Saturday, December 15, 2012

Rotator cuff treatment


Rotator cuff treatment update, as well as a new method

Management of degenerative rotator cuff tears: a review and treatment strategy
Nicholas D Clement, Yuan X Nie and Julie M McBirnie
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:48 doi:10.1186/1758-2555-4-48
Published: 14 December 2012
Abstract (provisional)
The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence.
Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction.
The management of these tears is controversial, as to whether they should be managed non-operatively or operatively.
In addition when operative intervention is undertaken, there is question as to what technique of repair should be used.
This review describes the epidemiology and natural history of degenerative rotator cuff tears.
The management options, and the evidence to support these, are reviewed.
We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement


Eva Ageberg1,2,7*, Gunnar Engström3,4,Maria Gerhardsson de Verdier3, Jan Rollof3, Ewa M Roos5 and L S Lohmander1,5,6
1 Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
2 Department of Health Sciences, Lund University, Lund, Sweden
3 AstraZeneca R&D, Lund, Molndal, Sweden
4 Epidemiology Research Group, Clinical Sciences, Malmö, Lund University, Lund, Sweden
5 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
6 Department of Orthopedics and Traumatology, University of Southern Denmark, Odense, Denmark
7 Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden
For all author emails, please log on.
BMC Musculoskeletal Disorders 2012, 13:73 doi:10.1186/1471-2474-13-73
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2474/13/73
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Studies on leisure time physical activity as risk factor or protective factor for knee or hip osteoarthritis (OA) show divergent results. Longitudinal prospective studies are needed to clarify the association of physical activity with future OA. The aim was to explore in a prospective population-based cohort study the influence of leisure time physical activity on severe knee or hip OA, defined as knee or hip replacement due to OA.

Methods

Leisure time physical activity was reported by 28320 participants (mean age 58 years (SD 7.6), 60% women) at baseline. An overall leisure time physical activity score, taking both duration and intensity of physical activities into account, was created. The most commonly reported activities were also used for analysis. The incidence of knee or hip replacement due to OA over 11 years was monitored by linkage with the Swedish hospital discharge register. Cox’s proportional hazards model (crude and adjusted for potential confounding factors) was used to assess the incidence of total joint replacement, or osteotomy (knee), in separate analyses of leisure time physical activity.

Results

There was no significant overall association between leisure time physical activity and risk for knee or hip replacement due to OA over the 11-year observation time. For women only, the adjusted RR (95% CI) for hip replacement was 0.66 (0.48, 0.89) (fourth vs. first quartile), indicating a lower risk of hip replacement in those with the highest compared with the lowest physical activity. The most commonly reported activities were walking, bicycling, using stairs, and gardening. Walking was associated with a lower risk of hip replacement (adjusted RR 0.76 (95% CI 0.61, 0.94), specifically for women (adjusted RR 0.75 (95% CI 0.57, 0.98)).

Conclusions

In this population-based study of middle-aged men and women, leisure time physical activity showed no consistent overall relationship with incidence of severe knee or hip OA, defined as joint replacement due to OA, over 11 years. For women, higher leisure time physical activity may have a protective role for the incidence of hip replacement. Walking may have a protective role for hip replacement, specifically for women.

New Duke study says aerobic exercise trumps resistance training for weight and fat loss


We all know obesity is a problem in today's society. Trying to modify anyone's daily routine so as to fit in an effective exercise program is a huge challenge. Choose a program that is effective and fits with in your time restrains. Remember that aerobic exercise does burn more calories during activity, but anaerobic exercises is also needed to keep the body strong during these activities. Find a nice combination of the two that will fit your goals as well as allow you to stay on track. 


New Duke study says aerobic exercise trumps resistance training for weight and fat loss

DURHAM, N.C. – Aerobic training is the best mode of exercise for burning fat, according to Duke researchers who compared aerobic training, resistance training, and a combination of the two.
The study, which appears Dec. 15, 2012, in the Journal of Applied Physiology, is the largest randomized trial to analyze changes in body composition from the three modes of exercise in overweight or obese adults without diabetes.
Aerobic exercise – including walking, running, and swimming – has been proven to be an effective way to lose weight. However, recent guidelines have suggested that resistance training, which includes weight lifting to build and maintain muscle mass, may also help with weight loss by increasing a person’s resting metabolic rate. Research has demonstrated health benefits for resistance training, such as improving glucose control, but studies on the effects of resistance training on fat mass have been inconclusive.
“Given that approximately two-thirds of adults in the United States are overweight due to excess body fat, we want to offer clear, evidence-based exercise recommendations that will truly help people lose weight and body fat,” said Leslie H. Willis, MS, an exercise physiologist at Duke Medicine and the study’s lead author.
Researchers enrolled 234 overweight or obese adults in the study. Participants were randomly assigned to one of three exercise training groups: resistance training (three days per week of weight lifting, three sets per day, 8-12 repetitions per set), aerobic training (approximately 12 miles per week), or aerobic plus resistance training (three days a week, three set per day, 8-12 repetitions per set for resistance training, plus approximately 12 miles per week of aerobic exercise).
The exercise sessions were supervised in order to accurately measure adherence among participants. Data from 119 people who completed the study and had complete body composition data were analyzed to determine the effectiveness of each exercise regimen.
The groups assigned to aerobic training and aerobic plus resistance training lost more weight than those who did just resistance training. The resistance training group actually gained weight due to an increase in lean body mass.
Aerobic exercise was also a more efficient method of exercise for losing body fat. The aerobic exercise group spent an average of 133 minutes a week training and lost weight, while the resistance training group spent approximately 180 minutes exercising a week without shedding pounds.
The combination exercise group, while requiring double the time commitment, provided a mixed result. The regimen helped participants lose weight and fat mass, but did not significantly reduce body mass nor fat mass over aerobic training alone. This group did notice the largest decrease in waist circumference, which may be attributed to the amount of time participants spent exercising.
Resting metabolic rate, which determines how many calories are burned while at rest, was not directly measured in this study. While theories suggest that resistance training can improve resting metabolic rates and therefore aid in weight loss, in this study, resistance training did not significantly decrease fat mass nor body weight irrespective of any change in resting metabolic rate that might have occurred.
“No one type of exercise will be best for every health benefit,” Willis added. “However, it might be time to reconsider the conventional wisdom that resistance training alone can induce changes in body mass or fat mass due to an increase in metabolism, as our study found no change.”
Duke researchers added that exercise recommendations are age-specific. For older adults experiencing muscle atrophy, studies have found resistance training to be beneficial. However, younger, healthy adults or those looking to lose weight would see better results doing aerobic training.
“Balancing time commitments against health benefits, our study suggests that aerobic exercise is the best option for reducing fat mass and body mass,” said Cris A. Slentz, PhD, a Duke exercise physiologist and study co-author. “It’s not that resistance training isn’t good for you; it’s just not very good at burning fat.”
In addition to Willis and Slentz, Duke study authors include Lori A. Bateman, Lucy W. Piner, Connie W. Bales, and William E. Kraus. East Carolina University study authors include A. Tamlyn Shields and Joseph A. Houmard.
The study was funded with a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health (2R01-HL057354).