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Background: Elderly patients are a growing population in cardiac rehabilitation (CR). As postural control declines with age, assessment of impaired balance is important in older CR patients in order to predict fall risk and to initiate counteracting steps. Functional balance tests are subjective and lack adequate sensitivity to small differences, and are further subject to ceiling effects. A quantitative approach to measure postural control on a continuous scale is therefore desirable. Force plates are already used for this purpose in other clinical contexts, therefore could be a promising tool also for older CR patients. However, in this population the reliability of the assessment is not fully known., Research Question: Analysis of test-retest reliability of center of pressure (CoP) measures for the assessment of postural control using a force plate in older CR patients., Methods: 156 CR patients (≥75 years) were enrolled. CoP measures (path length (PL), mean velocity (MV), and 95% confidence ellipse area (95CEA)) were analyzed twice with an interval of two days in between (bipedal narrow stance, eyes open (EO) and closed (EC), three trials for each condition, 30 s per trial), using a force plate. For test-retest reliability estimation absolute differences (Δ: T0-T1), intraclass correlation coefficients (ICC) with 95% confidence intervals, standard error of measurement and minimal detectable change were calculated., Results: Under EO condition ICC were excellent for PL and MV (0.95) and good for 95CEA (0.88) with Δ of 10.1 cm (PL), 0.3 cm/sec (MV) and 1.5 cm 2 (95CEA) respectively. Under EC condition ICC were excellent (≥ 0.95) for all variables with larger Δ (PL: 21.7 cm; MV: 0.7 cm/sec; 95CEA: 2.4 cm 2 )., Significance: In older CR patients, the assessment of CoP measures using a force plate shows good to excellent test-retest reliability., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Electrical muscle stimulation (EMS) is an increasingly popular training method and has become the focus of research in recent years. New EMS devices offer a wide range of mobile applications for whole-body EMS (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. The present study aimed to determine the differences in exercise intensity between WB-EMS-superimposed and conventional walking (EMS-CW), and CON and WB-EMS-superimposed Nordic walking (WB-EMS-NW) during a treadmill test. Eleven participants (52.0 ± years; 85.9 ± 7.4 kg, 182 ± 6 cm, BMI 25.9 ± 2.2 kg/m 2 ) performed a 10 min treadmill test at a given velocity (6.5 km/h) in four different test situations, walking (W) and Nordic walking (NW) in both conventional and WB-EMS superimposed. Oxygen uptake in absolute (VO 2 ) and relative to body weight (rel. VO 2 ), lactate, and the rate of perceived exertion (RPE) were measured before and after the test. WB-EMS intensity was adjusted individually according to the feedback of the participant. The descriptive statistics were given in mean ± SD. For the statistical analyses, one-factorial ANOVA for repeated measures and two-factorial ANOVA [factors include EMS, W/NW, and factor combination (EMS * W/NW)] were performed (α = 0.05). Significant effects were found for EMS and W/NW factors for the outcome variables VO 2 (EMS: p = 0.006, r = 0.736; W/NW: p < 0.001, r = 0.870), relative VO 2 (EMS: p < 0.001, r = 0.850; W/NW: p < 0.001, r = 0.937), and lactate (EMS: p = 0.003, r = 0.771; w/NW: p = 0.003, r = 0.764) and both the factors produced higher results. However, the difference in VO 2 and relative VO 2 is within the range of biological variability of ± 12%. The factor combination EMS * W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values ( p = 0.035, r = 0.613), RPE differences for W/NW and EMS * W/NW were not significant. The current study results indicate that WB-EMS influences the parameters of exercise intensity. The impact on exercise intensity and the clinical relevance of WB-EMS-superimposed walking (WB-EMS-W) exercise is questionable because of the marginal differences in the outcome variables., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Verch, Stoll, Hadzic, Quarmby and Völler.)

Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare., Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare., Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints., Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note., Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare., Trial Registration: German Clinical Trials Register DRKS00010009; https://www.drks.de/drks&#95;web/navigate.do? navigationId=trial.HTML&TRIAL&#95;ID=DRKS00010009., (©Sarah Eichler, Annett Salzwedel, Sophie Rabe, Steffen Mueller, Frank Mayer, Monique Wochatz, Miralem Hadzic, Michael John, Karl Wegscheider, Heinz Völler. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 07.11.2019.)

Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR)., Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered., Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P <0.01; 6MWT: 380 m vs 421 m, P <0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P <0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P <0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2-0.6, P <0.01), negative occupational expectations (OR 0.4, 95% CI 0.3-0.7, P <0.01) and depression (OR 0.3, 95% CI 0.1-0.8, P =0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated., Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care., Competing Interests: The authors report no conflicts of interest in this work., (© 2019 Salzwedel et al.)

According to recent literature sodium bicarbonate (NaHCO 3 ) has been proposed as a performance enhancing aid by reducing acidosis during exercise. The aim of the current review is to investigate if the duration of exercise is an essential factor for the effect of NaHCO 3 . To collect the latest studies from electronic database of PubMed, study publication time was restricted from December 2006 to December 2016. The search was updated in July 2018. The studies were divided into exercise durations of > 4 or ≤ 4 minutes for easier comparability of their effects in different exercises. Only randomized controlled trials were included in this review. Of the 775 studies, 35 met the inclusion criteria. Study design, subjects, effects as well as outcome criteria were inconsistent throughout the studies. Seventeen of these studies reported performance enhancing effects after supplementing NaHCO 3 . Eleven of twenty studies with exercise duration of ≤ 4 minutes showed positive and four diverse results after supplementing NaHCO 3 . On the other hand six of fifteen studies with an exercise duration of >4 minutes showed performance enhancing and two studies showed diverse results. Consequently, the duration of exercise might be influential for inducing a performance enhancing effect when supplementing NaHCO 3 , but to which extent, remains unclear due to the inconsistencies in the study results.

Core-specific sensorimotor exercises are proven to enhance neuromuscular activity of the trunk. However, the influence of high-intensity perturbations on training efficiency is unclear within this context. Sixteen participants (29±2yrs; 175±8cm; 69±13kg) were prepared with a 12-lead bilateral trunk EMG. Warm-up on a dynamometer was followed by maximum voluntary isometric trunk (flex/ext) contraction (MVC). Next, participants performed four conditions for a one-legged stance with hip abduction on a stable surface (HA) repeated randomly on an unstable surface (HAP), on a stable surface with perturbation (HA+P), and on an unstable surface with perturbation (HAP+P). Afterwards, bird dog (BD) was performed under the same conditions (BD, BDP, BD+P, BDP+P). A foam pad under the foot (HA) or the knee (BD) was used as an unstable surface. Exercises were conducted on a moveable platform. Perturbations (ACC 50m/sec 2 ;100ms duration;10rep.) were randomly applied in the anterior-posterior direction. The root mean square (RMS) normalized to MVC (%) was calculated (whole movement cycle). Muscles were grouped into ventral right and left (VR;VL), and dorsal right and left (DR;DL). Ventral-Dorsal and right-left ratios were calculated (two way repeated-measures ANOVA;α=0.05). Amplitudes of all muscle groups in bird dog were higher compared to hip abduction (p≤0.0001; Range: BD: 14±3% (BD;VR) to 53±4%; HA: 7±2% (HA;VR) to 16±4% (HA;DR)). EMG-RMS showed significant differences (p<0.001) between conditions and muscle groups per exercise. Interaction effects were only significant for HA (p=0.02). No significant differences were present in EMG ratios (p>0.05). Additional high-intensity perturbations during core-specific sensorimotor exercises lead to increased neuromuscular activity and therefore higher exercise intensities. However, the beneficial effects on trunk function remain unclear. Nevertheless, BD is more suitable to address trunk muscles., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The Star Excursion Balance Test (SEBT) is effective in measuring dynamic postural control (DPC). This research aimed to determine whether DPC measured by the SEBT in young athletes (YA) with back pain (BP) is different from those without BP (NBP). 53 BP YA and 53 NBP YA matched for age, height, weight, training years, training sessions/week and training minutes/session were studied. Participants performed 4 practice trials after which 3 measurements in the anterior, posteromedial and posterolateral SEBT reach directions were recorded. Normalized reach distance was analyzed using the mean of all 3 measurements. There was no statistical significant difference ( p > 0.05) between the reach distance of BP (87.2 ± 5.3, 82.4 ± 8.2, 78.7 ± 8.1) and NBP (87.8 ± 5.6, 82.4 ± 8.0, 80.0 ± 8.8) in the anterior, posteromedial and posterolateral directions respectively. DPC in YA with BP, as assessed by the SEBT, was not different from NBP YA.