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Objective: The main objective of this study was to investigate the effect of a self-regulated dual task on muscle endurance within a single rehabilitation session in patients recovering from an elbow fracture. Design: This is a cross-sectional study of individuals recovering from elbow fractures (N = 20). Muscle endurance was tested using elastic bands at Borg’s CR10 intensity 3—during four conditions: singletask and dual-task for elbow flexion and extension. Results: The cognitive condition significantly influenced muscle endurance ( P < 0.001), while the type of elbow exercise (flexion or extension) did not show significant differences ( P = 0.592). The perceived difficulty of the tasks showed a significant interaction effect ( P = 0.032). The dual-task condition showed an average increase of about 15 repetitions. A moderate negative correlation was found between the differences in repetitions and the perceived difficulty of the flexion exercise (r = 0.677, P = 0.001). Conclusions: Dual-task with self-regulation enhances muscle endurance among patients recovering from an elbow fracture. However, the improvements seem to depend on the perceived difficulty of the cognitive task. Future randomized controlled trials are required to understand the therapeutic implications of dual-tasking. [ABSTRACT FROM AUTHOR]

The distribution and amount of intramuscular fat and fibrous tissue can be influenced by biological sex and impact muscle quality in both the functional (force‐generating capacity) and morphological (muscle composition) domains. While ultrasonography (US) has proven effective in assessing age‐ or sex‐related differences in muscle quality, limited information is available on sex differences in children. Quantitative ultrasonographic measurements, such as echo intensity (EI), EI bands (number of pixels across 50‐unit intervals) and texture, may offer a comprehensive framework for identifying sex differences in muscle composition. The aim of our study was to examine the effect of sex on the rectus femoris (RF) muscle quality in children. We used EI (mean and bands) and texture as muscle quality estimates derived from B‐mode US. We hypothesised that RF muscle quality differs significantly between girls and boys. Additionally, we also hypothesised that there is a significant correlation between EI bands and texture. Forty‐four non‐active healthy children were recruited (n = 22 girls, 12.8 ± 1.5 years; and n = 22 boys, 13.5 ± 1.2 years). RF was assessed using EI mean, EI bands, and texture analysis (homogeneity and correlation) using the Gray‐Level Co‐Occurrence Matrix. The results revealed significant (p < 0.05) sex differences in RF EI bands and texture. Boys displayed higher values in the 0–50 EI band and had more homogeneous muscle texture than girls. Conversely, girls displayed greater values in the 51–100 EI band and had less homogenous texture compared to boys (p < 0.05). A positive correlation was observed between the 0–50 EI band and muscle homogeneity. However, the 51–100 EI band correlated negatively with homogeneity (p < 0.05), particularly for girls. In conclusion, our study revealed sex‐specific differences in mean EI, EI bands, and texture of the RF muscle in children. The variations in the correlations between the first and second EI bands and texture reveal different levels of homogeneity in each band. This indicates that distinct muscle tissue constituents, such as intramuscular fat and/or connective tissue, may be reflected in EI bands. Overall, the methods used in this study may be useful for examining muscle quality in healthy children and those with medical conditions. [ABSTRACT FROM AUTHOR]

Introduction: No previous studies have implemented a standard blood flow restriction (BFR) training session in people with severe haemophilia (PwH), where this type of training has been contraindicated. Aims: The purpose of this study was to evaluate the tolerability, adverse events, and neuromuscular and perceptual responses to an acute session of low load (LL) knee extensions with BFR in PwH under prophylaxis. Methods: Eight PwH performed one LL‐BFR session with 40% arterial occlusion pressure (AOP). Perceptual responses and adverse effects were assessed, together with high‐density surface electromyography of vastus medialis (VM) and lateralis (VL). Results: Significant normalized root mean square differences were found within each set, but not between sets. Spatial distribution (centroid displacement (p >.05), modified entropy (VM, set two, cycles three and five, p =.032) and coefficient of variation (VM, set two, cycles four and five lower than cycle three (p =.049; p =.036)) showed changes within each set. Median frequency showed a slight increase during cycle four of set four (p =.030). Rate of perceived exertion slightly increased with each set while tolerability slightly decreased in the last set and fear of training with BFR generally decreased after the session. Conclusions: In PwH, a LL‐BFR session at 40% AOP is safe and feasible. Our results suggest that potential muscle impairments may blunt neuromuscular adaptations induced by BFR. [ABSTRACT FROM AUTHOR]

Introduction: Regular assessment of motor impairments is crucial in people with haemophilic arthropathy (PwHA). This study aimed to determine if there are differences in 30‐seconds sit‐to‐stand (30‐STS) power and maximal voluntary isometric contraction (MVIC) of the knee extensors between PwHA and healthy control group (CG). The secondary aims were to investigate the correlation between 30‐STS power and MVIC of knee extensors with clinical characteristics and to assess their effectiveness in identifying motor impairment in PwHA. Methods: A cross‐sectional study was conducted by collecting data from PwHA (n = 17) and a sedentary CG (n = 15). MVIC (torque) and 30‐STS power were normalised to body mass. Correlation analysis and simple linear regression adjusted for age were used to assess the association between tests and clinical variables. Using z‐scores derived from the mean and standard deviation of the CG, we compared the MVIC and the 30‐STS power in PwHA. Results: PwHA showed lower MVIC and 30‐STS power compared to CG (p <.001; large effect size d >.8). Lower 30‐STS power was associated with greater joint impairment and greater fear of movement, whereas MVIC showed no association with clinical variables. 30‐STS power showed a lower z‐score compared to MVIC (p <.001). In addition, 30‐STS power detected 47% of PwHA with motor impairment compared to 0% for MVIC (p =.002). Conclusions: Our results suggest that 30‐STS power may be more effective than knee extensors MVIC in detecting motor impairment in PwHA. Consequently, lower limb skeletal muscle power, rather than maximum knee extensor strength, appears to be more affected in PwHA. [ABSTRACT FROM AUTHOR]

Introduction: Although resistance training is frequently prescribed for people with haemophilia (PWH), no previous meta‐analyses have quantified the effect of this intervention on muscle strength, nor the implications of the intervention's modality and duration. Aim: (1) To determine the effects of resistance training on muscle strength in adults with haemophilia; (2) To determine the most effective duration and modality among the exercise protocols. Methods: A systematic search from inception until 28 November 2023 was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases. We included randomised controlled trials or before‐after studies that involved resistance training without other physiotherapy co‐interventions. Study selection, data extraction and risk of bias assessment were independently performed by two reviewers. Disagreements were resolved in consultation with a third author. The level of evidence was determined according to the GRADE methodology. Results: Seven studies were included. Measurements of knee extensor strength and elbow extensor strength were included in the meta‐analysis. Subgroup analysis showed significant effects for both elastic resistance protocols (SMD: 0.54; 95% CI: 0.02–1.07) and conventional training (isometric and weight‐based equipment) (SMD: 0.88; 95% CI: 0.50–1.25), demonstrating small and moderate effect sizes respectively. Additionally, both protocols of duration 5–7 weeks (SMD: 1.16, 95% CI: 0.63–1.69) as well as those of duration ≥8 weeks (SMD: 0.57, 95% CI: 0.20–0.94) showed a significant difference. Conclusion: Resistance training is effective in improving muscle strength of the knee and elbow extensors in PWH. Both elastic resistance and conventional training show benefits. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the neuromuscular responses and their relationship with health status, kinesiophobia, pain catastrophizing, and chronic pain self-efficacy in patients with end-stage knee osteoarthritis during acute resistance training with different levels of blood flow restriction (BFR). Seventeen patients with end-stage knee osteoarthritis participated in 3 experimental sessions separated by 3 days, performing 4 sets of knee extensions with low load and 3 levels of concurrent BFR performed in a random order: control (no BFR), BFR at 40% arterial occlusion pressure (AOP), and BFR at 80% AOP. Normalized root-mean-square (nRMS), nRMS spatial distribution (centroid displacement, modified entropy, and coefficient of variation), and normalized median frequency (nFmed) were calculated from the vastus medialis (VM) and lateralis (VL) using high-density surface electromyography. Subjects were asked to report adverse effects after the sessions. In the VM, nRMS was higher with 80% AOP than with 40% AOP (p = 0.008) and control (p < 0.001), whereas there were no differences between conditions in the VL. Normalized root-mean-square also showed an association with pain catastrophizing, chronic pain self-efficacy, and health status (VM: -0.50, 0.49, -0.42; VL: -0.39, 0.27, -0.33). Spatial distribution varied between conditions but mostly in the VL. Overall, nFmed did not vary, with only a slight increase in the VL with 40% AOP, between set 3 and 4. BFR during knee extensions at 80% AOP increases VM activity and VL amplitude distribution more than 40% AOP and control. Importantly, muscle activity increases are modulated by pain catastrophizing, chronic pain self-efficacy, and health status in these patients, and kinesiophobia seems to especially modulate entropy. [ABSTRACT FROM AUTHOR]

The article discusses the democratization of physiotherapy for people with hemophilia. Physiotherapy plays a crucial role in treating and preventing musculoskeletal issues in individuals with hemophilia. However, limited access to replacement factor treatment and prophylaxis, particularly in low-income countries, poses a significant barrier to physiotherapy. Other factors such as education, economic and political situations, patient literacy, and access to technology also impact the accessibility of physiotherapy. The article emphasizes the need to recognize and address these factors to enhance the democratization of physiotherapy for people with hemophilia. [Extracted from the article]

This article discusses a study that compared the kinematic analysis of indoor and outdoor gait in people with haemophilia and total knee replacement (TKR). Haemophilic arthropathy, which affects the range of motion, muscle strength, and functionality, is common in people with haemophilia. The study used a low-cost sensorized knee brace to measure knee kinematics during outdoor gait on grassy terrain and indoor gait in a hospital corridor. The results showed that walking on grass terrain increased knee range of motion compared to walking in a hospital corridor. The study highlights the importance of incorporating outdoor assessments in rehabilitation programs for people with haemophilia. [Extracted from the article]

To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile. A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation. A total of 424 older adults were included. Female sex (β = 0.95, 95% CI: 0.22 to 1.68) and loneliness (β = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (β=-0.70, 95% CI: −1.39 to −0.02), living in company (β=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (β=-5.04, 95% CI:-6.33 to −3.75) and greater resilience (β=-0.30, 95% CI: −0.38 to −0.23) were preventive factors. These results provide useful evidence to develop mental health prevention or control strategies for older adults. The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life. [ABSTRACT FROM AUTHOR]

Individuals with chronic ankle instability (CAI) present muscular weakness and potential changes in the activation of the peroneus longus muscle, which likely explains the high recurrence of ankle sprains in this population. However, there is conflicting evidence regarding the role of the peroneus longus activity in CAI, possibly due to the limited spatial resolution of the surface electromyography (sEMG) methods (i.e., bipolar sEMG). Recent studies employing high‐density sEMG (HD‐sEMG) have shown that the peroneus longus presents differences in regional activation, however, it is unknown whether this regional activation is maintained under pathological conditions such as CAI. This study aimed to compare the myoelectric activity, using HD‐sEMG, of each peroneus longus compartment (anterior and posterior) between individuals with and without CAI. Eighteen healthy individuals (No‐CAI group) and 18 individuals with CAI were recruited. In both groups, the center of mass (COM) and the sEMG amplitude at each compartment were recorded during ankle eversion at different force levels. For the posterior compartment, the sEMG amplitude of CAI group was significantly lower than the No‐CAI group (mean difference = 5.6% RMS; 95% CI = 3.4–7.6; p = 0.0001). In addition, it was observed a significant main effect for group (F1,32 = 9.608; p = 0.0040) with an anterior displacement of COM for the CAI group. These findings suggest that CAI alters the regional distribution of muscle activity of the peroneus longus during ankle eversion. In practice, altered regional activation may impact strengthening programs, prevention, and rehabilitation of CAI. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction (BFR) training could be a valuable treatment to induce exercise‐induced hypoalgesia (EIH) in patients with end‐stage knee osteoarthritis. However, the use of BFR in these patients is poorly explored and there is no evidence about the training dosage needed. Objective: To evaluate the effect of resistance training protocols with different occlusion levels of blood flow restriction (BFR) on EIH in patients with end‐stage knee osteoarthritis. Design: Crossover study. Setting: University physical exercise laboratory. Participant s : 26 adults with end‐stage knee osteoarthritis. Interventions: Patients performed four sets (30, 15, 15, and 15 repetitions) separated by 1‐minute rests of three protocols/sessions of low‐load (30% one‐repetition‐maximum) seated knee extensions with elastic bands and BFR: placebo (sham BFR), BFR at 40% arterial occlusion pressure (AOP) and BFR at 80% AOP. Main Outcome Measures: Pressure Pain Thresholds (PPT) and Visual Analog Scale (VAS) collected before, immediately after session, and after 10 minutes. Results: No differences in EIH were found between the different levels of BFR. However, 80% AOP protocol worsened VAS scores immediately (mean difference [MD]: −21.2 (95% confidence interval [CI] −33.9 to −8.5) while improving PPT immediately (MD affected limb: −.6 [95% CI −1.1 to −.2]); contralateral: −.6 (95% CI −1.0 to −.2]) and at 10 minutes (MD affected limb: −.6 [95% CI) −1.2 to −.1]; contralateral: −.7 [95% CI −1.1 to −.2]; and forearm: −.5 [95% CI −.9 to −.05]) post‐exercise compared to baseline. Conclusions: There is no EIH difference after using different occlusion levels. EIH is modulated by pain‐related psychological constructs and self‐perceived health status. [ABSTRACT FROM AUTHOR]

Introduction: The impact of joint damage on functional capacity in patients with mild haemophilia (PwMH) has yet to be well studied. The primary aim of this study was to investigate the effect of joint impairment on the functional capacity of the lower limb in PwMH. The secondary aim was to identify physical predictors of lower limb functional capacity. Method: Forty‐nine PwMH were evaluated. Dynamic balance was assessed using Time Up and Go (TUG). Thirty‐second sit‐to‐stand (30‐STS) and 60‐second‐STS (60‐STS) were used to assess muscle power and endurance, respectively. Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) was used to assess joint damage. PwMH were divided based on HEAD‐US: with joint damage (≥3 points) and without or with very low joint damage (0–2 points). Univariate ANOVA and multiple regression analyses were performed to identify differences in functional capacity and potential physical predictors. Results: Only 30‐STS showed significant differences between groups (p =.002). TUG and 60‐STS were primarily explained by age (r2 =.21 and r2 =.44, respectively), while for 30‐STS, age combined with joint damage and pain level explains 54% of the variance. Conclusion: Our findings indicate that the 30‐STS is useful for assessing functional deterioration in people with early‐stage haemophilia‐related arthropathy. Our results also indicate that joint damage, combined with ageing and pain, may impact 30‐STS outcomes in PwMH. Furthermore, our findings show that the loss in TUG and 60‐STS performance in PwMH is related to ageing. [ABSTRACT FROM AUTHOR]

Little is known about gender differences in stiffness of forearm muscles during voluntary actions. This study aimed to investigate the effect of forearm rotation on flexor carpi ulnaris (FCU) stiffness in men and women during submaximal handgrip contractions. During a single session, measurements were made on 20 young participants (9 females). Two positions of the forearm were compared in random order with the elbow flexed 90 degrees: (i) neutral position and (ii) maximal supination. In each position, participants performed two submaximal handgrip contractions at 25% and 50% of maximal voluntary contraction, while compressive stiffness was collected using a hand myometer (MyotonPRO). A mixed repeated measurement ANOVA was applied to assess the interaction between gender, forearm position, and contraction intensity. The FCU stiffness is affected by handgrip contraction intensity (p < 0.001), gender (p < 0.001), BMI (p = 0.009), and forearm rotation (p = 0.007). Only the gender factor was found to have significant interaction with forearm rotation (p = 0.037). Men's FCU was stiffer than women's in both positions and contraction intensities (p < 0.05). Only in men a significant increase in FCU stiffness was observed when comparing contraction intensities at both forearm positions (p < 0.05), as well as when the forearm was rotated from neutral to supine at both intensities (p < 0.05). In conclusion, FCU stiffness during handgrip contraction differed significantly between men and women. Women have fewer stiffness changes in FCU when performing different levels of handgrip contraction. We also observed that only men increased FCU stiffness by changing the forearm position from neutral to supine position for both handgrip intensities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown. OBJECTIVE: To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height. METHODS: Participants (7 to 15 years old; female, n = 113; male, n = 128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals. RESULTS: Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R = 2 0.45; p < 0.001) for 6mWT distance, and the resting heart rate explained a change in R 2 of only 2% (p = 0.008). CONCLUSIONS: Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth's capacity. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders of the upper extremity are among the most common occupational problems affecting nurses. The aim of this study was to analyze the prospective association between vitality and mental health and increased upper extremity pain intensity in female hospital nurses during a 1-year follow-up. A prospective cohort of 1185 female nurses from 19 hospitals in Denmark was conducted using baseline and 12-month follow-up questionnaires to identify potential associations between levels of vitality and mental health (SF-36 subscales) with pain intensity (0–10 scale) in the shoulder, elbow and hand/wrist regions. Associations were modeled using cumulative logistic regression. The fully adjusted model included the variables of age, baseline pain, body mass index, smoking status, years of occupation, leisure time physical activity level, number of daily patient transfers/handlings, as well as recognition and influence at work. The mean age was 48.3 (SD: 10.4) years. In the fully adjusted model, significant associations between low vitality levels and the odds of shoulder pain (OR = 1.96; 95%CI: 1.43–2.68) and hand/wrist pain (OR = 2.32; 95%CI: 1.58–3.42) were observed. Likewise, moderate levels of mental health was associated with increased odds of shoulder pain at follow-up (OR = 1.50; 95%CI: 1.16–1.93). These results provide an important incentive for nursing managers to assess vitality and mental health among hospital nurses and to consider this factor in prevention strategies to ensure good worker health and, by extension, high-quality care. [ABSTRACT FROM AUTHOR]

Background: People with haemophilia (PWH) tend to be less physically active than the general population, but there is a lack of research on the specific barriers and facilitators affecting their participation in physical activities. Objectives: This study aims to explore perceived barriers and facilitators to physical activity in severe PWH. Design: An explorative qualitative study based on focus groups. Methods: Four focus groups including 16 participants (severe haemophilia A patients) were conducted to examine the factors perceived as facilitators or barriers to haemophiliacs engaging in physical activity. One researcher conducted a thematic analysis of all data. Results: Three themes were identified: body function, personal factors, and environmental factors. Key facilitators identified were access to prophylaxis treatment to reduce the risk of bleeding(s), the enjoyability of physical activity, fitness and health motives, social interaction, support, and low cost. PWH faced additional barriers to being physically active including hurtful joints, mobility issues, haemophilic arthropathy, dislike or disinterest, lack of motivation, fear of injury, tiredness, lack of time, lack of guidance, negative social influence, restriction, and lack of coordination of prophylaxis treatment. Conclusion: This exploratory study demonstrated that participation in physical activity in PWH is influenced not only by their own abilities and attitudes, but also by external variables, including family, friends, healthcare professionals, structures, and communities. The results of this study may be used to assist caregivers and health professionals, inform programs, interventions, and policies to promote physical activity and health in severe PWH. [ABSTRACT FROM AUTHOR]

Objective: To compare the safety, feasibility, and neuromuscular activity of acute low‐load resistance exercise with/without blood flow restriction (BFR) in people with severe hemophilia (PwH). Methods: Eight PwH under prophylaxis (5 with resistance training experience) performed 6 randomly ordered conditions of 3 intensity‐matched knee extensions: no external load and no BFR, no external load and light BFR (20% of arterial occlusion pressure [AOP]), no external load and moderate BFR (40% AOP), external low load and no BFR, external low load with light BFR, and external low load with moderate BFR. Rated perceived exertion, pain, exercise tolerability, and adverse effects were assessed. Normalized root‐mean‐square (nRMS), nRMS spatial distribution, and muscle fiber‐conduction velocity (MFCV) were determined using high‐density surface electromyography for the vastus medialis and lateralis. Results: Exercises were tolerated, without pain increases or adverse events. Externally resisted conditions with/without BFR provided greater nRMS than nonexternally resisted conditions (p < 0.05). Spatial distribution and MFCV did not vary between conditions. Conclusions: In these patients, knee extensions with low external resistance and BFR at 20% or 40% AOP appear safe, feasible and do not cause acute/delayed pain. However, BFR during three consecutive repetitions does not increase nRMS nor changes nRMS spatial distribution or MFCV. [ABSTRACT FROM AUTHOR]

Introduction: Although strength exercise is often prescribed for people with haemophilia (PWH), it remains unknown how exercise variables and pain thresholds are used to prescribe strength training in PWH. Aim: To analyse how strength exercise variables and pain thresholds have been used to prescribe strength training in PWH. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases from inception to 7 September 2022. Studies whose intervention included strengthening training in adults with haemophilia were included. Two independent reviewers were involved in study selection, data extraction and risk of bias assessment. Results: Eighteen studies were included. The least reported variables among the studies were: prophylactic factor coverage (11.1%), pain threshold/tolerability (5.6%), intensity (50%), total or partial range of motion (27.8%), time under tension (27.8%), attentional focus modality (0%), therapist experience in haemophilia (33.3%) and adherence assessment (50%). In contrast, weekly frequency (94.4%), duration (weeks) (100%), number of sets/repetitions (88.9%), repetitions to failure/not to failure (77.8%), types of contraction (77.8%), rest duration (55.6%), progression (55.6%), supervision (77.8%), exercise equipment (72.2%) and adverse event record (77.8%) had a higher percentage of reported (>50% of studies). Conclusion: Future research on strength training for PWH should improve information on pain threshold and other important variables such as prophylactic factor coverage, intensity, range of motion, time under tension, attentional focus modality, therapist experience in haemophilia and adherence assessment. This could improve clinical practice and comparison of different protocols. [ABSTRACT FROM AUTHOR]