed group than in the unfed group , whereas grip strength and maximal inspiratory pressure were not significantly different . Postoperative mobility also was lower in the fed patients ( p < 0.05 ) and tended to recover less rapidly ( p = 0.07 ) . Fatigue increased and vigor decreased after surgery ( both p < or = 0.001 ) , but changes were similar in the fed and unfed groups . Intensive care unit and postoperative hospital stay did not differ between groups . CONCLUSIONS Immediate postoperative jejunal feeding was associated with impaired respiratory mechanics and postoperative mobility and did not influence the loss of muscle strength or the increase in fatigue , which occurred after major surgery . Immediate postoperative enteral feeding should not be routine in well-nourished patients at low risk of nutrition-related complications Background Nutrition intake in the context of a resistance training ( RT ) bout may affect body composition and muscle strength . However , the individual and combined effects of whey protein and carbohydrates on long-term resistance training adaptations are poorly understood . Methods A four-week preparatory RT period was conducted in previously untrained males to st and ardize the training background of the subjects . Thereafter , the subjects were r and omized into three groups : 30 g of whey proteins ( n = 22 ) , isocaloric carbohydrates ( maltodextrin , n = 21 ) , or protein + carbohydrates ( n = 25 ) . Within these groups , the subjects were further r and omized into two whole-body 12-week RT regimens aim ing either for muscle hypertrophy and maximal strength or muscle strength , hypertrophy and power . The post-exercise drink was always ingested immediately after the exercise bout , 2–3 times per week depending on the training period . Body composition ( by DXA ) , quadriceps femoris muscle cross-sectional area ( by panoramic ultrasound ) , maximal strength ( by dynamic and isometric leg press ) and serum lipids as basic markers of cardiovascular health , were analysed before and after the intervention . Results Twelve-week RT led to increased fat-free mass , muscle size and strength independent of post-exercise nutrient intake ( P < 0.05 ) . However , the whey protein group reduced more total and abdominal area fat when compared to the carbohydrate group independent of the type of RT ( P < 0.05 ) . Thus , a larger relative increase ( per kg bodyweight ) in fat-free mass was observed in the protein vs. carbohydrate group ( P < 0.05 ) without significant differences to the combined group . No systematic effects of the interventions were found for serum lipids . The RT type did not have an effect on the adaptations in response to different supplementation paradigms . Conclusions Post-exercise supplementation with whey proteins when compared to carbohydrates or combination of proteins and carbohydrates did not have a major effect on muscle size or strength when ingested two to three times a week . However , whey proteins may increase abdominal fat loss and relative fat-free mass adaptations in response to resistance training when compared to fast-acting carbohydrates Background : Monophasic high voltage stimulation ( MHVS ) is widely prescribed for the treatment of inflammation associated with muscle injury . However , limited scientific evidence exists to support its purported benefits in humans . Objective : To examine the efficacy of early initiation of MHVS treatment after muscle injury . Methods : In a r and omised , cross over design , 14 men performed repetitive eccentric contractions of the elbow flexor muscles followed by either MHVS or control treatment . MHVS treatments were applied five minutes and 3 , 6 , 24 , 48 , 72 , 96 , and 120 hours after eccentric contractions . Results : MHVS result ed in a significant reduction ( p<0.05 ) in delayed onset muscle soreness 24 hours after eccentric exercise compared with controls . Elbow extension was significantly increased immediately after administration of MHVS compared with controls . No significant differences were observed between MHVS treatment and controls for maximal isometric strength , flexed arm angle , or arm volume . Conclusions : Early and frequent application of MHVS may provide transient relief from delayed onset muscle soreness and short term improvements in range of motion after injurious exercise . However , MHVS treatment may not enhance recovery after muscle injury because of lack of improvements in strength and active range of motion Background : It has been hypothesized that quadriceps muscle weakness is directly associated with the onset and progression of posttraumatic osteoarthritis after  anterior cruciate ligament ( ACL ) injury and reconstruction ( ACLR ) .  This relationship , however , has not been studied with a prospect i ve approach that includes the use of tibiofemoral joint space width difference ( JSW-D ) measurements to characterize the onset of posttraumatic osteoarthritis before the clinical manifestation of the disease . Purpose : To assess the relationship between thigh muscle strength and JSW-D at presurgery baseline and at 1- and 4-year follow-up after ACLR compared with healthy , noninjured participants of similar sex , age , body mass index , and activity level . Study Design : Cohort study ; Level of evidence , 3 . Methods : A total of 39 unilateral ACL-injured patients and 32 healthy controls were followed prospect ively . During each follow-up , JSW , isokinetic knee strength , single-legged hop , and clinical - and patient-oriented outcomes were assessed . At final follow-up , ACL-injured participants who had JSW-D values ( considered as the injured minus normal knee ) that were less than the 95 % confidence interval of controls were considered to be in the ACLR-narrow group , while those with JSW-D values that fell within the confidence intervals were in the ACLR-normal group . Relationships were evaluated between ACLR groups and controls via multilevel regression , as well as Kruskal-Wallis tests for between-group comparisons at 4-year follow-up . Results : At 4-year follow-up , 30 participants ( 79 % ) were in the ACLR-normal group and 8 ( 21 % ) were in the ACLR-narrow group . At baseline , the extension , flexion , and extension/flexion ratio strength values for both ACLR groups were significantly lower than those of controls ( P ≤ .05 ) , while the ACLR-narrow group had significantly lower extension strength at 60 and 180 deg/s ( P = .04 and .03 , respectively ) , as well as extension/flexion ratio at 60 deg/s ( P = .04 ) in comparison with the ACL-normal group . At 4-year follow-up , 60 deg/s extension strength deficits persisted in the ACLR-narrow group compared with controls and ACLR-normal participants ( P = .01 and .04 , respectively ) . Flexion strength at 180 and 300 deg/s was also significantly lower in the ACLR-narrow group compared with ACLR-normal ( P = .02 and .04 , respectively ) , as was single-legged hop distance ( P = .04 ) . Conclusion : Strength deficits present within months after ACL injury and persist through 4 years after ACLR in participants with significantly narrowed JSW-D , compared with ACLR participants with normal JSW-D and controls . This study revealed a significant relationship between quadriceps strength loss that occurred soon after injury and JSW narrowing STUDY DESIGN A between groups design was used to compare recovery following eccentric muscle damage under 2 experimental conditions . OBJECTIVE To determine if a compression sleeve donned immediately after maximal eccentric exercise would enhance recovery of physical function and decrease symptoms of soreness . BACKGROUND Prior investigations using ice , intermittent compression , or exercise have not shown efficacy in relieving symptoms of delayed onset muscle soreness ( DOMS ) . To date , no study has shown the effect of continuous compression on DOMS , yet this would offer a low cost intervention for patients suffering with the symptoms of DOMS .  METHODS AND MEASURES Twenty nonimpaired non-strength-trained women participated in the study . Subjects were matched for age , anthropometric data , and one repetition maximum concentric arm curl strength and then r and omly placed into a control group ( n = 10 ) or an experimental compression sleeve group ( n = 10 ) . Subjects were instructed to avoid pain-relieving modalities ( eg , analgesic medications , ice ) throughout the study . The experimental group wore a compressive sleeve garment for 5 days following eccentric exercise . Subjects performed 2 sets of 50 passive arm curls with the dominant arm on an isokinetic dynamometer with a maximal eccentric muscle action superimposed every fourth passive repetition . One repetition maximum elbow flexion , upper arm circumference , relaxed elbow angle , blood serum cortisol , creatine kinase , lactate dehydrogenase , and perception of soreness question naires were collected prior to the exercise bout and daily thereafter for 5 days . RESULTS Creatine kinase was significantly elevated from the baseline value in both groups , although the experimental compression test group showed decreased magnitude of creatine kinase elevation following the eccentric exercise . Compression sleeve use prevented loss of elbow motion , decreased perceived soreness , reduced swelling , and promoted recovery of force production . CONCLUSIONS Results from this study underline the importance of compression in soft tissue injury management We did a retrospective review and follow-up examina tion to investigate the incidence , risk factors , and out come of patients who developed loss of motion after arthroscopic anterior cruciate ligament reconstruction . Two hundred forty-four patients with a minimum fol lowup of 1 year were review ed . Loss of motion ( defined as a loss of extension of more than I0 ° or flexion of less than 125 ° ) was identified in 27 patients for an overall incidence of 11.1 % . Factors associated with loss of motion included acute reconstruction ( less than 1 month from initial injury ) , male sex , and concomitant medial collateral ligament repair or posterior oblique ligament reefing or both . Twenty-one patients required surgery to regain their motion ; three patients required a second procedure . Twenty-one of 27 patients with loss of motion under went a detailed followup and were compared with 24 r and omly chosen controls who had a normal range of motion after anterior cruciate ligament reconstruction .  At followup , patients who experienced loss of motion had a significant decrease in noninvolved to involved knee extension and flexion compared to the control patients . There was no difference between our patients and the controls regarding patellofemoral problems , anterior knee laxity , and functional strength . Sixty- seven percent of patients with loss of motion had a good or excellent result in comparison to 80 % of the controls This report presents results of a comparison perineal muscle function between antepartum and postpartum measurements in a cohort of women with different perineal conditions after childbirth . Data were obtained by using prospect i ve electromyographic perineometry measurements to objective ly determine perineal muscle function before and after delivery in 102 women . In addition , 24 nulliparous , non-pregnant women were studied to determine the effect of pregnancy on perineal muscle function . Pregnancy is associated with a decrease in perineal muscle strength and endurance compared with the postpartum state . The degree to which women improved or did not improve perineal muscle function after birth was related to perineal trauma at delivery . After controlling for parity , maternal age , birthweight , smoking status , and antepartum scores , the order of best to worst performance was cesarean birth , intact perineum , first-degree perineal injury , second- or third-degree perineal injury , and episiotomy .  Pre- and post-delivery scores were compared for each woman and analyzed according to perineal outcome . Although all other perineal outcome groups increased muscle function by 6 months postpartum , women with an episiotomy had a mean net loss of perineal muscle performance after birth . These observations do not support the use of episiotomy for the purpose of preserving perineal muscle function Ciliary neurotrophic factor ( CNTF ) is a neuroactive cytokine found in Schwann cells , which appears to be released in response to nerve injury . The ALS CNTF Treatment Study ( ACTS ) clinical trial was a phase II-III r and omized , placebo-controlled , double-blind study design ed to evaluate the safety , tolerability , and efficacy of subcutaneous administration of recombinantly produced human CNTF ( rHCNTF ) in slowing disease progression in 730 patients with amyotrophic lateral sclerosis ( ALS ) . Patients were r and omized to receive 30 micrograms/kg or 15 micrograms/kg rHCNTF or placebo subcutaneously three times a week for 9 months . The primary endpoint of the study , the slope of decline of isometric muscle strength in treated versus placebo patients , showed no statistically significant difference between rHCNTF and placebo-treated patients , and was complicated by an initial statistically significant decrease in strength early in rHCNTF-treated patients . Mortality was similar in all three study arms . There were no statistically significant treatment effects among the secondary measures . Side effects of rHCNTF included anorexia , weight loss , and cough and were sufficient to limit dosing in many patients OBJECTIVE To investigate the effects of low-energy diet-induced weight loss on lower-extremity muscle mass and knee muscle strength in obese patients with knee osteoarthritis ( OA ) , and the associations of these effects . METHODS We studied 159 obese patients with knee OA and available data from body composition analysis that had been performed using dual x-ray absorptiometry scanning and isometric muscle strength testing of the knee in extension and in flexion . The data had been obtained as part of a r and omized controlled trial , with measurements performed before and after a supervised low-energy diet-induced weight loss intervention lasting 16 weeks . RESULTS The patients lost an average of 12.9 kg ( 95 % confidence interval [ 95 % CI ] 10.2 , 15.7 ) ( 13 % of baseline weight ) . The weight loss consisted of 10.9 kg fat mass ( 95 % CI 8.9 , 12.9 ) , of which 3.8 kg ( 95 % CI 2.7 , 4.9 ) was leg fat mass . Total lean body mass was reduced by 1.9 kg ( 95 % CI 0.05 , 3.8 ) , of which 0.785 kg ( 95 % CI 0.09 , 1.476 ) was leg lean mass . Absolute muscle strength decreased by ∼3 - 4 % after the weight loss , whereas body mass-normalized muscle strength increased by 11 - 12 % . At baseline , leg lean mass was significantly related to muscle strength , but changes in these measurements at followup were not related . CONCLUSION Weight loss induced by a low-energy diet led to independent losses of leg muscle tissue and strength . The weight loss was accompanied by increased normalized muscle strength along with improved self-reported disability and pain -- all of which are beneficial to patients with knee OA . The present results suggest that significant weight loss in patients with knee OA should be followed by an exercise regimen to restore or increase muscle mass QUESTION Does progressive resistance training improve strength and activity after stroke ? Does any increase in strength carry over to activity ? DESIGN Systematic review of r and omised trials with meta- analysis . PARTICIPANTS Adults who have had a stroke . INTERVENTION Progressive resistance training compared with no intervention or placebo . OUTCOME MEASURES The primary outcome was change in strength . This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention . The secondary outcome was change in activity . This measurement had to be a direct measure of performance that produced continuous or ordinal data , or with scales that produced ordinal data . RESULTS Eleven studies involving 370 participants were included in this systematic review . The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8 , representing medium quality . The effect size of  progressive resistance training on strength was 0.98 ( 95 % CI 0.67 to 1.29 , I2=0 % ) . The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies . The effect size of progressive resistance training on activity was 0.42 ( 95 % CI -0.08 to 0.91 , I2=54 % ) . CONCLUSION After stroke , progressive resistance training has a large effect on strength compared with no intervention or placebo . There is uncertainty about whether these large increases in strength carry over to improvements in activity . REVIEW REGISTRATION PROSPERO CRD42015025401 . [ Dorsch S , Ada L , Alloggia D ( 2018 ) Progressive resistance training increases strength after stroke but this may not carry over to activity : a systematic review . Journal of Physiotherapy 64 : 84 - 90 ] Objectives The primary objective of this review was to determine , from the available evidence , the effectiveness of an antenatal and /or a post‐natal program of pelvic floor muscle exercises ( PFME ) compared with usual care on preventing , reducing or resolving the incidence and severity of stress incontinence , urge incontinence or mixed stress and urge urinary incontinence following childbirth . Secondary objectives were included to examine the effectiveness of a PFME program on pelvic floor muscle strength and on encouraging adherence to an exercising program . Inclusion criteria Types of studies R and omised controlled trials and non‐r and omised controlled trials were included in the review if , in relation to urinary incontinence , and /or adherence to a PFME program , and /or pelvic floor muscle strength , the following had been explored : antenatal PFME compared with usual care ; post‐natal PFME compared with usual care ; a PFME program compared with usual care . Usual care is commonly used to describe the care women normally receive from health professionals in the antenatal and /or post‐natal period . In some cases usual care includes a st and ard information package given to all women attending the health service and in others it is advice about performing PFME . Types of participants Participants included women who experienced a spontaneous onset of labour and who subsequently delivered at more than 20 weeks gestation either vaginally , both spontaneous and assisted , or by non‐elective caesarean section . Exclusions : women who delivered by elective caesarean section ; women experiencing post‐partum overflow urinary incontinence . Types of interventions 1 Pelvic floor muscle exercises . 2 PFME instruction and a PFME program 's components , such as educational material s , feedback ( including biofeedback , e.g. information about strength of pelvic floor muscle contractions by various means ) and number of PFME . Exclusions : electrical stimulation of pelvic floor muscles ; vaginal cones ; or other adjunct therapies . In studies that included a subgroup treated with one of these interventions , the results of the subgroup were excluded from the review 's analysis . Types of outcome measures Outcomes that were of interest : non‐occurrence of urinary incontinence following childbirth ; a change in the frequency , duration or severity ( as appropriate ) of urinary incontinence up to 12 months following childbirth . a change in the strength of pelvic floor muscle contractions ; period of time  PFME continued after initial instruction ; frequency of PFME undertaken ; women 's awareness of the importance  of PFME ; satisfaction with PFME instruction . Search strategy All major electronic sources of information relevant to the topic ( e.g. PubMed , CINAHL and the Cochrane Library ) were search ed to identify published and unpublished studies and previous work in the field . Printed journals were h and ‐ search ed and reference lists checked for potentially useful research . The review included any studies undertaken between 1981 and 2003 . The search did not attempt to locate unpublished research before 1991 . Assessment of quality An independent Review Panel carried out quality assessment of studies . Two members of the panel , using quality assessment checklists developed for the review , review ed each study . Disagreements between review ers were resolved through discussion or a third review er examining a study . Data extraction and analysis A data extraction tool was developed to extract data relating to participant characteristics , study methods , interventions and outcomes . Two review ers independently extracted the required data . R and omised controlled trials included in the review were pooled in several meta‐analyses using RevMan software program . Heterogeneity between studies was determined to ensure that they were sufficiently similar to allow for the pooling of their results . Non‐r and omised controlled trials were discussed in narrative comparisons . Results Six r and omised controlled trials met the inclusion criteria for the primary objective of the systematic review . The results of this review indicate that antenatal PFME and post‐natal PFME are effective in resolving or reducing urinary incontinence following childbirth . There was insufficient evidence to conclude that PFME can prevent urinary incontinence in post‐partum women . In most of these studies women were selected r and omly and therefore included women without urinary incontinence and women with urinary incontinence . Two r and omised controlled trials selected their sample on the criteria of existing post‐partum urinary incontinence . A subgroup analysis of these studies showed that post‐natal PFME also have a significant effect on reducing or resolving urinary incontinence in women with existing post‐partum urinary incontinence . Seven r and omised controlled trials and three non‐r and omised controlled trials met the inclusion criteria for the secondary objectives of the review . Findings of the studies included in the review suggest a PFME program will improve the frequency with which women perform PFME  . Two studies found that women receiving the intervention ( a PFME program ) and who were performing PFME regularly in the month before data collection were significantly less likely to have any incontinence . The review 's results support previous findings showing there is little evidence that a high‐intensity PFME program is more effective than a low‐intensity PFME regimen of exercising . No conclusions about the effectiveness of feedback to a woman about pelvic floor muscle strength , for example , perineometer measures , as part of a PFME program can be reached . The mixed results of this review mean that no conclusions can be reached about the effectiveness of a PFME program , antenatal or post‐natal , on improving pelvic floor muscle strength . A number of studies reported a high percentage of women lost to follow‐up and the data collected in most of the studies relied on self‐reports relating to urinary incontinence and /or frequency of exercising . These factors may have affected the overall results of the review . However , wherever possible , tests for heterogeneity were carried out to determine if studies should be combined in meta‐analyses and in other cases the results ' limitations are acknowledged . Implication s for practice In terms of the effectiveness of PFME programs , the results of this review indicate that urinary incontinence following childbirth can be improved by performing PFME and that any form of a specific PFME program appears to improve exercising frequency . However , the value of individual components of PFME programs , such as take‐home material s , reminder telephone calls and feedback of exercising effectiveness , is less clear . Encourage women to undertake both antenatal and post‐natal PFME ( E1 ) . Pay particular attention to women with antenatal and post‐natal urinary incontinence in providing advice and PFME instruction ( E1 ) . To encourage adherence and continuation , PFME education programs should be multifaceted with a number of components , rather than only supplying an information booklet ( E4 ) . Include PFME as a specific program in all antenatal and post‐natal care , incorporating at least two individual instruction sessions into the program ( E1 ) . Provide post‐partum contact , particularly for those discharged early , either by telephone , electronic or home visits ( E4 ) . Design pelvic floor muscle home exercise programs that are realistic given the dem and s on a mother and that can be incorporated into her daily routine in terms of number and frequency . Two or more training sessions per week are recommended ( E4 ) . Health professionals working with women in the post‐partum period should ask about symptoms of incontinence to ensure assistance is offered to those experiencing urinary incontinence ( E4 ) OBJECTIVES The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history . In addition , we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise  , and report the incidence of musculoskeletal injuries upon initiation of an exercise program . DESIGN A population -based , single blinded , r and omized controlled trial with three exercise groups and one control group . SETTING A large urban health maintenance organization . PARTICIPANTS Older men and women ( N = 105 ) aged 68 to 85 , with leg strength below the 50th percentile for their age , sex , height , and weight and without neuromuscular disease or active cardiovascular disease . INTERVENTIONS Supervised exercise in 1-hour sessions , three times each week , for 24 to 26 weeks . One exercise group did strength training ( ST ) using weight machines ( n = 25 ) ; another group did endurance training ( ET ) using stationary cycles ( n = 25 ) ; and the third group did combined strength training and endurance training ( ST+ET ) ( n = 25 ) . The control group ( n = 30 ) received no intervention . MEASUREMENTS Strength was measured at the ankle , knee , hip , and elbow using an isokinetic dynamometer . Joint symptoms were rated on a 6-point scale ( 0 = none , 5 = severe ) . Arthritis severity was based on self-reported use of arthritis medication . Health status was measured with subscales of the SF-36 and Sickness Impact Profile ( SIP ) . RESULTS Joint symptoms fluctuated over time in all exercise groups , but they did not improve or worsen significantly in any group . The physical dimension of the SIP and SF-36 subscale scores , including Bodily Pain Scores , did not change over time in any group . Subjects with arthritis and joint symptoms gained as much strength with strength training as did subjects without joint symptoms . Adjustment for age , gender , baseline strength , adherence , and exercise group did not affect this finding . The rate of minor musculoskeletal injuries was 2.2 injuries per 1000 exercise hours . CONCLUSIONS Moderate intensity stationary cycle exercise and vigorous intensity strength training do not appear to produce or exacerbate joint symptoms in older adults . Joint symptoms did not explain the large variation in gains in strength in older adults participating in a st and ardized strength training exercise program .  Musculoskeletal injuries occurred relatively infrequently , and no major injuries occurred . In evaluating joint pain that occurs in older adults in well regulated exercise programs , clinicians should consider other etiologies before attributing pain to exercise per se Physical exercise is often recommended as a therapeutic tool to combat pre- and postmenopausal loss of bone density . However , the relationship between training dosage ( intensity , duration , frequency ) and the effect on bone density still is undergoing discussion . Furthermore , the exercise quantification programs are often described so inadequately that they are neither quantitatively nor qualitatively reproducible . The aim of this investigation was to determine whether a clearly defined training of muscle strength , under defined safety aspects , performed only twice weekly , can counteract bone density loss in women with postmenopausal osteopenia . Data from 16 women in the training group ( age , 63.6 + /- 6.2 yr ) and 15 women in the control group ( age , 67.4 + /-9.7 yr ) , of comparable height and weight , were evaluated .  Strength training was performed for 6 mo as continually adapted strength training , providing an intensity of about 70 % of each test person 's one repetition maximum . Bone mineral density of lumbar vertebrae 2 to 4 and the femoral neck was measured by dual-energy x-ray absorptiometry . Maximum performance in watts and parameters of hemodynamics were controlled with a bicycle ergometer test to maximal effort . In addition , metabolic data were assessed . In the lumbar spine and femoral neck , the training group showed no significant changes , whereas the control group demonstrated a significant loss of bone mineral density , especially in the femoral neck ( P<0.05 ) . The strength increase was highly significant in all exercised muscle groups , rising to about 70 % above the pretraining status ( P<0.001 ) . Heart rate and blood pressure data indicated a slight economization , metabolism was not significantly influenced . Based on these findings , we conclude that continually adapted strength training is an effective , safe , reproducible , and adaptable method of therapeutic strength training , following only two exercise sessions per week BACKGROUND Loss of muscle power due to normal aging has greater functional impact than loss of strength alone . The present study compared two resistance training programs , one aim ed at enhancing muscle power and one at increasing muscle strength , on muscle function and functional performance in older adults . METHODS Sixty-seven healthy , independent older adults ( 65 - 84 years ) were r and omized to a high-velocity varied resistance ( HV ) , constant resistance ( ST ) , or nontraining control ( CO ) group . Participants trained twice weekly for 24 weeks using six exercises .  Dynamic and isometric muscle strength , muscle power , movement velocity , muscle endurance , and a battery of functional performance tasks were assessed . Secondary outcomes included body composition , quality of life , and balance confidence . RESULTS Muscle strength increased significantly ( p < .001 ) and similarly in the training groups compared to controls ( HV , 51.0 + /- 9.0 % ; ST , 48.3 + /- 6.8 % ; CO , 1.2 + /- 5.1 % ) . Peak muscle power also increased with training ( p < .05 ) , with no difference between training groups . The change in peak power was 50.5 + /- 4.1 % , 33.8 + /- 3.8 % , and -2.5 + /- 3.9 % in the HV , ST , and CO groups , respectively . Training also improved selected functional performance tasks in the HV and ST groups compared to controls ( p < .05 ) , and the HV group reported improved quality of life ( p = .018 ) . CONCLUSION Muscle power and muscle strength improved similarly using either resistance training protocol , and these changes were accompanied by improvements in several functional performance tasks . However , improvements in the HV group occurred with less total work performed per training session OBJECTIVE To determine the safety , feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome ( FMS ) . METHODS Fifteen women with confirmed FMS were monitored for injury and exercise compliance , and assessed for muscle strength ( 1-repetition maximum technique ) , cardiovascular endurance ( 6-minute walk test ) , and functional status ( Fibromyalgia Impact Question naire [ FIQ ] ) before and after a 20-week exercise intervention . RESULTS Zero injuries and an 81 % compliance rate occurred during training . Improvement was seen in muscle strength of the lower ( 191 + /- 75 to 265 + /- 67 pounds ; P < 0.001 ) and upper ( 61 + /- 18 to 76 + /- 18 pounds ; P < 0.001 ) body , 6-minute walk distance ( 530 + /- 80 to 629 + /- 74 meters ; P < 0.001 ) , and in FIQ score ( 44 + /- 9 to 32 + /- 14 ; P < 0.01 ) . CONCLUSION A program of progressive strength training and cardiovascular exercise can be safe , well tolerated , and effective at improving muscle strength , cardiovascular endurance and functional status in women with FMS without exacerbating symptoms . This program may also contribute to a reduction in the severity of several symptoms BACKGROUND The effects of weight loss on muscle function in older adults have not been well studied . This study determined the effects of a 6-month weight-loss intervention on muscle strength and quality in older obese adults with knee osteoarthritis . METHODS Participants were r and omized to a weight loss ( WL ) ( n = 44 , 70 + /- 6 years ) or weight stable ( WS ) ( n = 43 , 69 + /- 6 years ) group . The WL intervention consisted of weekly educational meetings , a meal replacement diet , and a three-session-per-week structured exercise program to achieve 10%-12 % weight loss . The WS intervention included bimonthly group meetings and newsletters .  Body composition and knee extensor strength were measured at baseline and after intervention . RESULTS The WL group decreased body weight , lean body mass , fat mass , and percent body fat ( p < .001 for all ) . Concentric extension strength increased 25 % in WL ( p > .05 ) , whereas eccentric extension decreased 6 % in WS ( p = .028 ) . Concentric muscle quality ( strength per kg body weight or lean body mass ) increased in WL ( p < .05 ) , whereas eccentric muscle quality decreased in WS ( p < .05 ) . Changes in lean body mass and fat mass were inversely associated with changes in most muscle strength and quality measures ( p < .05 ) . Men and women did not differ in response to the intervention in knee strength outcomes . CONCLUSIONS Hypocaloric dieting in combination with exercise training had beneficial effects on muscle strength/ quality , despite loss of lean body mass in this sample of older men and women . Greater fat loss was associated with greater gains in muscle strength and quality . More studies are needed regarding the mechanisms by which loss of fat mass increases muscle strength and quality A considerable increase in muscle strength and bone mass can be achieved in young adults through athletic exercise programs . We studied a less dem and ing nonloading exercise program for the back extensor muscles in postmenopausal women who were not on estrogen therapy .  We r and omly assigned 65 healthy Caucasian women without evidence of or risk factors for osteoporosis into an exercise group and a control group . The strength of the back extensor muscles and bone mineral density of the lumbar spine were measured at baseline and every 6 months for 2 years . In addition , a physical activity score was determined . Compliance was assessed by regular interviews and review of diaries . During the 2-year study , the mean rates of bone loss in the two groups were not statistically different . The strength of the back extensor muscles increased in both groups but significantly more ( P = 0.002 ) in the exercise group . We conclude that postmenopausal bone loss is unaffected by a modest exercise program despite an increase in muscle strength .  Nonloading muscle exercise may be ineffective in retarding vertebral bone loss in ambulatory , healthy postmenopausal women OBJECTIVES Total knee arthroplasty ( TKA ) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength . We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate , L-arginine , and L-glutamine ( HMB/Arg/Gln ) on the postoperative recovery of quadriceps muscle strength in patients after TKA . METHODS Study subjects were 23 patients ( 12 women ; mean age : 70.5 ) who underwent TKA . The patients were r and omly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation ( HMB/Arg/Gln group ) . HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery , and maximal quadriceps strength was measured at 7 days before the surgery , and at 14 , 28 and 42 days after the surgery . During the study , total energy expenditure was measured using a lifestyle recording device . The two groups followed the rehabilitation in the same way . RESULTS The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group ( p=0.02 ) , and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group . Although the control group experienced a significant loss of muscle strength after the surgery , the HMB/Arg/Gln group did not . There was no significant difference in total energy expenditure between the two groups . CONCLUSIONS Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA . Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength Aim To determine whether rotator cuff strength , glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male h and ball players . Methods A total of 206 players in the Norwegian elite h and ball league for men were tested prior to the 2011–2012 season . Measures included : ( 1 )  glenohumeral internal and external rotation range of motion , ( 2 ) isometric internal rotation , external rotation and abduction strength and ( 3 ) assessment of scapular dyskinesis .  Players were followed prospect ively for the entire regular season ( 30 weeks ) , with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Question naire . A cumulative severity score was calculated for each player based on their question naire responses . This was used as the outcome measure in risk factor analyses . Results The average prevalence of shoulder problems throughout the season was 28 % ( 95 % CI 25 % to 31 % ) . The prevalence of substantial shoulder problems , defined as those leading to moderate or severe reductions in h and ball participation or performance , or to time loss , was 12 % ( 95 % CI 11 % to 13 % ) . Significant associations were found between obvious scapular dyskinesis ( OR 8.41 , 95 % CI 1.47 to 48.1 , p<0.05 ) , total rotational motion ( OR 0.77 per 5 ° change , 95 % CI 0.56 to 0.995 , p<0.05 ) and external rotation strength ( OR 0.71 per 10 Nm change , 95 % CI 0.44 to 0.99 , p<0.05 ) and shoulder injury . Conclusions Injury prevention programmes should incorporate interventions aim ed at improving glenohumeral rotational range of motion , external rotation strength and scapular control PURPOSE To assess prospect ively if a short imaging examination performed with low-field-strength dedicated magnetic resonance ( MR ) imaging in addition to radiography is effective and cost saving compared with the current diagnostic imaging strategy ( radiography alone ) in patients with recent acute traumatic injury of the wrist , knee , or ankle . MATERIAL S AND METHODS Institutional review board approval and informed consent were obtained . Patients with recent trauma of the wrist , knee , or ankle were r and omized across two diagnostic strategies : radiography alone ( reference group ) or radiography followed by a short MR imaging examination ( intervention group ) . Measures of effectiveness included the number of additional diagnostic procedures , time to last diagnostic procedure , and number of days absent from work . Measures of effectiveness were analyzed by using an exact Wilcoxon-Mann-Whitney test . Time to convalescence and quality of life were analyzed by using a t test . Cost analysis was performed from a societal perspective and analyzed by using a t test . RESULTS Five hundred patients ( 207 women , 293 men ; mean age , 34.8 years ) with acute injury of the wrist , knee , or ankle were r and omized . In the intervention group , quality of life for patients with knee injuries was significantly higher during the first 6 weeks , and time to completion of diagnostic work-up was significantly shorter ( mean , 3.5 days for intervention group vs 17.3 days for reference group ) . The number of additional diagnostic procedures was significantly lower in the intervention group versus the reference group ( nine vs 35 , respectively ) for patients with knee injuries . Patients with knee injuries showed the largest difference in costs ( intervention group , 1820 [ $ 1966 ] ; reference group , 2231 [ $ 2409 ] ) owing to a reduction in productivity loss . Costs were higher in patients with wrist injuries and almost equal in patients with ankle injuries . All cost differences , however , were not significant . CONCLUSION Compared with radiography , MR imaging in patients with acute wrist or ankle injuries is neither cost saving nor effective in expediting diagnostic work-up or improving quality of life . In patients with knee injuries , a short MR imaging examination shortens the time to completion of diagnostic work-up , reduces the number of additional diagnostic procedures , improves quality of life in the first 6 weeks , and may reduce costs associated with lost productivity Flexibility ( joint range of motion ) is promoted as an important component of physical fitness ( Pollock et al. , 1998 ) . It is widely conjectured that increasing flexibility will promote better performances and reduce the incidence of injury ( Shellock & Prentice , 1985 ; Smith , 1994 ) . Consequently , stretching exercises design ed to enhance flexibility are regularly included in many athletes ’ training programs and pre-event warm-up activities ( Gleim & McHugh , 1997 ; Holcomb , 2000 ) . Notwithst and ing the widespread acceptance and use of stretching exercises as a major component of pre-event activities , the purported benefits of stretching on performance and injury prevention have been question ed in several review papers ( Gleim & McHugh , 1997 ; Herbert & Gabriel , 2002 ; Knudson , 1999 ; Weldon & Hill , 2003 . ) . In addition , recent research has established an adverse effect of acute static stretching  on various different maximal performances . Pre-event stretching has demonstrated an inhibitory effect on maximal force or torque production ( Avela , Kyrolainen , & Komi , 1999 ; Behm , Button , & Butt ; 2001 ; Evetovich , Nauman , Conley , & Todd , 2003 ; Fowles , Sale , & MacDougall , 2000 ; Kokkonen , Nelson , & Cornwell , 1998 ; Nelson , Allen , Cornwell , & Kokkonen , 2001 ; Nelson , Guillory , Cornwell , & Kokkonen , 2001 ; Nelson & Kokkonen , 2001 ) , vertical jump performance ( Church , Wiggins , Moode , & Crist , 2001 ; Cornwell , Nelson , Heise , & Sidaway , 2001 ; McNeal & S and s , 2003 ; Young & Behm , 2003 ; Young & Elliott , 2001 ) , and running speed ( Nelson , Driscoll , L and in , Young , & Schexnayder , 2005 ; Siatras , Papadopoulos , Mameletzi , Gerodimos , Kellis , 2003 ) . This paradox between accepted dogma and current research places a difficult decision on coaches and athletes . Do they include flexibility exercises in their preevent activities and risk the loss of maximal performance , or do they drop the flexibility exercises and increase the risk of injury ? To help answer this question , it would be helpful to know if high flexibility has a different influence on force production . Unfortunately , little information is available about individuals ’ degree of flexibility in the aforementioned studies . Four of the studies ( Church et al. , 2001 ; McNeal & S and s , 2003 ; Nelson et al. , 2005 ; Siatras et al. , 2003 ) made measurements on competitive athletes . While it is reasonable to assume that competitive athletes perform stretching exercises as part of their training regimen , one can not be positive that these stretching exercises will routinely yield high flexibility . Moreover , two of the studies ( McNeal & S and s , 2003 ; Siatras et al. , 2003 ) used children whose mean ages were less than 13 years , thus , increasing rather than decreasing the number of possible confounding factors . In addition , the studies reporting the initial flexibility of the individuals tested ( Kokkonen et al. , 1998 ; Nelson & Kokkonen , 2001 ) reported sit- and -reach scores below the 50th percentile of the published norms ( for norms , see Hoegar & Hoegar , 1990 ) . Thus , it is possible that the negative impact of stretching is present primarily in individuals who do not regularly engage in  stretching  activities and /or whose sit- and -reach scores are below the recommended normal percentile ( i.e. , < 60th percentile for the sit- and -reach ) . Strength Inhibition Following An Acute Stretch Is Not Limited To Novice Background Childhood obesity is one of the most critical public health problems in the world . It is associated with low neuromuscular function and postural deformities . Whether weight loss can improve postural stability and neuromuscular control , benefit daily activities , or prevent injury is unknown . Therefore , this study attempts to investigate the effect of a 6 month weight management program on postural stability and neuromuscular control among obese children . Methods / design We will conduct a prospect i ve , single-blind , r and omized controlled trial with 120 prepubescent obese children . Participants will be r and omly assigned to a weight management group or a control group . The weight management group will participate in a dietary and exercise program . The control group will receive health education . After the intervention , participants will be followed for 6 months with no active intervention . The primary and secondary outcomes will be assessed at the baseline , and after 6 months and 12 months . Primary outcome measures will include body weight , body height , body mass index , waist circumference , hip circumference , and body fat percentage . Secondary outcome measures will include three-dimensional functional biomechanics in different tasks , proprioception tests of the knee and ankle , neuromuscular response of the leg muscles , and muscle strength tests of the knee and ankle . Furthermore , adverse events will be recorded and analyzed . An intention-to-treat analysis will be performed if any participants withdraw from the trial . Discussion The important features of this trial include the r and omization procedures and large sample size . This study attempts to estimate the effect of weight loss intervention on outcomes , including daily life function , postural stability , and neuromuscular control in prepubescent obese children . Therefore , our results can be useful for obese children , medical staff , and healthcare decision makers . Trial registration Chinese Clinical Trial Registry ChiCTR-IOB-15005874 Purpose This study aim ed to evaluate the hypothesis that exercise attenuates the reductions in lean mass , muscle strength , bone mineral density , and V˙O2max that accompany modest weight loss induced by calorie restriction ( CR ) . Methods Overweight , sedentary women and men ( n = 52 , 45–65 yr ) were r and omized to 6%–8 % weight loss by using CR , endurance exercise training ( EX ) , or both ( CREX ) . The CR and the CREX groups underwent counseling to reduce energy intake by 20 % and 10 % , respectively . The EX and the CREX groups exercised 7.4 ± 0.5 and 4.4 ± 0.5 h·wk−1 , respectively . Before and after 16.8 ± 1.1 wk of weight loss , lean mass and bone mineral density were measured with dual-energy x-ray absorptiometry , strength was measured with dynamometry , and aerobic capacity ( V˙O2max ) was measured with indirect calorimetry during maximal-intensity treadmill exercise . Results Weight loss was ~7 % in all groups . Decreases in whole-body ( ~2 % , P = 0.003 ) and lower extremity ( ~4 % , P < 0.0001 ) lean mass occurred in the CR group ( both P < 0.05 ) . Despite similar weight loss , these reductions were attenuated in the CREX group ( ~1 % , P = 0.44 and ~2 % , P = 0.05 , respectively ) and absent in the EX group . Absolute aerobic capacity decreased ~6 % in the CR group ( P = 0.04 ) , was unchanged in the CREX group ( P = 0.28 ) , and increased ~15 % in the EX group ( P < 0.0001 ) . No changes in muscle strength or bone were observed . Conclusions Modest weight loss ( ~7 % ) induced by 20  % CR in overweight women and men  decreases lean mass and reduces absolute V˙O2max . Exercise protects against these effects . Although the CR-induced changes might be considered physiologically appropriate for a reduced body weight , exercise preserves and /or improves these parameters during weight loss , which likely improves physical function . These findings support the notion of using exercise as an important component of weight loss programs RATIONALE Diaphragmatic function is a major determinant of the ability to successfully wean patients from mechanical ventilation ( MV ) .  Paradoxically , MV itself results in a rapid loss of diaphragmatic strength in animals . However , very little is known about the time course or mechanistic basis for such a phenomenon in humans . OBJECTIVES To determine in a prospect i ve fashion the time course for development of diaphragmatic weakness during MV ; and the relationship between MV duration and diaphragmatic injury or atrophy , and the status of c and i date cellular pathways implicated in these phenomena . METHODS  Airway occlusion pressure ( TwPtr ) generated by the diaphragm during phrenic nerve stimulation was measured in short-term ( 0.5 h ; n = 6 ) and long-term ( > 5 d ; n = 6 ) MV groups . Diaphragmatic biopsies obtained during thoracic surgery ( MV for 2 - 3 h ; n = 10 ) and from brain-dead organ donors ( MV for 24 - 249 h ; n = 15 ) were analyzed for ultrastructural injury , atrophy , and expression of proteolysis-related proteins ( ubiquitin , nuclear factor-κB , and calpains ) . MEASUREMENTS AND MAIN RESULTS TwPtr decreased progressively during MV , with a mean reduction of 32 ± 6 % after 6 days . Longer periods of MV were associated with significantly greater ultrastructural fiber injury ( 26.2 ± 4.8 vs. 4.7 ± 0.6 % area ) , decreased cross-sectional area of muscle fibers ( 1,904 ± 220 vs. 3,100 ± 329 μm² ) , an increase of ubiquitinated proteins ( + 19 % ) , higher expression of p65 nuclear factor-κB ( + 77 % ) , and greater levels of the calcium-activated proteases calpain-1 , -2 , and -3 ( + 104 % , + 432 % , and + 266 % , respectively ) in the diaphragm . CONCLUSIONS Diaphragmatic weakness , injury , and atrophy occur rapidly in critically ill patients  during MV  , and are significantly correlated with the duration of ventilator support BACKGROUND & AIMS Undernutrition after an acute stroke increases the risk of poor outcome . We wanted to examine the effect of individualized , nutritional support on weight loss and functional outcomes in stroke patients . METHODS Acute stroke patients at nutritional risk were r and omized to either individualized , nutritional care or routine care while in hospital . Patients in the intervention group received an individualized treatment plan aim ing to prevent weight loss . In accordance with routine care , the controls did not have such a treatment plan . Patients were review ed at follow-up after three months . Primary outcome measure was the percentage of patients with weight loss ≥5 % . Secondary outcomes measures were quality of life ( QoL ) , h and grip strength and length of hospital stay . This trial is registered with Clinical Trials.gov , number NCT00163007 . RESULTS At follow-up , 20.7 % of the intervention group ( n = 58 ) lost ≥5 % weight compared with 36.4 % in the control group ( n = 66 ) ( P = 0.055 ) . The intervention group had a significantly higher increase in QoL score ( P = 0.009 ) and in h and grip strength ( P = 0.002 ) . There was no difference in length of hospital stay . CONCLUSIONS Individualized , nutritional treatment strategy can prevent clinical ly significant weight loss and improve QoL in elderly acute stroke patients at nutritional risk Introduction Weight loss significantly increases postmenopausal bone loss , but the effects of muscle strength change on weight-loss-associated bone loss remain unclear . The study population , 587 peri- and postmenopausal women , was a r and om sample of the original Osteoporosis Risk Factor and Prevention Study ( OSTPRE ) study cohort ( n=14,220 ) in Kuopio , Finl and .  Bone mineral density ( BMD ) at the lumbar spine ( LS ) and femoral neck ( FN ) was measured with dual x-ray absorptiometry , and grip strength was measured with a pneumatic squeeze dynamometer at baseline in 1989–1991 and at the 10-year follow-up in 1999–2001 . Methods Women were divided into three groups according to change in age-grouped grip-strength quartile in both of the measurements : " decreased " ( n=133 ) , " maintained " ( n=300 ) , and " improved " ( n=154 ) . In addition , the study sample was divided into two groups according to weight change during the follow-up : weight losers ( n=156 ) and weight gainers ( n=431 ) . Results There were no differences in the change status of grip ( muscle ) strength between the weight loss and weight gain groups ( p>0.500 , Pearson chi-square test ) . Women losing weight during the follow-up and within the improved grip-strength-change group had a significantly lower bone loss rate compared with those in the maintained and decreased grip-strength-change groups ( p<0.01 in comparison to the decreased group ) . This was in contrast to women who gained weight during the follow-up ( not significant between any grip-strength-change groups ) . Furthermore , women who lost body weight and were in the improved grip-strength-change group had a bone loss rate comparable with that of the women who gained body weight ( not significant ) . This was in contrast to the maintained ( p<0.05 between weight losers versus gainers in LS ) and decreased grip-strength-change groups ( p<0.01 weight losers versus gainers in LS and FN ) . Conclusion The present study suggests that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss . Accordingly , exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons BACKGROUND Although research has documented the efficacy of maximal voluntary contraction ( MVC ) exercise for improved pelvic floor muscle ( PFM ) strength , the efficacy of submaximal voluntary contraction ( SVC ) exercise for treatment of genuine stress urinary incontinence ( GSUI ) has not been described . OBJECTIVE To compare the training-induced changes in endurance , strength , and muscle activity recruitment , and continence control in groups of women with GSUI who exercised the PFM using either near-maximal voluntary contraction ( NMVC ) or SVC effort . METHODS Training-induced changes in PFM response to exercise were tested by using a quasi-experimental design . Thirty-two women , r and omly assigned to either the SVC or NMVC exercise protocol group , were tested before and after training on endurance , muscle contraction strength , muscle activity recruitment , 10-hour weighed pad test for grams of urine loss , and subject-rated severity and frequency of leakage episodes . Repeated measures of specific study variables were retrieved and analyzed from home-training device computer memory and diary records . Changes in muscle activity recruitment , measured as microvolts of electromyogram ( EMG ) amplitude , were correlated with changes in muscle contraction strength and endurance . RESULTS Increases in muscle contraction strength ( t = 1.75 ; p = 0.045 ) and decreases in grams of urine leakage ( t = -1.86 ; p = 0.036 ) were significant for the SVC group . No significant differences were found between the groups for changes in endurance , muscle activity recruitment , frequency of leakage episodes , or subject-rated severity of urine loss based on a 7-point Likert scale . CONCLUSIONS Study findings suggest that SVC exercise design ed with specificity for gain in neuromuscular control may be beneficial for strengthening the PFM and increasing endurance of contractions to attain and maintain continence in women with GSUI Background The use of sports massage is very common in the athletic community . However , only a few studies have shown any therapeutic effect of massage . Hypothesis Sports massage can improve the recovery after eccentric exercise . Study Design Prospect i ve r and omized clinical trial . Methods Sixteen subjects performed 300 maximal eccentric contractions of the quadriceps muscle bilaterally .  Massage was given to 1 leg , whereas the other leg served as a control . Subjects were treated once daily for 3 days . Maximal strength was tested on a Kin-Com dynamometer , and functional tests were based on 1-leg long jumps . Pain was evaluated using a visual analog scale . Results There was a marked loss of strength and function of the quadriceps directly after exercise and on the third day after exercise . The massage treatment did not affect the level or duration of pain or the loss of strength or function following exercise . Conclusion Sports massage could not improve the recovery after eccentric exercise Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made OBJECTIVE To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients . METHODS A r and omized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation . The patients were divided into a conventional physical therapy group ( control group , n=14 ) that received the sector 's st and ard physical therapy program and an early mobilization group ( n=14 ) that received a systematic early mobilization protocol .  Peripheral muscle strength was assessed with the Medical Research Council score , and respiratory muscle strength ( determined by the maximal inspiratory and expiratory pressures ) was measured using a vacuum manometer with a unidirectional valve . Systematic early mobilization was performed on five levels . RESULTS Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group . However , no statistically significant improvement was observed for maximal expiratory pressure or MV duration ( days ) , length of stay in the intensive care unit ( days ) , and length of hospital stay ( days ) . CONCLUSION The early mobilization group showed gains in inspiratory and peripheral muscle strength BACKGROUND Lower extremity kinematics may change as a result of impaired hip muscle function , thereby placing athletes at increased risk of injury . The purpose of this study was to examine whether experimentally-induced hip extensor fatigue alters lower extremity kinematics during a jump-l and ing task in women . METHODS Forty healthy women were r and omly assigned to an experimental group in which participants performed modified Biering-Sørenson tests to fatigue the hip extensors or to a sham control group in which participants performed repeated push-ups to exhaustion . Three-dimensional hip and knee kinematics and gluteus maximus electromyography ( EMG ) signals were measured during jump-l and ing tests to examine the effects of hip extensor fatigue . FINDINGS Hip extension strength decreased in the experimental group by 25 % following the intervention , thereby confirming effects of the fatigue intervention . No group × time interactions in hip and knee motions were statistically significant , indicating that hip and knee kinematics did not change following the fatigue-inducing intervention . Gluteus maximus recruitment during the post-fatigue test , however , increased by 55 % in the experimental group . INTERPRETATION A 25 % reduction in hip extensor strength did not lead to changes in hip or knee kinematics . Rather , participants accommo date d for the loss of strength by recruiting more Gmax activation to complete the task . Gmax recruitment may compensate when hip extensor strength is impaired , suggesting that improved neuromuscular control can influence motor performance when strength is diminished CONTEXT Repletion of lean body mass ( LBM ) that patients lose in human immunodeficiency virus ( HIV ) infection has proved difficult . In healthy , HIV-seronegative men , synergy between progressive resistance exercise ( PRE ) and very high-dose testosterone therapy has been reported for gains in LBM and muscle strength . OBJECTIVE To determine whether a moderately supraphysiologic and rogen regimen , including an anabolic steroid , would improve LBM and strength gains of PRE in HIV-infected men with prior weight loss and whether protease inhibitor antiretroviral therapy prevents lean tissue anabolism . DESIGN Double-blind , r and omized , placebo-controlled trial ; post hoc analysis for effect of HIV-protease inhibitor therapy conducted from January to October 1997 . SETTING Referral center in San Francisco , Calif. PATIENTS Volunteer sample of 24 eugonadal men with HIV-associated weight loss ( mean , 9 % body weight loss ) , recruited from an AIDS clinic and by referral and by advertisement . INTERVENTION For 8 weeks , all subjects received supervised PRE with physiologic intramuscular testosterone replacement ( 100 mg/wk ) to suppress endogenous testosterone production . R and omization was between an anabolic steroid , ox and rolone , 20 mg/d , and placebo . MAIN OUTCOME MEASURES Lean body mass , nitrogen balance ( 10-day metabolic ward measurements ) , body weight , muscle strength , and and rogen status . RESULTS Twenty-two subjects completed the study ( 1 1 per group ) . Both groups showed significant nitrogen retention and increases in LBM , weight , and strength . The mean ( SD ) gains were significantly greater in the ox and rolone group than in the placebo group ( 5.6 [ 2.1 ] vs 3.8 [ 1.8 ] g of nitrogen per day [ P=.05 ] ; 6.9 [ 1.7 ] vs 3.8 [ 2.9 ] kg of LBM [ P=.005 ] ; greater strength gains for various upper and lower body muscle groups by maximum weight lifted [ P = .02-.05 ] and dynamometry [ P = .01 -.05 ] ) . The mean ( SD ) high-density lipoprotein cholesterol level declined 0.25 ( 0.14 ) mmol/L ( 9.8 [ 5.4 ] mg/dL ) significantly in the ox and rolone group ( P < .001 compared with placebo ) . Results were similar whether or not patients were taking protease inhibitors . One subject in the ox and rolone group discontinued the study because of elevated liver function test results . CONCLUSIONS A moderately supraphysiologic and rogen regimen that included an anabolic steroid , ox and rolone , substantially increased the lean tissue accrual and strength gains from PRE , compared with physiologic testosterone replacement alone , in eugonadal men with HIV-associated weight loss . Protease inhibitors did not prevent lean tissue anabolism OBJECT Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns . These fractures classically consist of a fracture line through the posterior bony elements ; involvement of the posterior ligamentous complex is , however , common . Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis , and the surgery traditionally consists of an open posterior approach with instrumented fusion . Percutaneous pedicle screw fixation for these injuries , with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization , has recently been reported in the literature , but to date , a direct comparative study comparing open and percutaneous fixation has not been reported . The authors report their experience treating these fractures with both techniques and review the available literature . METHODS Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospect ively followed .  American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission , discharge , and follow-up . Data regarding intraoperative blood loss and operative time were obtained from a chart review . Patients treated with open versus minimally invasive procedures were compared . RESULTS The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period ; one of these patients declined surgery . All had injury to the posterior ligamentous complex .  Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients , while 11 patients underwent minimally invasive pedicle screw placement . Overall , there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery ( MIS ) groups . The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups . There was a trend toward shorter operative time for the MIS group , and patients who underwent minimally invasive procedures had significantly less blood loss . CONCLUSIONS Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques . Therefore it should be considered as an option for the treatment of this type of injury Background The effects of neuromuscular electrical stimulation ( NMES ) in critically ill patients after cardiothoracic surgery are unknown . The objectives were to investigate whether NMES prevents loss of muscle layer thickness ( MLT ) and strength and to observe the time variation of MLT and strength from preoperative day to hospital discharge . Methods In this r and omized controlled trial , 54 critically ill patients were r and omized into four strata based on the SAPS II score . Patients were blinded to the intervention . In the intervention group , quadriceps muscles were electrically stimulated bilaterally from the first postoperative day until ICU discharge for a maximum of 14 days . In the control group , the electrodes were applied , but no electricity was delivered . The primary outcomes were MLT measured by ultrasonography and muscle strength evaluated with the Medical Research Council ( MRC ) scale . The secondary functional outcomes were average mobility level , FIM score , Timed Up and Go Test and SF-12 health survey . Additional variables of interest were grip strength and the relation between fluid balance and MLT . Linear mixed models were used to assess the effect of NMES on MLT , MRC score and grip strength . Results NMES had no significant effect on MLT . Patients in the NMES group regained muscle strength 4.5 times faster than patients in the control group . During the first three postoperative days , there was a positive correlation between change in MLT and cumulative fluid balance ( r = 0.43 , P = 0.01 ) . At hospital discharge , all patients regained preoperative levels of muscle strength , but not of MLT . Patients did not regain their preoperative levels of average mobility ( P = 0.04 ) and FIM score ( P = 0.02 ) at hospital discharge , independent of group allocation . Conclusions NMES had no effect on MLT , but was associated with a higher rate in regaining muscle strength during the ICU stay . Regression of intramuscular edema during the ICU stay interfered with measurement of changes in MLT . At hospital discharge patients had regained preoperative levels of muscle strength , but still showed residual functional disability and decreased MLT compared to pre-ICU levels in both groups . Trial registration Clinical trials.gov identifier NCT02391103 . Registered on 7 March 2015 Background : Numerous antioxidant and anti-inflammatory agents have been identified in tart cherries . Objective : To test the efficacy of a tart cherry juice blend in preventing the symptoms of exercise induced muscle damage . Methods : This was a r and omised , placebo controlled , crossover design . Fourteen male college students drank 12 fl oz of a cherry juice blend or a placebo twice a day for eight consecutive days . A bout of eccentric elbow flexion contractions ( 2 × 20 maximum contractions ) was performed on the fourth day of supplementation . Isometric elbow flexion strength , pain , muscle tenderness , and relaxed elbow angle were recorded before and for four days after the eccentric exercise . The protocol was repeated two weeks later with subjects who took the placebo initially , now taking the cherry juice ( and vice versa ) . The opposite arm performed the eccentric exercise for the second bout to avoid the repeated bout protective effect . Results : Strength loss and pain were significantly less in the cherry juice trial versus placebo ( time by treatment : strength p<0.0001 , pain p = 0.017 ) . Relaxed elbow angle ( time by treatment p = 0.85 ) and muscle tenderness ( time by treatment p = 0.81 ) were not different between trials . Conclusions : These data show efficacy for this cherry juice in decreasing some of the symptoms of exercise induced muscle damage . Most notably , strength loss averaged over the four days after eccentric exercise was 22 % with the placebo but only 4 % with the cherry juice STUDY DESIGN A 2-year prospect i ve inception cohort study of back injury in nurses . OBJECTIVES To determine the extent to which characteristics of nurses , of the injury , and of the workplace predict occurrence and duration of time loss from work after back injury . SUMMARY OF BACKGROUND DATA During 2 years , 320 nurses incurred 416 back injuries at a large teaching hospital in Winnipeg , Canada . Nurses injured on preselected wards were targeted for early intervention , including provision of modified work , whereas nurses injured on other wards received the usual care . METHODS Time loss attributable to the back injury during the 6 months after injury was analyzed . Three statistical models were used to examine occurrence of time loss ( logistic regression ) , duration of time loss ( Tobit regression ) , and duration of time loss once an injury incurring time loss had been documented ( least-squares regression ) . RESULTS In 218 of the 416 injuries , the injured nurse consented to interview . Whereas perceived disability was related to whether a time loss injury would ensue , self-reported pain was strongly related to the duration of time loss once an injury had become a time loss injury . Duration of time loss was reduced by participation in the return-to-work program . Mechanism of injury , specifically injury occurring while lifting patients , result ed in greater time loss . CONCLUSIONS Focusing on reducing the perception of disability at the time of injury is critical to preventing time loss , but once time loss has occurred , offer of modified work and attention to pain reduction are warranted . The findings add to the evidence that workplace-based intervention programs can be effective in reducing the morbidity result ing from back injury Background Identifying risk factors for knee pain and anterior cruciate ligament ( ACL ) injury can be an important step in the injury prevention cycle . Objective We evaluated two unique prospect i ve cohorts with similar population s and method ologies to compare the incidence rates and risk factors associated with patellofemoral pain ( PFP ) and ACL injury . Methods The ‘ PFP cohort ’ consisted of 240 middle and high school female athletes . They were evaluated by a physician and underwent anthropometric assessment , strength testing and three-dimensional l and ing biomechanical analyses prior to their basketball season . 145 of these athletes met inclusion for surveillance of incident ( new ) PFP by certified athletic trainers during their competitive season . The ‘ ACL cohort ’ included 205 high school female volleyball , soccer and basketball athletes who underwent the same anthropometric , strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury . A one-way analysis of variance was used to evaluate potential group ( incident PFP vs ACL injured ) differences in anthropometrics , strength and l and ing biomechanics . Knee abduction moment ( KAM ) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts . Results KAM during l and ing above 15.4 Nm was associated with a 6.8 % risk to develop PFP compared to a 2.9 % risk if below the PFP risk threshold in our sample . Likewise , a KAM above 25.3 Nm was associated with a 6.8 % risk for subsequent ACL injury compared to a 0.4 % risk if below the established ACL risk threshold . The ACL-injured athletes initiated l and ing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group . Also , when comparing across cohorts , the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample ( p<0.05 ) . Conclusions In adolescent girls aged 13.3 years , > 15 Nm of knee abduction load during l and ing is associated with greater likelihood of developing PFP . Also , in girls aged 16.1 years who l and with > 25 Nm of knee abduction load during l and ing are at increased risk for both PFP and ACL injury PURPOSE Are eccentric hamstring strength and between-limb imbalance in eccentric strength , measured during the Nordic hamstring exercise , risk factors for hamstring strain injury ( HSI ) ? METHODS Elite Australian footballers ( n = 210 ) from five different teams participated .  Eccentric hamstring strength during the Nordic exercise was obtained at the commencement and conclusion of preseason training and at the midpoint of the season . Injury history and demographic data were also collected . Reports on prospect ively occurring HSI were completed by the team medical staff . Relative risk ( RR ) was determined for univariate data , and logistic regression was employed for multivariate data . RESULTS Twenty-eight new HSI  were recorded . Eccentric hamstring strength below 256 N at the start of the preseason and 279 N at the end of the preseason increased the risk of future HSI 2.7-fold ( RR , 2.7 ; 95 % confidence interval , 1.3 to 5.5 ; P = 0.006 ) and 4.3-fold ( RR , 4.3 ; 95 % confidence interval , 1.7 to 11.0 ; P = 0.002 ) , respectively . Between-limb imbalance in strength of greater than 10 % did not increase the risk of future HSI . Univariate analysis did not reveal a significantly greater RR for future HSI in athletes who had sustained a lower limb injury of any kind within the last 12 months . Logistic regression revealed interactions between both athlete age and history of HSI with eccentric hamstring strength , whereby the likelihood of future HSI in older athletes or athletes with a history of HSI was reduced if an athlete had high levels of eccentric strength . CONCLUSION Low levels of eccentric hamstring strength increased the risk of future HSI . Interaction effects suggest that the additional risk of future HSI associated with advancing age or previous injury was mitigated by higher levels of eccentric hamstring strength IMPORTANCE While vitamin D supplementation and exercise are recommended for prevention of falls for older people , results regarding these 2 factors are contradictory . OBJECTIVE To determine the effectiveness of targeted exercise training and vitamin D supplementation in reducing falls and injurious falls among older women . DESIGN , SETTING , AND PARTICIPANTS A 2-year r and omized , double-blind , placebo-controlled vitamin D and open exercise trial conducted between April 2010 and March 2013 in Tampere , Finl and . Participants were 409 home-dwelling women 70 to 80 years old . The main inclusion criteria were at least 1 fall during the previous year , no use of vitamin D supplements , and no contraindication to exercise . INTERVENTIONS Four study groups , including placebo without exercise , vitamin D ( 800 IU/d ) without exercise , placebo and exercise , and vitamin D ( 800 IU/d ) and exercise . MAIN OUTCOMES AND MEASURES The primary outcome was monthly reported falls . Injurious falls and the number of fallers and injured fallers were reported as secondary outcomes . In addition , bone density , physical functioning ( muscle strength , balance , and mobility ) , and vitamin D metabolism were assessed . RESULTS Intent-to-treat analyses showed that neither vitamin D nor exercise reduced falls . Fall rates per 100 person-years were 118.2 , 132.1 , 120.7 , and 113.1 in the placebo without exercise , vitamin D without exercise , placebo and exercise , and vitamin D and exercise study groups , respectively ; however , injurious fall rates were 13.2 , 12.9 , 6.5 , and 5.0 , respectively . Hazard ratios for injured fallers were significantly lower among exercisers with vitamin D ( 0.38 ; 95 % CI , 0.17 - 0.83 ) and without vitamin D ( 0.47 ; 95 % CI , 0.23 - 0.99 ) . Vitamin D maintained femoral neck bone mineral density and increased tibial trabecular density slightly . However , only exercise improved muscle strength and balance .  Vitamin D did not enhance exercise effects on physical functioning . CONCLUSIONS AND RELEVANCE The rate of injurious falls and injured fallers more than halved with strength and balance training in home-dwelling older women , while neither exercise nor vitamin D affected the rate of falls . Exercise improved physical functioning . Future research is needed to determine the role of vitamin D in the enhancement of strength , balance , and mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00986466 OBJECTIVES To evaluate whether valproate ( VPA ) result ed in laboratory or clinical evidence of a change in bleeding-related measures associated with VPA therapy in patients sustaining a traumatic brain injury . METHODS Fibrinogen , platelet count and clot elastic shear modulus using the Thrombelastograph ( TEG ) coagulation analyzer were measured at baseline , 4 , 14 , 30 , and 180 days post-injury . Clinical ly significant events , defined as the trigger for requiring a transfusion , were identified and evaluated as to possible treatment effects . RESULTS Compared to baseline , the platelet count in the VPA groups was decreased on day 4 , increased by 100 % on day 14 , and returned to baseline levels by day 30 . Fibrinogen was significantly increased by day 4 and returned to baseline by day 30 . The platelet count was correlated with an increase in the maximum amplitude or width of the TEG tracing ; a measure of strength of the clot , suggesting that valproate did not alter the clot strength contributed by platelets . None of the clinical events requiring transfusions appeared to be treatment related . CONCLUSIONS No serious hemostatic adverse events occurred in the trauma patients receiving VPA or phenytoin  that could be attributed to treatment The primary purpose of this study was to evaluate whether a preseason strength training programme for the hamstring muscle group - emphasising eccentric overloading - could affect the occurrence and severity of hamstring injuries during the subsequent competition season in elite male soccer players . Thirty players from two of the best premier-league division teams in Sweden were divided into two groups ; one group received additional specific hamstring training , whereas the other did not . The extra training was performed 1 - 2 times a week for 10 weeks by using a special device aim ing at specific eccentric overloading of the hamstrings . Isokinetic hamstring strength and maximal running speed were measured in both groups before and after the training period and all hamstring injuries were registered during the total observational period of 10 months . The results showed that the occurrence of hamstring strain injuries was clearly lower in the training group ( 3/15 ) than in the control group ( 10/15 ) . In addition , there were significant increases in strength and speed in the training group . However , there were no obvious coupling between performance parameters and injury occurrence . These results indicate that addition of specific preseason strength training for the hamstrings - including eccentric overloading - would be beneficial for elite soccer players , both from an injury prevention and from performance enhancement point of view Abstract Objective To compare two forms of device-specific training – body-weight-supported ( BWS ) ambulation on a fixed track ( TRK ) and BWS ambulation on a treadmill ( TM ) – to comprehensive physical therapy ( PT ) for improving walking speed in persons with chronic , motor-incomplete spinal cord injury ( SCI ) . Methods Thirty-five adult subjects with a history of chronic SCI ( > 1 year ; AIS ‘ C ’ or ‘ D ’ ) participated in a 13-week ( 1 hour/day ; 3 days per week ) training program . Subjects were r and omized into one of the three training groups . Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert . For each training session , performance values and heart rate were monitored . Pre- and post-training maximal 10-m walking speed , balance , muscle strength , fitness , and quality of life were assessed in each subject . Results All three training groups showed significant improvement in maximal walking speed , muscle strength , and psychological well-being . A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group . In all groups , post-training measures of fitness , functional independence , and perceived health and vitality were unchanged . Conclusions Our results demonstrate that persons with chronic , motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy , regardless of training method . Improvement in walking speed was associated with improved balance and muscle strength . In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups , these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength . It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training The effects of detraining subsequent to strength training on neuromuscular function were examined in 39 recent-onset rheumatoid arthritis ( RA ) patients . Eighteen age- and sex-matched healthy people ( H ) served as controls . Patients were r and omly allocated either to the experimental group ( PE ) , who carried out progressive strength training for 6 months , or to the control group ( PC ) , who maintained only their habitual physical activities . After 6 months , PE returned to their earlier physical activities and strength training was terminated . At baseline , the maximal strength of the trunk extensors ( not significant ) , grip strength and maximal dynamic strength and the shape of the force-time curve of the knee extensors were lower in PE and PC ( P < 0.05 - 0.001 ) than in H. Strength training in PE led to remarkable increases ( P < 0.05 - 0.001 ) in the maximal strength of all muscle groups without changes in the shape of the force-time curve . The increases in muscle strength in PE obtained by strength training were lost to a great degree during the detraining period for the isometric trunk extension ( P < 0.01 ) and flexion ( P < 0.01 ) strength and for the dynamic knee extension strength ( P < 0.05 ) , but not for the grip strength . In PC , trunk extension and flexion strength decreased significantly throughout the study period . At the post-test , all the strength values in both patient groups were much lower than in H. RA is a chronic disease which seems to need continuous physical exercise with sufficient intensity to minimize/prevent the loss of muscle strength and functional capacity BACKGROUND Muscle size and strength decrease with aging , and the result ant muscle weakness has been implicated in increased risk of falls in older adults . These falls have large economic and functional costs . METHODS The purpose of this r and omized , controlled study was to determine if an 8-week , 3-day per week intense ( 77.8 + /- 3.4 % of 1-repetition maximum [ 1RM ] ) strength training program could improve functional ability related to the risk of falling in subjects aged 61 - -87 years ( mean 72 , SD 6.3 ) . Twelve strength-training-naive subjects performed two sets of 10 repetitions for six lower body exercises while 12 subjects served as nonintervention controls . Subjects were tested pre- , mid- , and postintervention for strength gain and on three tests of functional ability . RESULTS Postintervention strength was significantly better ( p < .017 ) in all training subjects across all exercises , and no injuries were reported as a result of either training or 1RM testing . After controlling for preintervention differences , repeated measure analysis of covariance ( ANCOVA ) found a significant difference between experimental and nonintervention control subjects for postintervention maximal walking speed [ F(1,19 ) = 5.03 , p < .05 ] . There were no significant between-group differences for 1-leg blind balance time or 5-repetition sit-to-st and performance [ F(1,19 ) = .082 ; F(1,19 ) = .068 , respectively , p > .05 ] . CONCLUSIONS These findings suggest that strength training alone does not appear to enhance st and ing balance or sit-to-st and performance in active , community-dwelling older adults but that it may improve maximal walking speed . The relationship between strength gain and risk of falls remains unclear . The data do reinforce the notion that intense strength training is a safe and effective way to increase muscle strength in this population OBJECTIVES To investigate whether functionally based resistance exercise could improve strength , physical function , and disability among prostate cancer survivors ( PCS ) on and rogen deprivation therapy ( ADT ) ; and to explore potential mediators of changes in outcomes from exercise . DESIGN R and omized controlled trial . SETTING Academic medical center . PARTICIPANTS PCS ( N=51 ; mean age , 70.2y ) on ADT . INTERVENTION PCS were r and omized to moderate to vigorous intensity resistance training or stretching ( placebo control ) for 1 year . MAIN OUTCOME MEASURES Maximal leg press and bench press strength , objective and self-reported physical function , and self-reported disability . Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates . RESULTS Retention in the study was 84 % , and median attendance to supervised classes was 84 % in the resistance group . No study -related injuries occurred . Maximal leg strength ( P=.032 ) and bench press strength ( P=.027 ) were improved after 1 year of resistance training , whereas little change occurred from stretching .  Self-reported physical function improved with resistance training , whereas decreases occurred from stretching ( P=.016 ) . Disability lessened more with resistance training than stretching ( P=.018 ) . One-year change in leg press strength mediated the relation between groups ( resistance or stretching ) and 1-year change in self-reported disability ( P<.05 ) . CONCLUSIONS One year of resistance training improved muscle strength in and rogen-deprived PCS . Strengthening muscles using functional movement patterns may be an important feature of exercise programs design ed to improve perceptions of physical function and disability . Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer Objective : To determine whether the addition of electrical stimulation to progressive resistance training increases the voluntary strength of the wrist muscles in people with tetraplegia . Design : Assessor-blind within-subject r and omised controlled trial . Setting : Two Australian spinal cord injury units and the community . Participants : Sixty-four wrists of 32 people with tetraplegia and bilateral weakness of the wrist extensor or flexor muscles ( grade 2 - 4 Medical Research Council grade s ) . Interventions : Participants ' wrists were r and omly allocated to one of two conditions . Wrist muscles of the experimental arm received electrical stimulation superimposed on progressive resistance training . The wrist muscles of the contralateral arm received sham electrical stimulation superimposed on progressive resistance training . Both arms received 6 sets of 10 contractions three times a week for eight weeks such that the only difference between arms was the application of electrical stimulation . Main Measures : The primary outcome was maximal voluntary isometric strength . Secondary outcomes were a fatigue resistance ratio representing voluntary and electrically-stimulated endurance . Measurements were taken at the start and end of the eight-week treatment period . Results : The mean treatment effect ( 95 % Confidence Interval ) of electrical stimulation for voluntary strength was 0.04 Nm ( 95 % CI , -0.5 to 0.6 ; p = 0.89 ) . The mean treatment effect ( 95 % CI ) for fatigue ratio representing voluntary endurance and electrically-stimulated endurance was -0.01 ( 95 % CI , -0.1 to 0.1 ; p = 0.78 ) and -0.07 ( 95 % CI , -0.3 to 0.1 ; p = 0.47 ) , respectively . Conclusions : Voluntary strength of the wrist is not enhanced by the addition of electrical stimulation to progressive resistance training programs in people with tetraplegia Objective : Weight loss in HIV-infected patients is extremely common and is associated with increased morbidity and mortality . Decreased testosterone concentrations occur commonly in patients with HIV disease and are associated with weight loss . This study assessed the effect of testosterone therapy on HIV associated weight loss in patients with AIDS . Methods : Forty HIV-seropositive patients with CD4 + counts of < 2 × 105/l and weight loss greater than 5 % of usual body weight were r and omized in a double-blind manner to receive 200 mg of testosterone cypionate or placebo intramuscularly every 2 weeks for 3 months . Patients were then crossed to receive the alternate treatment for the next 3 months . Outcome variables included weight , skin fold measurement , a quality -of-life question naire , Karnofsky score , T-cell subset analysis , complete blood count , routine blood chemistry measurements and free testosterone concentration . Results : Thirty-nine patients entered the study . Of these , 35 completed the first 3-month period ( 18 on placebo , 17 on testosterone ) and 23 completed the whole 6 month trial . Analysis of these 23 patients did not show any significant differences between testosterone and placebo treatment . Analysis of the first 3 months only for the 35 patients who completed it did not show any significant difference between the effects of testosterone and placebo treatment on weight gain . Patients treated with testosterone reported improved overall well-being ( P = 0.03 ) and a trend towards increased muscle strength ( P = 0.08 ) . There was no difference between the two groups in terms of side-effects or other effects on hematopoetic , liver , renal or immune function . Conclusions : Treatment with testosterone cypionate compared with placebo did not result in significant weight gain .  Testosterone supplementation did appear to produce an improved overall sense of well-being and possibly some increase in muscle strength . This r and omized , double-blinded study does not confirm the results of other recent studies which show potential benefits of testosterone and its analogs when used as a treatment for weight loss in HIV-positive patients
Conclusion Overall , our findings do not support the presence of a secondary loss of strength following an acute muscle injury , and strongly suggest that strength , on average , recovers steadily over the first 3 days post-injury
Background An immediate loss of strength follows virtually all types of muscle injury but there is debate whether the initial strength loss is maximal or if a secondary loss of strength occurs during the first 3 days post-injury .
Objective The objective of this analysis was to conduct a systematic review and meta- analysis of the research literature to determine if a secondary loss of strength occurs after an injurious initiating event .