Auswahl der wissenschaftlichen Literatur zum Thema „Aerobic limitation“

Background: There is a need to understand physical activity types associated with health-related work limitations (also known as presenteeism). This study tests whether additive effects between physical activity types are associated with health-related work limitations among employees from a public university system. Methods: A cross-sectional study using health assessment data (n = 10,791) was used to examine aims. Analysis of covariance models tested differences in work limitations between physical activity groups based on combinations of stretching behavior, aerobic, and muscle-strengthening physical activities. Planned contrasts compared differences between selected groups. Results: There were significant group differences (P < .001) in reported work limitations after controlling for demographic, season, and health-related variables. Employees who reported participating in aerobic physical activity had significantly lower work limitation levels compared with inactive employees (P = .027). Employees who reported participating in both aerobic and muscle-strengthening physical activities had the lowest work limitation levels compared with all groups and significantly lower work limitation levels compared with employees who participated in aerobic physical activity only (P = .026). Conclusions: Results provide evidence of an additive effect where participating in a combination of aerobic and muscle-strengthening physical activities may be most beneficial when targeting health-related work limitations.

ABSTRACT We investigated the regulation of the central aerobic and hypoxic metabolism of the biocontrol and non-Saccharomyces wine yeast Pichia anomala. In aerobic batch culture, P. anomala grows in the respiratory mode with a high biomass yield (0.59 g [dry weight] of cells g of glucose−1) and marginal ethanol, glycerol, acetate, and ethyl acetate production. Oxygen limitation, but not glucose pulse, induced fermentation with substantial ethanol production and 10-fold-increased ethyl acetate production. Despite low or absent ethanol formation, the activities of pyruvate decarboxylase and alcohol dehydrogenase were high during aerobic growth on glucose or succinate. No activation of these enzyme activities was observed after a glucose pulse. However, after the shift to oxygen limitation, both enzymes were activated threefold. Metabolic flux analysis revealed that the tricarboxylic acid pathway operates as a cycle during aerobic batch culture and as a two-branched pathway under oxygen limitation. Glucose catabolism through the pentose phosphate pathway was lower during oxygen limitation than under aerobic growth. Overall, our results demonstrate that P. anomala exhibits a Pasteur effect and not a Crabtree effect, i.e., oxygen availability, but not glucose concentration, is the main stimulus for the regulation of the central carbon metabolism.

ABSTRACT Production of a photosynthetic apparatus in Roseateles depolymerans 61A, a recently discovered freshwater β-Proteobacterium showing characteristics of aerobic phototrophic bacteria, was observed when the cells were subjected to a sudden decrease in carbon sources (e.g., when cells grown with 0.1 to 0.4% Casamino Acids were diluted or transferred into medium containing ≤0.04% Casamino Acids). Accumulation of bacteriochlorophyll (BChl) a was observed in the presence of oxygen and was enhanced under semiaerobic conditions (2% oxygen) but was reduced in the presence of light. Similarly to what has been reported regarding some aerobic phototrophic bacteria belonging to the α subclass of the Proteobacteria, viability of the cells in the carbon source-free medium was prolonged under aerobic-light (10 W m−2) conditions, possibly due to photosynthetic energy conversion, but was not prolonged under aerobic-dark conditions. The puf operon, which encodes most of the apoproteins of light-harvesting and reaction center complexes, was sequenced, and the effect of changes in Casamino Acids concentrations, oxygen, and light on its expression was estimated by the accumulation of its mRNA. The expression of the puf operon was induced by the decrease in carbon sources, similarly to what was observed for the accumulation of BChl a under aerobic and semiaerobic conditions (≥0.2% O2), and was reduced in the presence of light. Transcription of the R. depolymerans puf operon is considered to be controlled by changes in carbon nutrients in addition to oxygen tension and light intensity.

Microbial cells buried in subseafloor sediments comprise a substantial portion of Earth’s biosphere and control global biogeochemical cycles; however, the rate at which they use energy (i.e., power) is virtually unknown. Here, we quantify organic matter degradation and calculate the power utilization of microbial cells throughout Earth’s Quaternary-age subseafloor sediments. Aerobic respiration, sulfate reduction, and methanogenesis mediate 6.9, 64.5, and 28.6% of global subseafloor organic matter degradation, respectively. The total power utilization of the subseafloor sediment biosphere is 37.3 gigawatts, less than 0.1% of the power produced in the marine photic zone. Aerobic heterotrophs use the largest share of global power (54.5%) with a median power utilization of 2.23 × 10−18 watts per cell, while sulfate reducers and methanogens use 1.08 × 10−19 and 1.50 × 10−20 watts per cell, respectively. Most subseafloor cells subsist at energy fluxes lower than have previously been shown to support life, calling into question the power limit to life.

Obesity, as an inflammatory state, can cause multi-organ disease, which often manifested in poor physical fitness involving the respiratory, cardio-vascular and muscles limitation. Bariatric surgery has become an important treatment option in severe obesity. The remarkably and rapid surgical weight loss, the obese patient gave feedback that they can walk further, but feels “no energy in his feet to speed up, when they need to run a few steps to catch the bus”. Had her physical condition already improved? Does weight loss after surgery equal improved physical condition? How does the heart, lungs, and muscles response to exercise? In order to search for the answer, we reviewed the previous relevant research, regarding the changes of postoperative aerobic capacity and we tried to discuss from a holistic perspective our observations.The thesis is divided into two modules including three studies.The first module including study 1 and 2, which are designed to identifies the determinants of the aerobic exercise capacity following weight loss reduced by bariatric surgery. We turn the daily problems feedback from obese patients who underwent bariatric surgery into three scientific questions:- What is the impact of adipose tissue on determinants of aerobic exercise capacity?- What is the impact of bariatric surgery on determinants of aerobic exercise capacity?- Do obese patients return to normal after bariatric surgery?Based on the limited knowledge and experience of predecessors about how obesity influences exercise pulmonary hemodynamics, the second module including study 3, which are designed to further analysed the right ventricle - pulmonary circulation during exercise and to answer the following question:- how does obesity affect right ventricular, pulmonary circulation and gas exchange adaptation during exercise?To answer these questions, we recruited 29 obese subjects and paired to age-, sex- and height- matched 29 healthy controls. A subgroup of thirteen patients who underwent bariatric surgery were retested 6 months after surgery and compared with theirs controls. Then, we comprehensive analysed the results of following tests: blood test, clinical assessment, body composition analysis, muscle strength measurements, pulmonary function (spirometry and diffusion capacity), exercise stress echocardiography, questionnaires and exercise capacity tests.The results of study 1 shown that, obese subjects had lower weekly moderate-to-vigorous physical activity (MVPA) and SF-36 scores, maximal workload and peak oxygen consumption (VO2peak) relative to body weight, but similar absolute VO2peak. Bariatric surgery resulted in -22% body weight,vi- 34% fat mass, -40% visceral adipose tissue and -12% lean mass (LM) changes. Absolute handgrip, quadriceps or respiratory muscle strength remained unaffected but accompanied by an increase in MVPA, SF-36 scores and quadriceps strength relative to LM. No changes in absolute VO2peak were observed after surgery but the ventilatory threshold was decreased.The results of study 2 shown that, obese subject had lower resting lung diffusion capacity with mainly a reduction in pulmonary capillary blood volume and alveolar volume (VA). After bariatric surgery, lung diffusion capacity for nitric oxide, VA and membrane diffusion capacity have improved to varying degrees.The results of study 3 shown that, there was no difference in pulmonary circulation at rest between the two groups, but the pulmonary vascular resistance index (PVRi) was higher with lower heart rate, cardiac output, cardiac index (CI) and mean pulmonary arterial pressure (mPAP) in obese subjects at peak exercise. After being normalized by CI at a common maximum exercise level, the PVRi was still higher, but the difference of mPAP disappeared and manifested a higher mPAP and mPAP/CI slope. The tricuspid annular plane systolic excursion /systolic PAP was lower at rest and at a common maximum exercise level when normalized by CI.In summary, obesity was associated to low vigorous daily physical activity levels, SF-36 physical and mental component scores, higher muscle mass but lower strength/LM ratio and aerobic capacity. Lower spirometry and lung diffusion capacity with mainly reduction in Vc and VA may also limit maximum aerobic exercise capacity. At rest, the pulmonary hemodynamic is preserved, but with a weakness of right ventricular-arterial coupling. At exercise, obesity has a modest, but observable impact on the pulmonary circulation and right ventricular adaptation at exercise, with unexhausted chronotropic reserve and normal chemo-sensibility.Bariatric surgery shows beneficial effects on fat mass loss, metabolic parameters, daily physical activities, SF-36 scores, lung function and stimulated the chronotropic response. However, aerobic capacity is not improved and is associated with a reduced LM and ventilatory threshold potentially triggering hyperventilation.
Doctorat en Sciences de la motricité
info:eu-repo/semantics/nonPublished

Polyhydroxyalkanoates (PHA) are biodegradable polyesters with comparable properties to some petroleum-based polyolefins. Within the context of the B-PLAS process, the PHA production is integrated with a wastewater treatment process aimed at recovering energy and C through platform molecules such as volatile fatty acids (VFAs). Eventually, selected mixed microbial cultures (MMCs) are provided with a fermentation broth under an aerobic dynamic feeding regime to produce PHA-enriched biomass. In this study, an anoxic/aerobic selection and accumulation process has been explored and compared on a bench scale with the standard and most studied full aerobic alternative. A final setup for both the bench-scale experiments and the B-PLAS pilot plant has also been proposed, allowing to achieve, on-demand, a higher dried biomass PHA content (>50%) compared to the analogous aerobic setup. In addition, the selected population has been proven to respond positively to reduced oxygenation conditions, opening new possibilities to maximise the production of the pilot plant while reducing the oxygenation-related costs and streamlining the process scheme.

Long-chain fatty acids (LCFA) movement into muscle cells stems from a highly mediated process utilizing membrane-associated LCFA transport proteins. It is believed that the multifunctional protein CD36 plays a significant role in the facilitation of LCFAs for β-oxidation, particularly during increased metabolic stress (i.e. exercise and postprandially). Single nucleotide polymorphisms (SNPs) in the CD36 gene have been linked to chronic disease states in older cohorts. Functional hypothesis-driven research is required to elucidate the role of these genes, particularly in younger populations. A systematic literature review supported the hypothesis that CD36 was the primary protein regulator of short-term upregulation of LCFA uptake and oxidation. All experimental chapters investigated two CD36 SNPs, rs1527479 and rs1984112, as they have previously been associated with chronic disease risk in older cohorts. Impaired whole body fat oxidation (Fatox) is one hypothesis for the development of insulin resistance, with reduced Fatox in TT carriers at rs1527479 in our pooled data consistent with an increased prevalence of type II diabetes in an older cohort. Associations with fasting triglyceride (TG) and rs1984112 were present in both Chapters 6 and 7, with AA carriers significantly greater than G-allele carriers, consistent with previously published data in older adults. In regard to genotypic training response, a number of the metabolically favourable adaptations were present in the hypothesised “at-risk” groups (Fatox, TG, and BP). The associations identified are of interest within a healthy population theoretically free of overt pathology, and indicate that CD36 SNP carriers could be added to a model of risk profiling incorporated in primary care moving forward. These data have the potential to inform future research in order to gain a greater understanding of the potential genetic mechanisms resulting in chronic diseases associated with CD36 SNPs in older adults.

The main metabolic pathway involved during an exercise of duration greater than 1 minute is the oxidative metabolism. The functional evaluation of oxidative metabolism is based on the analysis of two main functional indexes: O2max and O2 kinetics. These indexes are determined by a finite ability to deliver oxygen to the working muscles (central factor) and a limited ability of the muscles to extract oxygen (peripheral factor). The relative contribution of central and peripheral factors to the overall limitation of oxidative metabolism, yet remains controversial. Near Infrared Spectroscopy (NIRS) was recently added to the classical methods of muscle oxidative metabolism functional evaluation. NIRS is a non-invasive technology that continuously monitors changes (relative or absolute) in oxygenated and deoxygenated haemoglobin (HHb). NIRS HHb signal directly depends on the ratio between the muscular O2 utilization rate and the capillary O2 delivery in the region explored by the probe, providing a non-invasive estimate of the changes in O2 extraction occurring inside the muscles. The general aim of the thesis is to elucidate the relative contribution of central and peripheral factors in limiting oxidative metabolism by the application of non invasive techniques. We have proposed to modulate oxidative metabolism with different manipulations: 1) High fat diet; 2) Heavy intensity warm up and 3) two kinds of training: Aerobic and Isotonic. In the study #1 we used a high fat diet (HFdiet) to manipulate the peripheral factor in healthy young moderate trained males. Animal and human studies suggest that fat adaptation induces structural and functional muscle adaptations that may benefit oxidative metabolism. We tested the hypothesis that a long term HFdiet enhances oxidative metabolism by augmenting the muscle’s capacity to extract oxygen. 22 young healthy moderately trained males (28±5 yrs, 53±6 ml*Kg-1*min-1) were randomly assigned to: Hdiet (HFD, 55% of calories from fat, 30% carbohydrate and 15% proteins) or control diet (C, 30, 55 and 15%) for 10 days. Before and after the diet the subjects performed an incremental cycling test to exhaustion and 3 step transitions at moderate intensity. Respiratory variables and heart rate (HR) were measured bbb. The maximal and submaximal response to exercise were evaluated ( O2, respiratory exchange ratio, R) and the kinetics of pulmonary O2 were fitted by a double exponential model. HF diet was associated with a shift in substrate selection towards a higher contribution of fat to the production of energy in the moderate intensity domain of exercise (reduced R). Furthermore, HFD increased the speed of adaptation of pulmonary O2 kinetics by the reduction of the time constant of the primary component. Our findings support the hypothesis that, in healthy young males, a 10-day high fat diet may increase the speed of adaptation of oxidative metabolism at the onset of a moderate intensity exercise by increasing the relative contribution of fats oxidation to ATP production. In the study #2 we applied heavy intensity warm-up (HWu) to manipulate O2 delivery in sedentary healthy older adults. HWu increases VO2 kinetics during successive moderate intensity transitions. We tested the hypothesis that such improvement is due to a better matching of O2 delivery to utilization within the working muscles. We tested the hypothesis that HWu improvement is due to a better matching of O2 delivery to utilization within the working muscles, rather than to an increase in O2 bulk delivery. In 21 healthy older adults (65.7 5 yrs) we measured contemporarily and non-invasively indexes of the overall speed of adaptation of the oxidative metabolism ( i.e. pulmonary O2 kinetic), of the bulk O2 delivery (i.e. ) and of the rate of muscle deoxygenation (i.e. HHb) during moderate intensity step transitions, either with (Wu) or without (nWu) prior Hwu. The local matching of O2 delivery to utilization was evaluated by the HHb/ O2 ratio index. The innovative findings of this study are: i) HWu does not modify the speed of adaptation of bulk O2 delivery (i.e. ) and TPR; ii) HWu reduces the “overshoot” of the HHb/ O2 ratio, suggesting a better matching of O2 delivery to O2 utilization. Our data are compatible with the hypothesis that, in older adults, HWu, may beneficially affect oxidative metabolism thanks to acute improvement of the local matching of O2 delivery to O2 utilization. The evidences of Study # 2 motivated us to apply a manipulation that modifies O2 delivery in an adaptive way. Thus in the study #3 we applied aerobic training (AT) to manipulate O2 delivery in sedentary healthy older adults. We tested the hypothesis that older adults may benefit from 12 weeks of AT mainly thanks to an adaptive enhancement of O2 delivery to the working muscles. 14 healthy elderly (66 ± 6 yrs) were tested before and after a 12-week training consisting of an AT or a control (remained sedentary). Subjects performed: the same test protocol described in study # 2. Cardio-respiratory variables were measured bbb and muscle oxygen extraction (HHb) was measured, at the vastus lateralis, by quantitative NIRS. We calculated the time delay and the time constant of both the primary component of the pulmonary O2 and of HHb. The main findings of this study wereAT: i) increased O2max and pulmonary O2 kinetics, preceded (Wu) or not (nWu) by HWu; ii) did not modify the speed of adaptation of muscle oxygen extraction (HHb kinetics); iii) abolished the HWu effect in pulmonary O2 kinetics; iv) attenuated HWu effect in muscle oxygen extraction kinetics; v) abolished the peak of the HHb/ O2 ratio. Our data are compatible with the hypothesis that, in older adults, AT may beneficially affect oxidative metabolism thanks to an adaptive improvement in the matching of O2 delivery to the local O2 utilization. The attenuation yet not an abolishment of the HWu effect in HHb kinetics suggested us an underlying limitation in muscle O2 extraction, unaffected by AT. Isotonic Training is known to increase strength and muscle mass in older adults. We tested the hypothesis that older adults may benefits from 12 weeks of isotonic + aerobic training (IT) thanks to an adaptive enhancement in O2 delivery and O2 utilization. 14 healthy elderly (66 ± 6 yrs) were tested before and after a 12-week training consisting of an isotonic training added to aerobic training (IT) or a control condition (remained sedentary). Subjects performed the test protocol described in study #2 and were measured the variables and analyzed data as described for study # 4 The main finding of this study was that IT produced at the lungs an attenuation of HWu effect (i.e.TD remained shorter). These results suggested that older adults can be beneficially affected by IT, however it is not enough to produce the necessary variations in muscle O2 delivery to completely avoid HWu effect. Furthermore at muscle level the variations IT supressed the HWu effect. Thus in agreement with our hypothesis isotonic training added to aerobic training was enough to eliminate completely the effect of priming exercise. Regarding nWu exercise, the effect of IT was a reduction in the HHb/ O2 ratio peak, suggestive of a better matching in O2 delivery to the O2 utilization following training. Our data are compatible with the hypothesis that in older adults oxidative metabolism may be beneficially affected by IT thanks to an adaptive improvement of the local O2 delivery and a further adaptations in the working muscle to O2 utilization. In summary, eucaloric high fat diet, priming and training (aerobic and isotonic) beneficially affect the speed of adaptation of oxidative matabolism at the onset of an exercise of moderate intensity. The observed benefits are related to a variable combination of adaptations in O2 delivery and utilization that have been non-invasively evaluated in our studies.
The main metabolic pathway involved during an exercise of duration greater than 1 minute is the oxidative metabolism. The functional evaluation of oxidative metabolism is based on the analysis of two main functional indexes: O2max and O2 kinetics. These indexes are determined by a finite ability to deliver oxygen to the working muscles (central factor) and a limited ability of the muscles to extract oxygen (peripheral factor). The relative contribution of central and peripheral factors to the overall limitation of oxidative metabolism, yet remains controversial. Near Infrared Spectroscopy (NIRS) was recently added to the classical methods of muscle oxidative metabolism functional evaluation. NIRS is a non-invasive technology that continuously monitors changes (relative or absolute) in oxygenated and deoxygenated haemoglobin (HHb). NIRS HHb signal directly depends on the ratio between the muscular O2 utilization rate and the capillary O2 delivery in the region explored by the probe, providing a non-invasive estimate of the changes in O2 extraction occurring inside the muscles. The general aim of the thesis is to elucidate the relative contribution of central and peripheral factors in limiting oxidative metabolism by the application of non invasive techniques. We have proposed to modulate oxidative metabolism with different manipulations: 1) High fat diet; 2) Heavy intensity warm up and 3) two kinds of training: Aerobic and Isotonic. In the study #1 we used a high fat diet (HFdiet) to manipulate the peripheral factor in healthy young moderate trained males. Animal and human studies suggest that fat adaptation induces structural and functional muscle adaptations that may benefit oxidative metabolism. We tested the hypothesis that a long term HFdiet enhances oxidative metabolism by augmenting the muscle’s capacity to extract oxygen. 22 young healthy moderately trained males (28±5 yrs, 53±6 ml*Kg-1*min-1) were randomly assigned to: Hdiet (HFD, 55% of calories from fat, 30% carbohydrate and 15% proteins) or control diet (C, 30, 55 and 15%) for 10 days. Before and after the diet the subjects performed an incremental cycling test to exhaustion and 3 step transitions at moderate intensity. Respiratory variables and heart rate (HR) were measured bbb. The maximal and submaximal response to exercise were evaluated ( O2, respiratory exchange ratio, R) and the kinetics of pulmonary O2 were fitted by a double exponential model. HF diet was associated with a shift in substrate selection towards a higher contribution of fat to the production of energy in the moderate intensity domain of exercise (reduced R). Furthermore, HFD increased the speed of adaptation of pulmonary O2 kinetics by the reduction of the time constant of the primary component. Our findings support the hypothesis that, in healthy young males, a 10-day high fat diet may increase the speed of adaptation of oxidative metabolism at the onset of a moderate intensity exercise by increasing the relative contribution of fats oxidation to ATP production. In the study #2 we applied heavy intensity warm-up (HWu) to manipulate O2 delivery in sedentary healthy older adults. HWu increases VO2 kinetics during successive moderate intensity transitions. We tested the hypothesis that such improvement is due to a better matching of O2 delivery to utilization within the working muscles. We tested the hypothesis that HWu improvement is due to a better matching of O2 delivery to utilization within the working muscles, rather than to an increase in O2 bulk delivery. In 21 healthy older adults (65.7 5 yrs) we measured contemporarily and non-invasively indexes of the overall speed of adaptation of the oxidative metabolism ( i.e. pulmonary O2 kinetic), of the bulk O2 delivery (i.e. ) and of the rate of muscle deoxygenation (i.e. HHb) during moderate intensity step transitions, either with (Wu) or without (nWu) prior Hwu. The local matching of O2 delivery to utilization was evaluated by the HHb/ O2 ratio index. The innovative findings of this study are: i) HWu does not modify the speed of adaptation of bulk O2 delivery (i.e. ) and TPR; ii) HWu reduces the “overshoot” of the HHb/ O2 ratio, suggesting a better matching of O2 delivery to O2 utilization. Our data are compatible with the hypothesis that, in older adults, HWu, may beneficially affect oxidative metabolism thanks to acute improvement of the local matching of O2 delivery to O2 utilization. The evidences of Study # 2 motivated us to apply a manipulation that modifies O2 delivery in an adaptive way. Thus in the study #3 we applied aerobic training (AT) to manipulate O2 delivery in sedentary healthy older adults. We tested the hypothesis that older adults may benefit from 12 weeks of AT mainly thanks to an adaptive enhancement of O2 delivery to the working muscles. 14 healthy elderly (66 ± 6 yrs) were tested before and after a 12-week training consisting of an AT or a control (remained sedentary). Subjects performed: the same test protocol described in study # 2. Cardio-respiratory variables were measured bbb and muscle oxygen extraction (HHb) was measured, at the vastus lateralis, by quantitative NIRS. We calculated the time delay and the time constant of both the primary component of the pulmonary O2 and of HHb. The main findings of this study wereAT: i) increased O2max and pulmonary O2 kinetics, preceded (Wu) or not (nWu) by HWu; ii) did not modify the speed of adaptation of muscle oxygen extraction (HHb kinetics); iii) abolished the HWu effect in pulmonary O2 kinetics; iv) attenuated HWu effect in muscle oxygen extraction kinetics; v) abolished the peak of the HHb/ O2 ratio. Our data are compatible with the hypothesis that, in older adults, AT may beneficially affect oxidative metabolism thanks to an adaptive improvement in the matching of O2 delivery to the local O2 utilization. The attenuation yet not an abolishment of the HWu effect in HHb kinetics suggested us an underlying limitation in muscle O2 extraction, unaffected by AT. Isotonic Training is known to increase strength and muscle mass in older adults. We tested the hypothesis that older adults may benefits from 12 weeks of isotonic + aerobic training (IT) thanks to an adaptive enhancement in O2 delivery and O2 utilization. 14 healthy elderly (66 ± 6 yrs) were tested before and after a 12-week training consisting of an isotonic training added to aerobic training (IT) or a control condition (remained sedentary). Subjects performed the test protocol described in study #2 and were measured the variables and analyzed data as described for study # 4 The main finding of this study was that IT produced at the lungs an attenuation of HWu effect (i.e.TD remained shorter). These results suggested that older adults can be beneficially affected by IT, however it is not enough to produce the necessary variations in muscle O2 delivery to completely avoid HWu effect. Furthermore at muscle level the variations IT supressed the HWu effect. Thus in agreement with our hypothesis isotonic training added to aerobic training was enough to eliminate completely the effect of priming exercise. Regarding nWu exercise, the effect of IT was a reduction in the HHb/ O2 ratio peak, suggestive of a better matching in O2 delivery to the O2 utilization following training. Our data are compatible with the hypothesis that in older adults oxidative metabolism may be beneficially affected by IT thanks to an adaptive improvement of the local O2 delivery and a further adaptations in the working muscle to O2 utilization. In summary, eucaloric high fat diet, priming and training (aerobic and isotonic) beneficially affect the speed of adaptation of oxidative matabolism at the onset of an exercise of moderate intensity. The observed benefits are related to a variable combination of adaptations in O2 delivery and utilization that have been non-invasively evaluated in our studies.

Osteoarthritis (OA) is a common condition which often causes pain and functional limitation, significantly impacting on a person's quality of life. A comprehensive assessment of the impact of OA should be performed before selecting therapies and treatment goals. Current recommended therapies include a combination of pharmacological and non-pharmacological therapies, which should be considered for all people with OA, regardless of anatomical site of involvement. Non-pharmacological treatments include education, muscle strengthening and aerobic exercises, weight loss if appropriate, splints and devices, and aids. Pharmacological therapies include paracetamol, oral and topical non-steroidal anti-inflammatory drugs, topical capsaicin, intra-articular corticosteroid injections, and opioids. Many existing therapies have only a small analgesic effect size and, in the case of drug therapies, may be associated with important side effects, so an individual's symptoms and comorbidities must be taken into account when selecting therapies. For those who do not respond to these treatments, surgery such as a total joint arthroplasty may be required. There is a strong need for new analgesic treatments for OA. As it is becoming increasingly clear that the sources of pain in OA are complex and multifactorial, future treatments for OA will need to target both peripheral and central pain mechanisms.

Regular exercise can increase the healthy lifespan of elderly patients. Despite this, most seniors are not getting enough exercise. This chapter summarizes the age-related declines in physical capacity, including loss of muscle power, decreased aerobic capacity (VO2max), sarcopenia, and increased adipose tissue, that can lead to inflammation and limitations of functional reserve. The concept of frailty is discussed. Clinicians are given practical techniques for evaluating risks in patients, providing an “exercise prescription” in an individually tailored manner, and measuring progress in their geriatric patients.

As part of a scientific support programme, physiological monitoring has the potential to enhance knowledge and understanding of the development of elite young athletes in order to optimize their present and future sporting performance. However, the ethics of physiological testing of minors and the development of individualized, reliable, valid, and sport-specific physiological monitoring programmes are challenging. For example, the assessment of body composition, muscle strength, and anaerobic and aerobic fitness in sport-specific contexts and environments is complex. A plethora of laboratory and field tests have been developed to monitor young athletes. However, adequate interpretation of elite performance in youth can only be accomplished by procedures that satisfy rigorous criteria. Clear understanding of the merits and limitations of physiological tests is required for the development of appropriate scientist-coach-young athlete relationships.

The physiological adaptations to exercise training have been evaluated extensively in children and youth. In particular, considerable research has examined the changes in cardiovascular function that occur with aerobic exercise training. Various indicators of cardiovascular function have been assessed at rest and during exercise. Many of these measures have important implications from performance and health-related perspectives. Owing to the importance of oxygen (O2) transport for human performance and health, this chapter reviews comprehensively the varied non-invasive and invasive methods of assessing cardiac function including an in-depth evaluation of the limitations and strengths of each methodology. Specific reference is given to the applicability and ease of usage of each technology with young people. This chapter also deals extensively with the evaluation of cardiovascular regulation and vascular function owing to their role in optimal exercise performance and health.

Bring the benefits of strength training to seniors–regardless of their fitness levels–with Fitness Professional's Guide to Strength Training Older Adults, Second Edition. This resource contains the information and tools you need to educate, motivate, and assist older adults in committing to and benefiting from individualized strength training programs. Baechle and Westcott, leading authorities in fitness and strength training, offer information and guidance based on their combined 50–plus years of experience as strength training athletes, coaches, instructors, and researchers. The authors summaries of current research will update your knowledge of the specific health benefits of strength training for senior populations, including those with chronic conditions. Guidelines for senior strength training provide a basis for your program design, and recommendations for program modifications will assist you in constructing strength training programs that meet each client's needs, abilities, and limitations. Previously published as Strength Training for Seniors, this new edition has been retooled to assist health and fitness instructors at health clubs, YMCAs, community centers, nursing homes, retirement communities, and other organizations in helping older adults obtain the far–reaching benefits of strength training. Fitness Professional's Guide to Strength Training Older Adults includes these updates: • A new chapter on sport conditioning programs, which provides specific strength training exercises to boost performance and reduce risk of injury for older runners, cyclists, swimmers, skiers, golfers, tennis players, rowers, rock climbers, hikers, softball players, and triathletes • Updated research regarding program design and performance for special populations, including seniors with diabetes, cardiovascular disease, low–back pain, balance issues, arthritis, osteoporosis, fibromyalgia, frailty, and poststroke impairments • Updated nutrition information and specific nutrition guidelines to help seniors properly fuel their bodies for aerobic exercise, muscle building, and daily living Precise illustrations and biomechanically sound instructions for exercises that use resistance machines, free weights, body weight, elastic bands, and balls help you review proper techniques and provide your clients with clear explanations. Unique teaching scripts offer strategies for communicating information that will help your clients avoid errors that cause injury or reduce the effectiveness of the exercise. Use the sample 10–week workout to help your beginning clients establish a foundation of muscle strength to improve everyday tasks and increase cardiovascular capability. You'll also find intermediate and advanced workout programs focused on increasing muscle size, strength, and endurance along with specific considerations for older adults at each fitness level. In addition, practical methods for client assessment assist you in measuring muscle strength, hip and trunk flexibility, and body composition; guidelines also help your clients assess their own progress. Featuring principles, protocols, and adaptations, Fitness Professional's Guide to Strength Training Older Adults has everything you need for designing and directing sensible strength training programs for seniors. Information is presented progressively, making it easy to apply for fitness and health care professionals with varied backgrounds and experiences. In addition, numerous references for each topic offer starting points for further study, and tables, figures, and logs provide guidance in exercise program design and education for your clients. Substantial research has shown that strength training can reverse many of the degenerative processes associated with aging and reduce the risk and severity of several health problems common among older adults. Use the information and tools in Fitness Professional's Guide to Strength Training Older Adults to help your senior clients understand the benefits of strength training, overcome their intimidation, and commit to a training program that will enable them to enjoy a more vibrant and active lifestyle.

Musculoskeletal pain is a common symptom in inflammatory arthritides such as juvenile idiopathic arthritis; however, identifying the underlying pathological process is often challenging for health care providers due to the extensive differential diagnoses. In children with inflammatory arthritides, physical examination abnormalities including swelling and/or pain on movement and joint limitation accompany the pain at initial presentation. Control of disease activity through anti-inflammatories and other disease-modifying agents can limit disease progression and joint damage; however, pain may persist in spite of these measures. Optimal treatment of pain in juvenile idiopathic arthritis and related conditions is based on a biopsychosocial model, which addresses biological, environmental, and cognitive-behavioural factors. Analgesics such as opioids and neuropathic pain medications, in conjunction with other modalities such as pain coping skills training, aerobic exercise, and improved sleep hygiene may be appropriate in certain circumstances. Further research is needed to prospectively identify patients and families early in the course of disease who would benefit from additional support to optimize pain management and limit distress. In addition, future clinical trials should assess the impact of study interventions on pain as a primary endpoint, assessed independently from other response variables.

Deep wastewater treatment is carried out by a bioconveyer technology and a direct-flow system of multistage biological treatment (DSMBT). To reduce excess biomass and energy costs, the first bioreactors (sections) of the DSMBT provide for partial removal of soluble organics in the absence of oxygen, the rest are intended for aerobic water treatment. Development of a method for engineering calculation of anaerobic biofiltration as applied to the first sections of DSMBT is the main aim of the study. Anaerobic substrate utilization is modeled at two levels using two stage biokinetics. The behavior of the substrate and its derivatives within a representative biofilm are analyzed, taking into account surface and molecular diffusion, limitation of the rates of the substrate and acid biodegradation, coexistence of two communities of microorganisms. The behavior of the original and newly formed organic substrates in the volume of a representative section is studied by analytical methods. A theoretical base and an engineering method for calculating anaerobic biofiltration are developed and illustrated, which can serve as the basis for applied optimization of the parameters of bioconveyer plants. It is justified to use the derived calculation dependencies for similar complex biological treatment plants with any filtering material.

Osteoarthritis (OA) is a common condition which often causes pain and functional limitation, significantly impacting on a person’s quality of life. A comprehensive assessment of the impact of OA should be performed before selecting therapies and treatment goals. Current recommended therapies include a combination of pharmacological and non-pharmacological therapies, which should be considered for all people with OA, regardless of anatomical site of involvement. Non-pharmacological treatments include education, muscle strengthening and aerobic exercises, weight loss if appropriate, splints and devices, and aids. Pharmacological therapies include paracetamol, oral and topical non-steroidal anti-inflammatory drugs, topical capsaicin, intra-articular corticosteroid injections, and opioids. Many existing therapies have only a small analgesic effect size and, in the case of drug therapies, may be associated with important side effects, so an individual’s symptoms and comorbidities must be taken into account when selecting therapies. For those who do not respond to these treatments, surgery such as a total joint arthroplasty may be required. There is a strong need for new analgesic treatments for OA. As it is becoming increasingly clear that the sources of pain in OA are complex and multifactorial, future treatments for OA will need to target both peripheral and central pain mechanisms.

This part of the collective monograph is devoted to the discussion of the main object of biotechnology, namely, the effectiveness of the cultivation of biological agents. Based on this position, the subject of this scientific research is the analysis of the situation, about how the physiological and biochemical properties of biological agents determine the choice of equipment for the cultivation of biological agents in aerobic conditions. The methodology for the implementation of this subject of scientific research is that for the implementation of mass transfer processes and the analysis of technical features of fermenters at the cultivation stage, an analysis of hydrodynamics in the fermenter is required due to the design characteristics of the devices. The work provides an analysis of specific phenotypic features of biological agents and defined conditions for effective realization of their genetic potential during cultivation. Modern biotechnology at the stage of cultivation of biological agents focuses on the use of fermenters of various designs, but there are no scientific and practical recommendations, so the purposeof this work was to create a classification of fermenters depending on the methods of energy input, taking into account the features of the technology. For aerobic biological agents, the influencing factors at the cultivation stage are the mass transfer efficiency of the limiting substrates and the uniformity of the phase distribution in the volume of the fermenter. In the known designs of industrial fermenters, various systems of energy input into the culture liquid are used for effective mass transfer of limiting substrates and homogenization of interacting phases. This part of the monograph provides an analysis and rationale for the classification of typical industrial designs of fermenters by energy input methods, which makes it possible to select equipment for effective cultivation, taking into account the specifics of biological agents. Classification according to general characteristics is a guarantee of the correctness of calculations of hydrodynamic, mass exchange and heat exchange characteristics. The overview of fermenter designs presented in the monograph revealed that this type of device design is the simplest and most reliable due to the absence of moving parts of the design and the simplicity of the body elements. The conclusion of the presented work is that the choice of devices of this type can be proposed for microbial protein biotechnologies when using yeast as biological agents that are resistant to contamination. This part of the monograph makes it possible to identify biotechnologies for which it is appropriate to use devices of this type using the above classification based on the efficiency of the mass transfer processes of the limiting substrate – oxygen and on the structural features of the fermenter. Such biotechnologies include the production of feed microbial protein in non-aseptic cultivation conditions with a high rate of oxygen consumption. In the given review of specific physiological and biochemical features and specifics of the culture fluid, the possibility of using these devices for technologies with difficult-to-dissolve substrates is determined. A significant limitation of the use of devices of this type is the presence of significant shear forces during aeration of the culture liquid, which does not allow the cultivation of biological agents that are affected by shear forces.

Landfilling is the most common and popular method to dispose of solid waste. The production of leachate from landfill sites is a major problem associated with the landfill technique of solid waste disposal. This chapter presents a general idea of the technical applicability of aerobic and anaerobic treatment of landfill leachate. This chapter reviews the performance, mechanism, application, limitations, and upgradation of various existing aerobic and anaerobic treatment techniques such as activated sludge (AS), sequencing batch reactors (SBRs), aerated lagoons, rotating biological contactors, upflow anaerobic sludge blanket (UASB) reactors, and constructed wetlands. The designing parameters such as hydraulic retention time (HRT) and organic loading rate and performance indicators are discussed. Among the aerobic and anaerobic treatment processes, AS, SBRs, and UASB are the most often used techniques. These techniques are effective in reducing chemical oxygen demand up to 90% and NH3-N up to 80%. Generally, the selection of the effective treatment technique for landfill leachate depends on leachate characteristics, technical applicability, HRT, economics, and further environmental impacts.

Abstract Intellectual disability (ID) is a condition characterised by intellectual limitations and limitations in adaptive (social, behavioural, self-care) skills occurring and diagnosed before the age of 18 years. The aetiology of ID is often unknown but common aetiologies include Down syndrome (DS), foetal alcohol syndrome, disease/infection, and birth defects. Physical fitness and physical activity can be accurately measured following appropriate familiarisation using validated tests with excellent reliability. This includes treadmill protocols with oxygen uptake measurements, various field tests of aerobic capacity, isokinetic and isometric muscle testing, and field tests such as sit-ups, push-ups, and standing long jump. Physical activity is typically measured using steps per day or accelerometery, but to accurately interpret results population-specific cut-points need to be used. Children with ID typically have low aerobic capacity, muscle endurance, muscle strength, and physical activity levels. Furthermore, children with ID with DS have even lower values, yet obesity does not appear to influence aerobic capacity in the same manner as the general population in children with DS. Interventions have been shown to increase aerobic capacity in children with ID, but it is unclear if aerobic capacity is increased in children with DS. Run performance is improved with exercise training, as is muscle strength and endurance. Body weight and body composition are not likely to change appreciably with exercise training alone but can be improved with multifactorial interventions.

Abstract Hydrodynamic, energetic and physiological limitations dictate the swimming speed and duration of submergence of marine mammals. To determine the effects of these limitations on swimming and diving performance by cetaceans, we examined the relationships among aerobic transport costs, oxygen stores and locomotor speed of bottlenose dolphins. Metabolic rate and the cost of transport were assessed for two adult dolphins trained to swim next to a boat.

This chapter discusses HCI interfaces used in controlling aerial robotic systems (otherwise known as aerobots). The autonomy control level of aerobot is also discussed. However, due to the limitations of existing models, a novel classification model of autonomy, specifically designed for multirotor aerial robots, called the navigation control autonomy (nCA) model is also developed. Unlike the existing models such as the AFRL and ONR, this model is presented in tiers and has a two-dimensional pyramidal structure. This model is able to identify the control void existing beyond tier-one autonomy components modes and to map the upper and lower limits of control interfaces. Two solutions are suggested for dealing with the existing control void and the limitations of the RC joystick controller –the multimodal HHI-like interface and the unimodal BCI interface. In addition to these, some human factors based performance measurement is recommended, and the plans for further works presented.

This chapter discusses HCI interfaces used in controlling aerial robotic systems (otherwise known as aerobots). The autonomy control level of aerobot is also discussed. However, due to the limitations of existing models, a novel classification model of autonomy, specifically designed for multirotor aerial robots, called the navigation control autonomy (nCA) model is also developed. Unlike the existing models such as the AFRL and ONR, this model is presented in tiers and has a two-dimensional pyramidal structure. This model is able to identify the control void existing beyond tier-one autonomy components modes and to map the upper and lower limits of control interfaces. Two solutions are suggested for dealing with the existing control void and the limitations of the RC joystick controller –the multimodal HHI-like interface and the unimodal BCI interface. In addition to these, some human factors based performance measurement is recommended, and the plans for further works presented.

Abstract Decline of function over time is found in most patients with rheumatoid arthritis (RA). About 50% of patients show evidence of articular damage with radiographic joint space narrowing and/or erosions within the first two years of disease . Early retirement, within three years, has been found in 37% of early cases of rheumatoid arthritis . The main functional limitations pertain to pain, decreased joint motion, muscle weakness, reduced endurance, and limitations in aerobic capacity. The unpredictable course of the disease often causes anxiety and depression, and reduces self-efficacy. Physiotherapy is an essential part of comprehensive management for patients with rheumatoid arthritis, and there is a growing body of knowledge concerning the efficacy of physiotherapeutic interventions . Most recent research on physiotherapy has focused on exercise therapy.

The success of NASA's Ingenuity Helicopter underscores the importance of aerobots in Mars exploration, however, its limitations in endurance and payload capacity necessitate optimization of the next-generation rotorcrafts. This paper proposes an approach to enhance Martian rotorcraft within specified parameters, aiming to improve performance and meet evolving mission demands. For rotorcrafts with both overlapping and non-overlapping rotors, such as coaxial, tandem, and multirotor configurations, the equations are derived and generalized based on the momentum theory for the conventional helicopter. These equations estimate the required power for flight segments such as hover, vertical climb, and forward flight, considering constraints such as spacecraft aeroshell size. The resulting performance informs initial rotor and battery sizing for aerobot design. Among the configurations created and investigated, the quadcopter emerges as the most efficient choice, offering a balance of performance and mechanical simplicity, while a conventional single main rotor configuration appeared to be the least efficient within the specified constraints.

The F109-GA-100 (F109) engine, originally developed by Garrett under contract to the U.S. Air Force, is a state-of-the-art powerplant designed specifically for trainer use. The engine has been designed and demonstrated to be fully aerobatic capable, without limitations throughout the training envelope. To minimize student pilot workload, the engine features a full-authority digital electronic fuel control with automatic start and restart, automatic overspeed-/temperature-limiting, simple power management with no restrictions in operation and automatic thrust trim. Maintenance features include extensive built-in test and data logging to support effective life management. Designed for an 18,000-hour life to a duty cycle with a mission severity comparable to that of a fighter, the F109 has demonstrated exceptional durability and high reliability. This durability — coupled with excellent fuel efficiency that rivals a turboprop — resulted in extremely low life-cycle-cost (LCC) as demonstrated in accelerated mission testing. This paper describes the design features of the F109 that establish this engine as a trendsetter for the 1990s and beyond.

Objective: Getting back to regular physical activity soon after completing the treatment for breast cancer may be a challenge for most women. To assess the impact of physical exercise on physical fitness and body composition in women who have completed breast cancer treatment, we designed a personalized program of physical exercises, considering their individual basal physical activity levels. Methods: The prospective study included 107 women aged 18–60 years shortly after curative treatment for localized breast cancer. All participants were evaluated for cardiovascular morbidities, body composition, and exercise performance. After careful physical evaluation by a personal physical trainer, each woman was individually oriented on how to perform each exercise correctly and follow the program of nonsupervised exercises on their own at home, either indoor or outdoor. Women were motivated to adhere to personalized aerobic exercises, localized muscular strength/resistance, and flexibility exercises, considering individual capabilities and limitations. Evaluations including body composition, VO2max, and localized muscle resistance were performed preintervention (basal) and after 6 and 9 months of intervention. Results: Among all, 25.23% and 44.85% were fat or overweight, respectively, at the study entrance, and 21.49% reported doing physical exercise regularly; 78 women adhered to the training program (72.8%), and 29 chose not to adhere (27.2%). After 9 months of regular and individualized intervention, adherent women showed significantly better results in all variables of body composition and physical fitness: body mass (-4.38±3.67 kg; p0.05), as well as it was not influenced by breast cancer characteristics (e.g., histology, stage, and molecular subtypes) or treatment (e.g., mastectomy, axillary surgery, chemotherapy, or radiotherapy) (p>0.05). Conclusion: Our study reinforces that women in follow-up after breast cancer, regardless of body fatness or fitness, can adopt lifestyle measures to prevent a recurrence, and medical societies should include recommendations to promote physical activity early during surveillance.

Introduction: Much has been discussed about benefits of physical exercise in women who have ended breast cancer treatment, which includes not only the improvement of their quality of life but also a remarkable decreased risk of recurrence. To achieve these benefits, it is important that the parameters for prescribing and monitoring physical activity for this population are well defined, as well as the evaluation of factors that may interfere with the results and the adherence to physical exercises. Objectives: To assess the impact of physical exercise on physical fitness and body composition in women who have ended breast cancer curative treatment and to evaluate the impact of physical exercise on women with binge eating disorder. Methods: This prospective study included 107 women between 18 and 60 years of age shortly after the end of their curative treatment for breast cancer (surgery and/or chemotherapy and/or radiotherapy). The participants, after signing the informed consent form, were motivated to do aerobic exercises, localized muscular strength/resistance, and flexibility exercises. Intervention consisted of sets of physical exercises prescribed to all participants by a physical educator in progressive intensities and volumes over the months, according to their adaptive responses, considering individual capabilities and limitations. All participants were evaluated at entrance for cardiovascular morbidities and oriented how to exercise by their own at their homes. Evaluations including body composition, VO2max, and localized muscle resistance were performed at pre-intervention (basal), after 6 and 9 months of intervention. Results: A total of 78 (72.8%) women adhered to the training program, and 29 (27.2%) chose not to adhere. After 9 months of regular and individualized intervention, adherent women showed significantly better results in all variables of body composition and physical fitness: body mass (-4.38±3.67 kg; p0.05), as well as it was not influenced by breast cancer characteristics (e.g., histology, stage, and molecular subtypes) or treatment (i.e., mastectomy, axillary surgery, chemotherapy, or radiotherapy; p>0.05). Conclusion: Our study shows that individualized programs of self-training sets of physical exercises, remotely guided by a physical education professional, could improve the body composition and physical fitness of women in surveillance after breast cancer, regardless of the history of breast cancer or treatment, showing that it is possible to reduce risk factors associated with breast cancer recurrence and to contribute to a better quality of life for these women.

As part of the postclosure safety assessment of Ontario Power Generation’s (OPG’s) proposed Deep Geologic Repository (DGR) for Low and Intermediate Level Waste (L&ILW) at the Bruce site, Ontario, a Gas Generation Model (GGM) has been developed and used to model the detailed generation of gas within the DGR due to corrosion and microbial degradation of the organics and metals present. The GGM is based on a kinetic description of the various microbial and corrosion processes that lead to the generation and consumption of various gases. It takes into account the mass-balance equations for each of the species included in the model, including three forms of organic waste (cellulose, ionexchange resins, and plastics and rubbers), four metallic waste forms and container materials (carbon and galvanised steel, passivated carbon steel, stainless steel and nickel-based alloys, and zirconium alloys), six gases (CO2, N2, O2, H2, H2S, and CH4), five terminal electron acceptors (O2, NO3−, Fe(III), SO42−, and CO2), five forms of biomass (aerobes, denitrifiers, iron reducers, sulphate reducers, and methanogens), four types of corrosion product (FeOOH, FeCO3, Fe3O4, and FeS), and water. The code includes the possibility of the limitation of both microbial and corrosion reactions by the availability of water. The GGM has been coupled with TOUGH2 to produce T2GGM; a code that models the generation of gas in the repository and its subsequent transport through the geosphere. T2GGM estimates the peak repository pressure, long time repository saturation and the total flux of gases from the geosphere. The present paper describes the development of T2GGM and the numerical modelling work undertaken to calculate the generation and build-up of gas in the repository, the two-phase exchange of gas and groundwater between the repository and the surrounding rock, and between the rock and the surface environment. The results have been used to inform the safety assessment modelling.

Stroke basically consists in brain-cells death due to lack or excess of blood. Stroke has many important consequences and falls are one of the most concerning. Falls can produce several injures from minor lacerations to fractures and death. It has been found that balance and gait impairments after stroke are important risk factors for fall. Hence, improving balance and gait ability in stroke survivors can significantly reduce falls rate. In this literature review, we review the main characteristic and the therapeutic results of different therapeutic interventions aimed at improving balance and walking ability. The main therapeutic interventions included are the Bobath therapy, exercise-based interventions, orthotic and assistive devices, modality treatments, alternative therapies, robotic-assisted training, and computational-based interventions. The parameters considered as evidence of balance and/or gait recovery after a specific intervention are: walking speed (WS), cadence, endurance, stride/step length, weight/walking symmetry, and sway. Our main findings are: 1) The wide use of the Bobath concept is not well supported by evidence due to its performance has been found to be inferior to some exercises-based interventions such as walking training; 2) exercises-based interventions were classified as strength and task-specific training. The former improves muscular and bone health, aerobic capability, and prepares the patient to perform a more demanding activity. The latter is designed as a repetitive training of a functional activity, mainly walking, and sit to stand exercises, which improve both gait and balance. Orthotic and assistive devices have effects on balance and gait but only while they are worn or used; 3) robotic assisted walking-training presented similar results to overground or treadmill walking training in terms of walking speed and balance recovery. However, the most important advantage lies on the reduction of burden for therapists; 4) thee most important use of motion analysis is as a tool for identify the causes deficits in a patient and the to design a therapy in accordance; 5) motion synthesis can be used as a tool to answer very specific questions related to capabilities/limitations of a patient. For instance, “what would be the effect of increasing hip-torque capability of a stroke survivor on the walking-symmetry?” The answer to this question would either help to design an exercise/intervention or to discard such intervention due to low impact; 6) some treatments are added to a main therapy to increase its effect on a given parameter. Functional electrical stimulation, which is added to cycling training to improve motion patterns. Biofeedback is used during balance training to reduce weight-asymmetry. And virtual reality and video games are used to increase motivation and permanence of patient on a therapy; 7) we found some alternative or no widely used therapies. Among the most promising we can mention Tai-Chi exercises, which integrates physical and mental activities to improve balance and gait and rhythmic auditory stimulation that improves WS and weight-symmetry; and 8) orthotics devices help to reduce falls by extending the base of support but the effect appears only while they are worn. In general, there is not an ultimate therapy able to fit to every patient. The choice should depend on patient’s goals and conditions. Moreover, falls can not be eliminated but they can be substantially reduced by improving balance and gait.