Short Term Effects of Bracing on Exercise Performance in Mild Idiopathic Thoracic Scoliosis

Abstract

In adolescent idiopathic thoracic scoliosis (ITS) working capacity may be reduced during exercise. Despite concern about its usefulness, bracing is still being used in ITS. Thus the effects of bracing on exercise performance need to be examined. We studied six females, ages 12-15 years who had mild ITS (Cobb angle range 20-35 degrees). Pulmonary volumes, maximal voluntary ventilation (MVV), breathing pattern, the lowest (most negative in sign) pleural pressure during sniff maneuver (Pplsn), and pleural pressure swings (Pplsw) were measured first. Then, Pplsw, O2 uptake (VO2), CO2 output (VCO2), heart rate (HR) at rest and during progressive incremental exercise on a cycling ergometer (10 watts/min) were recorded. The exercise test was performed under control conditions without bracing (C) and after 7 days of bracing with the braced on (B). Dyspnea was measured by a modified Borg scale. At rest, bracing mildly affected total lung capacity and forced vital capacity (p < 0.03 for both) but not breathing pattern, Pplsn, or Pplsw (%Pplsn), a measure of respiratory effort. Furthermore, bracing did not consistently affect maximum work rate (WRmax). In both B and C VO2 was below (< 70%) the predicted value, VE was below (< 45%) MVV, and HR reserve was < 15 beats/min, indicating some cardiovascular deconditioning. On the other hand, respiratory frequency (Rf) increased more in B than in C (p < 0.03). In addition, Pplsw, Pplsw (%Pplsn), and Pplsw (%Pplsn)/VT, an index of neuroventilatory dissociation (NVD) of the respiratory pump, were greater in B (p < 0.03 for all). At a similar work rate, the Borg rating score was greater with bracing on than off, and the difference (delta Borg) tended to relate to concurrent changes in Pplsw (%Pplsn)/VT (r2 = 0.71; p < 0.07). We conclude that bracing affects respiratory effort, NVD, and dyspnea score during progressive exercise. These effects are consistent with increased lung elastance. Diminished exercise tolerance in patients with mild ITS probably reflects impaired physical fitness but is not affected by bracing. Training programs proposed for this subset of patients to increase peripheral muscle performance might also consider NVD of the respiratory pump.

Aptidão física relacionada à saúde de escolares brasileiros: dados do projeto esporte Brasil

“…In developed countries the reverse phenomenon is observed, that is to say, the majority of students presents flexibility suitable to health (26,30) . The low levels of flexibility are especially of concern for the associated risks to low back pain and higher incidence of postural problems, besides a possible explanation for the low school performance (10)(11)(12) . A longitudinal study carried out in Finland revealed that, after 25 years, children with low levels of flexibility in the school period reported more back pain in adulthood (12) .…”

“…Studies with children and adolescents have reported a straight association between motor performance and physical activity (4,5) . Good motor performance and physical fitness level related to heath, in the initial phases of life, is associated to good health indicators such as: low cholesterol and triglycerides levels (6,7) , balanced heart rate and insulin sensitivity (6)(7)(8) , lower obesity risk (9) , low prevalence of low back pain and posture problems (10)(11)(12) , besides reflecting in good academic performance 13,14) . The mostly used battery of motor tests in the investigations with students was proposed by the American Alliance for Health, Physical Education, Recreation and Dance -AAHPERD (15) , and the results interpretation suggested by the Physical Best (15) .…”

Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

“…The outcome "Exercise efficiency", added after Consensus, refers to the same bibliographic references. BF has been used as a means to evaluate patients before and after surgery[ 109 , 110 ], and even the type of surgery to be performed[ 111 ], but it has also been evaluated during bracing, both while wearing it [ 112 - 115 ] and in the long term[ 113 ]. Many studies focused on exercises and rehabilitation means to improve this function in adolescent idiopathic scoliosis [ 116 - 123 ], while the most related to biomechanics and physiologic studies on pulmonary function in patients[ 124 , 125 ].…”

Effects of A Spinal Brace on the Functional Profile of the Feet in Adolescent Idiopathic Scoliosis

“…The baropodometric and stabilometric tests were performed under two conditions without bracing at baseline and with 7 days of bracing with brace on (17). The tests were conducted by the second investigator, who had four years of experience in baropodometric analysis.…”