Abstract 11 protection against exercise-induced oxidative stress in the obese elderly with chronic resistance training. Heather K. Vincent, PhD (Univ Virginia, Charlottesville, VA); Kevin R. Vincent, MD, PhD; Cheryl Bourguignon, PhD; Randy W. Braith, PhD, e-mail: [email protected]

Abstract 11 protection against exercise-induced oxidative stress in the obese elderly with chronic resistance training. Heather K. Vincent, PhD (Univ Virginia, Charlottesville, VA); Kevin R. Vincent, MD, PhD; Cheryl Bourguignon, PhD; Randy W. Braith, PhD, e-mail: [email protected]

2004 Academy Annual Assembly Abstracts week. Participants: 15 healthy elderly men and 13 women participated in a 1-y training program; 20 subjects ser...

29KB Sizes 0 Downloads 22 Views

2004 Academy Annual Assembly Abstracts week. Participants: 15 healthy elderly men and 13 women participated in a 1-y training program; 20 subjects served as controls. Intervention: Strength training was carried out with MultiGym machines at 60% of the repetition maximum. In home sessions, subjects used elastic bands. Main Outcome Measures: (1) Muscle function: knee (range, 20°–90° of flexion) and ankle (range, ⫺20° to 20° of plantarflexion) maximum isometric strength, and leg extensor power (LEP); (2) functional ability: functional reach, chair rise 1 (CR1) and 10 (CR10) times, bed rise, 6-min walking test (6MWT), stair climbing, 1-leg standing, and Get Up & Go (GUG) test; and (3) physical activity profile. Results: LEP increased (right leg, 17.1%; left leg, 14.2%; P⫽.00006) more than strength. Women showed better responses to training than men and, in particular, greater improvements in LEP than in functional ability. All the functional ability tests significantly improved. The GUG test (19.6%, P⫽.001), stair climbing (12%, P⫽.00004), 6MWT (4.7%, P⫽.0007), and CR10 (28%, P⫽.0002) showed higher correlations with LEP than with strength. The CR1 (24%, P⫽.0002) and bed rise (17%, P⫽.0002) correlated better with strength. Physical activity increased by 2% (from 29.5⫾5.6 to 33.1⫾4.5Kcal 䡠kg⫺1䡠 d⫺1, P⫽.04). Conclusions: Women were weaker than men at baseline and derived greater benefits from training. LEP appears to be a more influential determinant of performance in old age than strength. Power is crucial for performance in women, whereas men have safety margins of power. The GUG test, stair climbing, CR10, and 6MWT could represent surrogate means of identifying muscle power in ambulatory care. Key Words: Elderly; Muscles; Rehabilitation. Abstract 11 Protection Against Exercise-Induced Oxidative Stress in the Obese Elderly With Chronic Resistance Training. Heather K. Vincent, PhD (Univ Virginia, Charlottesville, VA); Kevin R. Vincent, MD, PhD; Cheryl Bourguignon, PhD; Randy W. Braith, PhD, e-mail: [email protected]. Disclosure: H.K. Vincent, None; K.R. Vincent, None; C. Bourguignon, None; R.W. Braith, None. Objective: To compare oxidative stress levels in nonobese, overweight, and obese elderly adults after an acute maximal aerobic exercise (AX) challenge before and after chronic resistance exercise (RX). Design: Randomized controlled trial. Setting: Clinical exercise laboratory, wellness center. Participants: Elderly adults 60 –72y (N⫽46), stratified based on body mass index (BMI): nonobese (mean, 22.3kg/m2), overweight (mean, 27.5kg/m2), and obese (mean, 34.1kg/m2); and they were further randomized within groups to RX or no exercise treatment. Interventions: 6 months of RX (3⫻ wk, full body exercises). Main Outcome Measures: Plasma lipid peroxidation (PEROX), exercise oxygen consumption, respiratory exchange ratio (RER), and plasma thiol antioxidants. Results: Basal PEROX levels were elevated in the overweight and obese groups compared with the nonobese group (2.9 vs 2.9 vs 2.3nmol/mL respectively; P⬍.05). Prior to any intervention, the obese group had a greater change in PEROX during AX compared with the nonobese and overweight groups (.058 vs .028 and .015nmol 䡠 kg 䡠 ⫺1min⫺1, respectively; P⬍.05). After RX training, basal PEROX no longer differed between groups (P⬎.05). The change in PEROX during AX was lower than pretraining values in the obese group (P⬍.05), indicating a protective effect of RX in the obese group. Regression analysis revealed that when baseline PEROX and BMI levels were controlled, fat free mass, RER, and antioxidant protein thiols were significant collective contributors to the change in PEROX after AX (R2⫽.47, P⬍.05). Conclusions: Obese elderly persons are at a greater risk for oxidative stress than nonobese counterparts, but RX can attenuate this obesity-induced oxidant stress. The PEROX response is likely due to multiple factors, including mechanical loading from excess body weight, elevated metabolism, and antioxidant thiol profiles. Lowering oxidative stress through RX may confer protection against oxidant-stress related conditions such as sarcopenia, atherosclerosis, neuropathies, and diabetes in the elderly. Key Words: Elderly; Exercise; Obesity; Oxidative stress; Rehabilitation. Abstract 12 Tai Chi Chuan Versus Brisk Walking in Healthy Elderly Woman: A Randomized Controlled Trial. Joseph F. Audette, MA, MD (Spaulding Rehabil Hosp, Boston, MA); Young Soo Jin, MD, PhD; Lauren Stein, MD; Renee Newcomer, PhD, e-mail: [email protected]. Disclosure: J.F. Audette, None; Y.S. Jin, None; L. Stein, None; R. Newcomer, None. Objective: To evaluate whether a simplified style of Tai Chi Chuan (TCC) has physiologic effects on fitness, strength, and balance when compared with the training effects of brisk walking in elderly woman. Design: A randomized controlled pilot study. Setting: Outpatient rehabilitation center. Participants: 26 sedentary healthy women aged 65 and older were randomly assigned to the TCC group (n⫽10) versus a brisk walking group (BWG; n⫽8) relative to a sedentary control group (SCG) of healthy elderly woman (n⫽8). Interventions: Subjects were randomized into 2 exercise protocols, TCC and BWG, each meeting for 1h/d, 3d/wk for 12wk. The TCC was a short, 10-movement Yang style. The BWG progressively increased subjects’ walking time at 60%–70% of their age-predicted maximum heart rate. Main Outcome Measures: Maximal oxygen uptake ˙ O2max) was estimated using the American College of Sports Medicine submaximal, bicycle (V ergometry protocol. Other measures included isometric knee extension and handgrip strength, single-leg stance time, the State Trait Anxiety Inventory, and Profile of Mood States questionnaires. ˙ O2max in the TCC group relative to the SCG (TCC Results: Significant improvement was found in V vs SCG, P⫽.003; TCC vs BWG, P⫽.08; BWG vs SCG, P⫽.085). There was also significant improvement in the measures of the nondominant knee extensor strength and single-leg stance with eyes closed in the TCC group relative to the BWG (TCC vs BWG, P⬍.05). Conclusions: TCC was significantly better than brisk walking at protecting healthy, sedentary elderly woman from a decline in aerobic fitness over a 3-mo period. There is also the suggestion that TCC provided greater protective benefits in terms of lower-extremity strength and balance when compared with a standard, brisk walking protocol. Key Words: Aged; Physical fitness; Rehabilitation; Tai Chi. Abstract 13 Cyclobenzaprine (5mg) Significantly Improves Symptom Response in Patients With Acute Muscle Spasm. George J. Wan, PhD, MPH (McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, PA); Patrick E. Ciccone, MD; Debra L. Bowen, MD, e-mail: [email protected]. Disclosure: G.J. Wan, employee of McNeil Consumer & Specialty Pharmaceuticals; P.E. Ciccone, employee of McNeil Consumer & Specialty Pharmaceuticals; D.L. Bowen, employee of McNeil Consumer & Specialty Pharmaceuticals.

E3

Objective: To compare response with cyclobenzaprine or placebo in patients with acute muscle spasm (AMS). Design: 2 randomized, double-blind, placebo-controlled, multicenter, 7-d trials. Setting: Primary care centers in the United States. Participants: Most patients (64%) had a duration of muscle spasm ⬎3 to 14d prior to study enrollment. Interventions: Cyclobenzaprine doses of 2.5mg 3 times daily (CYC2.5), 5mg 3 times daily (CYC5), and 10mg 3 times daily (CYC10), or placebo (1405 randomized; 223 to CYC2.5; 464 to CYC5; 249 to CYC10; 469 to placebo). Main Outcome Measures: Patient-rated clinical global impression (PCGI) of change was assessed after 7d of therapy using a scale from 0-4 (0, worse; 4, marked improvement). Positive symptom response was defined as a PCGI score ⱖ2. Effect sizes (ESs) were calculated by dividing the difference of the mean PCGI scores (active vs placebo) by the pooled SD (larger ES reflects larger treatment effect). Results: Response rates were 89% for CYC5, 86% for CYC10, 81% for CYC2.5, and 76% for placebo. CYC5 and CYC10 were significantly superior to placebo for symptom response (P⬍.01). More patients achieved a response with CYC5 versus CYC2.5 (P⬍.01). No significant differences in response were observed between CYC5 and CYC10, CYC10 and CYC2.5, or CYC2.5 and placebo. Because CYC2.5 responses did not differ significantly from placebo, ESs were compared between the 2 effective doses, CYC5 and CYC10. ESs were .37 (95% CI, .24 –.50) for CYC5 and .33 (95% CI, .17–.48) for CYC10. Conclusions: More patients with AMS achieved a response compared with placebo with both CYC5 and CYC10. No significant differences in response were observed between CYC5 and CYC10 and the ESs were of similar magnitude. CYC2.5 did not differ significantly from placebo. These analyses support the conclusion that CYC5 is as effective for AMS as CYC10. Key Words: Cyclobenzaprine; Rehabilitation.

Abstract 14 Racial Disparities in Referral to Cardiac Rehabilitation. Patricia C. Gregory, MD (Johns Hopkins Univ Sch Med, Baltimore, MD); Thomas A. Laveist, PhD; Crystal F. Simpson, MD, MHS, e-mail: [email protected]. Disclosure: P.C. Gregory, None; T.A. Laveist, None; C.F. Simpson, None. Objectives: To determine whether racial disparity exists in providers’ referral patterns to cardiac rehabilitation programs and to see if this might explain the low utilization by eligible patients. Design: Observational population-based study. Setting: Communities of Baltimore City and Baltimore County, MD. Participants: 1933 community-dwelling adults enrolled in the Cardiac Access longitudinal study. Interventions: Not applicable. Main Outcome Measures: Rate of referral to cardiac rehabilitation programs among black and white patients. The odds ratio (OR) after adjusting for potential confounding variables. Results: Only 4.7% of black patients eligible for cardiac rehabilitation were referred in comparison to 11.5% of white patients. Whites were 2 times more likely to be referred for cardiac rehabilitation than were blacks (OR⫽2.52; 95% CI, 1.75–3.63). Even after controlling for potential confounders like insurance, sex, and cardiology consultation, whites were still more likely to be referred for cardiac rehabilitation (OR⫽1.81; 95%CI, 1.22–2.68). Conclusions: Racial disparities exist in the referral for cardiac rehabilitation and this could partially explain the low utilization rates. Education programs, which focus on elimination of these barriers, should be implemented with patients and providers. Key Words: Cardiovascular disease; Race; Rehabilitation.

Friday, October 8, 2004 2:30 –3:30 PM, Yuma 22–23 Miscellaneous Abstract 15 Preliminary Efficacy of a Family Problem-Solving Intervention for Children With Traumatic Brain Injury. Linda J. Michaud, MD (Cincinnati Children’s Hosp Med Ctr, Cincinnati, OH); Shari L. Wade, PhD; Tanya M. Brown, MA, e-mail: [email protected]. Disclosure: L.J. Michaud, None; S.L. Wade, None; T.M. Brown, None. Objective: To assess the efficacy of a family-centered problem-solving intervention (FPS) for pediatric traumatic brain injury (TBI). Design: Randomized controlled trial. Setting: Tertiary pediatric hospital. Participants: Families of 37 school-aged children with moderate to severe TBI, randomly assigned to receive FPS (n⫽19) or standard care (SC; n⫽18). Intervention: FPS consisted of 7–11 ninety-minute sessions providing training in problem-solving and strategies for responding to the behavioral sequelae of TBI. Main Outcome Measures: The Child Behavior Checklist (CBCL), completed at baseline and 6-mo follow-up, provided a measure of child behavior problems. Parental psychologic distress was assessed with the Brief Symptom Inventory. Parentchild interaction was evaluated using the Conflict Behavior Questionnaire. A satisfaction survey was developed to assess parent, child, and sibling perceptions of the intervention. Results: Significant group effects were found for the CBCL internalizing-total and CBCL anxiety/depression and withdrawal subscales. Corresponding effect sizes were large (.17–.21). For internalizing symptoms, the FPS parent group reported a 5.81-point decline, whereas the SC group reported a 2.07-point increase, from baseline to follow-up. Groups did not differ on parental distress or parent-child conflict. Greater parental education, lower injury severity, older child age, and more recent injury were associated with greater improvement in internalizing behaviors. Parents and children rated the program as extremely helpful. All participants indicated they would recommend the program. Conclusions: FPS holds promise for reducing child behavior problems, the most common persistent sequelae post-TBI. Modification is indicated to address parental problem-solving/stress management to reduce parental distress and parent-child conflict. Parental adaptation measures such as parenting efficacy, coping, and satisfaction will be considered for future investigations. FPS content may need simplification to increase benefits for parents with less education or whose children have greater impairment. Multicenter investigations of the effectiveness of the modified intervention will be necessary. Key Words: Brain Injuries; Child; Family; Rehabilitation.

Arch Phys Med Rehabil Vol 85, September 2004