Exercise studies in neuromuscular diseases like spinal muscular atrophy (SMA), a devastating disease caused by survival of motor neuron 1 (SMN1) gene mutations, are drawing attention due to its beneficial effects. In this study, we presented a constructed arm cycling exercise protocol and evaluated the benefits on SMA patients. Five SMA type II patients performed 12 weeks of supervised arm cycling exercise. The physical functions were evaluated together with the SMN2 copy numbers, SMN protein levels, insulin-like growth factor 1(IGF1) and binding protein 3 (IGFBP3) levels. The active cycling distance and duration of patients significantly improved. Significant changes could not have detected either SMN or IGF1 and IGFBP3 levels in response to exercise. The findings demonstrated that the patients tolerated the exercise protocol and gained a benefit from arm cycling but benefits could not be associated with SMN2 copy number, SMN protein level, IGF1, or IGFBP3 levels.

Objective: Prevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated.Design: Chart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture.Results: Two hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side,P= 0.021), quadriceps strength (right side,P= 0.025), and shoulder abduction strength (right, left, and fracture side;P= 0.028,P= 0.027, andP= 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25⁰vs. −7.29⁰,P= 0.004; 2.67⁰vs. −12⁰,P= 0.001; and 2.41⁰vs. −7.42⁰,P= 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs,P= 0.005).Conclusions: Fracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture.To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME Objectives: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy.Level: Advanced.Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Purpose The presence of kinesiophobia was identified in patients with foot problems. There was no finding of foot functionality according to the level of kinesiophobia in lower extremity problems. The aim of this study was to compare the lower extremity functional status in foot problems with a low or high level of kinesiophobia. Materials and methods Evaluated herein were 37 patients with foot problems (plantar fasciitis, hallux valgus, flat foot). Physical and demographic characteristics were recorded. Patients were divided into two groups based on if they had a high or low level of kinesiophobia using the Tampa kinesiophobia scale. Ankle plantar flexor and knee flexor muscles tightness were recorded. The foot posture was evaluated using the Foot Posture Index. Foot-related pain was measured using the Visual Analog Scale Foot & Ankle. The Foot Function Index and the American Orthopaedics Foot and Ankle Foundation Ankle-Hindfoot Scale and Hallux Metatarsophalangeal-Interphalangeal Scale were used to assess the foot function. The general functional status of the lower extremities was evaluated using the Lower Extremity Functional Scale. Results Foot function was better in patients with a low level of kinesiophobia (p < 0.05). Pain was higher in patients with high level of kinesiophobia than in patients with a low level of kinesiophobia (p < 0.05). There was no difference between the groups in terms of foot posture index and muscle tightness (p > 0.05). The general lower extremity function was more negatively affected in patients with a high level of kinesiophobia (p < 0.05). Conclusions Patients with a high level of kinesiophobia presented with more functional problems in the foot and whole lower extremity; hence, function-based rehabilitation and pain coping strategies should be a crucial part of the rehabilitation program at the earliest opportunity.

Purpose: To investigate the relationship between physical activity, musculoskeletal system problems, sleep, and screen exposure time in university students during the distance learning process. Methods: Three hundred and one students (183 female, 118 male) participated in the study via online survey. The screen exposure time was recorded. The physical activity using Short Form International Physical Activity Questionnaire and pain using Visual Analog Scale were evaluated. Nordic Musculoskeletal System Questionnaire was used to evaluate musculoskeletal symptoms. The Pittsburg Sleep Quality Index was applied for the details of sleep quality. Results: The students had a low level of physical activity (58.8%) and poor sleep quality (70.8%). Musculoskeletal pain was reported in upper back (85%), lower back (85%), neck (79.4%), shoulder (71.4%). The pain was correlated with total sleep quality (r=0.320, p<0.001), daytime dysfunction (r=0.282, p<0.001), sleep quality (r=0.256, p<0.001), and sleep disturbances (r=0.232, p<0.001). The screen time exposure-education was weakly correlated with PSQI total score (r=0.118, p=0.04) and total activity (r=-0.148, p=0.01). Conclusion: The low-level physical activity, worsened sleep quality, high rate of musculoskeletal problems and increased amount of screen exposure were reported in the distance learning process. We believed that these problems could be the reason for serious health issues later, so approaches targeting to improve physical activity levels, better posture while studying could be beneficial.