Objective: The purpose of this systematic review was to investigate the effect of adding the cognitive behavioral treatment (CBT) component to routine physical therapy (PT) on pain and depression reduction, improvement in quality of life, and enhanced function in patients with chronic low back pain (CLBP). Type: Systematic review. Literature Survey: Google Scholar, PubMed, Ovid, ScienceDirect, ProQuest, Scopus, Cochrane Library, and Embase electronic databases were explored for the key terms of "behavioral (or behavioural) treatment" OR "behavior (behaviour) treatment" OR "behavior (behaviour) therapy" OR "cognitive behavior (or behaviour) treatment" OR "cognitive treatment" OR "cognitive therapy" OR "operant behavior (or behaviour) treatment" OR "respondent behavior (or behaviour) treatment" AND "physical therapy" OR "physiotherapy" OR "exercise therapy" OR "electrotherapy" OR "electrical therapy" OR "manual therapy" OR "myofascial therapy" OR "rehabilitation" AND "low back pain" OR "lower back pain" OR "back pain" OR "chronic back pain" OR "chronic lower back pain", with no limitation on language, through January 2018. Methodology: All randomized controlled trials that statistically compared the effectiveness of CBT + PT and PT were included for quality analysis. Studies were rated by high to poor quality, using Hailey's classification, based on their design and performance. Synthesis: Of the 10 included studies, 7 were rated as high quality and 3 as good quality. Although CBT + PTwas found to be superior to PT for pain, disability, quality of life, and functional capacity variables in some of the included studies, no extra benefit from CBT was documented in other investigations. The included studies also failed to show any advantage of CBT + PT over PT in reducing depression, and PT was even found to be superior to CBT + PT in one high-quality study. Conclusions: Although appearing to be advantageous by reducing pain and disability and enhancing functional capacity and quality of life, CBT effects on depression cannot be teased out from the effects of PT. Level of Evidence: I

Background Mitochondrial dysfunction has been implicated in the pathogenesis of multiple sclerosis (MS). Whether mitochondrial alterations are a function of ambulatory dysfunction or are of a non-ambulatory systemic nature is unclear. Objective To compare oxidative capacity, and rest muscle oxygen consumption (mVO2) in the upper limb of persons with multiple sclerosis (PwMS) to a control group (CON), whereby an upper limb would be comparatively independent of ambulation or deconditioning. Methods Near infra-red spectroscopy was used to measure oxidative capacity of the wrist flexors in PwMS (n = 16) and CON (n = 13). Oxidative capacity was indicated by the time constant (TC) of mVO2 recovery following brief wrist flexion contractions. Measurements included well-being, depression, symptomatic fatigue, disability, handgrip strength, cognition, and functional endurance. Analysis was by T-tests and Pearson correlations with p ≤ 0.05. Data are mean (SD). Results TC of mVO2 recovery was slower in PwMS (MS = 47(14) sec, CON = 36(11) sec; p = 0.03). No significant correlations were found between oxidative capacity and any other measures. Rest mVO2 was not different between groups, but correlated with symptomatic fatigue (r = 0.694, p = 0.003) and strength (0.585, p = 0.017) in PwMS. Conclusion Oxidative capacity was lower in the wrist flexors of PwMS, possibly indicating a systemic component of the disease. Within PwMS, rest mVO2 was associated with symptomatic fatigue.

Resistance exercise alone or in conjunction with caffeine increases heart rate and blood pressure in resistance-trained women. While acute resistance exercise has been shown to increase measures of left ventricular workload, the addition of caffeine on these responses is unknown. PURPOSE: To evaluate alterations in left ventricular workload at rest, following acute caffeine supplementation or placebo, as well as during recovery from a fatiguing bout of resistance exercise in resistance-trained women. METHODS: Eleven resistance-trained women (Mean±SD: Age: 24 ± 4yrs) participated in a counterbalanced, double blind, placebo-controlled, crossover-design study. Each participant drank 4mg/kg of caffeine mixed with water. Applanation tonometry was used to measure left ventricular workload at rest (Rest1), 45 minutes after caffeine ingestion (Rest2), immediately postresistance exercise (Post 1), and 10 minutes post-resistance exercise (Post2). The acute bout of resistance exercise consisted of two sets at 75% 1-repetition maximum (1RM) for 10 repetitions, and one set at 70%1RM with repetitions to failure on the squat and bench press. Two minutes of rest were given between sets and exercises. A 2x4 two-way analysis of variance (ANOVA) was used to assess the effects of condition with a repeated measure of time. RESULTS: There were significant main effects of time for wasted left ventricular energy (Rest1

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Muscle weakness and fatigue are two disabling symptoms of Multiple Sclerosis (MS). Photobiomodulation therapy (PBMT) using red/near-infrared light is an emerging therapeutic modality thought to improve endurance or strength in healthy populations. Previously presented work revealed that a single acute high energy dose of PBMT may improve muscle force recovery in persons with MS (PwMS). PURPOSE: To investigate the effect of extended PBMT at an optimal dose of energy on muscle strength and endurance during a fatiguing contraction in PwMS. METHODS: Randomized crossover design. Persons with mild-moderate relapsing-remitting MS (n=12, F=11) were recruited. Participants applied PBMT (active or placebo) to the gastrocnemius and Tibialis Anterior (TA) muscles of both legs twice a day. The optimal dose of energy of the active device for each participant was 40J, 80J, or 120J as determined individually from preliminary studies. The effect of PBMT on muscle function was assessed in five sessions, pre-and post-treatment, and post-washout. The measurements comprised three maximal voluntary contractions (MVCs) of the right TA, followed by an intermittent contraction at 50% MVC to task failure. The measurements were obtained at baseline, after which