The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.

EART FAILURE IS A NATIONAL epidemic, affecting nearly 5 million persons in the United States, with an additional 550 000 diagnosed each year. 1 This burden is disproportionately borne by black Americans, who have a higher incidence and prevalence of heart failure than members of other racial groups. 1 Despite this greater burden, black patients may receive less intensive and poorer-quality care for heart failure than whites. 2-5 Some studies, however, suggest that black patients receive similar quality of care as members of other racial groups. 6-10 Because prior studies evaluated patients treated in selected centers or regions 6-10 and assessed treatment or utilization patterns and not objective measures of quality of care, 3,9,10 it is unclear if reported racial differences reflect shortfalls in care or appropriate treatment or are representative of current national practice patterns. A national evaluation of racial patterns of heart failure care is timely given the

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Purpose Exercise is associated with a decrease in bone mineral density under certain conditions. One potential mechanism is increased bone resorption due to an exercise-induced increase in parathyroid hormone (PTH), possibly triggered by dermal calcium loss. The purpose of this investigation was to determine whether calcium supplementation either before or during exercise attenuates exercise-induced increases in PTH and C-terminal telopeptide of type I collagen (CTX; a marker of bone resorption). Methods Male endurance athletes (n=20) completed three 35-km cycling time trials under differing calcium supplementation conditions: 1) 1000 mg calcium 20 minutes before exercise and placebo during, 2) placebo before and 250 mg calcium every 15 minutes during exercise (1000 mg total), or 3) placebo before and during exercise. Calcium was delivered in a 1000 mg/L solution. Supplementation was double-blinded and trials were performed in random order. PTH, CTX, bone-specific alkaline phosphatase (BAP; a marker of bone formation), and ionized calcium (iCa) were measured before and immediately after exercise. Results CTX increased and iCa decreased similarly in response to exercise under all test conditions. When compared to placebo, calcium supplementation before exercise attenuated the increase in PTH (55.8 ± 15.0 vs. 74.0 ± 14.2; mean ± SE; p=0.04); there was a similar trend (58.0 ± 17.4; p=0.07) for calcium supplementation during exercise. There were no effects of calcium on changes in CTX, BAP, and iCa. Conclusions Calcium supplementation before exercise attenuated the disruption of PTH. Further research is needed to determine the effects of repeated increases in PTH and CTX on bone (i.e., exercise training), and whether calcium supplementation can diminish any exercise-induced demineralization.

Objective The purpose of this study was to examine the safety and efficacy of a high-intensity progressive rehabilitation protocol (HI) beginning 4 days after total knee arthroplasty (TKA) compared to a low-intensity (LI) rehabilitation protocol. Methods One hundred sixty-two participants (aged 63±7 years; 89 females) were randomized to either the HI group or LI group after TKA. Key components of the HI intervention were the utilization of progressive resistance exercises and a rapid progression to weight-bearing exercises and activities. Both groups were treated in an outpatient setting 2-3 times per week for 11 weeks (26 total sessions). Outcomes included the stair climbing test (SCT) (primary outcome), timed-up-and-go (TUG) test, 6-minute walk (6MW) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12 (SF-12), knee ROM, quadriceps and hamstring strength, and quadriceps activation. Outcomes were assessed preoperatively and at 1, 2, 3 (primary end point), 6, and 12 months postoperatively. Results There were no significant differences between groups at 3 or 12 months in SCT, TUG, 6MW, WOMAC scores, knee ROM, quadriceps and hamstrings strength, quadriceps activation, or adverse event rates. By 12 months, outcomes on the 6MW, TUG, WOMAC, SF-12, quadriceps and hamstring strength, and quadriceps activation had improved beyond baseline performance in both groups. Conclusion Both the HI and LI interventions were effective in improving strength and function after TKA. High-intensity progressive rehabilitation is safe for individuals after TKA. However, its effectiveness may be limited by arthrogenic muscular inhibition in the early postoperative period.