Search results for: breathing exercise

Authors: Vasudha Govil, Suresh Singhal

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Introduction: Patients with oropharyngeal masses pose a challenge for an anaesthetist in terms of ventilation and tracheal intubation. Thus, preoperative assessment and preparation become an integral part of managing such anticipated difficult airway cases. Case report: A 45- year old female presented with growth in the oropharynx causing dysphagia and hoarseness of voice. Clinical examination and investigations predicted a difficult airway. It was managed with fibreoptic nasotracheal intubation with a successful perioperative outcome. Tracheostomy was kept as plan B in case of the CVCI situation. Conclusion: Careful preoperative examination and assessment is required to prepare oneself for difficult airway. Fibreoptic bronchoscope-guided nasotracheal intubation in a spontaneously breathing patient is a safe and successful airway management technique in difficult airway cases.

Keywords: airway, difficult, mass, oropharyngeal

Procedia PDF Downloads 192

Authors: Andreas Aceranti, Riccardo Dossena, Marco Colorato, Simonetta Vernocchi

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By the term “limbic resonance,” we usually refer to a state of deep connection, both emotional and physiological, between people who, when in resonance, find their limbic systems in tune with one another. Limbic resonance is not only about sharing emotions but also physiological states. In fact, people in such resonance can influence each other’s heart rate, blood pressure, and breathing. Limbic resonance is fundamental for human beings to connect and create deep bonds among a certain group. It is fundamental for our social skills. A relationship between gifted and resonant subjects is perceived as feeling safe, living the relation like an isle of serenity where it is possible to recharge, to communicate without words, to understand each others without giving explanations, to strengthen the balance of each member of the group. Within the circle, self-esteem is consolidated and makes it stronger to face what is outside, others, and reality. The idea that gifted people who are together may be unfit for the world does not correspond to the truth. The circle made up of people with high cognitive potential characterized by a limbic resonance is, in general, experienced as a solid platform from which you can safely move away and where you can return to recover strength. We studied 8 adults (between 21 and 47 years old). All of them with IQ higher than 130. We monitored their brain waves frequency (alpha, beta, theta, gamma, delta) by means of biosensing tracker along with their physiological states (heart beat frequency, blood pressure, breathing frequency, pO2, pCO2) and some blood works only (5-HT, dopamine, catecholamines, cortisol). The subjects of the study were asked to adhere to a protocol involving bonding activities (such as team building activities), role plays, meditation sessions, and group therapy. All these activities were carried out together. We observed that after about 4 months of activities, their brain waves frequencies tended to tune quicker and quicker. After 9 months, the bond among them was so important that they could “sense” each other inner states and sometimes also guess each others’ thoughts. According to our findings, it may be hypothesized that large synchronized outbursts of cortex neurons produces not only brain waves but also electromagnetic fields that may be able to influence the cortical neurons’ activity of other people’s brain by inducing action potentials in large groups of neurons and this is reasonably conceivable to be able to transmit information such as different emotions and cognition cues to the other’s brain. We also believe that upcoming research should focus on clarifying the role of brain magnetic particles in brain-to-brain communication. We also believe that further investigations should be carried out on the presence and role of cryptochromes to evaluate their potential roles in direct brain-to-brain communication.

Keywords: limbic resonance, psychotherapy, brain waves, emotion regulation, giftedness

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Authors: Mohd Faridz Ahmad, Muhammad Amir Asyraf Rosli

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Aerobic dance has becoming a popular mode of exercise especially among women due to its fun nature. With a catchy music background and joyful dance steps, aerobic dancers would be able to have fun while sweating out. Depending on its level of aggressiveness, aerobic may also improve and maintain cardiorespiratory fitness other than being a great tool for weight loss. This study intends to prove that aerobic dance activity can bring the same, if not better impacts on health than other types of cardiovascular exercise such as jogging and cycling. The objective of this study was to evaluate and identify the effect of six weeks aerobic dance on cardiovascular fitness and weight loss among women. This study, which was held in Seremban Fit Challenge, used a quasi-experimental design. The subjects selected include a total of 14 women (n = 14) with age (32.4 years old ± 9.1), weight (65.93 kg ± 11.24) and height (165.36 ± 3.46) who joined the Seremban Fit Challenge Season 13. The subjects were asked to join an aerobic dance class with duration of one hour for six weeks in a row. As for the outcome, cardiovascular fitness was measured with a 1-mile run test while any changes on weight was measured using the weighing scale. The result showed that there was a significant difference between pre and post-test for cardiovascular fitness when p = 0.02 < 0.05 and weight loss when p = 0.00 < 0.05. In conclusion, a six-week long aerobic dance program would have a positive effect on cardiovascular fitness and weight. Therefore, aerobic dance may be used as an alternative tool for people who wish to lead a healthy lifestyle in a fun way.

Keywords: aerobic dance, cardiovascular fitness, weight loss, 1-mile run test

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Authors: Pavel Bulai, Taras Pitlik, Tatsiana Kulahava, Timofei Lipski

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The method of Electrocardiography (ECG) interpretation for post-exercise recovery tracking was developed. Metabolic indices (aerobic and anaerobic) were designed using ECG-derived features. This study reports the associations between aerobic and anaerobic indices and classical parameters of the person’s physiological state, including blood biochemistry, glycogen concentration and VO2max changes. During the study 9 participants, healthy, physically active medium trained men and women, which trained 2-4 times per week for at least 9 weeks, fulfilled (i) ECG monitoring using Apple Watch Series 4 (AWS4); (ii) blood biochemical analysis; (iii) maximal oxygen consumption (VO2max) test, (iv) bioimpedance analysis (BIA). ECG signals from a single-lead wrist-wearable device were processed with detection of QRS-complex. Aerobic index (AI) was derived as the normalized slope of QR segment. Anaerobic index (ANI) was derived as the normalized slope of SJ segment. Biochemical parameters, glycogen content and VO2max were evaluated eight times within 3-60 hours after training. ECGs were recorded 5 times per day, plus before and after training, cycloergometry and BIA. The negative correlation between AI and blood markers of the muscles functional status including creatine phosphokinase (r=-0.238, p < 0.008), aspartate aminotransferase (r=-0.249, p < 0.004) and uric acid (r = -0.293, p<0.004) were observed. ANI was also correlated with creatine phosphokinase (r= -0.265, p < 0.003), aspartate aminotransferase (r = -0.292, p < 0.001), lactate dehydrogenase (LDH) (r = -0.190, p < 0.050). So, when the level of muscular enzymes increases during post-exercise fatigue, AI and ANI decrease. During recovery, the level of metabolites is restored, and metabolic indices rising is registered. It can be concluded that AI and ANI adequately reflect the physiology of the muscles during recovery. One of the markers of an athlete’s physiological state is the ratio between testosterone and cortisol (TCR). TCR provides a relative indication of anabolic-catabolic balance and is considered to be more sensitive to training stress than measuring testosterone and cortisol separately. AI shows a strong negative correlation with TCR (r=-0.437, p < 0.001) and correctly represents post-exercise physiology. In order to reveal the relation between the ECG-derived metabolic indices and the state of the cardiorespiratory system, direct measurements of VO2max were carried out at various time points after training sessions. The negative correlation between AI and VO2max (r = -0.342, p < 0.001) was obtained. These data testifying VO2max rising during fatigue are controversial. However, some studies have revealed increased stroke volume after training, that agrees with findings. It is important to note that post-exercise increase in VO2max does not mean an athlete’s readiness for the next training session, because the recovery of the cardiovascular system occurs over a substantially longer period. Negative correlations registered for ANI with glycogen (r = -0.303, p < 0.001), albumin (r = -0.205, p < 0.021) and creatinine (r = -0.268, p < 0.002) reflect the dehydration status of participants after training. Correlations between designed metabolic indices and physiological parameters revealed in this study can be considered as the sufficient evidence to use these indices for assessing the state of person’s aerobic and anaerobic metabolic systems after training during fatigue, recovery and supercompensation.

Keywords: aerobic index, anaerobic index, electrocardiography, supercompensation

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Authors: Alireza Barari

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Physical activity and diet are factors that influence the body's structure. The purpose of this study was to compare the effects of four weeks of resistance training, and glutamine supplement consumption on growth hormone (GH), and Insulin-like growth factor 1 (IGF-1) Axis. 40 amateur male bodybuilders, participated in this study. They were randomly divided into four equal groups, Resistance (R), Glutamine (G), Resistance with Glutamine (RG), and Control (C). The R group was assigned to a four week resistance training program, three times/week, three sets of 10 exercises with 6-10 repetitions, at the 80-95% 1RM (One Repetition Maximum), with 120 seconds rest between sets), G group is consuming l-glutamine (0.1 g/kg^-1/day^-1), RG group resistance training with consuming L-glutamine, and C group continued their normal lifestyle without exercise training. GH, IGF1, IGFBP-III plasma levels were measured before and after the protocol. One-way ANOVA indicated significant change in GH, IGF, and IGFBP-III between the four groups, and the Tukey test demonstrated significant increase in GH, IGF1, IGFBP-III plasma levels in R, and RG group. Based upon these findings, we concluded that resistance training at 80-95% 1RM intensity, and resistance training along with oral glutamine shows significantly increase secretion of GH, IGF-1, and IGFBP-III in amateur males, but the addition of oral glutamine to the exercise program did not show significant difference in GH, IGF-1, and IGFBP-III.

Keywords: strength, glutamine, growth hormone, insulin-like growth factor 1

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Authors: Sdiqeh Jalali, M. R. Khazdair

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Liver X receptors (LXR) have an essential role in the regulation of cholesterol metabolism, and their activation increase ABCG5 and ABCG8 genes expression for the improvement of cholesterol excretion from the body during reverse cholesterol transport (RCT). The aim of this study was to investigate the effects of high-intensity interval (HIT) and low intensity continuous (LIT) trainings on gene expression of these substances after a high-fat diet in Wistar rats. Materials and Methods: Fifteen male Wistar rats were divided into 3 groups: control group (n = 5), HIT exercise group (n = 5) and LIT exercise group (n = 5). All groups used a high-fat diet for 13 weeks, and the HIT and LIT groups performed the specific training program. The expression of LXRβ, ABCG5, and ABCG8 genes was measured after the training period. Findings: Data analysis showed significantly higher levels of LXRβ, ABCG5, and ABCG8 gene expression in HIT and LIT groups compared to the control group (P ≤ 0.05). Conclusion: HIT and LIT trainings after a high-fat diet have beneficial effects on RCT that prevent heart attack. Also, HIT training may have a greater effect on cholesterol excretion during the reverse cholesterol transport mechanism than LIT.

Keywords: liver X receptor, atherosclerosis, interval training, endurance training

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Authors: Huang Wei-Yi

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Objective: This article explores the intensive care nursing experience of a terminal lung cancer patient who received palliative care after tracheal intubation. The patient was nearing death, and the family experienced sadness and grief as they faced the patient’s deteriorating condition and impending death. Methods: The patient was diagnosed with lung cancer in 2018 and received chemotherapy and radiation therapy with regular outpatient follow-ups. Due to brain metastasis and recent poor pain control and treatment outcomes, the patient was admitted to the intensive care unit (ICU), where the tracheal tube was removed, and palliative care was initiated. During the care period, a holistic assessment was conducted, addressing the physical, psychological, social, and spiritual aspects of care. Medical records were reviewed, interviews and family meetings were held, and a comprehensive assessment was carried out by the critical care team in collaboration with the palliative care team. The primary nursing issues identified included pain, ineffective breathing patterns, fear of death, and altered tissue perfusion. Results: Throughout the care process, the palliative care nurse, along with the family, utilized listening, caring, companionship, pain management, essential oil massage, distraction, and comfortable positioning to alleviate the patient’s pain and breathing difficulties. The use of Morphine 6mg in 0.9% N/S 50ml IV drip q6h reduced the FLACC pain score from 6 to 3. The patient’s respiratory rate improved from 28 breaths/min to 18-22 breaths/min, and sleep duration increased from 4 to 7 uninterrupted hours. The holistic palliative care approach, coupled with the involvement of the palliative care team, facilitated expressions of gratitude, apologies, and love between the patient and family. Visiting hours were extended, and with the nurse’s assistance, these moments were recorded and shared with the patient’s consent, providing cherished memories for the family. The patient’s end-of-life experience was thus improved, and the family was able to find peace. This case also served to promote the concept of palliative care, ensuring that more patients and families receive high-quality nursing care. Conclusion: When caring for terminal patients, collaboration with the palliative care team, including social workers, clergy, psychologists, and nutritionists, is essential. Involving the family in decision-making and providing opportunities for closeness and expressions of gratitude improve personalized care and enhance the patient's quality of life. Upon transferring to the ward, the patient’s hemodynamic stability was maintained, including SBP 110-130 mmHg, respiratory rate 20-22 breaths/min, and pain score <3. The patient was later discharged and transitioned to home hospice care for ongoing support.

Keywords: intensive care, lung cancer, palliative care, ICU

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Authors: Turki Mohammed Al Mohaid

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High arousal may lead to inhibited athletic performance, or high positive arousal may enhance performance is controversial. To evaluate and review this issue, 31 athletes (all male) were induced into high pre-determined goal arousal and high arousal without pre-determined goal motivational states and tested on a standard grip strength task. Paced breathing was used to change psychological and physiological arousal. It was noted that significant increases in grip strength performance occurred when arousal was high and experienced as delighted, happy, and pleasant excitement in those with no pre-determined goal motivational states. Blood pressure, heart rate, and other indicators of physiological activity were not found to mediate between psychological arousal and performance. In a situation where athletic performance necessitates maximal motor strength over a short period, performance benefits of high arousal may be enhanced by designing a specific motivational state.

Keywords: high arousal, athletic, performance, physiological

Procedia PDF Downloads 116

Authors: Mohamed M. Ragab, Neveen A. Abdel Raoof, Reham H. Diab

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Background: Delayed onset muscle soreness (DOMS) is the most common symptom when ordinary individuals and athletes are exposed to unaccustomed physical activity, especially eccentric contraction which impairs athletic performance, ordinary people work ability and physical functioning. A multitude of methods have been investigated to reduce DOMS. One of the valuable method to control DOMS is repeated bout effect (RBE) as a prophylactic method. Purpose: To compare the repeated bout effect of submaximal eccentric contraction versus maximal isometric contraction on induced DOMS. Methods: Sixty normal male volunteers were assigned randomly into three groups of equal number: Group (A) “first study group”: 20 subjects received submaximal eccentric contraction on non-dominant elbow flexors as prophylactic exercise. Group (B) “second study group”: 20 subjects received maximal isometric contraction on non-dominant elbow flexors as prophylactic exercise. Group (C) “control group”: 20 subjects did not receive any prophylactic exercise. Maximal isometric contraction peak torque of elbow flexors and patient related elbow evaluation (PREE) scale were measured for each subject 3 times before, immediately after and 48 hours after induction of DOMS. Results: Post-hoc test for maximal isometric peak torque and PREE scale immediately and 48 hours after induction of DOMS revealed that group (A) and group (B) resulted in significant decrease in maximal isometric strength loss and elbow pain and disability rather than control group (C), but submaximal eccentric group (A) was more effective than maximal isometric group (B) as it showed more rapid recovery of functional strength and less degrees of elbow pain and disability. Conclusion: Both submaximal eccentric contraction and maximal isometric contraction were effective in prevention of DOMS but submaximal eccentric contraction had the greatest protective effect.

Keywords: delayed onset muscle soreness, maximal isometric peak torque, patient related elbow evaluation scale, repeated bout effect

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Authors: Shoumodip Roy, Ankit Singhania, M. K. G. Choudhury, Santanu Mallick, M. K. Agarwal, R. V. Ramna, Uttam Singh

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One of the key corporate goals of Tata Steel company is to demonstrate Environment Leadership. Decreasing specific CO₂ emission is one of the key steps to achieve the stated corporate goal. At any Blast Furnace, specific CO₂ emission is directly proportional to fuel intake. To reduce the fuel intake at G Blast Furnace, an initial benchmarking exercise was carried out with international and domestic Blast Furnaces to determine the potential for improvement. The gap identified during the exercise revealed that the benchmark Blast Furnaces operated with superior raw material quality than that in G Blast Furnace. However, since the raw materials to G Blast Furnace are sourced from the captive mines, improvement in the raw material quality was out of scope. Therefore, trials were taken with different operating regimes, to identify the key process parameters, which on optimization could significantly reduce the fuel intake in G Blast Furnace. The key process parameters identified from the trial were the Stoichiometric Oxygen Ratio, Melting Capacity ratio and the burden distribution inside the furnace. These identified process parameters were optimized to bridge the gap in fuel intake at G Blast Furnace, thereby reducing specific CO₂ emission to benchmark levels. This paradigm shift enabled to lower the fuel intake by 70kg per ton of liquid iron produced, thereby reducing the specific CO₂ emission by 15 percent.

Keywords: benchmark, blast furnace, CO₂ emission, fuel rate

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Authors: M. Golzade Gangraj, A. Abdi, N. ganji

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Aim: The aim of this study was to evaluate the Effect of aerobic training with Coriandrum sativum extract on selection of oxidative stress markers in diabetic rats. Methods: The population of male Wistar rats is the Pasteur Institute. Forty rats were randomly selected as subjects. After moving the mouse in vitro and stay for a week in a cage for sustainability, were diabetic. Diabetes induced by injection STZ (55 mg per kg of body weight of mice) was performed. According blood glucose was randomly divided into four experimental groups (control, training, extract and training-extract). Extract group consumed 150 mg per kg of body weight per day coriander juice. Training group performed aerobic training (50-55% VO2max). Result: The results showed that aerobic exercise training and coriander seed extract caused a significant increase in total antioxidant; superoxide dismutase and catalase were significantly decreased malondialdehyde. Conclusion: the research findings can be stated that the exercise with coriander seed extract has the ability to inhibit free radicals and can have beneficial effects on the body's antioxidant defense system and reduce oxidative stress in diabetic rats with STZ. Because it improves the body's antioxidant defense by increasing serum levels of antioxidant enzymes.

Keywords: aerobic training, coriandrum sativum, antioxidant, diabetes

Procedia PDF Downloads 513

Authors: Özge Çeliker Tosun, Melda Başer Secer, İsmail Düşmez, Sedat Çapar, İlkay Kozak, Melahat Aktaş, Furkan Can Şimşek, Gökhan Tosun

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Purpose: Portable innovative balance room system with digital game program; It was created to be able to be divided into small areas, such as inside the house, garden, balcony, to enable the person to enter and perform both evaluation and exercise safely, and to ensure that these results can be stored and sent to the therapist live or later when desired. The aim is to compare the effectiveness of the exercise program applied by the elderly within this system and the exercise program implemented under the supervision of a physiotherapist on balance and urinary incontinence symptoms. Materials and Methods: The study was conducted in a randomized controlled manner on 63 people with urinary incontinence (mean age: 75.5 years) at Narlıdere Nursing Home Elderly Care and Rehabilitation Center. Elderly people participating in the study were divided into 3 groups: 1. Group, an exercise program consisting of pelvic floor muscle training and OTOGA exercises, 2. Group, only pelvic floor muscle training, and 3. Group, pelvic floor muscle training and Otoga exercises in the form of a digital game program in a portable balance room system. (self-administered) for 12 weeks. Pelvic floor distress inventory (PTDE-20) and bladder diary were used to evaluate the incontinance symptoms of the cases. Pelvic floor muscle function was evaluated with superficial EMG. Berg, Fall Effectiveness Scale (FES) and Functional Status Evaluations (Chair Stand Test, Eight (8) Food Up and Go Test, Chair Sit and Reach Test, Two Minutes Step Test) were used to evaluate balance. The existence of differences between groups was analyzed using Krusskal Wallis analysis of variance, and the difference between before and after exercise was analyzed with Wilcoxon tests. Results: After treatment, PTDE-20, daily urinary incontinence and toilet visits values decreased significantly in all three groups (p < 0.001). While there was a statistically significant increase in pelvic floor muscle EMG values in the 2nd and third groups after treatment, there was no change in the other group (2nd Group PFM average EMG before-after: 5.5 (4.15-10.95) - 10.95 (8.68-13.68), P=0.05, 3 Group PFM average EMG before-after: 6.5 (4.28-11.55) - 11.75 (8.67-14.26), p=0.04). While BERG score, Chair Stand Test, Eight (8) Food Up and Go Test, and Two Minutes Step Test values increased in all groups (p<0.05), Fall Effectiveness Scale (FES) values did not change after treatment. Conclusion: Although pelvic floor muscle training combined with balance exercises reduces symptoms, it may not lead to a positive improvement in the functions of the pelvic floor muscles. For this reason, recovery lasts for a short time, and then symptoms may reoccur in the future. However, thanks to the new system, when balance exercises are combined with a game program for the pelvic floor muscles, a double effect can be achieved with a single application and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on this subject. However, thanks to the new system, a double effect can be achieved with a single application, and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on new system

Keywords: fall, urinary incontinance, balance, elderly

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Authors: Amany Mohamed, Alaa Balbaa, Magdoline Mishel

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Background: Pain in the neck or scapular region is one of the most frequent symptoms in cervical radiculopathy, which is commonly caused by degenerative process in the spine. Purpose: To determine the effect of scapular stabilization exercises in the treatment of chronic neck pain regarding pain and disability and limitation in the range of motion. Patients and Methods: Thirty male and female patients with chronic neck pain were involved. Aged between 30-50 years old. They were randomly assigned into two groups. In group (A), patients received physical therapy program in the form of infrared, transcutaneous electrical nerve stimulation (TENS), Stretching and cervical stabilization exercises. In group (B), patients received scapular stabilization exercises in addition to the same physical therapy program. Treatment was given 3 times a week for 4 weeks. Range of motion of the cervical spine, range of motion of the scapula, neck pain and disability were assessed before and after treatment. Results: There was significant improvement in both groups (A and B) in cervical range of motion, pain and disability. Group (B) showed more significant improvement than group (A) in cervical range of motion and pain and disability. There was no significant improvement in both groups in scapular range of motion. Conclusion: Scapular stabilization exercises should be used as an integral part in the rehabilitation program

Keywords: Neck pain, neck stabilization exercise, scapular stabilization exercise, chronic neck pain

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Authors: Pawan Kumar, Dhananjoy Shaw, Manoj Kumar Rathi

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Purpose of the study were to compare between (a) frequencies among the four quartiles of percentile norms of autonomic variables from power events and (b) frequencies among the four quartiles percentile norms of autonomic variables from aerobic events of Indian sportspersons withdrawn from competitive games and sports in regard to number of samples falling in each quartile. The study was conducted on 430 males of 30 to 35 years of age. Based on the nature of game/sports the retired sportspersons were classified into power events (throwers, judo players, wrestlers, short distance swimmers, cricket fast bowlers and power lifters) and aerobic events (long distance runners, long distance swimmers, water polo players). Date was collected using ECG polygraphs. Data were processed and extracted using frequency domain analysis and time domain analysis. Collected data were computed with frequency, percentage of each quartile and finally the frequencies were compared with the chi square analysis. The finding pertaining to norm reference comparison of frequencies among the four quartiles of Indian sportspersons withdrawn from competitive games and sports from (a) power events suggests that frequency distribution in four quartile namely Q1, Q2, Q3, and Q4 are significantly different at .05 level in regard to variables namely, SDNN, Total Power (Absolute Power), HF (Absolute Power), LF (Normalized Power), HF (Normalized Power), LF/HF ratio, deep breathing test, expiratory respiratory ratio, valsalva manoeuvre, hand grip test, cold pressor test and lying to standing test, whereas, insignificantly different at .05 level in regard to variables namely, SDSD, RMSSD, SDANN, NN50 Count, pNN50 Count, LF (Absolute Power) and 30: 15 Ratio (b) aerobic events suggests that frequency distribution in four quartile are significantly different at .05 level in regard to variables namely, SDNN, LF (Normalized Power), HF (Normalized Power), LF/HF ratio, deep breathing test, expiratory respiratory ratio, hand grip test, cold pressor test, lying to standing test and 30: 15 ratio, whereas, insignificantly different at .05 level in regard to variables namely, SDSD, RMSSD. SDANN, NN50 count, pNN50 count, Total Power (Absolute Power), LF(Absolute Power) HF(Absolute Power), and valsalva manoeuvre. The study concluded that comparison of frequencies among the four quartiles of Indian retired sportspersons from power events and aerobic events are different in four quartiles in regard to selected autonomic functions, hence the developed percentile norms are not homogenously distributed across the percentile scale; hence strengthen the percentage distribution towards normal distribution.

Keywords: power, aerobic, absolute power, normalized power

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Authors: Renee Moten

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Introduction: Knee pain becomes chronic because the therapy used focuses only on the symptoms of knee pain and not the causes of knee pain. Preventing knee injuries is not in the toolbox of the traditional practitioner. This research was done to show that we must reduce the inflammation (holistically), reduce the swelling and regain flexibility before considering any type of exercise. This method of performing the correct exercise stops the bowing of the knee, corrects the walking gait, and starts to relieve knee, hip, back, and shoulder pain. Method: The holistic method that is used to heal knees is called the Knee Pain Recipe. It’s a six step system that only uses alternative medicine methods to reduce, relieve and restore knee joint mobility. The system is low cost, with no hospital bills, no physical therapy, and no painkillers that can cause damage to the kidneys and liver. This method has been tested on 200 women with knee, back, hip, and shoulder pain. Results: All 200 women reduce their knee pain by 50%, some by as much as 90%. Learning about ankle and foot flexibility, along with understanding the kinetic chain, helps improve the walking gait, which takes the pressure off the knee, hip and back. The knee pain recipe also has helped to reduce the need for a cortisone injection, stem cell procedures, to take painkillers, and surgeries. What has also been noted in the research was that if the women's knees were too far gone, the Knee Pain Recipe helped prepare the women for knee replacement surgery. Conclusion: It is believed that the Knee Pain Recipe, when performed by men and women from around the world, will give them a holistic alternative to drugs, injections, and surgeries.

Keywords: knee, surgery, healing, holistic

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Authors: Stephanie P. Nigro

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The Exhale Breath Hold (EBH) technique presents a promising approach to enhance the precision and efficacy of External Beam Radiation Therapy (EBRT) for abdominal tumours, which include liver, pancreas, kidney, and adrenal glands. These tumours are challenging to treat due to their proximity to organs at risk (OARs) and the significant motion induced by respiration and physiological variations, such as stomach filling. Respiratory motion can cause up to 40mm of displacement in abdominal organs, complicating accurate targeting. While current practices like limiting fasting help reduce motion related to digestive processes, they do not address respiratory motion. 4DCT scans are used to assess this motion, but they require extensive workflow time and expose patients to higher doses of radiation. The EBH technique, which involves holding the breath in an exhale with no air in the lungs, stabilizes internal organ motion, thereby reducing respiratory-induced motion. The primary benefit of EBH is the reduction in treatment volume sizes, specifically the Internal Target Volume (ITV) and Planning Target Volume (PTV), as demonstrated by smaller ITVs when gated in EBH. This reduction also improves the quality of 3D Cone Beam CT (CBCT) images by minimizing respiratory artifacts, facilitating soft tissue matching akin to stereotactic treatments. Patients suitable for EBH must meet criteria including the ability to hold their breath for at least 15 seconds and maintain a consistent breathing pattern. For those who do not qualify, the traditional 4DCT protocol will be used. The implementation involves an EBH planning scan and additional short EBH scans to ensure reproducibility and assist in contouring and volume expansions, with a Free Breathing (FB) scan used for setup purposes. Treatment planning on EBH scans leads to smaller PTVs, though intrafractional and interfractional breath hold variations must be accounted for in margins. The treatment decision process includes performing CBCT in EBH intervals, with careful matching and adjustment based on soft tissue and fiducial markers. Initial studies at two sites will evaluate the necessity of multiple CBCTs, assessing shifts and the benefits of initial versus mid-treatment CBCT. Considerations for successful implementation include thorough patient coaching, staff training, and verification of breath holds, despite potential disadvantages such as longer treatment times and patient exhaustion. Overall, the EBH technique offers significant improvements in the accuracy and quality of abdominal EBRT, paving the way for more effective and safer treatments for patients.

Keywords: abdominal cancers, exhale breath hold, radiation therapy, respiratory motion

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Authors: Aran Abd Al Rahman

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Joubert syndrome regards as a congenital cerebellar ataxia caused by autosomal recessive carried on X chromosome. The disease diagnosed by brain imaging—the so-called molar tooth sign. Neurological signs were present from the neonatal period and include hypotonia progressing to ataxia, global developmental delay, ocular motor apraxia, and breathing dysregulation. These signs are variably associated with multiorgan involvement, mainly of the retina, kidneys, skeleton, and liver. 30 causative genes have been identified so far, all of which encode for proteins of the primary cilium or its apparatus, The purpose of our project was to detect the mutant gene (INPP5E gene) which cause Joubert syndrome. There were many methods used for diagnosis such as MRI and CT- scan and molecular diagnosis by doing ARMS PCR for detection of mutant gene that we were used in this research project. In this research for individual family which reported, the two children with parents, the two children were affected and were carrier.

Keywords: Joubert syndrome, genetic disease, Kurdistan region, Sulaimani

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Authors: Amós García Montaño

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In a democracy, a public policy must be developed within the regulatory framework and considering citizen participation in its planning, design, execution, and evaluation stages, necessary factors to have both legal support and sufficient legitimacy for its operation. However, the complexity and magnitude of certain public problems results in difficulties for the generation of consensus among society members, leading to unstable and unsuccessful scenarios for the exercise of the right to citizen participation and the generation of effective and efficient public policies. This is the case of public policies against corruption, an issue that in Mexico is difficult to define and generates conflicting opinions. To provide a possible solution to this delicate reality, this paper analyzes the principle of reasonableness as a tool for identifying the basic elements that guarantee a fundamental level of the exercise of the right to citizen participation in the fight against corruption, adopting elements of human rights indicator methodologies. In this sense, the relevance of having a legal framework that establishes obligations to incorporate proactive and transversal citizen participation in the matter is observed. It is also noted the need to monitor the operation of various citizen participation mechanisms in the decision-making processes of the institutions involved in the fight and prevention of corruption, which lead to an increase in the improvement of the perception of the citizen role as a relevant actor in this field. It is concluded that the principle of reasonableness is presented as a very useful tool for the identification of basic elements that facilitate the fulfillment of human rights commitments in the field of public policies.

Keywords: anticorruption, public participation, public policies, reasonableness

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Authors: Maya de Vries Kedem, Abir Jubran, Diana Baron

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Employment in Israel offers Palestinian workers an income double what they can earn in the West Bank. The need to support their families leads many educated Palestinians to forgo finding work in their profession in the Palestinian Authority and instead look for employment in those sectors open to them in Israel, particularly the construction, agriculture, and industry sectors. The International Labor Organization estimated that about 1,200 workers in Israel die every year because of occupational diseases (diseases caused by working conditions). Construction workers in Israel are constantly exposed to dust, noise, chemical materials, and work in awkward postures, which require prolonged bending, repetitive motion, and other risk factors that can lead to illnesses and death. Occupational health is vastly neglected in Israel and construction workers are particularly at risk . As of June 2022, the Israeli quota in the construction sector for Palestinian workers stood at 80,000. Kav LaOved released a new study on the state of occupational health among Palestinian workers employed in construction in Israel. The study Roadmap to Health: Palestinian Workers in Israel's Construction Sector reviews the extent to which the health of Palestinian workers is protected at work in Israel. The report includes analysis of a survey administered to 256 workers as well as interviews with 10 workers and with 5 Israeli occupational health experts. Report highlights: • Among survey respondents, 63.9% stated that safety procedures to protect their health are rarely followed in their workplace (e.g., taking breaks, using protective gear, following restrictions on lifting heavy items, and having inspectors regularly on site to monitor safety). • All 256 Palestinian workers who participated to the survey said that their health has been directly or indirectly harmed by working in Israel and reported suffering from the following problems: orthopedic problems such as joint, hand, leg or knee problems (100%); headaches (75%); back problems (36.3%); eye problems (23.8%); breathing problems (17.6%); chronic pain (14.8%); heart problems (7.8%); and skin problems (3.5%). • Workers who are injured or do not feel well often continue working for fear of losing their payment for that day. About half of the 256 survey respondents reported that they pay brokerage fees to find an employer with a work permit, often paying between 2,000 and 3,000 NIS per month. “I have an obligation—I pay about NIS 120 a day for my permit, [and] I have to pay for it whether I work or not" a worker said. • Most Palestinian construction workers suffer from stress and mental health problems. Workers pointed to several issues that greatly affect their mood and mental state: daily crossings at crowded checkpoints where workers stand for hours; lack of sleep due to leaving home daily at 3:00-3:30 am; commuting two to four hours to work in each direction; and abusive work environments. A worker told KLO that the sight of thousands of workers standing together at the checkpoint causes “high blood pressure and the feeling that you are going to be squeezed.” Another said, “I felt that my bones would break.” In the survey workers reported suffering from insomnia (70.1%), breathing difficulties (35.8%), chest pressure (27.6%), or rapid pulse rate (12.2%).

Keywords: construction sector, palestinian workers, occupational health, Israel, occupation

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Authors: Seyyed Javad Ziaolhagh

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Background: The purpose of present study was to investigate, the effects of anabolic steroid Boldenone (BOL) with eight weeks of resistance training on structural changes in rat liver. Method: 21 Male adult Wistar rats, 12 weeks old and 228/53±7/94 g initial body weight were randomly assigned to three groups: group1: Control+ Placebo (C), group2: training+ Placebo (T), group3: Boldenone intramuscular injections 5mg/kg (B). The endurance training protocol consisted three exercise sessions weekly started by a 30-minute run with the speed of 12 m/min and lasted by 60min run with the speed of 30 m/min in 8 weeks. At the end of the experiment, for light microscopic study Slides were prepared. Results: Sections stained of rat's livers showed no any cell degeneration and cytoplasmic lipid vacuoles in all groups, but few samples were seen. Indeed, congested blood sinusoids, cell infiltration and degeneration were seen in the Boldenone-treated group. Hepatotoxic effects were severe in group treatment received 5 mg/kg and directly depended on the doses. Indeed, training group was no any hepatocyte degeneration, inflammation and congestion. Conclusion: The present results showed that BOL has a marked adverse effect on the liver tissue, even with low– dose and endurance training. As a result, athletes should aware of Boldenone dosage consumption.

Keywords: anabolic androgenic steroids, Boldenone, blood congestion, cellular inflammation, cellular degeneration, lipid vocuolations, endurance training

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Authors: Kei Okubo, Yosuke Kurihara, Takashi Kaburagi, Kajiro Watanabe

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Many of the ever-growing elderly population require exercise, such as running, for health management. One important element of a runner’s training is the choice of shoes for exercise; shoes are important because they provide the interface between the feet and road. When we purchase shoes, we may instinctively choose a pair after trying on many different pairs of shoes. Selecting the shoes instinctively may work, but it does not guarantee a suitable fit for running activities. Therefore, if we could select suitable shoes for each runner from the viewpoint of brain activities, it would be helpful for validating shoe selection. In this paper, we describe how brain activities show different characteristics during particular task, corresponding to different properties of shoes. Using five subjects, we performed a verification experiment, applying weight, softness, and flexibility as shoe properties. In order to affect the shoe property’s differences to the brain, subjects run for ten min. Before and after running, subjects conducted a paced auditory serial addition task (PASAT) as the particular task; and the subjects’ brain activities during the PASAT are evaluated based on oxyhemoglobin and deoxyhemoglobin relative concentration changes, measured by near-infrared spectroscopy (NIRS). When the brain works actively, oxihemoglobin and deoxyhemoglobin concentration drastically changes; therefore, we calculate the maximum values of concentration changes. In order to normalize relative concentration changes after running, the maximum value are divided by before running maximum value as evaluation parameters. The classification of the groups of shoes is expressed on a self-organizing map (SOM). As a result, deoxyhemoglobin can make clusters for two of the three types of shoes.

Keywords: brain activities, NIRS, PASAT, running shoes

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Authors: Elnaz Sabzehparvar, Pouya Rabiei, Houman Rezaei

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Few studies have been conducted about the effects of compound exercises emphasizing local stability and global stabilization subsystems on the performance of athletes. The present research aimed to study the effect of 6 weeks of compound exercises emphasizing local and global stability on the dynamic balance of elite male Taekwondo athletes. Twenty-seven elite male Taekwondo athletes (with a mean age, mass, and height of 24.4 ± 4.9 years, 75.7 ± 15.1kg, and 181.4 ± 7.8 cm, respectively) were assigned to two groups of control (n=12) and exercise (n=15). 6 weeks of compound exercises in 2 local and global phases. The first phase included activation exercises which were done separately and locally for 3 weeks. Then, integrative exercises specific to the global stabilization subsystems (longitudinal-depth, posterior oblique and anterior, and lateral) was carried out for next 3 weeks. The dynamic balance of subjects was measured in the pre-test and post-test using the Y Balance Test (YBT). After 6 weeks of compound exercises, scores of the YBT in the exercise group showed a significant improvement in all three anterior (p=0.035), posterolateral (p=0.017) and medial (p=0.001) directions in the post-test compared to the control group (p ≤ 0.05 for all comparisons). The findings of the present study suggested that compound exercises focusing on muscle as separate units and then as interdependent chains (muscular subsystems) can significantly increase YBT on elite male Taekwondo athletes in all three directions.

Keywords: Taekwondo, compound exercises, local and global stability, muscular subsystems

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Authors: Hanan H. ALQahtani, Karen Jones

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Catching a ball during sitting is a functional exercise commonly used in rehabilitation to enhance trunk muscle activity. To progress this exercise, physiotherapists incorporate a Swiss ball or change seat height. However, no study has assessed the effect of different seating surfaces on trunk muscle activity while catching a ball. Objective: To investigate the effect of catching a ball during sitting on a Swiss ball, a low seat and a high seat on trunk muscle activity. Method: A repeated-measures, counterbalanced design was used. A total of 26 healthy participants (15 female and 11 male) performed three repetitions of catching a ball on each seating surface. Using surface electromyography (sEMG), the activity of the bilateral transversus abdominis/internal oblique (TrA/IO), rectus abdominis (RA), erector spinae (ES) and lumbar multifidus (MF) was recorded. Trunk muscle activity was normalized using maximum voluntary isometric contraction and analyzed. Statistical significance was set at p ≤ .05. Results: No significant differences were observed in the activity of RA, TrA/IO, ES or MF between a low seat and a Swiss ball. However, the activity of the right and left ES on a low seat was significantly greater than on a high seat (p = .017 and p = .017, respectively). Conversely, the activity of the right and left RA on a high seat was significantly greater than on a low seat (p = .007 and p = .004, respectively). Conclusion: This study suggests that replacing a low seat with a Swiss ball while catching a ball is insufficient to increase trunk muscle activity, whereas changing the seat height could induce different trunk muscle activities. However, research conducted on patients is needed before translating these results into clinical settings.

Keywords: catching, electromyography, seating, trunk

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Authors: Chiung-Hua Chan, Fang-Yuan Chang, Li-Chi Huang

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Stroke patients received regular rehabilitation therapy have measurable advancement in muscle strength, balance, control upper and lower physical activity, walking speed and endurance. This study aimed to investigate the relationship between increases in bedside rehabilitation time and the function of activities and daily living (ADL) in stroke patients. The study was quasi-experimental research design and randomized sampling. The researcher collected 12 stroke patients of stroke patients transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. All participants then were assigned to case group and control group. Data collection was through direct observation of assessment ADL of stroke patients by researchers on Day 1. Case group received regular rehabilitation, exercises in increase of bedside rehabilitation schedules exercise programs by ward nurses. Bedside rehabilitation exercise content with physical, functional and linguistic frequency and time, Control group only give routine rehabilitation schedule care. This was a randomized study performed in 12 patients who were stroke patients and transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. First, the researcher explained the purpose and method of the study to the patients or the family members. All participants completed a consent informed before participation. Patients were randomly assigned to a ‘bedside rehabilitation program’ (BRP) group and a control (C) group. The BRP group received bedside rehabilitation schedules exercise programs by ward nurses. while the C group did not. Both groups received routine rehabilitation schedule. The Functional Independence Measure was used to measure outcome at the first, 14th and the 28th day of rehabilitation ward admitted. Data were analyzed using SPSS 22.0. After implementation of standardized ‘‘bedside rehabilitation program’, the results were: (1) the increasing of bedside rehabilitation had significant difference (p<.05) in promotion ADL function of stroke patients (2) the extend time of the bedside rehabilitation has significant difference (p<.05) in promotion ADL function of stroke patients compared with the control group. This study demonstrated that the ‘bedside rehabilitation program’ enhanced the ADL function in stroke patients. The nurses and rehabilitation ward managers need to understand that the extend time and frequency of rehabilitation provide a chance to enhanced the ADL function of stroke patients.

Keywords: stroke, bedside rehabilitation, functional activity, ADL

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Authors: B. X. Tchomeni, A. A. Alugongo, T. B. Tengen

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In this paper, de Laval rotor system has been characterized by a hinge model and its transient response numerically treated for a dynamic solution. The effect of the ensuing non-linear disturbances namely rub and breathing crack is numerically simulated. Subsequently, three analysis methods: Orbit Analysis, Fast Fourier Transform (FFT) and Wavelet Transform (WT) are employed to extract features of the vibration signal of the faulty system. An analysis of the system response orbits clearly indicates the perturbations due to the rotor-to-stator contact. The sensitivities of WT to the variation in system speed have been investigated by Continuous Wavelet Transform (CWT). The analysis reveals that features of crack, rubs and unbalance in vibration response can be useful for condition monitoring. WT reveals its ability to detect non-linear signal, and obtained results provide a useful tool method for detecting machinery faults.

Keywords: Continuous wavelet, crack, discrete wavelet, high acceleration, low acceleration, nonlinear, rotor-stator, rub

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Authors: Reham H. Diab, Amira A. A. Abdallah, Eman A. Embaby

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Background: The effectiveness of bracing on preventing spino-pelvic alignment deterioration in idiopathic scoliosis has been extensively studied especially in the frontal plane. Yet, there is lack of knowledge regarding the effect of soft braces on spino-pelvic alignment in the sagittal plane. Achieving harmonious sagittal plane spino-pelvic balance is critical for the preservation of physiologic posture and spinal health. Purpose: This study examined the kyphotic angle, lordotic angle and pelvic inclination in the sagittal plane and trunk imbalance in the frontal plane before and after a six-month rehabilitation period. Methods: Nineteen patients with idiopathic scoliosis participated in the study. They were divided into two groups; experimental and control. The experimental group (group I) used the SpineCor brace in addition to a rehabilitation exercise program while the control group (group II) had the exercise program only. The mean ±SD age, weight and height were 16.89±2.15 vs. 15.3±2.5 years; 59.78±6.85 vs. 62.5±8.33 Kg and 162.78±5.76 vs. 159±5.72 cm for group I vs. group II. Data were collected using for metric Π system. Results: Mixed design MANOVA showed that there were significant (p < 0.05) decreases in all the tested variables after the six-month period compared with “before” in both groups. Moreover, there was a significant decrease in the kyphotic angle in group I compared with group II after the six-month period. Interpretation and conclusion: SpineCor brace is beneficial in reducing spino-pelvic alignment deterioration in both sagittal and frontal planes.

Keywords: adolescent idiopathic scoliosis, SpineCor, spino-pelvic alignment, biomechanics

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Authors: Kasbparast Mehdi, Hassani Zainab

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Aim: The purpose of this research was to investigate the effectiveness of therapeutical sensorimotor exercise. The statistical population of women who were diagnosed with patellofemoral pain syndrome by a doctor and were between the ages of 35 and 45 and registered for the first time in a sports club in the 4th district of Tehran, 30 people by random sampling and according to The include and exclude criteria were selected and divided into 2 equal control and experimental and homogeneous groups (in terms of height, weight and BMI).In both control and experimental groups, the pain was measured using a Visual Analog Scale(VAS) functionality was measured using the step-down test and quality of life was measured using a World Health Organization Quality of Life Scale (WHOQOL-BREF) (pre-test). Then, only the experimental group performed sensorimotor exercises for 12 weeks and 3 sessions each week, a total of 24 sessions and each session for 1 hour, and during this period, the control group only continued their daily activities. After the end of the training period, the desired factors were evaluated again (post-test) in the same way as the pre-test was done for them (experimental group and control group), with the same quality. Findings: The statistical results showed that in the experimental group, the amount of pain, function and quality of life had a statistical improvement (P≤0.05). Conclusion: In general conclusion, it can be stated that using sensorimotor exercises not only improved functionality and quality of life but also reduced the amount of pain in people with patellofemoral pain syndrome.

Keywords: pain, PFPS, sensori motor training, functionality

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Authors: Trevor R. Higgins

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The aim of this study was to compare muscle activation of the latissimus dorsi between pin-loaded machine (Lat Pull Down), resistance band (Lat Pull Down) and body-weight (Chin Up) exercises. A convenient sample of male college students with >2 years resistance training experience volunteered for the study. A paired t-test with repeated measures designs was carried out on results from EMG analysis. EMG analysis was conducted with Trigno wireless sensors (Delsys) placed laterally on the latissimus dorsi (left and right) of each participant. By conventional criteria the two-tailed P value suggested that differences between pin-loaded and body-weight was not significantly different (p = 0.93) and differences between pin-loaded and resistance band was not significantly different (p = 0.17) in muscle activity. In relation to conventional criteria the two-tailed P value suggested differences between body-weight and resistance band was not quite significantly different (p = 0.06) in muscle activity. However, effect size trends indicated that both body-weight and pin-loaded exercises where more effective in stimulating muscle electrical activity than a resistance band with male college athletes with >2 years resistance training experience. Although, resistance bands have increased in popularity in health and fitness centres, that for well-trained participants, they may not be effective in stimulating muscles of the latissimus dorsi. Therefore, when considering equipment and exercise selection for experienced resistance training participants pin-loaded machines and body-weight should be prescribed.

Keywords: pin-loaded, resistance bands, body weight, EMG analysis

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Authors: Y. H. Chen, P. Y. Chiang, T. Sugiarto, I. Karsuna, Y. J. Lin, C. C. Chang, W. C. Hsu

Abstract:

Task-specific training with intense practice of functional tasks has been emphasized for the approaches in motor rehabilitation in patients with hemiplegic strokes. Although reciprocal actions which may increase demands on motor control during seated stepping exercise, motor control is not explicitly trained with emphasis and instruction focused on traditional strengthening. Apart from cycling and treadmill, various forms of seated exerciser are becoming available for the lower extremity exercise. The benefit of seated exerciser has been focused on the effect on the cardiopulmonary system. Thus, the aim of current study is to investigate the effect of seated distance on muscle activation during seated strengthening in patients with stroke with extensor synergy pattern in the lower extremities. Electrodes were placed on the surface of lower limbs muscles, including rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF) and gastrocnemius (GT) of both sides. Maximal voluntary contraction (MVC) of the muscles were obtained to normalize the EMG amplitude obtained during dynamic trials with analog raw data digitized with a sampling frequency of 2000 Hz, fully rectified and the linear enveloped. Movement cycle was separated into two phases by pushing (PP) and Return (RP). Integral EMG (iEMG) is then used to quantify level of activation during each of the phases. Subjects performed strengthening with moderate resistance with speed of 60 rpm in two different distances (D1, short) and (D2, long). The results showed greater iEMG in RF and smaller iEMG in VL and BF with obvious increase range of motion of hip flexion in D1 condition. On the contrary, no significant involvement of RF while greater level of muscular activation in VL and BF during RP was found during PP in D2 condition. In addition, greater hip internal rotation was observed in D2 condition. In patients with stroke with abnormal tone revealed by extensor synergy in the lower extremities, shorter seated distance is suggested to facilitate hip flexor muscle activation while avoid inducing hyper extensor tone which may prevent a smooth repetitive motion. Repetitive muscular contraction exercise of hip flexor may be helpful for further gait training as it may assist hip flexion during swing phase of the walking.

Keywords: seated strengthening, patients with stroke, electromyography, synergy pattern

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Authors: P. J. Sweeney, T. Ahtoniemi, J. Puoliväli, T. Laitinen, K.Lehtimäki, A. Nurmi, D. Wells

Abstract:

Duchenne muscular dystrophy (DMD) is an X-linked, lethal muscle wasting disease for which there are currently no treatment that effectively prevents the muscle necrosis and progressive muscle loss. DMD is among the most common of inherited diseases affecting around 1/3500 live male births. MDX (X-linked muscular dystrophy) mice only partially encapsulate the disease in humans and display weakness in muscles, muscle damage and edema during a period deemed the “critical period” when these mice go through cycles of muscular degeneration and regeneration. Although the MDX mutant mouse model has been extensively studied as a model for DMD, to-date an extensive temporal, non-invasive imaging profile that utilizes magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (1H-MRS) has not been performed.. In addition, longitudinal imaging characterization has not coincided with attempts to exacerbate the progressive muscle damage by exercise. In this study we employed an 11.7 T small animal MRI in order to characterize the MRI and MRS profile of MDX mice longitudinally during a 12 month period during which MDX mice were subjected to exercise. Male mutant MDX mice (n=15) and male wild-type mice (n=15) were subjected to a chronic exercise regime of treadmill walking (30 min/ session) bi-weekly over the whole 12 month follow-up period. Mouse gastrocnemius and tibialis anterior muscles were profiled with baseline T2-MRI and 1H-MRS at 6 weeks of age. Imaging and spectroscopy was repeated again at 3 months, 6 months, 9 months and 12 months of age. Plasma creatine kinase (CK) level measurements were coincided with time-points for T2-MRI and 1H-MRS, but also after the “critical period” at 10 weeks of age. The results obtained from this study indicate that chronic exercise extends dystrophic phenotype of MDX mice as evidenced by T2-MRI and1H-MRS. T2-MRI revealed extent and location of the muscle damage in gastrocnemius and tibialis anterior muscles as hyperintensities (lesions and edema) in exercised MDX mice over follow-up period.. The magnitude of the muscle damage remained stable over time in exercised mice. No evident fat infiltration or cumulation to the muscle tissues was seen at any time-point in exercised MDX mice. Creatine, choline and taurine levels evaluated by 1H-MRS from the same muscles were found significantly decreased in each time-point, Extramyocellular (EMCL) and intramyocellular lipids (IMCL) did not change in exercised mice supporting the findings from anatomical T2-MRI scans for fat content. Creatine kinase levels were found to be significantly higher in exercised MDX mice during the follow-up period and importantly CK levels remained stable over the whole follow-up period. Taken together, we have described here longitudinal prophile for muscle damage and muscle metabolic changes in MDX mice subjected to chronic exercised. The extent of the muscle damage by T2-MRI was found to be stable through the follow-up period in muscles examined. In addition, metabolic profile, especially creatine, choline and taurine levels in muscles, was found to be sustained between time-points. The anatomical muscle damage evaluated by T2-MRI was supported by plasma CK levels which remained stable over the follow-up period. These findings show that non-invasive imaging and spectroscopy can be used effectively to evaluate chronic muscle pathology. These techniques can be also used to evaluate the effect of various manipulations, like here exercise, on the phenotype of the mice. Many of the findings we present here are translatable to clinical disease, such as decreased creatine, choline and taurine levels in muscles. Imaging by T2-MRI and 1H-MRS also revealed that fat content or extramyocellar and intramyocellular lipids, respectively, are not changed in MDX mice, which is in contrast to clinical manifestation of the Duchenne’s muscle dystrophy. Findings show that non-invasive imaging can be used to characterize the phenotype of a MDX model and its translatability to clinical disease, and to study events that have traditionally been not examined, like here rigorous exercise related sustained muscle damage after the “critical period”. The ability for this model to display sustained damage beyond the spontaneous “critical period“ and in turn to study drug effects on this extended phenotype will increase the value of the MDX mouse model as a tool to study therapies and treatments aimed at DMD and associated diseases.

Keywords: 1H-MRS, MRI, muscular dystrophy, mouse model

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