ECSS Paris 2023: OP-MH14
INTRODUCTION: Wheelchair users (WCU) are at risk of low bone mineral density (BMD, Z-score<-1.0) due to lack of skeletal stimuli. Previous interventions like electrical stimulation, vibration and standing therapy have shown minimal to no efficacy in improving BMD in populations such as those with spinal cord injury (SCI)1. In contrast, resistance exercise (RE) improves regional BMD in ambulant populations, but its effects in non-ambulant individuals who primarily engage in upper body exercises are unknown. Thus, we aimed to investigate the impact of high load RE on lumbar spine (LS) and hip BMD in WCU with non-progressive impairments. METHODS: In this multi-centre 24-wk RCT, volunteers (WC use<50%) were stratified by sex and activity level and randomly allocated to either upper body RE 3 x/wk combined with nutrition optimisation (EX, n=24), or nutrition optimisation only (CON, n=21). At pre-, mid- and post-intervention, we measured LS, femoral neck (FN) and total hip BMD with dual-energy x-ray absorptiometry, maximal strength, serum bone turnover markers and vitamin D, and conducted 3x24-hr dietary recalls. The training programme consisted of four isometric and two dynamic upper body exercises aiming to load the LS and hip. Nutrition was optimised through supplementing whey protein (3x30 g/wk), vitamin D (40-120 ug/d) and calcium (500-1500 mg/d). Linear mixed model analysis was employed with random intercept for participants and fixed effects for group, time and interaction, and potential moderating factors. Values are frequencies or estimates (95%CI). RESULTS: Forty-five WCU participated (SCI: 49%, cerebral palsy: 27%, other: 24%; 40% female; age: 37±9 y; mass: 67±19 kg; BMD Z-score<-1.0 LS: 41%, FN: 83%, hip: 80%), of which 33 completed the study. EX improved more than CON in maximal isometric (+2.0 [0.4-3.5] kg) and 1RM OHP (+2.9 [1.1-4.7] kg), as well as 1RM bench press: (+4.2 [1.4-7.1] kg). Nutrition optimisation increased, in both groups, serum vitamin D over time (+14 [10-18] nmol/L), reducing the prevalence of subclinical deficiency (<50 nmol/L; from 60% to 3%), and increased calcium intake (+167 [15-319] mg/d). No effects were found on LS BMD (EX n=8, CON=16; group: -.072 [-.232 - .089] g/cm2; time: +.004 [-.005 - .013] g/cm2), and similarly no effects on FN or total hip, nor the prevalence of Z-score<-1.0 (all p>.05). Lastly, the bone formation to resorption ratio P1NP/CTX-1 increased over time in both groups (+17 [6 - 28]). CONCLUSION: High load RE over 24 weeks did not improve BMD, despite a significant increase in maximal upper body strength. Further analyses will explore if strength development influences BMD, with findings presented at the conference. The positive bone formation-to-resorption ratio shift suggests the positive role of nutrition in bone health. Lastly, a longer intervention period and/or larger sample may be necessary to observe changes in BMD in this population and warrants further investigation. 1: Sutor et al., IJMS, 2022. https://doi.org/10.3390/ijms2302060
Read CV Linn Christin RisvangECSS Paris 2023: OP-MH14
INTRODUCTION: Isometric exercise effectively reduces blood pressure (BP) . However, the utilization of IE in the context of the rehabilitation of patients with IHD has,thus far,been prevented by the concern that it may result in an excessive increase in myocardial oxygen consumption. In this study we aimed to investigate the hemodynamic effects produced by two different isometric exercise modalities in hypertensive patients with ischemic heart disease (IHD) METHODS: Forthy-eight stable, trained patients with hypertension and IHD were enrolled. They were randomly assigned to perform a single session of bilateral knee extension (IKE) or handgrip (IHG) or no exercise (control) with a 1:1:1 ratio. Both exercises were performed at 30% of maximal voluntary contraction and lasted three minutes. Speckle-tracking echocardiography with the assessment myocardial work and BP measurements were performed at rest, during the exercise and after ten minutes of recovery. RESULTS: Both exercises were well tolerated, and no side effects occurred. During the exercise: systolic BP increased significantly in the IKE group compared to IHG and control (ANOVA p <0.001). LVGLS decreased significantly in IKE (-21%) compared IHG and control (ANOVA p 0.002). The global work index increased significantly in IKE (+28%) compared to HG and control (ANOVA p 0.034). Global constructive work and wasted work increased significantly in the IKE compared to IHG and control (ANOVA p 0.009 and <0.001 respectively). Global work efficiency decreased significantly in the IKE group (-8%) while remained unchanged in the IHG and controls (ANOVA p 0.002). During the recovery, systolic BP dropped significantly in the IKE group compared to IHG and control (ANOVA p 0.022). CONCLUSION: We observed that myocardial work efficiency was impaired during isometric bilateral knee extension but not during handgrip. Handgrip evoked a very limited hemodynamic response. Our data suggests that in hypertensive patients with underlying IHD, performing isometric exercise with handgrip seems a viable choice in terms of hemodynamic tolerability. Future studies should clarify whether handgrip is also effective in lowering BP in these patients.
Read CV Giuseppe CaminitiECSS Paris 2023: OP-MH14
INTRODUCTION: As the ageing population increases, elderly individuals with physical disabilities face higher risks of falls and cognitive decline, leading to reduced independence and quality of life. Traditional rehabilitation methods often pose mobility and accessibility challenges, limiting participation. Aquatic rehabilitation exercise provides a low-impact alternative, using buoyancy and resistance to enhance physical function, balance, and cognitive health while minimizing joint strain. METHODS: This research, guided by the Leisure Ability Model (LAM), consists of two components. A systematic review was conducted to analyze existing research on aquatic rehabilitation interventions for ageing adults with physical disabilities, identifying key findings and limitations. An experimental intervention was implemented to assess the effects of aquatic rehabilitation exercise on fall-related physical fitness and cognitive function, measuring balance, muscle strength, flexibility, reaction time, memory, attention, and executive function. The relationship between physical and cognitive improvements was examined, along with the long-term impact on fall prevention and well-being. RESULTS: Findings from the systematic review highlighted positive effects of aquatic rehabilitation on mobility, strength, and cognitive function but indicated a lack of research on long-term outcomes. The experimental study demonstrated significant improvements in balance, muscle strength, and cognitive function among participants engaged in aquatic rehabilitation compared to non-participants. A strong correlation between physical and cognitive enhancements was observed. CONCLUSION: Aquatic rehabilitation exercise effectively improves fall-related physical fitness and cognitive function in elderly individuals with physical disabilities. The findings support the development of accessible, evidence-based rehabilitation programs to promote healthy ageing, fall prevention, and enhanced quality of life.
Read CV Yongho LeeECSS Paris 2023: OP-MH14