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This prospective study was designed to evaluate changes in upper extremity lymphatic drainage after ALND in comparison to the preoperative status using lymphoscintigraphy. The study enrolled 44 women (mean age: 57.95; range: 35-80) with a new diagnosis of unilateral invasive breast carcinoma who had been scheduled to undergo ALND. This was a substudy of the physiotherapeutic project, in which subjects after ALND were randomized into 4 groups treated with: 1) rehabilitation exercises; 2) manual lymphatic drainage; 3) pneumatic compression pump; and 4) education only. Clinical evaluation which included arm measurements and lymphoscintigraphy was performed in every subject before surgery and 3 times after surgery (1-6 weeks, 1 and 2 years after ALND). Follow-up was completed in 44 subjects at 1 year and in 32 subjects at 2 years. Lymphedema diagnosis was made in 4 subjects 1 year after ALND (9%) and in 8 subjects 2 years after ALND (25%). Among them, respectively, only 50% and 62% noticed and reported lymphedema. Quantitative analysis of lymphoscintigrams and photoplethysmography results did not reveal upper extremities lymphatic transport and/or venous function impairment after the ALND procedure. Qualitative analysis of lymphoscintigrams revealed most commonly disappearance of previously functional lymph nodes and appearance of dermal backflow in subjects who developed lymphedema. Conversely, appearance of functional lymph nodes in different locations after ALND may indicate protection from development of upper extremity lymphedema. [ABSTRACT FROM AUTHOR]

Introduction: A typical symptom of chronic lower-limb ischaemia is lower-limb pain, which occurs during walking forcing the patient to stop, intermittent claudication (IC). Exercise rehabilitation is the basic form of treatment for these patients., Aim: The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency., Materials and Methods: Ninety-five people qualified for the 3-month supervised motor rehabilitation programme, conducted three times a week. The respondents were assigned to three types of rehabilitation programmes using a pseudo-randomization method: Group I (TW), subjects undertaking treadmill walking training; Group II (NW), subjects undertaking Nordic walking training; Group III (RES+NW), subjects undertaking resistance and Nordic walking training. Treadmill test, 6 Minute Walk Test (6MWT), and isokinetic test were repeated after 3 months of rehabilitation, which 80 people completed., Results: Combined training (RES+NW) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters (p<0.05) in patients with intermittent claudication. Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication (p<0.05), especially in 6MWT (p=0.001). Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT, both in Group III (RES + NW) and in Group II (NW) at the level of moderate and strong correlation strength, which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer., Conclusions: Given both the force-velocity parameters and the covered distance, the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone. All types of training increased walking distance, which is an important aspect of the everyday functioning of people with IC.

Background: An aggressive reduction of cardiovascular risk factors in patients with intermittent claudication (IC) is extremely important., Objectives: The aim of this study was to investigate patients' adherence to current guidelines for the recognition and reduction of atherosclerosis risk factors in peripheral arterial disease (PAD) in Poland., Material and Methods: The study included 126 patients with PAD stage II, according to the Fontaine Classification, who over a period of 2 years attended an angiological outpatient clinic and were referred for physical rehabilitation., Results: In the 77% of PAD patients diagnosed with dyslipidemia, 72% had hypertension and 31% had diabetes. Suboptimal treatment was being given to 85.5% of patients with dyslipidemia, to 26% of patients with hypertension and to 95% of diabetics. In this study, a diagnosis of dyslipidemia, hypertension and diabetes was made for the 1st time in 22%, 7% and 4% of patients, respectively. As many as 17.5% of PAD patients with claudication were not receiving any antiplatelet therapy., Conclusions: The diagnosis of dyslipidemia was insufficient (about 1/3 of the patients were undiagnosed), and diagnoses of hypertension and diabetes prevailed. It was established that the effective control of risk factors using relevant treatment is insufficient in dyslipidemia, hypertension and diabetes. Antiplatelet therapy was not prescribed in approx. 20% of cases.

Objectives: The objective of this article is to review the literature regarding the effectiveness and safety of Nordic walking (NW) in therapeutic rehabilitation in patients of an advanced age., Methods: Randomized studies comparing NW with different patterns of long-lasting physical rehabilitation in older adults (average age 65 years) were selected for the review. Studies were identified through a Medline database search covering the last 21 years., Results: Seventy-four studies on this subject were identified, 37 of them fulfilled the required criteria and 27 of these were analyzed in this review., Discussion: Nordic walking provides a safe and effective way to enhance physical activity in the elderly. It could also serve as a method of rehabilitation that improves fitness, the performance and the exercise capacity of aged persons with diseases associated with an advanced age: cardiovascular diseases due to atherosclerosis; metabolic syndrome without diabetes; early stage Parkinson's disease; chronic obstructive pulmonary disease and lowering depression in women with Sjögren's Syndrome.

Purpose: The aim of the study was to compare the efficacy of Nordic pole walking (NPW) training with traditional treadmill training (TT) on a claudication (CD) and maximum walking distance (MWD) in patients with peripheral arterial disease (PAD)., Method: Patients with intermittent claudication (IC) (n = 70; age=68.27) in the Fontaine class II were randomized into a two three-month rehabilitation programs performed three times per week. TT were finished by 31 patients, NPW by 21. Walking capacity was measured by an exercise treadmill test (ETT) with the Gardner-Skinner protocol (before and after the program) and six minute walk test (6MWT) (before, during and after the program)., Results: In an ETT both groups reached significant increase in CD and MWD (p ≤ 0.005). In 6MWT NPW group reached significant increase in both CD (p = 0.001) and MWD (p = 0.001), whereas the TT group only in MWD (p = 0.001)., Conclusions: NPW has been shown to be as effective as the standard TT and is much less expensive. It should be the preferred method of exercise for PAD patients with IC., Implications for Rehabilitation: Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease (PAD) patients with intermittent claudication (IC). Nordic walking has been shown to be as efficient as traditional treadmill training. It is however more cost-effective method of rehabilitation in PAD patients.

Objectives: The aim of this study is to compare values of force-velocity and functional walking capacity in elderly patients with intermittent claudication with respect to the control group., Materials and Methods: The study involved 135 individuals: 85-peripheral arterial disease (PAD) group diagnosed with stage II chronic lower limb ischemia, according to Fontaine's classification, and 50-control group. The studies included an assessment of walking capacity using a six-minute walk test (6MWT) and measurement of force-velocity parameters (peak torque-PTQ, total work-TW, average power-AVGP) of the lower limbs obtained by means of a functional dynamometry under isokinetic conditions., Results: The peripheral arterial disease group is characterized by significantly lower values of force-velocity parameters compared to the control group (p<0.005). Walking capacity in this group is significantly reduced due to significant differences in the distance covered (p<0.0001), walking speed (p<0.01), and its intensity (p<0.01). Further, a positive correlation was found between the maximum distance specified in the six-minute walk test and lower limb muscle strength in the isokinetic test., Conclusions: Mean values of all force-velocity parameters and walk distance were significantly higher in the control group than in the peripheral arterial disease group. In the PAD group, in both men and women, the value of the agonist/antagonist ratio of both lower limbs are lower in men and women comparing to the control group. A rehabilitation program for patients with intermittent claudication must consider exercises improving strength, exercise capacity, and endurance in patients with PAD., (Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Alterations in axillary lymph nodes (ALNs) after complete axillary lymph node dissection (ALND) in comparison to the preoperative status were evaluated using lymphoscintigraphy performed preoperatively and 1-6 weeks after surgery in 30 women with a new diagnosis of unilateral, invasive breast carcinoma. Analysis of lymphoscintigrams revealed that ALNs after surgery were present in 26 of 30 examined women. In comparison to preoperative status, they were visualized in the same location (12 women), in the same and additionally in different locations (9 women), or only in different locations (4 women). No lymph nodes were visualized in one woman and lymphocoele were in 4 women. Thus, after ALND, a variable number of axillary lymph nodes remain and were visualized on lymphoscintigraphy in the majority of women. The classical ALND, therefore, does not allow complete dissection and removal of axillary nodes with total disruption of axillary lymphatic pathways, accounting in part for the variable incidence and severity of lymphedema after the procedure.

The cycle time and number of chambers in the pneumatic sleeve may influence the outcome of lymphedema therapy with intermittent compression devices. The aim of our study was to assess efficacy of several commonly used different IPC protocols on edema volume reduction in women with postmastectomy lymphedema. Fixty-seven (57) women with secondary arm lymphedema (age 39-80) were selected to the study. Women were randomly assigned to two study groups with different IPC cycle times: I--90:90s and II--45:15s. Both groups were then randomly divided into two subgroups with different sleeves: A--1 chamber sleeve (28 women) and B--3 chamber sleeve (29 women). All women underwent IPC treatment for 5 weeks, 5 times a week for 1 hour (25 sessions). Arm volume measurements were performed before and after each IPC session. Significant reduction of edema volume was observed in all therapeutic subgroups, regardless of cycle times and number of chambers. In the group with short IPC cycle, better efficacy was noticed with 3-chamber sleeve. IPC is an effective method of volume reduction in women with postmastectomy arm lymphedema regardless of cycle times and number of sleeve chambers.