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Purpose: To explore occupational, physical, and speech-language pathology therapists’ perceived effectiveness of telehealth and how the COVID-19 pandemic has affected their professional roles. Method: Participants were recruited for the study through a research flyer distrusted via postal mail, emails, social media, and national association websites. An anonymous electronic 19-item survey was developed for this study by the researchers based on a review of the literature and clinical experience. Results. In total, 186 survey responses were obtained, with 152 meeting the inclusion criteria. The average age of participants was 38.6 years with an average work duration of 12.7 years ± 12.5 in their current profession. Participants reported an average of 32.2 ± 17.4 patients on their case load per week, of which 58% were face-to-face, 50.85% were seen via video, and 3.2% via phone. Results from the Likert scale questions revealed that almost 60% of the participants reported they viewed telehealth as a relevant service delivery method and 48.7% reported it is effective in delivering therapy. However, only 17.8% of participants agreed that telehealth is as effective as in-person therapy. Approximately 77% of participants did not have experience with using telehealth before the pandemic and 42.1% felt they did not receive adequate training for the use of telehealth during the pandemic. Benefits of using telehealth reported by participants include increased access to care (38.8%), reduced travel time (53.3%), schedule flexibility (49.3%), and improved continuity of care (26.3%). Conclusions. The findings of this study reveal that the switch to telehealth services provided multiple benefits for therapist and client. Many therapists also held multiple roles such as spouse and parent during the pandemic, making it important to understand how to deal with professional disruption while continuing to deliver therapy services with minimal interruption in client-centered care.

OBJECTIVES: To assess the effectiveness of a program to implement long-term diet, lifestyle, and behavioral changes in bariatric surgery patients. METHODS: Sixteen subjects (age = 45.9 ± 11.5 years; BMI = 46.1 ± 8.3 kg/m(2)) participated in a comprehensive 36-week lifestyle-based program to promote weight loss before and after bariatric surgery. During the preoperative phase, baseline data on body measurements, food frequency, meal patterns and timings, miscellaneous lifestyle habits, and perceived level of self-efficacy regarding eating behaviors were collected, after which subjects underwent an intensive 24-week lifestyle program. At the end of the intervention, the same outcomes were assessed again before surgery was performed. Following surgery, the subjects completed the same program for 12 weeks, with additional data (as above) being collected at the beginning and at the end of the 12 weeks. Intra- and inter-phase comparative analyses were conducted on body measurements (weight, BMI, and waist circumference) and lifestyle habits (changes in food frequency, meal patterns and timings, miscellaneous lifestyle habits, and perceived level of self-efficacy) using Wilcoxon Signed Ranks Test. RESULTS: There was a statistically significant reduction in both preoperative (P = 0.016) and postoperative weight (P = 0.003). A reduction in waist circumference was also observed post-surgery (P = 0.027). Overall, participants lost an average of 28% of their baseline body weight (P

Introduction: Sustainable methods of dietary lifestyle changes are essential to long term weight loss maintenance and enhancement in overall health and wellness A novel modified alternative method to caloric restriction is Time-Restricted Feeding (TRF), a sub-type of Intermittent Fasting. The purpose of this pilot study was to determine the effect of four weeks of TRF (without caloric deficit) on body composition, stress levels, sleep quality, hunger level, and quality of life. Methods: Sixteen participants, 9 males and 7 females, mean age 34.0 ± 11.7 years, completed the four-week protocol. Fasting program was 16 hours from the time of last meal of the evening to start of first meal the following day. Participants were required to consume their normal daily caloric intake within an 8-hour period. Results: There were significant reductions in mean body fat percentage (26.2±2.4 vs. 25.5±2.6, p=0.01), visceral fat (cm2) (98.2±15.3 vs. 94.1±15.7, p=0.003), body fat mass (kg) (21.6±3.0 vs. 21.0±3.2, p= 0.02), trunk fat (kg) (11.5±1.6 vs. 11.0±1.6, p=0.001) and stress levels (14.1±1.9 vs. 11.0±1.4, p=0.03). There was a significant drop in hunger levels over time (χ2 = 16.4, p=0.001). There were no significant changes in sleep quality or quality of life. Conclusion: TRF may be an effective option to decrease stress, body fat, visceral fat, and obesity-related diseases while not disrupting sleep quality and Quality of Life. Our pilot study demonstrated potential health benefits that could be incorporated by healthcare workers into whole-person wellness programs.

ObjectiveThe objective of this randomized controlled trial was to examine dynamic balance changes (reach distance) in middle-aged adults using the Y Balance Test (YBT) following 8 weeks of home-based exercise program adapted from the Otago Exercise Program (OEP).MethodsFifty-two healthy middle-aged adults with mean age of 54.4±5.4 years and body mass index of 27.7±5.7 kg/m2 were randomly assigned into either the exercise group (a modification of the Otago Exercise Program, that consisted of home-based balance and strength exercises) or the non-exercise group (continuation of usual lifestyle) by having the participants select a paper from a sealed envelope. The YBT was used to measure participants' dynamic balance in the right and left anterior (RA, LA), posteromedial (RPM, LPM), and posterolateral (RPL, LPL) directions.ResultsThe outcome in this trial was reach distance (cm). There was a significant group by time interaction in terms of reach distance for all directions (pConclusionThe modified version of OEP appears to be effective in improving parameters of dynamic balance in the middle-aged adult population. The improvements in YBT reach distance in the exercise group are indicative of the significance of performing balance and strength exercises regularly for this population.

Background With an increase in smartphone usage, constant neck flexion can lead to improper posture, which may impact on lung function. Therefore, the purpose of this study was to examine and compare the craniovertebral angle (CVA) and lung function between addicted and non-addicted boys and girls aged between 8-13 years who use smartphones for long periods of time. Methods A cross-sectional study was conducted on 24 boys and 26 girls (mean age 10.5 ± 1.6 years and body mass index 18.6 ± 3.0 kg/m2) . Participants were assigned to two groups based on their scores on the Smartphone Addiction Scale-Short Version (SAS-SV) for Adolescents: addicted group (score > 32, n = 32) and non-addicted group (score ≤ 32, n = 18). The outcome variables were CVA, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV), maximum inspiratory pressures (PImax), and maximum expiratory pressures (PEmax). Results There was a significant difference in mean CVA between addicted and non-addicted boys (49.4 ± 6.7 vs 55.5 ± 7.6, η2 = 0.9, P = 0.03) and girls (47.3 ± 6.3 vs 52.9 ± 6.1, η2 = 0.9, P = 0.02). Mean FVC, FEV1, and FEV6 were significantly lower in addicted versus non-addicted boys (P = 0.04, P = 0.05, and P = 0.02, respectively). PImax was significantly less in addicted compared to non-addicted girls (55.2 ± 16.4 vs 65.3 ± 13.8, η2 = 0.7, P = 0.05). Conclusion Our findings showed that children addicted to smartphones (when using the SAS-SV as an indicator for addiction) revealed lower CVA and lung function results. Therefore, education on proper posture while holding smartphones is essential to the children's postural and lung function status.

OBJECTIVES: A strong positive association exists between the consumption of fast food and risk of chronic diseases, such as heart disease and type 2 diabetes. Some individuals seek more healthful food alternatives, which include vegetarian products. The fast food industry is investing in more plant-based products. The objective of this study is to compare the change in blood biomarkers (lipids, glucose and high sensitivity C-reactive protein (hs-CRP) levels) after consumption of a beef burger versus a vegetarian burger. METHODS: Thirty-five healthy adults (22 females, 13 males), with mean age 28.5 ± 6.1 and mean Body Mass Index 24.4 kg/m² ± 3.5 completed a double blind, randomized, crossover study. After an eight-hour fast, they were randomly assigned to eat either a beef or vegetarian (Impossible) burger. One week later, the burgers were switched. The biomarkers were measured while fasting, and at 30, 60, and 120 min post-burger consumption. RESULTS: Linear mixed model was used for data fitting to assess the effect of adjusted covariates on selected nutrients. Blood triglyceride levels significantly increased from baseline over time after consumption of each type of burger (p ˂ 0.001). Consumption of the vegetarian burger showed significantly faster increase in triglycerides compared to the beef burger (p ˂ 0.001). At 120 min, there was no significant difference in the levels. Low-density lipoproteins significantly decreased over time following both types of burgers (p ˂ 0.001). There was no significant difference between the two burgers. Glucose levels showed significant changes over time for both groups (p ˂ 0.001). There was a significantly (p ˂ 0.004) greater change (initial increase, then decrease) in glucose levels after the vegetarian compared to the beef burger. Glucose levels peaked at 30 min, returning to baseline at 120 min for both groups. There was no significant difference in total cholesterol (p = 0.62), high-density lipoprotein (p = 0.81), or hs-CRP (p = 0.58) within or between groups. CONCLUSIONS: Contrary to popular thought, consumption of beef and vegetarian burgers produces similar changes in acute blood biomarkers. Future research is warranted. FUNDING SOURCES: This study was supported by Loma Linda University.

OBJECTIVES: The purpose of this study was to examine the effects of dietary nitrate and anthocyanins on exercise performance in healthy untrained individuals. METHODS: In a randomized double-blind crossover study, six men (mean age 24.3 y) and 23 women (mean age 24.1 y) were randomly assigned to Treatment A (5.05 g beetroot powder + placebo/d) or Treatment B (5.05 g beetroot powder + 480 mg tart cherry/d) for seven days. Each treatment was followed by a seven-day washout after which subjects switched treatments. At the end of each treatment period, subjects performed a modified Wingate Anaerobic Test on a Monark 928E bike. Data on speed (RPM), power (watts), and heart rate were collected and analyzed using linear mixed models adjusted for baseline subject characteristics, treatment sequence (A-B, B-A), energy (kcal), and sleep (hours). RESULTS: Average heart rate during the first five seconds of the cycling sprint was significantly lower after treatment A than after treatment B (−1.6 to 2.7 BPM, P

IntroductionUpper-limb amputations make up 10% to 20% of the total amputations in the United States. Of the two million individuals currently living with limb loss, 30% to 50% do not wear their prosthesis regularly. This is a result of lack of education, lack of training, discomfort, poor co

To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means.Cross-sectional repeated measure design study.Research laboratory.Three groups of 20 subjects, age range 20 to 40 years.Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied.Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin.The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P0.01). There was benefit to applying heat 24 hours after exercise, but to a smaller extent. This was corroborated by myoglobin, algometer, and stiffness data.Low-level continuous heat wraps left for 8 hours just after heavy exercise reduced DOMS in the population tested as assessed by subjective and objective measures.Although cold is commonly used after heavy exercise to reduce soreness, heat applied just after exercise seems very effective in reducing soreness. Unlike cold, it increases flexibility of tissue and tissue blood flow. For joint, it is still probably better to use cold to reduce swelling.

Background: This study examined the effects of smartphones addiction on cervical posture, and compared the cervical range of motion (ROM) between addicted and non-addicted boys and girls 8 to 13 years of age. Methods: Twenty-four boys and 26 girls were assigned to 2 groups; addicted group (score > 32, n=32) and non-addicted group (score ≤ to 32, n=18). Craniovertebral Angle (CVA) was assessed using side view photographs, forward head posture (FHP) was measured using ImageJ 64 software, and cervical ROM in each direction was measured using a cervical (CROM) device. Results: A forward multiple regression showed that addiction score and body mass index (BMI) were significant predictors of CVA (R2 =0.31, p

The purpose of this study was to compare the effects of over-the-counter treatments-ThermaCare HeatWraps (chemical reaction to produce heat above the skin), Icy Hot Patch, and Icy Hot Cream (topically applied menthol)-on skin and deep tissue temperature.This was a longitudinal crossover study. On each of 3 days, a ThermaCare HeatWrap, Icy Hot Cream, or Icy Hot Patch was applied randomly over the quadriceps muscle in 15 healthy volunteers with normal body mass. Skin and muscle temperature and blood flow were measured by laser flowmetry every 15 minutes for 2 hours.After 2 hours, mean temperature decreased by 2.1°C (7.0%; P = .02) in skin and 1.0°C (2.9%; P = .01) in muscle with Icy Hot Cream. Icy Hot Patch decreased skin and muscle temperature by 1.7°C (5.4%; P = .03) and 1.3°C (3.8%; P = .01), respectively. In contrast, ThermaCare raised skin and muscle temperature by 7.8°C (25.8%; P = .001) and 2.7°C (7.7%; P = .002), respectively; both were significantly warmer with ThermaCare vs either Icy Hot product (all P.007). Icy Hot products produced a net decrease in skin blood flow (Cream: 56.7 flux [39.3%; P = .003]; Patch: 19.1 flux [16.7%; P = .045]). Muscle blood flow decreased with the Patch (6.7 flux [7.0%; P = .02]). After a period of fluctuations, Icy Hot Cream produced a net increase vs baseline of 7.0 flux (16.9%; P = .02). ThermaCare more than doubled blood flow in skin (83.3 flux [109.7%; P = .0003]) and muscle (25.1 flux [148.5%; P = .004]).In this group of 15 healthy volunteers, ThermaCare HeatWraps provided the greatest degree of tissue warming and increase in tissue blood flow.

As healthspan and lifespan research breakthroughs have become more commonplace, the need for valid, practical markers of biological age is becoming increasingly paramount. The accessibility and affordability of biological age predictors that can reveal information about mortality and morbidity risk, as well as remaining years of life, has profound clinical and research implications. In this review, we examine 5 groups of aging biomarkers capable of providing accurate biological age estimations. The unique capabilities of these biomarkers have far reaching implications for the testing of both pharmaceutical and non-pharmaceutical interventions designed to slow or reverse biological aging. Additionally, the enhanced validity and availability of these tools may have increasingly relevant clinical value. The authors of this review explore those implications, with an emphasis on lifestyle modification research, and provide an overview of the current evidence regarding 5 biological age predictor categories: Telomere length, composite biomarkers, DNA methylation “epigenetic clocks,” transcriptional predictors of biological age, and functional age predictors.

Background: Cervical spine provides three-dimensional movements of the head on the body while keeping the horizontality of visual gaze. Thus, cervical range of motion (ROM) is an important assessment that is commonly used in clinical practice. The headscarf is commonly used attire by females in Islamic cultures. The study aimed to investigate the effect of wearing headscarves on cervical ROM in females who wear headscarves compared with females who don’t wear headscarves. Methods: A cross-sectional study was conducted on fifty-two females with mean age 28.1±3.1 years were divided into two groups: Headscarf group (n=26) and no-scarf group (n=26). Cervical Range of Motion Device was used to measure cervical spine range of motion in a seated position for flexion, extension, right lateral flexion, left lateral flexion, right rotation and left the rotation. Results: The headscarf group reported a significant limitation in cervical ROM in all six directions. Moreover, females in the headscarf group who wore the headscarf for more or equal to 6 hours had significantly less left rotation compared to those who wear it for less than 6 hours (71.3±2.1 vs. 64.5±2.1, η2=2.2; p=0.045). No significant differences in mean ROM by age at onset of wearing a headscarf (≤12 years vs. > 12 years) or a number of years worn (≤15 years vs. > 15 years) were detected (p>0.05). Conclusion: Wearing the headscarf may influence cervical ROM. Also, six hours or more of daily wear may result in further decline of cervical ROM.

Cacao or dark chocolate is a major source of flavonoids. Flavonoids are extremely potent antioxidants and anti-inflammatory agents, with known mechanisms beneficial for cardiovascular health. Howev...

Dark chocolate (70% Cacao) is a major source of flavonoid antioxidants, which appear to support cognitive, endocrine, and cardiovascular health benefits. However, the in vivo effects of cacao on hu...

Because of the differences in the exercise type, temperature, and timing of the use of cold and heat after exercise in different studies, there is no clear conclusion as to the efficacy of either modality on reducing delayed onset muscle soreness. One hundred subjects at similar fitness levels were examined. They accomplished leg squats for 15 minutes and heat and cold were applied after or 24 hours after exercise using ThermaCare heat or cold wraps. Measurements obtained were strength, the force to passively move the knee, analog visual pain scales, and blood myoglobin. Control subjects lost 24% strength after exercise. Subjects with heat or cold just after exercise only lost 4% strength (p < 0.01). For strength recovery, cold applied after 24 hours was better than heat at 24 hours. Heat or cold applied after exercise was significantly better to prevent elastic tissue damage (p < 0.01), whereas heat and cold immediately after exercise caused no loss in muscle myoglobin and heat or cold after 24 hours showed no less muscle damage from myoglobin than in control subjects. Myoglobin in the control and heat and cold 24-hour groups averaged 135.1% of the baseline data but averaged 106.1% of baseline in the immediate heat and cold groups. For reducing pain, control subjects showed a significant amount of pain the days after exercise. But cold immediately after exercise or 24 hours later was superior to heat in reducing pain. In conclusion, both cold and heat appear to be efficacious in reducing muscle damage after exercise.

Objective: Psychomotor imagery has been widely used to improve motor performance and motor learning. Recent research suggests that during visualization, changes occur in neurophysiological networks that make physical practice more effective in configuring functional networks for skillful behaviors. The aim of our pilot study was to determine if there was change and to what extent there was differentiation in modulation in electroencephalography (EEG) frequencies between visualizing a state of rest and a state of exercise performance and to identify the preponderant frequency. Design: Quasi-experimental design uncontrolled before and after study. Methods: EEG brain wave activity was recorded from 0-40 Hz from nine cerebral cortical scalp regions F3, Fz, F4, C3, Cz, C4, P3, POz, and P4 with a wireless telemetric EEG system. The subjects, while sitting on a chair with eyes closed, were asked to visualize themselves in a state of routine rest/relaxation and after a period of time in a state of their routine exercise performance. Results: The gamma frequency, 31-40 Hz, () was the predominant wave band in differentiation between visualizing a state of rest versus visualizing a state of exercise performance. Conclusions: We suggest these preliminarily findings show the EEG electrocortical activity for athletes is differentially modulated during visualization of exercise performance in comparison to rest with a predominant wave band frequency observed during the state of exercise. Further controlled experimental studies will be performed to elaborate these observations and delineate the significance to optimization of psychomotor exercise performance.

Objective: Lateral ankle sprains are common sport injuries that often result in structural and functional alterations leading to chronic ankle instability (CAI). Insufficiencies in proprioception, neuromuscular control, and strength are suggested as contributing factors to CAI. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercises often constitute the core of ankle specific training before progression to advanced training. Though commonly used in the management of CAI, there is no consensus regarding their efficacy on physical therapy outcomes. The purpose of this study was to compare the effect of OKC and CKC exercises on dynamic postural control, self-reported function, and subjective sense of instability in subjects with CAI. Methods: Subjects with unilateral CAI were randomly assigned into three groups: OKC (n=5), CKC (n=6), and control (n=6). Outcome measures included star excursion balance test (SEBT) reach distance, center of pressure (COP) sway velocity, sway area, and path length; and Foot and Ankle Ability Measure-Sport Subscale. Intervention groups completed 6 weeks of exercises. Also, subjects completed a global rating of change (GROC) form at week 6 post-intervention. Results: Following intervention, both OKC and CKC groups had significant improvements in the outcome measures, indicating an improvement in dynamic postural control and subjective function; however, CKC had greater improvements than OKC. The control group did not show improvements. GROC revealed a significant difference in median score for CKC group when compared to OKC and control groups (p=0.04 and p=0.03, respectively). Conclusion: The 6-week of OKC and CKC exercise programs improved parameters of postural control and subjective function in CAI subjects. CKC exercises, however, were more effective than OKC exercises. Hence, exercise programs should become more functional and task oriented. Further research is needed in a larger cohort of subjects to determine effects of both training programs on ankle joint injury risk factors.

Background/Purpose Ankle sprains are common and potentially disabling musculoskeletal injuries that often lead to chronic ankle instability (CAI). CAI has been linked to impairments in postural and neuromuscular control; however, inconsistent findings have been reported. Individuals who experience a lateral ankle sprain, but do not develop instability, termed copers, may adapt different neuromuscular control strategies after injury. This study aimed to compare postural control and electromyographic (EMG) activity of hip and ankle muscles during the performance of the Star Excursion Balance Test (SEBT) in subjects with and without CAI. Method 48 participants were classified into three groups (16 control, 16 copers, 16 CAI) based on ankle sprain history and Cumberland Ankle Instability Tool score. Outcome measures included normalized reach distance, center of pressure (COP), and integrated EMG activation of gluteus medius (Gmed), gluteus maximus (Gmax), tibialis anterior (TA), and peroneus longus (PL) during each reach direction of SEBT. Results Compared to copers and controls, CAI group demonstrated significantly diminished postural control (reach distance and COP measures, p< 0.05) and less EMG activity of TA during the anterior direction (CAI: 33.1% ± 10.1% versus copers: 44.8% ± 12.7% versus controls: 51.7% ± 8.4%, p

Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty.Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface.EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task.This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.

Summary Background Tissue healing is an intricate process that is regulated by circulation. Heat modalities have been shown to improve skin circulation. Recent research supports that passive vibration increases circulation without risk of burns. Study purpose is to compare and determine effects of short duration vibration, moist heat, and a combination of the two on skin blood flow (SBF) and skin temperature (ST) in elderly, non-diabetic individuals following short-term exposure. Material/Methods Ten subjects, 3 female and 7 male (55–73 years of age), received two interventions over three days: 1 – Active vibration, 2 – passive vibration, 3 – moist heat, 4 – moist heat combined with passive vibration (MHPV), 5 – a commercial massaging heating pad, and 6 – no intervention. SBF and ST were measured using a MOOR Laser Doppler before and after the intervention and the third measurement were taken 10 minutes following. Results Mean SBF following a ten-minute intervention were significantly different in the combination of moist heat and passive vibration from the control, active vibration, and the commercial massaging heating pad. Compared to baseline measurements, this resulted in mean SBF elevation to 450% (at conclusion of 10 minutes of intervention) and 379% (10 minutes post). MHPV (p=0.02) showed significant changes in ST from the commercial massaging heating pad, passive vibration, and active vibration interventions. Conclusions SBF in the lower legs showed greatest increase with MHPV. Interventions should be selected that are low risk while increasing lower extremity skin blood flow.

Summary Background Circulation plays an essential role in tissue healing. Moist heat and warm water immersion have been shown to increase skin circulation; however, these heating modalities can cause burns. Recent research has shown that passive vibration can also increase circulation but without the risk of burns. Material/Methods The aim of this study is to compare the effects of short-duration vibration, moist heat, and a combination of the two on skin blood flow (SBF) and skin temperature (ST). Ten (10) subjects, 5 female and 5 male, aged 20–30 years of age, received two interventions a day for 3 consecutive days: Intervention 1 – Active vibration only (vibration exercise), Intervention 2 – passive vibration only, Intervention 3 – moist heat only, Intervention 4 – passive vibration combined with moist heat, Intervention 5 – a commercial massaging heating pad, and Intervention 6 – no intervention, resting in supine only (control). SBF and ST were measured using a laser Doppler imager during the 10 minute intervention and then throughout the nine minute recovery period. Results The mean skin blood flow following a ten-minute intervention of the combination of passive vibration and moist heat was significantly different from the control, active vibration, and the commercial massaging heating pad. Skin temperature following the ten-minute interventions of moist heat alone and passive vibration alone were both significantly different from the commercial massaging heating pad and active vibration interventions. Conclusions The combination of passive vibration and moist heat produced the greatest increase in skin blood flow and the second highest increase in skin blood flow nine minutes post application.

Much attention has been given to the effect of pressure on skin blood flow in the feet of older people and people with diabetes. However, little attention has been paid to other areas of the body, especially under the belt at the waist where pressure might be high during body movements associated with exercise. This may be very important when devices such as heat packs are worn during the day under the belt because their safety relies on appropriate skin blood flow to dissipate the heat; in diabetes populations burns have been seen.Forty male and female subjects, with and without diabetes, were examined in two series of experiments to assess the vertical and shear pressure under a belt worn during different common exercises. Vertical and shear pressure under the belt, belt tension, and shear pressure were measured with a Tactilus (Sensor Products, Madison, NJ) pressure mapping system. Eleven different body movements were examined. Then, from the recorded pressures, a second series of experiments examined skin blood flow at these same pressures.The results of the experiments showed that there was little shear and vertical pressure in thin subjects during 10 different exercises. However, for overweight subjects, pressure under the belt was as high as 150 kPa. At these high levels of pressure, skin circulation was occluded.In subjects with diabetes who are generally overweight and have impaired circulation, hot packs should be used with caution because of the low blood flows at rest and occlusion of the circulation under the belt with body movement.

Hydrotherapy and whirlpool are used to increase skin blood flow and warm tissue. However, recent evidence seems to show that part of the increase in skin blood flow is not due to the warmth itself but due to the moisture content of the heat. Therefore, two series of experiments were accomplished on 10 subjects with an average age of 24.2 +/- 9.7 years and free of diabetes and cardiovascular disease. Subjects sat in a 37 degrees C hydrotherapy pool under two conditions: one in which a thin membrane protecting their skin from moisture while their arm was submerged in water and the second where their arm was allowed to be exposed to the water for 15 minutes. During this period of time, skin and body temperature were measured as well as skin blood flow by a Laser Doppler Imager. The results of the experiments showed that the vapor barrier blocked any change in skin moisture content during submersion in water, and while skin temperature was the same as during exposure to the water, the blood flow with the arm exposed to water increased from 101.1 +/- 10.4 flux to 224.9 +/- 18.2 flux, whereas blood flow increased to only 118.7 +/- 11.4 flux if the moisture of the water was blocked. Thus, a substantial portion of the increase in skin blood flow associated with warm water therapy is probably associated with moisturizing of the skin rather than the heat itself.

The present study examined the effects of local heat, global heat, and the interaction between these two endothelial stressors on the blood flow of the skin of the foot in people who are older and who have diabetes.Subjects who were older (mean age 64.2 +/- 5.9 years) and were younger (mean age 25.7 +/- 2.9 years) and subjects who had diabetes (mean age 62 +/- 5.9 years, mean duration 13.2 +/- 9.1 years) participated. Subjects were exposed to three global temperatures (16 degrees C, 24 degrees C, and 32 degrees C), and the blood flow response was recorded on the foot with a laser Doppler flow meter for 30 s following applications of local heat (30 degrees C, 33.5 degrees C, and 37 degrees C) using a Peltier junction to clamp the skin for 2 min.All three groups significantly increased blood flow from the 16-24 degrees C environments for the 37 degrees C application of local heat (P(Younger) = 0.02, P(Older) = 0.02, P(Diabetes) = 0.01). Those with diabetes and those who were older only increased blood flow 5% and 6% from the 24-32 degrees C environment, which was not statistically significant (P(Older) = 0.12, P(Diabetes) = 0.14).There appears to be considerable blood flow reserve in younger subjects to tolerate heat stress. In contrast, older subjects and those with diabetes reach a critical level after which additional heat does not cause in increase in blood flow.

Surface heating modalities are commonly used in physical therapy and physical medicine for increasing circulation, especially in deep tissues, to promote healing. However, recent evidence seems to indicate that in people who are overweight, heat transfer is impaired by the subcutaneous fat layer. The present investigation was conducted on 10 subjects aged 22-54 years, whose body mass index averaged 25.8+/-4.6. Subcutaneous fat above the quadriceps muscle varied from 0.51 to 0.86 cm of thickness. Three heating modalities were examined: the application of dry heat with a commercial chemical heat pack, hydrocollator heat packs (providing a type of moist heat), and a whirlpool, where conductive heat loss through water contact would be very high. The temperature of the skin and the temperature in the muscle (25 mm below the skin surface) were assessed by thermocouples. The results of the experiments showed that for heating modalities that are maintained in skin contact for long periods of time, such as dry heat packs (in place for 6 hours), subcutaneous fat did not impair the change in deep muscle temperature. In contrast, when rapid heat modalities were used, such as the hydrocollator and the whirlpool (15 minutes of sustained skin contact), the transfer of heat from the skin to deep muscle was significantly impaired in people with thicker subcutaneous fat layers. We observed that the greater the impairment in heat transfer to muscle from skin covered by body fat, the warmer the skin temperature increase during the modality.

It is well established that diabetes impairs vascular endothelial function. However, the impact of impaired endothelial function on thermal conductivity of the skin, especially in relation to a constant versus a sudden heat stress, has not been established. Further, there is some evidence that aging reduces skin dermal thickness and subcutaneous fat thickness. Since these are important determinates of heat dissipation by the skin, these parameters also need to be examined in people with diabetes.Ninety subjects (30 younger individuals, 30 patients with diabetes, and 30 patients age-matched to the diabetes subjects) participated in two series of experiments to determine (1) the thickness of the subcutaneous fat layer and skin thickness and the skin response to a sudden heat stress and (2) the response to a continuous heat stress on the lower back. Skin thickness and subcutaneous fat thickness were assessed by ultrasound, and skin blood flow was examined by infrared laser Doppler flow meter.People with diabetes had significantly less resting blood flow, blood flow in response to a single or continuous heat load, less subcutaneous fat, and thinner skin than either age-matched controls or younger people (P0.05). Subjects with diabetes also had the lowest concentration of red blood cells in their skin, implying a reduction in the number of capillaries in the skin.Thinning of the skin and probably a reduction in capillaries in the dermal layer contribute to a reduction in the blood flow response to heat. People with diabetes, in particular, have reduced skin heat dissipation because of less resting blood flow and thinner skin than that seen in age-matched controls.

Low back pain is a common and costly health care problem. This pilot study evaluated the sensitivity of the 2-stopwatch and Paris plinth methodologies for assessing time-to-onset of pain relief and flexibility, respectively, with continuous, low-level heatwrap therapy.Subjects aged 18 to 55 years with at least moderate baseline acute low back pain were randomly assigned to either heatwrap or oral placebo for 8 hours. Unheated wrap (sham) and oral ibuprofen were included for blinding purposes only.Sixty-one subjects were randomly assigned to either heatwrap (n = 26), oral placebo (n = 25), sham wrap (n = 5), or oral ibuprofen (n = 5). Median time to confirmed first perceptible pain relief and to meaningful pain relief were significantly shorter for the heatwrap group compared with those assigned to oral placebo (96.5 vs240.0 min and 215.7 vs240.0 min, respectively; P0.05 for both). Among subjects receiving the heatwrap, 53.8% reported first perceptible and meaningful relief, compared with 28.0% receiving oral placebo. Subjective measures of pain relief, back stiffness, and global evaluation were more sensitive in detecting treatment differences than the plinth assessments of flexibility, range of motion, and pain. Three adverse events were reported as mild in severity and considered unrelated to study treatment.The 2-stopwatch methodology is a viable approach for assessing onset of analgesia in low back pain; however, the plinth may not be a reliable method for assessing flexibility. Consistent with published studies involving much larger sample sizes, the heatwrap provided significantly faster and sustained pain relief than oral placebo in subjects with acute low back pain. Clinical Trial Identifier: NCT01045993.

With ageing, the damaging effects of stress can impair the ability to learn and sustain memory. The purpose was to examine the effect of watching a humor video on short term memory in 3 age matched...

Background It is well established that there is a reduction in the skin blood flow (SBF) in response to heat with age and diabetes. While it is known that high BMI creates a stress on the cardiovascular system and increases the risk of all cause of morbidity and mortality, little is known of the effect of high BMI on SBF response to heat. Since diabetes is associated with age and a higher BMI, the interrelationship between age, BMI and SBF needs to be investigated to better understand the contribution diabetes alone has to endothelial impairment. Material/Methods This study examined the SBF to heat in young and old people with low and high BMI and people with diabetes with high BMI to determine the contribution these variables have on SBF. Subjects were ten young and older people with BMI 20 and ten subjects with diabetes with BMI >20. The SBF response, above the quadriceps, was determined during a 6 minutes exposure to heat at 44°C. Results Even in young people, SBF after the stress of heat exposure was reduced in subjects with a high BMI. The effect of BMI was greatest in young people and lowest in older people and people with diabetes; in people with diabetes, BMI was a more significant variable than diabetes in causing impairment of blood flow to heat. BMI, for example, was responsible for 49% of the reduction in blood flow after stress heat exposure (R=−0.7) while ageing only accounted for 16% of the blood flow reduction (R=−0.397). Conclusions These results would suggest the importance of keeping BMI low not only in people with diabetes to minimize further circulatory vascular damage, but also in young people to diminish long term circulatory vascular compromise.

Background: Heat is commonly used in physical therapy following exercise induced delayed onset muscle soreness (DOMS). Most heat modalities used in a clinical setting for DOMS are only applied for 5 to 20 minutes. This minimal heat exposure causes little, if any, change in deep tissue temperature. For this reason, long duration dry chemical heat packs are used at home to slowly and safely warm tissue and reduce potential heat damage while reducing pain associated from DOMS. Clinically, it has been shown that moist heat penetrates deep tissue faster than dry heat. Therefore, in home use chemical moist heat may be more efficacious than dry heat to provide pain relief and reduce tissue damage following exercise DOMS. However, chemical moist heat only lasts for 2 hours compared to the 8 hours duration of chemical dry heat packs. The purpose of this study was to compare the beneficial effect of dry heat versus moist heat on 100 young subjects after exercise induce DOMS. Methods: One hundred subjects exercised for 15 minutes accomplishing squats. Before and for 3 days after, strength, muscle soreness, tissue resistance, and the force to passively move the knee were recorded. Heat and moist heat were applied in different groups either immediately after exercise or 24 hours later. Results: The research results of this study showed that immediate application of heat, either dry (8 hours application) or moist (2 hours application), had a similar preservation of quadriceps muscle strength and muscle activity. Results also revealed that the greatest pain reduction was shown after immediate application of moist heat. Never the less, immediate application of dry heat had a similar effect but to a lesser extent. Conclusion: It should be noted that moist heat had not only similar benefits of dry heat but in some cases enhanced benefits, and with only 25% of the time of application of the dry heat. doi: http://dx.doi.org/10.4021/jocmr1521w

With ageing, the damaging effects of stress can impair the ability to learn and sustain memory. The purpose of this pilot study was to examine the effect of watching a humor video on short term mem...

Balance is impaired in the elderly and people with diabetes. However, the effect of attempted balance on the autonomic nervous system has not been investigated.Ten control subjects, 10 subjects with type 2 diabetes (age range, 21-75 years), and 10 older subjects age-matched to the subjects with diabetes were examined to determine the effect of diabetes and age on balance and the associated autonomic stress. Subjects were asked to stand on a balance platform for 1-min periods under four conditions: (1) quiet standing, (2) quiet standing with eyes closed, (3) quiet standing eyes closed with the platform allowed to move side to side over a central pivot that allows the edge of the platform to rotate 4 inches up and down, and (4) the same platform with eyes closed. Blood pressure, electrocardiogram, and sway were recorded.Balance was worst in the subjects with diabetes, while the cardiovascular stress, as assessed by both heart rate and blood pressure, was greatest in the older group of subjects. But subjects with diabetes, while having a greater blood pressure response to the stress induced by balance, showed a poor heart rate response, probably due to diabetes-induced autonomic damage.Autonomic damage in the subjects with diabetes masked much of the stress of the inability to optimize balance in this population.

Pennes first described a model of heat transfer through the limb based only on calories delivered from a heat source, calories produced by metabolism and skin blood flow. The purpose of this study was to determine the effect of a moist versus a dry heat source on the skin in eliciting a blood flow response to add data to this model. Ten subjects were examined, both male and female, with a mean age of 32.5 +/- 11.6 years, mean height of 172.8 +/- 12.3 cm, and mean weight of 77.6 +/- 19.5 kg. Skin temperature was measured by a thermocouple placed on the skin and skin blood flow measured by a laser Doppler flow meter. The results of the experiments using a dry heat pack (commercially available chemical 42 degrees C cell dry heat source), moist hydrocollator pack (72.8 degrees C) separated from the skin by eight layers of towels, and whirlpool at 40 degrees C, showed that moist heat caused a significantly higher skin blood flow (about 500% greater) than dry heat (p0.01). Most of the greater increase in skin blood flow with moist heat was due to the greater rate of rise of skin temperature with moist versus dry heat while some of the increase in blood flow was due to the moisture itself. This could either be related to the greater heat flux across the skin with moist air or due to changing the ionic environment around skin thermo receptors by keeping the skin moist during heating. Skin thermo receptors are believed to be temperature sensitive calcium gated channels in endothelial cells which couple calcium influx to a release of nitric oxide. If true, reducing moisture in the skin might have the effect of altering ionic flux through these receptors. A correct model of skin heat flux should therefore take heat moisture content into consideration.

Numerous studies have examined the effect of local and global heating of the body on skin blood flow. However, the effect of the moisture content of the heat source on the skin blood flow response has not been examined. Thirty-three subjects, without diabetes or cardiovascular disease, between the ages of 22 and 32 were examined to determine the relationship between the effects of dry vs. moist heat applied for the same length of time and with the skin clamped at the same skin temperature on the blood flow response of the skin. The skin, heated with an infrared heat lamp (skin temperature monitored with a thermocouple) to 40 degrees C for 15 min, was either kept moist with wet towels or, in a separate experiment, kept dry with Drierite (a desiccant) between the towels to remove any moisture. Before and after heat exposure of the forearm, blood pressure, heart rate, skin moisture content, skin temperature, and skin blood flow were recorded. The results of the experiment showed that there was no change in skin moisture after 15 min exposure to dry heat at 40 degrees C. However, with moist heat, skin moisture increased by 43.7%, a significant increase (P0.05). With dry heat, blood flow increased from the resting value by 282.3% whereas with moist heat, blood flow increased by 386% over rest, a significant increase over dry heat (P0.05). Thus, with a set increase in skin temperature, moist heat was a better heating modality than dry heat. The reason may be linked to moisture sensitivity in calcium channels in the vascular endothelial cell.

The Pennes model predicts the ability of the skin to dissipate heat as a function of conductive heat transfer and blood flow. Conductive heat exchange may be affected by skin moisture and subcutaneous fat thickness, factors not considered by Pennes. In the present investigation, we sought to expand the Pennes model by examining subcutaneous fat and skin moisture as factors of heat dissipation and their effects on heat exchange and blood flow. Subjects who were older (O) (mean age 64.2+/-5.9 years, n=15), had diabetes (D) (mean age 62+/-5.9 years, mean duration 13.2+/-9.1 years, n=15), and were younger (Y) (mean age 25.7+/-2.9 years, n=15) participated. Thermisters were placed in an iron heat probe and on the skin to measure the change in skin temperature to create a thermal change index to demonstrate the ability of the skin to dissipate heat. The lower back had the thickest subcutaneous fat layer for all subjects, which contributed to higher skin temperatures than the foot and hand in response to local and global heat. There was a significant inverse correlation between skin moisture and skin temperature after 5s of heat application (r=-0.73, p0.001) with O and D having significantly less skin moisture than Y (p0.05). O and D had significantly increased skin temperatures in response to local heat, as compared to Y, in all global temperatures (p0.05). Thus, the Pennes model may need to be adjusted to take into consideration aging, diabetes, skin moisture, and subcutaneous fat thickness.