Double-arm elevation above shoulder level appears to be more challenging than other strength exercise variations. Partitioning exercises and limb position may reduce perceived exertion during training.

BackgroundWe have recently demonstrated the efficacy of balance training in addition to Pulmonary Rehabilitation (PR) at improving measures of balance associated with an increased risk of falls in individuals with Chronic Obstructive Pulmonary Disease (COPD). Few knowledge translation (KT) projects have been conducted in rehabilitation settings. The goal of this study was to translate lessons learnt from efficacy studies of balance training into a sustainable clinical service.MethodsHealth care professionals (HCPs) responsible for delivering PR were given an hour of instruction on the principles and practical application of balance training and the researchers offered advice regarding; prescription, progression and practical demonstrations during the first week. Balance training was incorporated three times a week into conventional PR programs. Following the program, HCPs participated in a focus group exploring their experiences of delivering balance training alongside PR. Service users completed satisfaction surveys as well as standardized measures of balance control. At six month follow-up, the sustainability of balance training was explored.ResultsHCPs considered the training to be effective at improving balance and the support provided by the researchers was viewed as helpful. HCPs identified a number of strategies to facilitate balance training within PR, including; training twice a week, incorporating an interval training program for everyone enrolled in PR, providing visual aids to training and promoting independence by; providing a set program, considering the environment and initiating a home-based exercise program early. Nineteen service users completed the balance training [ten male mean (SD) age 73 (6) y]. Sixteen patients (84 %) enjoyed balance training and reported that it helped them with everyday activities and 18 (95 %) indicated their wish to continue with it. Scores on balance measures improved following PR that included balance training (all p < 0.05). At six month follow-up balance training is being routinely assessed and delivered as part of standardised PR.ConclusionsImplementing balance training into PR programs, with support and training for HCPs, is feasible, effective and sustainable.Trail registrationClinical Trials ID: NCT02080442 (05/03/2014)Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0067-2) contains supplementary material, which is available to authorized users.

Purpose: To describe balance for 12 mo in people with chronic obstructive pulmonary disease (COPD). Methods: Individuals with COPD completed the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BEST), and the Activities-Specific Balance Confidence (ABC) scale before pulmonary rehabilitation (PR), post-PR and at 3, 6, and 12 mo. If an acute exacerbation of COPD (AECOPD) occurred, balance measures were repeated after 7 d and 1 mo. Descriptive data are displayed for balance measures at 5 time-points (pre-PR, post-PR, 3 mo, 6 mo, and 12 mo) in those without exacerbations. The outcome score at 7 d and 1 mo post-AECOPD was compared with the assessment closest to the AECOPD. Results: A total of 42 patients were recruited and 32 patients (17 male; mean age ± standard deviation = 68.5 ± 9.9 yr; FEV1 % predicted =38 ± 15%) completed balance measures post-PR. Seventeen, 11, and 6 patients, who did not exacerbate, completed balance measures at 3, 6, and 12 mo, respectively, with no overall change in balance measures over time. Of 32 patients, 15 experienced an AECOPD and of these, 8 and 11 completed measures at 7 d and 1 mo, respectively. Balance declined from baseline to 7 d (BBS, P = .010; BEST, P = .002) and to 1 mo post-AECOPD (BBS, P = .035). Balance recovered from 7 d to 1 mo post-AECOPD but did not return to baseline levels (BBS, P = .045; BEST, P = .006). There were no changes in balance confidence post-AECOPD. Conclusions: Balance remained stable over 12 mo after completion of PR in those who remained exacerbation-free. The impact of an AECOPD on measures of balance persisted after 1 mo.

Muscle strength and power were impaired at 6 months after ICU discharge and were associated with gait parameters. Future studies are needed to examine the role of muscle strength and power training in post-ICU rehabilitation programs to improve mobility.

The superficial palmar arc ensures the blood supply to the palm of the hand. It is formed by the ulnar artery and the superficial palmar branch of the radial artery (classic pattern), shows a distal convexity, from where three ordinary digital palmar arteries go out. It is located over the flexor muscles of the fingers, the lumbrical muscles, and the branches of the median and the ulnar nerves, under the protection of the palmar aponeurosis. PURPOSE: The fact of frequent anatomic variations attracted the interest in checking its incidence, improving the knowledge of the territory of the hand aiming clinical and surgical applications. The aim of this study is the observation of the morphology of the superficial palmar arc and the frequency of the variations regarding the contribution of the other arteries to its formation. METHODS: To carry out this work, 30 pieces of corpse, fixed in a watery solution of formaldehyde, were studied by the method of macroscopic dissection. The analyzed pieces were designed and photographs were taken, and the obtained results, statistically, applying the test of equality of proportions, had a level of trust of 95%. RESULTS: An amount of 100% showed the superficial palmar arc. From these, 18 cases (60%) showed anastomosis among the arteries that form the arc and 12 cases (40%) did not. Concerning about the arterial contribution for the arc formation, the following results were obtained: 11 cases (36,67%) were formed by the anastomosis of the ulnar artery with the superficial branch of the radial artery; 7 cases (23%) were formed by the ulnar artery only; 4 cases (13,33%) were formed by the ulnar artery and the superficial branch of the radial artery without anastomosis; 4 cases (13,33%) were formed by the anastomosis of the ulnar artery with the main artery of the thumb; 3 cases (10%) were formed by the anastomosis of the ulnar artery with the median artery of the forearm; 1 case (3,33%) was formed by the ulnar artery and the median artery without anastomosis. CONCLUSION: These results show the incidence of the classic pattern and variations of morphology and different types of contribution for the formation of the superficial palmar arc.

Immediate cardiorespiratory responses to an acute bout of resistance exercise appear to be independent of the exercise intensity in COPD. Although people with COPD are working closer to their (Equation is included in full-text article.)O2peak, their responses and RPE are comparable with healthy controls.

Purpose: We determined normative values for the Unsupported Upper Limb Exercise (UULEX) test and the 6-Minute Pegboard and Ring Test (6PBRT) in a sample of healthy Canadian adults aged 40–89 years. Method: Volunteers completed the UULEX test and the 6PBRT twice with an interval of 30 minutes between tests or after the variables of interest had returned to their baseline values. Results: A total of 97 volunteers completed the tests (53.4% female); their mean age was 64.3 (SD 13.9) years. Mean UULEX scores were 11.4 (SD 3.0) minutes for women and 12.4 (SD 2.5) minutes for men. The mean 6PBRT score was 404.7 (SD 100.1) rings moved. For both tests, younger individuals’ scores were higher.  As volunteers’ age increased, their functional performance on both tests was reduced: UULEX, r = –0.50 ( p = 0.001), and 6PBRT, r = –0.60 ( p = 0.001). Conclusions: These normative values increase the usefulness of these tests as measures of upper limb function.

Avaliamos o efeito do treinamento físico moderado (TFM) associado à reposição nutricional na parede das artérias carótida comum esquerda e aorta horizontal em 24 ratos Wistar machos adultos jovens, submetidos à desnutição proteica nas fases gestacional e neonatal. Os animais foram divididos em grupos Nutrido (N, n = 12, caseína 17%) e Desnutrido (D, n = 12, caseína 8%). Após o desmame, todos os animais receberam dieta padrão (Labina®) e aos 60 dias de vida, os dois grupos foram subdivididos em quatro com seis animais cada: Nutrido Não Treinado (NNT), Nutrido Treinado (NT), Reposição Não Treinado (RNT) e Reposição Treinado (RT). O TFM foi realizado em esteira durante oito semanas, cinco dias por semana, 60 minutos por dia. A histomorfometria de ambas as artérias foi realizada com o programa Scion Image for Windows (Beta 4.0.2). A espessura das paredes das artérias foi obtida a partir da média de aferição de quatro pontos diferentes (0°, 90°, 180°, 270°) e o diâmetro do lúmen dos vasos, a partir da média de aferição de dois valores, partindo de quatro pontos diametralmente opostos. Para a comparação entre os grupos utilizou-se o teste t de Student com os dados apresentados em média ± desvio padrão. A espessura média das artérias carótida comum esquerda (µm) e aorta horizontal (mm) foi menor no grupo RNT (32,51 ± 5,54; 0,11 ± 0,02, respectivamente), comparado com o NNT (40,91 ± 3,56; 0,15 ± 0,01). O diâmetro (µm) da artéria carótida comum esquerda foi maior nos animais RT (724 ± 44,64) do que nos RNT (630,73 ± 79,67). Conclui-se que o TFM associado à reposição nutricional não foi capaz de recuperar as alterações estruturais provocadas pela desnutrição na parede das artérias carótida comum esquerda e aorta horizontal.