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Use of a Cybex NORM dynamometer to assess muscle function in patients with thoracic cancer

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      BackgroundThe cachexia-anorexia syndrome impacts on patients' physical independence and quality of life. New treatments are required and need to be evaluated using acceptable and reliable outcome measures, e.g. the assessment of muscle function. The aims of this study were to: (i) examine the acceptability and reliability of the Cybex NORM dynamometer to assess muscle function in people with non-small cell lung cancer or mesothelioma; (ii) compare muscle function in this group with healthy volunteers and; (iii) explore changes in muscle function over one month.MethodsThe test consisted of 25 repetitions of isokinetic knee flexion and extension at maximal effort while seated on a Cybex NORM dynamometer. Strength and endurance for the quadriceps and hamstrings were assessed as peak torque and total work and an endurance ratio respectively. Thirteen patients and 26 volunteers completed the test on three separate visits. Acceptability was assessed by questionnaire, reliability by intraclass correlation coefficients (ICC) and tests of difference compared outcomes between and within groups.ResultsAll subjects found the test acceptable. Peak torque and work done were reliable measures (ICC >0.80), but the endurance ratio was not. Muscle function did not differ significantly between the patient and a matched volunteer group or in either group when repeated after one month.ConclusionFor patients with non-small cell lung cancer or mesothelioma, the Cybex NORM dynamometer provides an acceptable and reliable method of assessing muscle strength and work done. Muscle function appears to be relatively well preserved in this group and it appears feasible to explore interventions which aim to maintain or even improve this.

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      Most cited references 23

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        Isokinetic evaluation of muscular performance: implications for muscle testing and rehabilitation.

         P Kannus (1993)
        Interfacing of microprocessors with isokinetic dynamometers has enabled the rapid quantification of many parameters of muscle function including peak torque, angle-specific torque, work, power, torque acceleration energy, and various endurance indexes, and the measurements with these devices can be made isometrically at various angular positions and isokinetically (concentrically or eccentrically) with a large scale of angular speeds. Many of these parameters, however, lack evidence of validity, reproducibility, and/or clinical relevance. Peak torque has been and still is the most properly studied isokinetic strength testing parameter and its use can be recommended for research and clinical purposes. Concerning testing of muscular endurance, the absolute endurance parameters (for example, work performed during the last five repetitions and total work in a 25-repetition test with a speed of 240 degrees/s) are the best for use. Many internal and external factors in the isokinetic testing procedure can have an undesirable effect on the test result. However, through proper education and strict adherence to the test instructions, it is possible to successfully control the confounding variables. In scientific work, isokinetic devices have greatly expanded the possibilities for studying dynamic muscle function. There is also little doubt about their usefulness in documenting the progress of muscular rehabilitation. A disadvantage of isokinetic devices is that isokinetic movement seldom occurs in actual human performance tasks and that the isokinetic training effect is, therefore, quite (although not completely) specific to that type of movement. In addition, being normally an isolated joint exercise, isokinetic training can produce large loads on the involved joints and may, therefore, under certain conditions be dangerous for healing tissues.
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          Prevention and treatment of cancer cachexia: new insights into an old problem.

          Cancer cachexia (CC) is a multifactorial paraneoplastic syndrome characterized by anorexia, body weight loss, loss of adipose tissue and skeletal muscle, accounting for at least 20% of deaths in neoplastic patients. CC significantly impairs quality of life and response to anti-neoplastic therapies, increasing morbidity and mortality of cancer patients. Muscle wasting is the most important phenotypic feature of CC and the principal cause of function impairment, fatigue and respiratory complications, mainly related to a hyperactivation of muscle proteolytic pathways. Most therapeutic strategies to CC have proven to be only partially effective . The inhibition of catabolic processes in muscle has been attempted pharmacologically with encouraging results in animal models. However, data in the clinical setting are still scanty and contradictory. Stimulation of muscle anabolism could represent a promising and valid therapeutic alternative for cancer-related muscle wasting. This goal may be currently achieved with the conventional, short-acting and adverse side effect-rich anabolic steroids. Insulin-like growth factor-1 (IGF-1) plays a critical role in muscle homeostasis, hypertrophy and regeneration. IGF-1 overexpression at the muscular level by gene therapy reverses muscle hypotrophy secondary to catabolic conditions and induces muscle hypertrophy increasing muscle mass and strength. This allows the speculation that this approach could also prove effective in modulating cancer-induced muscle wasting, while avoiding the potentially hazardous side effects of systemic IGF-1 administration. The present review will focus on the potential biochemical and molecular targets of CC therapy, and will define the rationale for a novel, gene therapy-based approach.

            Author and article information

            [1 ]Hayward House Macmillan Specialist Palliative Cancer Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
            [2 ]Division of Physiotherapy Education, University of Nottingham, Nottingham, UK
            BMC Palliat Care
            BMC Palliative Care
            BioMed Central
            10 April 2008
            : 7
            : 3
            Copyright © 2008 Wilcock et al; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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