Manual Therapy and Therapeutic Exercise in the Treatment of Osteoarthritis of the Hip: A Systematic Review.

Manual therapy and therapeutic exercise in the treatment of osteoarthritis of the hip: a systematic review.

Reumatismo. 2013; 65(2): 63-74
Romeo A, Parazza S, Boschi M, Nava T, Vanti C

This systematic review aimed at investigating the role of therapeutic exercise and/or manual therapy in the treatment of hip osteoarthritis (OA). Two independent reviewers (AR, CV) searched PubMed, Cinahl, Cochrane Library, PEDro and Scopus databases and a third one (SP) was consulted in case of disagreement. The research criteria were publication period (from May 2007 to April 2012) and publication language (English or Italian). Ten randomized controlled trials matched inclusion criteria, eight of which concerning therapeutic exercise and two manual therapy. Few good quality studies were found. At mid- and long-term follow-up land-based exercises showed insufficient evidence of effectiveness with respect to pain and quality of life, but positive results were found for physical function. Water exercises significantly reduced fall risk when combined with functional exercises. Programs containing progressive and gradual exposure of difficult activities, education and exercises promoted better outcomes, higher adherence to home program and increased amount of physical activity, especially walking. Manual therapy seemed to reduce pain and decrease disability at short-term. Less use of nonsteroidal anti-inflammatory drugs was statistically significant at long-term follow-up in patients treated with manual therapy. The relationship between clinical results and radiological grade of OA was not investigated. Encouraging results were found in recent literature for manual therapy and functional training. Further research is needed to elucidate this issue through high-quality trials, especially addressing the aspects that have not been thoroughly explored yet, for instance type, amount and scheduling of conservative treatment. HubMed – rehab

Kinematic and Kinetic Comparison of Running in Standard and Minimalist Shoes.

Med Sci Sports Exerc. 2013 Jul 19;
Willy RW, Davis IS

The purpose of this study was to determine if running in a minimalist shoe results in a reduction in ground reaction forces and alters kinematics over standard shoe running. The secondary purpose of this study was to determine if within-session accommodation to a novel minimalist shoe occurs.Subjects were 14 male, rearfoot striking runners who had never run in a minimalist shoe. Subjects were tested while running 3.35 m/s for 10 minutes on an instrumented treadmill in a minimalist and a standard shoe as 3-D lower extremity kinematics and kinetics were evaluated. Data were collected at minute 1 and then again after 10 minutes of running in both shoe conditions to evaluate accommodation to the shoe conditions.Shoe x time interactions were not found for any of the variables of interest. Minimalist shoe running resulted in no changes in step length (p=0.967) nor step rate (p=0.230). At footstrike, greater knee flexion (p=0.001) and greater dorsiflexion angle (p=0.025) were noted in the minimalist shoe. Vertical impact peak (p=0.017) and average vertical loading rate (p<0.000) were greater during minimalist shoe running. There were main effects of time as dorsiflexion angle decreased (p=0.035), foot inclination at footstrike decreased (p=0.048) and knee flexion at footstrike increased (p=0.002), yet the vertical impact peak (p=0.002) and average vertical loading rate (p<0.000) increased.Running in a minimalist shoe appears to, at least in the short-term, increase loading of the lower extremity over standard shoe running. The accommodation period resulted in less favorable landing mechanics in both shoes. These findings bring into question whether minimal shoes will provide enough feedback to induce an alteration that is similar to barefoot running. HubMed – rehab

Exercise Capacity and Ventilatory Response During Exercise in COPD Patients With and Without ? Blockade.

Lung. 2013 Jul 23;
Thirapatarapong W, Armstrong HF, Bartels MN

Although ? blockade (BB) in patients with chronic obstructive pulmonary disease (COPD) does not show signs of worsening pulmonary function or respiratory symptoms, the effects on cardiopulmonary exercise testing (CPET) remain unclear. The aim of this study was to determine whether BB affects exercise capacity, gas exchange, and hemodynamic responses in patients with COPD.Twenty-four COPD subjects on BB were matched to 24 COPD subjects without BB according to age, gender, body mass index, and severity of COPD. All subjects underwent resting pulmonary function and symptom-limited CPET.Comparing COPD patients with and without BB revealed that percent peak oxygen consumption and VE/VCO2 nadir were not significantly different (45 ± 16 vs. 51 ± 23 %, p = 0.30, and 35.1 ± 8.5 vs. 36.2 ± 11.6 %, p = 0.69). Systolic blood pressure and heart rate at peak exercise were significantly decreased in COPD patients with BB (168 ± 16 vs. 185 ± 20 mmHg, and 109 ± 16 vs. 122 ± 14 bpm, respectively, p < 0.05).Exercise capacity and gas exchange remain unaffected in patients with COPD in the presence of BB, although heart rate and blood pressure are lower. These findings imply that BB does not adversely affect functional capacity in patients with COPD. HubMed – rehab

Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association.

Circulation. 2013 Jul 22;
Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA,

HubMed – rehab