Search

Although physical activity is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), the effect of physical activity on self-reported function and quality of life (QoL) has not yet been analyzed. The present study synthesizes the evidence for the effectiveness of physical activity on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA).The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using the RoB 2.0 tool), and data extraction were independently performed by 2 or more of the authors. Meta-analyses were conducted with a random-effects model.Systematic review included 55 RCTs, and meta-analysis included 37 RCTs. Of the 55 studies included, 76%, 20%, and 4% were designed to investigate RA, SpA, and PsA, respectively. In the RA studies, effects of physical activity on QoL and function were found compared to the group of inactive controls; no effects were found compared to the group of active controls. In the SpA studies, the effects of physical activity on QoL were in favor of the control group. Effects of physical activity on function were found compared to the group of inactive controls and sustained in fatigue and pain when compared to the group of active controls. In the PsA studies, no effects on QoL were found, but effects on function were noted when compared to the group of inactive controls. The effect size was below 0.30 in the majority of the comparisons.Physical activity may improve QoL and self-reported function in individuals with RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.

It is not clear whether oral contraceptive (OC) treatment affects premenstrual symptoms in women. The aim of the present study was to evaluate changes in premenstrual symptoms (PMS) in women starting to use or discontinuing the use of OCs. Twenty-four healthy women with no previous diagnosis of premenstrual dysphoric disorder were included in this study with a prospective crossover design. Nineteen women completed daily ratings of somatic and mood symptoms during two hormonally different cycles, during a normal menstrual cycle and while using OCs. The menstrual cycle phases were hormonally verified and the low-dose, monophasic OCs were used in a 21/7 regimen. The onset of OC use significantly decreased premenstrual somatic symptoms, but it did not affect mood symptoms. In the women who discontinued OC use, no significant changes in neither somatic nor mood symptoms appeared in the premenstrual phase.

Background We aimed to explore pressure pain sensitivity and the function of segmental and plurisegmental exercise-induced hypoalgesia (EIH) in persons with rheumatoid arthritis (RA) compared with healthy control subjects (HC). Methods Forty-six participants with RA (43 female, 3 male) and 20 HC (16 female, 4 male) participated in the study. Pressure pain thresholds, suprathreshold pressure pain at rest, and segmental and plurisegmental EIH during standardised submaximal contractions were assessed by algometry. Assessments of EIH were made by performing algometry alternately at the contracting (30% of the individual maximum) right m. quadriceps and the resting left m. deltoideus. Results Participants with RA had higher sensitivity to pressure pain (RA, 318 kPa; HC, 487 kPa; p 0.05). Conclusions Our results indicate a generally increased pain sensitivity but normal function of EIH among persons with RA and offer one possible explanation for pain reduction observed in this group of patients following clinical exercise programmes. Trial registration ISRCTN registry, ISRCTN25539102. Retrospectively registered on 4 March 2011.

Impaired left atrial dynamics and its improvement by guided physical activity reveal left atrial strain as a novel early indicator of reversible cardiac dysfunction in rheumatoid arthritis.

IntroductionPolycystic ovary syndrome (PCOS) is linked to hyperinsulinemia and insulin resistance with dysfunctional glucose metabolism. Pilot studies suggests that acupuncture treatment with combined manual and low-frequency electrical stimulation (electroacupuncture (EA)) of the needles decrease circulating glycated haemoglobulin (HbA1c) and homeostatic model assessment-insulin resistance. Therefore, we here aim to investigate if acupuncture treatment or metformin together with lifestyle or lifestyle management alone improves insulin sensitivity and related symptoms in overweight/obese women with PCOS.Methods and analysisThis is a two-centre multinational (Sweden and China), cross-sectional case–control study combined with an open-labelled randomised controlled trial (RCT). Participants are randomised to one of three groups: (1) EA 2–3 times/week during 4 months+lifestyle management; (2) metformin, 500 mg, three/day during 4 months+lifestyle management; or (3) lifestyle management alone. The primary outcome measure in the RCT is changes in HbA1C. A total of 123 obese overweight women with PCOS will be enrolled and randomised into one of the three groups with a target power of at least 80% and 5% significance level based on two-sided tests.Ethics and disseminationThe study has been approved by the Regional Ethical Review Board of Stockholm and of Peking University Third Hospital, China. Primary outcome data of the RCT will be published in a relevant journal together with supporting secondary outcome measurements. Further, outcome measurements will be published in separate papers as well as case–control data.Expected resultsWe anticipate that EA and metformin, both with lifestyle management, are equally effective and superior to lifestyle management alone for improvement of glycaemic control.Trial registration numbersNCT02647827and EudraCT2015-004250-18.

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Aim Variations in sex hormone levels during the menstrual cycle may affect neuromuscular performance and the risk of sustaining musculoskeletal injury in women. The aim of this study was to investigate mRNA and protein levels for sex steroid hormone receptors in skeletal muscle in three distinct phases of the menstrual cycle. Methods Fifteen, healthy women with regular menstrual cycles participated in the study. Muscle biopsies from the vastus lateralis were obtained in three hormonally verified phases of the menstrual cycle for each individual, that is the follicular phase, the ovulatory phase and the luteal phase. mRNA and protein levels of oestrogen (ERα and ERβ), progesterone (PR) and androgen (AR) receptors were analysed. Results There was an overall significant variation in mRNA and protein levels of ERα and PR across the menstrual cycle. mRNA and protein levels of ERα were highest in the follicular phase when oestradiol levels were low, whereas protein levels of PR were highest in the luteal phase when progesterone levels were high. mRNA levels of PR were highest in the ovulatory phase. No significant variation in AR levels was detected across the menstrual cycle. ERβ levels were very low in all three phases of the menstrual cycle. Conclusion Significant variations in mRNA and protein levels of ERα and PR were detected in skeletal muscle during three confirmed phases of the menstrual cycle. These results may have an impact on effects of muscular training and sports injuries in women.

Background By screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs’ reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care. Methods A qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups. Results Findings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work. Conclusion There is a need for a more proactive, transparent and systematic approach in the distribution of GPs’ time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved. Electronic supplementary material The online version of this article (10.1186/s12875-018-0883-6) contains supplementary material, which is available to authorized users.

Background We aimed to evaluate the 1-year and 2-year outcome of a health-enhancing physical activity (HEPA) support program on global pain, pressure pain sensitivity, and exercise-induced segmental and plurisegmental hypoalgesia (EIH) in persons with rheumatoid arthritis (RA). Methods Thirty participants (27 women and 3 men) were recruited from a larger intervention cohort that engaged in strength training and moderate-intensity aerobic activity. Assessments were performed before the HEPA intervention and at 1-year and 2-year follow-ups. Global pain was assessed on a visual analogue scale (0–100). Pressure pain thresholds (PPTs) and suprathreshold pressure pain at rest corresponding to 4/10 (medium pain) (SP4) and 7/10 (strong pain) (SP7) on Borg CR 10 scale were assessed by algometry. In a subsample (n = 21), segmental and plurisegmental EIH were assessed during standardized submaximal static contraction (30% of the individual maximum), by algometry, alternately at the contracting right M. quadriceps and the resting left M. deltoideus. Results Global pain decreased from before the intervention to 2-year follow-up (median 11 to median 6, P = 0.040). PPTs and SP4 pressure pain at rest did not change from before the intervention to 2-year follow-up, while SP7 decreased from mean 647 kPa to mean 560 kPa (P = 0.006). Segmental EIH during static muscle contraction increased from the assessment before the intervention (from mean 1.02 to mean 1.42, P = 0.001), as did plurisegmental EIH (from mean 0.87 to mean 1.41, P

Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, and functioning during the second year of a 2-year support program, determine aspects of adherence and response, and describe perceptions of the program.Methods.Out of 220 individuals with rheumatoid arthritis (RA), 177 participated in the followup. Group support, strength training, and moderate-intensity aerobic activity were encouraged. Data collection included HEPA, perceived health, functioning, and perceptions of the program. Participants with unchanged/improved general health perception and at least 2 of aerobic capacity, grip strength, or timed standing were considered responders.Results.Current and maintained HEPA decreased from 82% to 75% (p = 0.0141) and from 41% to 27% (p < 0.0001) during the second year. Minor declines in quality of life and activity limitation occurred (p = 0.0395 and 0.0038, respectively), while outcome expectations for benefits of physical activity increased (p = 0.0010 and 0.0186) and waist circumference tapered off (p = 0.0070). Strength training was performed on average 41 and 35 times among responders (n = 54) and nonresponders (n = 105), respectively (p = 0.2708); HEPA 194 and 171 days, respectively (p = 0.0828); and support group meetings 12 and 10 times, respectively (p = 0.0943). Strength training, aerobic activity, and short text message reminders were perceived as most valuable; step registration and the self-monitoring walk tests were less appreciated.Conclusion.About one-fourth of the originally sedentary individuals with RA sustained their new HEPA behaviors after 2 years and most improvements of health and functioning were sustained. Structured use of behavior change techniques and a second year to support maintenance with a reduced program might help patients with RA to sustain HEPA behavior.

Objective To establish how guided physical activity in patients with rheumatoid arthritis (RA) without known cardiovascular disease affected vascular and cardiac function, and how these two entities were prospectively interconnected in this patient group. Methods Prospective substudy of 29 participants in the Physical Activity in RA (PARA) 2010 trial. All subjects were examined at baseline, at year 1 and 2 with measures of pulse wave velocity and arterial augmentation index, as well as echocardiographic evaluation of diastolic parameters and ventricular-arterial coupling. Muscle strength and aerobic exercise capacity were assessed at baseline and yearly. All participants performed physiotherapist-guided aerobic and muscle strength exercise during two years and were reminded through SMS to report physical activity progress. Results This cohort of patients with RA exhibited increased vascular stiffness despite normal blood pressure. At baseline, lower muscle strength was associated with increased vascular stiffness (β = 0.68; P = 0.004), whereas lower aerobic working capacity was associated with left ventricular diastolic dysfunction (β = 0.85; P = 0.03). There was a significant positive correlation between vascular stiffness and diastolic dysfunction at baseline (R2 = 0.64) and for the changes in those parameters observed during two years of guided physical activity. Finally, a significant improvement in ventricular-arterial coupling was observed after exercise (P < 0.001). Conclusion These results indicate that although differentially associated with physical capacity parameters, improved vascular stiffness, and improved diastolic dysfunction are interrelated, and that an optimization of the ventricular-arterial coupling may contribute to the beneficial effects of physical activity in RA patients. This article is protected by copyright. All rights reserved.

ObjectiveFemale adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs.SubjectsTwo hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools.MethodsA web-based questionnaire containing questions related to menstrual status, contraception and current injury.ResultsOne third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen’s d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women.ConclusionOCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence-based self-esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, P

Objectives. The aims of this study were to document adherence to and changes in health-enhancing physical activity (HEPA) levels and self-reported and assessed functioning and to explore aspects of adherence and response during the first year of an outsourced 2-year HEPA programme in people with RA. Methods. Two-hundred and twenty patients participated in this observational cohort study, which included daily physical activity, twice-weekly circuit training and biweekly support group meetings. Self-reported data included current (past week) and maintained (past 6 months) HEPA levels, sociodemographics and disease-related and psychosocial factors. Tests of aerobic capacity and muscle function were performed and anthropometric data were collected. Results. Eighty-eight per cent of the participants completed 1 year assessments. Self-reported current and maintained HEPA increased. General health perception and a number of other self-reported disease-related and psychosocial factors improved, while exercise self-efficacy declined. Aerobic capacity, timed standing and grip strength improved and waist circumference decreased. The mean number of circuit training sessions performed was 48, the mean number of days with HEPA was 189 and the mean number of support group meetings attended was 9. Better adherence to circuit training improved general health, and better adherence to group meetings improved timed standing. Exercise self-efficacy improved among those adhering more to circuit training or support group meetings. Conclusion. The outsourced HEPA programme had high retention and reasonable adherence. A number of health outcomes improved. Relationships between adherence to the programme components and response were not clear-cut and need further attention. Trial registration: ISRCTN register; http://www.controlled-trials.com. Trial registration number ISRCTN25539102.

Objective Skeletal muscle weakness is a prominent clinical feature in patients with rheumatoid arthritis (RA), but the underlying mechanism(s) is unknown. Here we investigate the mechanisms behind arthritis-induced skeletal muscle weakness with special focus on the role of nitrosative stress on intracellular Ca2+ handling and specific force production. Methods Nitric oxide synthase (NOS) expression, degree of nitrosative stress and composition of the major intracellular Ca2+ release channel (ryanodine receptor 1, RyR1) complex were measured in muscle. Changes in cytosolic free Ca2+ concentration ([Ca2+]i) and force production were assessed in single-muscle fibres and isolated myofibrils using atomic force cantilevers. Results The total neuronal NOS (nNOS) levels were increased in muscles both from collagen-induced arthritis (CIA) mice and patients with RA. The nNOS associated with RyR1 was increased and accompanied by increased [Ca2+]i during contractions of muscles from CIA mice. A marker of peroxynitrite-derived nitrosative stress (3-nitrotyrosine, 3-NT) was increased on the RyR1 complex and on actin of muscles from CIA mice. Despite increased [Ca2+]i, individual CIA muscle fibres were weaker than in healthy controls, that is, force per cross-sectional area was decreased. Furthermore, force and kinetics were impaired in CIA myofibrils, hence actin and myosin showed decreased ability to interact, which could be a result of increased 3-NT content on actin. Conclusions Arthritis-induced muscle weakness is linked to nitrosative modifications of the RyR1 protein complex and actin, which are driven by increased nNOS associated with RyR1 and progressively increasing Ca2+ activation.

Objective To compare those who were finally included in a large well-defined sample of individuals with rheumatoid arthritis (RA) at target for a physical activity (PA) trial with those who were not. Methods In total, 3,152 individuals answered questionnaires on sociodemographic, disease-related, and psychosocial factors and PA levels. The differences between individuals making it to the baseline assessments and those who did not were analyzed in 3 steps. Results In a first step, 1,932 individuals were eligible for the trial if they were interested in participating, not physically active enough, and fluent in Swedish and if they were not participating in any other study. The participants were mainly younger women, had higher education and income, were more likely to live with children, and had better support for exercise and had higher outcome expectations of PA than the 1,208 ineligible individuals. In a second step, the 286 individuals accepting participation had higher income and education, more support for exercise, less fear-avoidance beliefs, and higher outcome expectations of PA than the 1,646 individuals declining participation. In a third step, the 244 individuals assessed at baseline reported less fatigue than the 42 withdrawing before assessment. Conclusion To our knowledge, this is the first study describing the entire selection procedure, from a target sample for a PA trial to the sample assessed at baseline, in individuals with RA. Factors other than those related to the disease seemed to mainly determine participation and largely resembled determinants in the general population. Sociodemographic and psychosocial factors should be recognized as important for PA in people with RA.

INTRODUCTION: Sport parachuting from aircraft (skydiving) is a major aerial activity in which parachutists are subject to decelerating forces during parachute opening shock (POS), possibly as much as 3-5 G. While traumatic incidents related to POS have been reported, epidemiological data on musculoskeletal pain among skydivers is absent in the literature. The aim was therefore to examine the prevalence of self-rated musculoskeletal pain related to POS in a skydiver population and elicit related risk factors. METHODS: There were 658 Swedish sport skydivers who completed a structured web-based questionnaire (70% response rate; email invitation) validated for use in skydivers. The questionnaire concerned individual and skydiving-related risk indicators, and musculoskeletal pain experiences. Multiple regression analysis was used to estimate the relationship between risk indicators and musculoskeletal pain related to POS. RESULTS: The 12-mo prevalence of musculoskeletal pain related to POS was highest for the neck region, 25% (95% CI = 21.4-28.2). Other upper-body regions were as follows: shoulder 16% thoracic spine 10%, and lower back 18%. A high number of parachute jumps in the last 12 mo, i.e., 30-90 jumps (RR = 1.7, 95% CI = 1.1-2.7), > 90 jumps (RR = 2.1, 95% CI = 1.3-3.4), and a high main parachute wing-loading, i.e., > 1.4 lb/ft2 (RR = 1.7, 95% CI = 1.1-2.6) were independent risk factors. CONCLUSIONS: Neck pain related to POS was common among skydivers. A high number of parachute jumps the last 12 mo and high wing-loading emerged as risk factors, suggesting that highly active skydivers using small canopies may be at risk. Studies on biomechanics under POS are suggested. Language: en

OBJECTIVE: The primary aim of this study was to compare muscle strength in the upper and lower limb as well as hop performance during oral contraceptive (OC) use with non-OC use in the same woman. A secondary aim was to compare muscle strength and hop performance within 3 specific phases of an OC cycle as well as during a menstrual cycle of the corresponding cycle days (non-OC cycle). DESIGN: Crossover. SETTING: Research laboratory. PARTICIPANTS: Seventeen moderate to highly recreationally active women participated in the study. INTERVENTION: Observational study with no intervention. MAIN OUTCOME MEASURES: Maximal isokinetic muscle strength of knee extensors isometric handgrip strength and one-leg hop test for distance were measured during one OC cycle and one non-OC cycle at 3 specific phases respectively using a crossover design. RESULTS: No significant differences were found in terms of muscle strength and hop performance between the OC cycle and the non-OC cycle. Furthermore no significant difference in muscle strength and hop performance could be demonstrated within the OC cycle or within the phases of the menstrual cycle except from maximal isokinetic muscle strength in the knee extensors detected between the early follicular phase and the luteal phase. CONCLUSIONS: We found no support for any significant influence of OC use on muscle strength and hop performance in healthy moderately active women.

The aim of the paper is to describe the introduction of a portfolio method of teaching and learning, and to describe students’ perceptions of the method as well as a peer-review system in a course, in the physiotherapy programme, at the Karolinska Institutet. A further aim was to describe the level of grades over time. A modified form of a showcase portfolio method together with a three-graded assessment criteria was introduced into the course. Students, over five semesters, were included in the project (n = 287) of which 91% answered questions and statements regarding their perception of the assessment method and the peer-review system. All portfolios were graded in a scale of three: fail, pass and pass with distinction. The majority of students were satisfied and reported positive learning effects with the assessment method and review system. However, the students asked for more guidance in how to give feedback. During these five semesters, the percentage of students that passed with distinction increas...

Objective. This study investigates postural control among women with and without premenstrual symptoms (PMS) on oral contraceptive (OC) treatment. Design. Prospective repeated measures design. Sett ...

An increased incidence of sports related injuries in the premenstrual phase as well as in the menstrual phase of the menstrual cycle has been described. This may be explained by alterations in proprioception and neuromuscular coordination due to hormonal variations. Prospective, within women analysis of knee joint kinesthesia and neuromuscular coordination were performed by repeated measures analysis of variance in three hormonally verified phases of three consecutive menstrual cycles. Thirty-two healthy, moderately active female subjects volunteered to participate in the study. Twenty-five of the subjects performed at least one hormonally verified menstrual cycle. A specially designed device was used to investigate knee joint kinaesthesia and neuromuscular coordination was measured with the square hop test. These tests were carried out in the menstrual phase, ovulation phase and premenstrual phase determined by hormone analyses in three consecutive menstrual cycles. An impaired knee joint kinaesthesia was detected in the premenstrual phase and the performance of square hop test was significantly improved in the ovulation phase compared to the other two phases. The results of this study indicate that the variation of sex hormones in the menstrual cycle has an effect on performance of knee joint kinaesthesia and neuromuscular coordination.

The purpose of this study was to investigate postural control in women with and without premenstrual symptoms (PMS) in three hormonally verified phases of the menstrual cycle. Thirty-two women were recruited to participate in the study and 25 of these women were included in the results. Menstrual cycle phases were determined by sex hormone analyses in serum and LH detection in urine. A prospective rating of PMS was used to divide the subjects into two groups: one with PMS (cyclic) and one without (non-cyclic). For measurement of postural control, subjects stood on a force platform (AMTI®) in two-legged stance (eyes open and closed) and one-legged stance (eyes open and closed). There were no significant differences in the two-legged stance between the phases of the menstrual cycle or between groups. In one-legged stance with eyes open, there was a significant increase in postural displacement in the mid-luteal phase in the cyclic group, but no differences were detected between phases in the non-cyclic group. These findings may be related to the previously reported increased injury rate and psychomotor slowing in the luteal phase in women with PMS.

To investigate muscle strength and muscle endurance in women during 3 well-determined phases of the menstrual cycle: early follicular phase, ovulation phase, and midluteal phase.Prospective, within-woman analysis was performed of muscle strength and muscle endurance by repeated measures analysis of variance in 3 hormonally verified phases of 2 consecutive menstrual cycles.Fifteen female subjects with moderate physical activity level and regular menstrual cycles volunteered to participate in the study. Analyses are based on 10 subjects who completed 2 consecutive menstrual cycles with hormonally verified phases.Handgrip strength, 1-leg hop test, isokinetic muscle strength, and muscle endurance were measured in 2 consecutive menstrual cycles in the early follicular phase, in the ovulation phase, and in the midluteal phase. Isokinetic muscle strength and endurance were tested with knee extension exercise on a standard instrument. Menstrual cycle phases were determined by analysis of sex hormone levels in serum, and ovulation was detected by luteinizing hormone surge in urine.No significant variation in muscle strength or muscle endurance could be detected during different well-determined phases of the menstrual cycle.This study detected no significant variation in muscle strength and muscle endurance during the menstrual cycle. In contrast to other studies showing variations in strength and endurance during the menstrual cycle, the present study was hormonally validated and was repeated in 2 consecutive menstrual cycles. However, it is unknown whether these data in moderately active university students would be relevant to the highly trained woman athlete.

Recent studies have indicated an increased incidence of female athletic injuries during the luteal phase and the first days of the menstrual period. The purpose of this study was to investigate whether postural sway and knee-joint kinesthesia very during the menstrual cycle, and whether premenstrual syndrome (PMS) influences postural balance and kinesthesia. A total of 13 subjects with regular menstrual cycles participated in the study. Postural sway and kinesthesia were measured in the early follicular phase, in the ovulation phase and in the mid-luteal phase. Postural sway was measured with an ankle disc placed on a Statometer, and kinesthesia was measured with a specially designed device. Menstrual cycle phases were determined by sex hormone analyses in serum and by luteinizing hormone (LH) detection in urine. The diagnosis of PMS was made prospectively using validated daily symptom ratings. Eight of 13 women were classified as having PMS. These women had a significantly greater postural sway (p = 0.002) and a greater threshold for detection of passive motion in the knee joints (p = 0.05) than women without PMS. A tendency (p = 0.06) towards greater postural sway in the mid-luteal phase was detected among women with PMS. This may explain the finding of an increased incidence of athletic injuries in the luteal phase, reported previously.

Background Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO2max by the Åstrand test. Methods Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO2max test). Pearson’s correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test. Results The correlation between the estimated and measured VO2max values were strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO2max by the Åstrand test. VO2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO2max. Conclusions Despite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method for self-monitoring VO2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO2max by the Åstrand test. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-305) contains supplementary material, which is available to authorized users.

The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA.Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed.Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups.Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.

OBJECTIVE: To assess the effect of pelvic floor muscle training (PFMT) on pelvic floor muscle strength and urinary incontinence (UI) in primiparous women who underwent a home training program between three and 9 months after delivery. DESIGN: Randomized controlled trial. POPULATION: One hundred primiparous women were consecutively recruited from four different antenatal clinics in the urban area of Stockholm, Sweden. Women with UI who had undergone normal term singleton vaginal delivery, 10-16 weeks postpartum were randomly allocated to either intervention or control group. METHODS: Maximally voluntary contraction (MVC) and endurance were measured with a perionometer. The Oxford grading scale was used to manually estimate the strength of the pelvic floor muscle and self-reported symptoms of UI was registered through the Bristol Female Lower Urinary Tract Symptoms Module (ICIQ FLUTS) questionnaire. MAIN OUTCOME MEASURES: Maximally voluntary contraction of the pelvic floor muscle measured with a perionometer. RESULTS: Maximally voluntary contraction increased significantly in both groups between baseline and follow up (p < 0.05). The median MVC in cmHg for the intervention and control group was 16.2 and 12.1 at baseline and 26.0 and 18.2 at follow up, respectively. The median endurance, in seconds, for the intervention and control group was 9.6 and 12.0 at baseline and 26.7 and 23.4 at follow up, respectively. Pelvic floor muscle strength measured with the Oxford Scale increased significantly in both groups between baseline and follow up (p < 0.05). CONCLUSION: The results indicate that home-based PFMT is effective. However, written training instructions were as efficient as home-based training with follow up visits every sixth week.

Background People with rheumatoid arthritis (RA) suffer increased risk of disability andpremature mortality. Health-enhancing physical activity (HEPA) could be one importantfactor to reduce this risk. Rising health care costs call for the development and evaluation ofnew modes of rehabilitation, including physical activity in settings outside the health caresystem. Methods/Design This cohort study targets 450 patients with RA that do not currently meet HEPA recommendations, recruited from six hospitals reporting to the Swedish Rheumatology Quality Registers (SRQ). We have developed a two-year real-life intervention program including a minimum of twice-weekly circuit training, moderately intense physical activity the remaining days of the week and group meetings to support behavior change every other week. Our hypothesis is that increased physical activity and exercise will improve perceived health, reduce pain and fatigue, increase muscle function and aerobic capacity, impact psychosocial factors and prevent future cardiovascular events. Research questions regard outcomes, retention rates, dose–response matters and the exploration of responder characteristics. This protocol outlines recruitment procedure, design, assessment methods and the intervention program of the study. Discussion The PARA 2010 project is designed to expand the knowledge on HEPA in RA by a progressive approach regarding population, setting, intervention, time frames and outcome measures. To our knowledge this is the first long-term HEPA program based on Social Cognitive Theory, and performed in a real life environment to demonstrate if this new setting can promote increased and maintained physical activity in people with RA. Trial registration number ISRCTN25539102

Item does not contain fulltext PURPOSE: The Fox-walk test is a new method used to estimate aerobic capacity outside a clinical environment, which may be useful in the implementation of daily health-enhancing physical activity. The aim of our study was to investigate the reliability of the test in people with rheumatoid arthritis (RA). METHOD: Fifteen participants performed the Fox-walk test three times with weekly intervals. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to estimate the reliability. General health perception, lower limb pain and fatigue were measured to determine their potential influence on the reliability. RESULTS: There were no systematic differences between the three test occasions (p = 0.190) and the reliability was almost perfect (ICC = 0.982). None of the covariates influenced the reliability. The SEM was 0.999 ml/kg/min or 3.4% and the SDC was 2.769 ml/kg/min or 9.4%. CONCLUSIONS: These findings demonstrate that the Fox-walk test is reliable in people with RA and enables differentiation between people with RA and monitoring progress. The validity of the test among people with RA is still to be determined. IMPLICATIONS FOR REHABILITATION: * The Fox-walk test is a new method to estimate aerobic capacity and could be performed walking or running. * The test is self administered without expensive equipment and is available in 150 public places in Sweden and several other European countries. * The Fox-walk test is a reliable test for use among people with rheumatoid arthritis monitoring the progress of their physical activity.

Background Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to a physically active lifestyle. Maximum aerobic tests in a laboratory setting are expensive and not always feasible for people with rheumatoid arthritis (RA) (1). Submaximal tests, if proven valid and reliable, could thus be an alternative to maximum tests. The Astrand submaximal bicycle test has been extensively used in clinic and research in people with RA, but never tested for validity and reliability in this population (2). Objectives To test the validity of the Astrand submaximal test for estimation of aerobic capacity, by exploring the correlation with the measured maximum oxygen uptake (measured VO2max) in people with RA. Methods Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, activity limitation according to the Stanford Health Assessment Questionnaire 0.412 (0.42) and Disease Activity Score 28 2.4 (0.42), participated in the study. The subjects performed the Astrand test and the measured VO2max test (Alpha version 4.5, Jaeger, KFA-2028-01) at the same test occasion. According to the Astrand-nomograms the VO2max was estimated using heart rate (HR) measurements from a single stage and adjusted for age or for maximal HR. Results The correlation between VO2max estimated by the Astrand test corrected for age and the measured VO2max test was r =0.82 (p Conclusions The Astrand test could be considered a valid instrument to estimate VO2max in physically active people with RA that are able to perform a submaximal cycle test during six minutes References Eurenius E, Brodin N, Opava CH. Clinical applicability of of two tests of aerobic fitness in patients with rheumatoid arthritis. Adv Physiother 2007(9):97-104. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7(2):218-21. Acknowledgements The Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5536

Background Health-enhancing physical activity increasingly takes place outside the health care system and calls for self-monitored feedback tests to retain motivation. The Fox-walk test is a new method used to estimate aerobic capacity outside a clinical environment, which may be useful in the implementation of daily health-enhancing physical activity. Its measurement properties have been established in different populations, but not yet among people with rheumatoid arthritis (RA). Objectives The purpose of this study was to determine the test-retest reliability of the Fox-walk test in patients with RA and to study potential influence on reliability of disease-related factors. Methods Fifteen participants (14 women, mean age 63 years, mean time since first clinical visit 3.5 years) with RA according to ACR 1987 criteria performed the Fox-walk test three times with weekly intervals. A sample size calculation (α =0.05, β =0.80) indicated that 10 subjects would be enough to demonstrate a reliability of >0.8 when repeating the measurements three times. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to estimate the reliability. General health perception, lower limb pain and fatigue were measured to determine their potential influence on the reliability. Results There were no systematic differences between the three test occasions (p=0.190) and the reliability was almost perfect (ICC =0.982). None of the covariates influenced the reliability. The SEM was 0.999 ml/kg/min or 3.4% and the SDC was 2.769 ml/kg/min or 9.4%. Conclusions Our findings demonstrate that the Fox-walk test is reliable in people with RA and enables differentiation between people with RA aas well as monitoring progress. The validity of the test among people with RA is however still to be determined. Disclosure of Interest None Declared

Background Physical activity (PA) is important to preserve functioning and avoid co morbidity in people with RA. To better understand how to tailor PA programs it is important to identify characteristics of those eligible versus those who are not. However, recruitment processes prior to PA programs are often poorly described in people with RA. Objectives The objective of our study, including a large well defined sample of individuals with RA at target for a PA trial, was to compare those that were finally included in the trial with those that were not as regards socio-demographic, disease-related, and psychosocial factors and current PA levels. Methods In this cross-sectional survey 3152 individuals ([1][1]), of which 12 were excluded due to participation in another study, below age 75 years and independent in daily activities (HAQ>2) answered questionnaires on socio-demographic, disease-related, and psychosocial factors and current PA levels. Differences between individuals making it to the baseline assessments of the trial and those who did not were analyzed in three steps. Results In a first step, 1932 individuals were identified as eligible for the trial as they were interested, not enough physically active and had good Swedish language skills. They were mainly female, younger, better educated, having higher income and more likely to live with children, had better social support for exercise and higher outcome expectations on PA compared to the 1208 that were not eligible. In a second step, 286 individuals consented to participate. They were better educated and had higher income, more social support for exercise, less fear avoidance beliefs and higher outcome expectations on PA compared to the 1646 that declined participation. Reasons for declining were ‘training centre too distant’, ‘no time due to family, work or other reasons’, ‘too expensive’, ‘feel very well and not in need for exercise’, ‘bothered by injury/co morbidity’, ‘RA too active/disabling’, ‘no energy’. In a third step, 244 individuals showed up for baseline assessments and reported less fatigue compared to the 42 that did not show up for assessments. Reasons for withdrawal included ‘dislike training center’, ‘prefer yoga’, ‘changed mind about participation’, ‘recent cancer diagnosis’, ‘recent foot injury’, ‘foot ulcer’, ‘aortic aneurysm’, ‘too expensive’, ‘time constraints’ and logistic problems related to time or place of assessments or training. Conclusions To our knowledge this is the first study to describe the entire selection procedure from a target sample for a PA trial to baseline assessment in individuals with RA. Our results indicate that factors other than those related to the disease seem to determine participation and largely resemble those seen in the general population. Based on our results caregivers may be able to identify factors that are essential for supporting PA in people with RA that are reluctant to participate in various programs. References 1. Demmelmaier I et al. Current and maintained health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study. Arthritis Care Res 2013 Jan 17 [Epub ahead of print] Acknowledgements We would like to acknowledge the contribution of the rheumatology clinics at Danderyd Hospital, Stockholm, Karolinska University Hospital, Solna and Huddinge, Linkoping University Hospital, Linkoping and Norrkoping, Malarsjukhuset, Eskilstuna, ostersund Hospital, Sunderby Hospital, Lulea, and the Swedish Rheumatology Quality Registers. Disclosure of Interest None Declared [1]: #p-6