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Journal of Cachexia, Sarcopenia and... Feb 2023Muscle ultrasound is an emerging tool for diagnosing sarcopenia. This review aims to summarize the current knowledge on the diagnostic test accuracy of ultrasound for... (Meta-Analysis)
Meta-Analysis Review
Muscle ultrasound is an emerging tool for diagnosing sarcopenia. This review aims to summarize the current knowledge on the diagnostic test accuracy of ultrasound for the diagnosis of sarcopenia. We collected data from Ovid Medline, Embase and the Cochrane Central Register of Controlled Trials. Diagnostic test accuracy studies using muscle ultrasound to detect sarcopenia were included. Bivariate random-effects models based on sensitivity and specificity pairs were used to calculate the pooled estimates of sensitivity, specificity and the area under the curves (AUCs) of summary receiver operating characteristic (SROC), if possible. We screened 7332 publications and included 17 studies with 2143 participants (mean age range: 52.6-82.8 years). All included studies had a high risk of bias. The study populations, reference standards and ultrasound measurement methods varied across the studies. Lower extremity muscles were commonly studied, whereas muscle thickness (MT) was the most widely measured parameter, followed by the cross-sectional area (CSA). The MTs of the gastrocnemius, rectus femoris, tibialis anterior, soleus, rectus abdominis and geniohyoid muscles showed a moderate diagnostic accuracy for sarcopenia (SROC-AUC 0.83, 8 studies; SROC-AUC 0.78, 5 studies; AUC 0.82, 1 study; AUC 0.76-0.78, 2 studies; AUC 0.76, 1 study; and AUC 0.79, 1 study, respectively), whereas the MTs of vastus intermedius, quadriceps femoris and transversus abdominis muscles showed a low diagnostic accuracy (AUC 0.67-0.71, 3 studies; SROC-AUC 0.64, 4 studies; and AUC 0.68, 1 study, respectively). The CSA of rectus femoris, biceps brachii muscles and gastrocnemius fascicle length also showed a moderate diagnostic accuracy (AUC 0.70-0.90, 3 studies; 0.81, 1 study; and 0.78-0.80, 1 study, respectively), whereas the echo intensity (EI) of rectus femoris, vastus intermedius, quadriceps femoris and biceps brachii muscles showed a low diagnostic accuracy (AUC 0.52-0.67, 2 studies; 0.48-0.50, 1 study; 0.43-0.49, 1 study; and 0.69, 1 study, respectively). The combination of CSA and EI of biceps brachii or rectus femoris muscles was better than either CSA or EI alone for diagnosing sarcopenia. Muscle ultrasound shows a low-to-moderate diagnostic test accuracy for sarcopenia diagnosis depending on different ultrasound parameters, measured muscles, reference standards and study populations. The combination of muscle quality indicators (e.g., EI) and muscle quantity indicators (e.g., MT) might provide better diagnostic test accuracy.
Topics: Humans; Middle Aged; Aged; Aged, 80 and over; Sarcopenia; Quadriceps Muscle; Ultrasonography; Rectus Abdominis; Diagnostic Tests, Routine
PubMed: 36513380
DOI: 10.1002/jcsm.13149 -
International Journal of Environmental... Jun 2020The aim of this study was to systematically review the current literature on the electromyographic (EMG) activity of six core muscles (the rectus abdominis, the internal...
The aim of this study was to systematically review the current literature on the electromyographic (EMG) activity of six core muscles (the rectus abdominis, the internal and external oblique, the transversus abdominis, the lumbar multifidus, and the erector spinae) during core physical fitness exercises in healthy adults. A systematic review of the literature was conducted on the Cochrane, EBSCO, PubMed, Scopus, and Web of Science electronic databases for studies from January 2012 to March 2020. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. The inclusion criteria were as follows: a) the full text available in English; b) a cross-sectional or longitudinal (experimental or cohorts) study design; c) the reporting of electromyographic activity as a percentage of maximum voluntary contraction (% MVIC), millivolts or microvolts; d) an analysis of the rectus abdominis (RA), transversus abdominis (TA), lumbar multifidus (MUL), erector spinae (ES), and the internal (IO) or external oblique (EO); e) an analysis of physical fitness exercises for core training; and f) healthy adult participants. The main findings indicate that the greatest activity of the RA, EO, and ES muscles was found in free-weight exercises. The greatest IO activity was observed in core stability exercises, while traditional exercises showed the greatest MUL activation. However, a lack of research regarding TA activation during core physical fitness exercises was revealed, in addition to a lack of consistency between the studies when applying methods to measure EMG activity.
Topics: Cross-Sectional Studies; Electromyography; Exercise; Exercise Therapy; Humans; Muscle, Skeletal; Physical Fitness
PubMed: 32560185
DOI: 10.3390/ijerph17124306 -
Brazilian Journal of Physical Therapy 2021Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period.
OBJECTIVE
To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum.
METHODS
Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI).
RESULTS
Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA.
CONCLUSION
There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.
Topics: Diastasis, Muscle; Exercise Therapy; Female; Humans; Pelvic Floor; Postpartum Period; Randomized Controlled Trials as Topic; Rectus Abdominis
PubMed: 34391661
DOI: 10.1016/j.bjpt.2021.06.006 -
Journal of Physiotherapy Jul 2023What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with... (Randomized Controlled Trial)
Randomized Controlled Trial
Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial.
QUESTION
What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with diastasis recti abdominis (DRA) 6 to 12 months postpartum? What is the effect of the program on: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain?
DESIGN
This was a two-arm, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
PARTICIPANTS
Seventy primiparous or multiparous women 6 to 12 months postpartum, having a single or multiple pregnancy following any mode of delivery, with a diagnosis of DRA (IRD > 28 mm at rest or > 25 mm during a curl-up).
INTERVENTION
The experimental group was prescribed a 12-week standardised exercise program including head lifts, abdominal curl-ups and twisted abdominal curl-ups 5 days a week. The control group received no intervention.
OUTCOME MEASURES
The primary outcome measure was change in IRD measured with ultrasonography. Secondary outcomes were: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain.
RESULTS
The exercise program did not improve or worsen IRD (eg, MD 1 mm at rest 2 cm above the umbilicus, 95% CI -1 to 4). The program improved rectus abdominis thickness (MD 0.7 mm, 95% CI 0.1 to 1.3) and strength (MD 9 Nm, 95% CI 3 to 16) at 10 deg; its effects on other secondary outcomes were trivial or unclear.
CONCLUSION
An exercise program containing curl-ups for women with DRA did not worsen IRD or change the severity of pelvic floor disorders or low back, pelvic girdle or abdominal pain, but it did increase abdominal muscle strength and thickness.
REGISTRATION
NCT04122924.
Topics: Pregnancy; Female; Humans; Rectus Abdominis; Pelvic Floor Disorders; Abdominal Muscles; Postpartum Period; Exercise Therapy; Diastasis, Muscle; Abdominal Pain
PubMed: 37286390
DOI: 10.1016/j.jphys.2023.05.017 -
The British Journal of Surgery Oct 2021The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been...
BACKGROUND
The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD.
METHOD
The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated.
RESULTS
Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias.
CONCLUSION
RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.
Topics: Hernia, Umbilical; Hernia, Ventral; Herniorrhaphy; Humans; Physical Therapy Modalities; Postoperative Care; Rectus Abdominis; Surgical Mesh
PubMed: 34595502
DOI: 10.1093/bjs/znab128 -
Journal of Sport Rehabilitation Nov 2020People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently... (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT
People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently developed to treat this condition.
OBJECTIVES
The present study was conducted to investigate the effect of IMT on core muscle activity, pulmonary parameters, and pain intensity in athletes with CLBP.
DESIGN
This study was designed as a single-blind, randomized, controlled trial.
SETTING
Clinical rehabilitation laboratory.
PARTICIPANTS
A total of 23 male and 24 female athletes with CLBP were randomly divided into the experimental and control groups.
MAIN OUTCOME MEASURES
The experimental group performed IMT for 8 weeks, 7 days per week and twice daily, using POWERbreathe KH1, beginning at 50% of maximum inspiratory pressure with a progressively increasing training load. The surface electromyography muscle activity of the erector spinae, multifidus, transverse abdominis and rectus abdominis, respiratory function and Visual Analogue Scale score were also measured before and after the intervention in both groups. The repeated-measures analysis of variance and 1-way analysis of covariance were further used to compare the intragroup and intergroup results following the intervention.
RESULTS
The findings of the study revealed that multifidus and transverse abdominis activity, as well as respiratory function, increased significantly in the IMT group (P < .05). Moreover, a descending trend was observed in the Visual Analogue Scale score in the experimental group (P < .05).
CONCLUSION
The results showed that IMT can improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with CLBP.
Topics: Athletes; Breathing Exercises; Electromyography; Female; Humans; Low Back Pain; Male; Muscle, Skeletal; Pain Measurement; Single-Blind Method; Young Adult
PubMed: 31910393
DOI: 10.1123/jsr.2019-0231 -
Medicina (Kaunas, Lithuania) Jul 2021: Prior studies have reported an activation of abdominal muscles during hypopressive exercises in women with pelvic floor disfunction. However, no previous research...
: Prior studies have reported an activation of abdominal muscles during hypopressive exercises in women with pelvic floor disfunction. However, no previous research analyzed the effects of hypopressive exercise on abdominal muscles in healthy populations to understand the normal biomechanics of this area. The aim of this study was to examine the thickness of abdominal muscles at rest and during hypopressive exercise in supine and standing positions with ultrasound imaging in healthy adults. : A cross-sectional study was carried out in 99 healthy university students. The thickness of the abdominal muscles at rest and during hypopressive exercise was assessed with ultrasound imaging in supine and standing positions. : During hypopressive exercise, there was a significant increase in the muscle thickness of transversus abdominis ( < 0.001) and internal oblique ( < 0.001) in supine and standing positions. External oblique only increased its thickness significantly in the standing position ( < 0.001) and rectus abdominis did not change during the hypopressive exercise in any position ( > 0.05). In conclusion, hypopressive exercises seem to increase the thickness of the deepest and most stabilized muscles such as transversus abdominis and internal oblique. : These findings should be considered for future interventions with hypopressive exercises in healthy subjects.
Topics: Abdominal Muscles; Abdominal Oblique Muscles; Adult; Cross-Sectional Studies; Exercise; Female; Humans; Ultrasonography
PubMed: 34356983
DOI: 10.3390/medicina57070702 -
Hernia : the Journal of Hernias and... Aug 2021Diastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but... (Review)
Review
PURPOSE
Diastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but with no fascia defect. To data there is no consensus about risk factors for DRA. The aim of this article is to critically review the literature about prevalence and risk factor of DRA.
METHOD
A total of 13 papers were identified.
RESULTS
The real prevalence of DRA is unknown because the prevalence rate varies with measurement method, measurement site and judgment criteria, but it is certainly an extremely frequent condition. Numbers of parity, BMI, diabetes are the most plausible risk factors. We identified a new anatomical variation in cadaveric dissection and in abdominal CT image evaluation: along the semilunar line the internal oblique aponeurosis could join the rectus sheath with only a posterior layer, so without a double layer (anterior and posterior) as usually described. We conducted a retrospective review of abdominal CT images and the presence of the posterior insertion only could be considered as a risk factor for DRA.
CONCLUSION
Further studies with large sample size, including nulliparous, primiparous, pluriparous and men too, are necessary for identify the real prevalence.
Topics: Female; Herniorrhaphy; Humans; Male; Pregnancy; Prevalence; Rectus Abdominis; Retrospective Studies; Risk Factors
PubMed: 34363190
DOI: 10.1007/s10029-021-02468-8 -
Scandinavian Journal of Surgery : SJS :... Sep 2021Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis...
BACKGROUND
Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike.
METHODS
The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience.
RESULTS
The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior.
DISCUSSION
The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
Topics: Abdominal Core; Abdominal Wall; Female; Hernia, Ventral; Humans; Pregnancy; Rectus Abdominis; Sweden
PubMed: 32988320
DOI: 10.1177/1457496920961000