Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis / Determinantes clínicos do teste do degrau incremental modificado em adultos com bronquiectasia não fibrocística

ABSTRACT Objectives: This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases. Methods: Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George's Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer. Results: The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R2 = 0.67, AR2 = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05). Conclusions: Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.

RESUMO Objetivos: Este estudo teve como objetivo principal investigar os determinantes clínicos do Teste do Degrau Incremental Modificado (TDIM) em adultos com bronquiectasia não fibrocística (BNFC). Um objetivo secundário foi comparar as respostas cardiopulmonares após o TDIM e o Teste Graduado de Caminhada (TGC), dois testes de campo máximos amplamente adotados e limitados por sintomas em doenças respiratórias crônicas. Métodos: Quarenta e seis pacientes com bronquiectasia clinicamente estável participaram deste estudo transversal. O TDIM e TGC foram realizados para determinar a capacidade de exercício, enquanto a gravidade da doença, fadiga e qualidade de vida foram avaliadas usando o Índice de Gravidade da Bronquiectasia (BSI), a Escala de Gravidade da Fadiga (FSS) e o Questionário Respiratório de Saint George (SGRQ), respectivamente. A força muscular do quadríceps foi avaliada usando um dinamômetro manual, a velocidade de caminhada com um dispositivo de sensor inercial sem fio e o nível de atividade física (passos/dia) com um pedômetro. Resultados: O escore BSI, a força muscular do quadríceps, a contagem diária de passos e o escore total do SGRQ explicaram 61,9% da variação no TDIM (p < 0,001, R2 = 0,67, AR2 = 0,619). O escore BSI (r = -0,412, p = 0,004), a força muscular do quadríceps (r = 0,574, p = 0,001), a contagem diária de passos (r = 0,523, p < 0,001), a velocidade de caminhada (r = 0,402, p = 0,006), o escore FSS (r = -0,551, p < 0,001) e o escore total do SGRQ (r = -0,570, p < 0,001) correlacionaram-se com o TDIM. Os pacientes atingiram maiores frequências cardíacas (FC), FC%, dessaturação, dispneia e fadiga nas pernas no TDIM em comparação com o TGC (p < 0,05). Conclusões: A gravidade da doença, a força muscular do quadríceps, o nível de atividade física e a qualidade de vida foram determinantes do TDIM. As vantagens do TDIM, incluindo uma resposta cardiopulmonar mais elevada que no TGC e maior portabilidade, que facilita sua utilização em diversos ambientes, fazem do TDIM a escolha preferencial para investigar a capacidade de exercício limitada por sintomas em pacientes com BNFC.

1St Year Resident, Department Of Radio-Diagnosis; SVP Hospital; Smt. NHL Municipal Medical College; Ahmedabad

Background:Tuberculosis (TB) is a major public health problem. Pulmonary TB sequelae can affect a person's physical and functional capacity leading to decreased quality of life and societal participation. The study aims at evaluating exercise capacity, quality of life, and social participation in patients with post-pulmonary tuberculosis. Material And Methods:An analytical cross-sectional study was carried out in 100 post-tuberculosis patients by convenient sampling. Quality of life was assessed using WHOQOL BREF and social participation was evaluated with the Impact on Participation and Autonomy Questionnaire (IPAQ). Exercise capacity was measured using a six-minute walk test (6MWT). Result:The mean 6MWT distance in males was 333.76 ± 47.10 meters and in females was 335.04 ± 52.34 meters. The mean VO2 peak in males and females was 13.32 ± 2.37 ml/kg/min and 14.02 ± 2.84 ml/kg/min respectively. The quality of life and social participation in both males and females was good. There was a very weak positive correlation between 6MWT and WHOQOL BREF (spearman's rho=0.251) and a moderate negative correlation between WHOQOL BREF and IPAQ (spearman's rho= -0.663) There was no relationship between 6MWT and IPAQ score. Conclusion:The study concludes that the majority of the patients post pulmonary tuberculosis hasfair effort tolerance and good quality of life. It also concludes that there is no statistically significant difference in the quality of life and social participation between males and females.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Abstract Objectives Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). Methods Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. Results The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). Conclusion Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography. Highlights OUES analysis is useful for assessing functional capacity in refractory angina. O2 pulse curve is correlated with contractile alterations in exercise echocardiogram. Cardiopulmonary exercise test is useful toll in patients with refractory angina.

High-intensity inspiratory muscle resistance training can improve the exercise capacity and life quality of persons with bronchiectasis / 中华物理医学与康复杂志

Objective:To explore any effect of high-intensity inspiratory muscle resistance training on exercise capacity and life quality for persons with bronchiectasis.Methods:Sixty patients with bronchiectasis were randomly divided into an observation group and a control group, each of 30. The observation group received two 30-minute sessions of inspiratory muscle resistance training daily using the PowerBreak inspiratory muscle trainer 3 days/week for 8 weeks. The intensity was 70% of the maximum inspiratory pressure (MIP). The control group underwent the same training with the intensity at 10% of the MIP. The severity of illness, pulmonary function, respiratory muscle strength and endurance, exercise capacity and life quality of the two groups were evaluated before and after the intervention.Results:Compared with before the intervention, the average MIP in the observation group and the average distance they walked in the 6min walk test (6MWT) improved significantly. Their average social factor score on the Leicester cough questionnaire had increased significantly, while their average heart rate and self-perceived exertion during the 6MWT had decreased significantly. There were no significant differences in any of these indicators for the control group.Conclusions:High-intensity inspiratory muscle resistance training can significantly improve the exercise capacity and life quality of patients with bronchiectasis. The treatment is worthy of further research and application in the clinic.

Effect of exercise therapy on exercise capacity and quality of life of maintenance hemodialysis patients / 中国实用护理杂志

Objective:To explore the effect of exercise therapy on the exercise capacity and quality of life of maintenance hemodialysis patients.Methods:A total of 90 patients who underwent regular dialysis in Henan Provincial People′s Hospital, People′s Hospital of Zhengzhou University from April to December, 2020 were selected as the research objects by convienient sampling method. They were divided into experimental group and control group by random number table method, with 45 cases in each group. The control group was given routine nursing, and the experimental group took exercise therapy on the basis of routine nursing. The intervention lasted for 12 weeks. The changes in the exercise capacity and quality of life of the two groups before and after the intervention were observed.Results:Finally, 43 patients were included in the control group and 41 patients in the experimental group. There was no significant difference in the exercise capacity and quality of life before the intervention between the two groups( P>0.05). After the intervention, the maximum oxygen uptake, anaerobic threshold, 6MWT distance were (15.22 ± 3.08) ml·kg -1·min -1, (620.70 ± 53.56) ml·kg -1·min -1, (475.36 ± 50.51) m in the experimental group, and (12.22 ± 2.46) ml·kg -1·min -1, (590.18 ± 52.07) ml·kg -1·min -1, (444.50 ± 46.09) m in the control group, the differences were statistically significant between the two groups( t=3.32, 2.68, 296, all P<0.05). After the intervention, the scores of physiological function, physiological intelligence, physical pain, overall health, vitality, social function, emotional function and mental health dimensions of the quality of life were (84.32 ± 18.53), (84.61 ± 25.80), (76.40 ± 18.15), (59.02 ± 15.38), (52.22 ± 13.68), (69.56 ± 17.29), (94.24 ± 29.47), (73.44 ± 12.86) points in the experimental group, and (76.25 ± 17.35) (66.37 ± 27.63), (65.68 ± 17.54), (47.26 ± 15.45), (44.86 ± 13.14), (61.82 ± 16.51), (76.30 ± 26.14), (64.17 ± 13.36) points in the control group, the differences were statistically significant between the two groups( t values were 2.08-3.54, all P<0.05). Conclusions:Exercise therapy during dialysis can enhance exercise capacity and improve quality of life in maintenance hemodialysis patients.

Capacidade de exercício e nível de atividade física diária de crianças e adolescentes com fibrose cística: associação com estado nutricional, função pulmonar, hospitalização e uso de antibióticos / Capacidad de ejercicio y nivel de actividad física diaria de niños y adolescentes con fibrosis quística: asociación con estado nutricional, función pulmonar, hospitalización y uso de antibióticos / Exercise capacity and daily physical activity levels in children and adolescents with cystic fibrosis: association with nutritional status, lung function, hospitalization and antibiotic use

RESUMO O objetivo deste trabalho é avaliar a capacidade de exercício e nível de atividade física diária de crianças e adolescentes com fibrose cística e associar com estado nutricional, função pulmonar, tempo de hospitalização e uso de antibióticos. Trata-se de estudo transversal em indivíduos com fibrose cística entre 6 e 18 anos, registrando-se informações sobre perfil clínico, histórico de hospitalizações e uso de antibióticos. Os participantes foram submetidos à espirometria, bioimpedância, avaliação da capacidade de exercício com teste de Shuttle modificado (MST), o nível da atividade física foi medido por meio do questionário internacional de atividade física (IPAQ) e usando acelerômetro por 5 dias. Participaram 30 indivíduos com idade de 11,2 ± 3,6 anos e volume expirado forçado (VEF1) de 68,0 ± 24,8%. A mediana da distância percorrida no MST foi de 820 metros (66,3%) e demonstrou associação com a função pulmonar (r = 0,78), estado nutricional (r = 0,38), tempo de hospitalização (r = -0,42) e uso de antibióticos (r = -0,46). De acordo com o questionário, 20 pacientes (64,6%) foram classificados como sedentários, o acelerômetro revelou que os indivíduos passam 354,2 minutos em atividades sedentárias e apenas 14,9 minutos em atividades moderadas a vigorosas por dia. Quanto maior a porcentagem de tempo em atividade física moderada a vigorosa, maior o índice de massa corpórea (IMC) e menor o tempo de hospitalização. Assim, a capacidade de exercício e nível de atividade física em crianças e adolescentes com fibrose cística apresentou-se reduzida e associada com menores valores de IMC e aumento do tempo de hospitalização.

RESUMEN El propósito de este trabajo fue evaluar la capacidad de ejercicio y el nivel de actividad física diaria de los niños y adolescentes con fibrosis quística, así como asociarlos con el estado nutricional, la función pulmonar, la duración de la permanencia hospitalaria y el uso de antibióticos. Este es un estudio transversal realizado con individuos con fibrosis quística con edades comprendidas entre los 6 y los 18 años, y que registra información sobre el perfil clínico, los antecedentes de hospitalizaciones y el uso de antibióticos. Los participantes se sometieron a la espirometría, la bioimpedancia, la evaluación de la capacidad de ejercicio con la prueba de Shuttle modificada (MST); para medir el nivel de actividad física se aplicó el Cuestionario Internacional de Actividad Física (IPAQ) y el uso del acelerómetro durante 5 días. Participaron 30 personas de entre 11,2 ± 3,6 años de edad y volumen espirado forzado (VEF1) de 68,0 ± 24,8%. La mediana de la distancia recorrida en el MST fue de 820 metros (66,3%) y se mostró asociación con la función pulmonar (r=0,78), el estado nutricional (r=0,38), la duración de la permanencia hospitalaria (r=-0,42) y el uso de antibióticos (r=-0,46). El cuestionario reveló que 20 pacientes (64,6%) estaban sedentarios, y el acelerómetro evidenció que ellos pasan 354,2 minutos en actividades sedentarias y solo 14,9 minutos en actividades moderadas a intensas al día. Cuanto mayor sea el porcentaje de tiempo dedicado a la actividad física moderada a intensa, mayor será el índice de masa corporal (IMC) y menor la duración de la permanencia hospitalaria. Por lo tanto, la capacidad de ejercicio y el nivel de actividad física de niños y adolescentes con fibrosis quística fueron menores y están asociadas con bajos valores de IMC y con una permanencia hospitalaria más prolongada.

ABSTRACT To evaluate the exercise capacity and daily physical activity level among children and adolescents with cystic fibrosis, and its association with nutritional status, lung function, hospitalization time, and days taking antibiotics. This is a cross-sectional study in individuals with cystic fibrosis aged 6 to 18 years. Information on clinical profile, history of hospitalizations and antibiotic use were collected. Participants were submitted to spirometry, bioimpedance, and an assessment of exercise capacity with modified shuttle test (MST), and the level of physical activity was measured with the International Physical Activity Questionnaire (IPAQ) using an accelerometer for 5 days. In total, 30 individuals participated, aged 11.2±3.6 years, and 68.0±24.8% in forced expired volume in the first second (FEV1). The median distance covered in the MST was 820 meters (66.3%), showing association with lung function (r=0.78), nutritional status (r=0.38), hospitalization time (r=-0.42) and antibiotic use (r=-0.46). According to the questionnaire, 20 patients (64.6%) were classified as sedentary, the accelerometer revealed that the individuals spend 354.2 minutes in sedentary activities and only 14.9 minutes in moderate to vigorous activities per day. The higher the percentage of time in moderate to vigorous physical activity, the higher the body mass index (BMI) and the shorter the hospitalization time. Exercise capacity and level of physical activity in children and adolescents with cystic fibrosis is reduced and associated with lower BMI values and with an increase in hospitalization time.

Analysis on exercise capacity of patients with pneumoconiosis and different degrees of pulmonary dysfunction / 中国职业医学

OBJECTIVE: To explore the exercise capacity of patients with occupational pneumoconiosis with varying degrees of pulmonary dysfunction. METHODS: A total of 488 hospitalized occupational pneumoconiosis patients were selected as study subjects using the judgment sampling method and examined for pulmonary function test and cardiopulmonary exercise test(CPET). Among them, 272 patients with normal lung function were assigned as the control group, and 216 patients with abnormal lung function as the case group. The case group was divided into mild, moderate and severe pulmonary dysfunction subgroups according to the forced expiratory volume in one second/predicted value ratio(FEV_1%pred).RESULTS: The FEV_1%pred, maximal voluntary ventilation(MVV), maximum exercise tidal volume(VT_(max)), breathing reserve(BR), maximal Watt(W_(max)), maximum oxygen uptake(VO_(2max)) and anaerobic threshold(AT) in patients of the case group were lower than that in the control group(all P<0.05). The FEV_1%pred, MVV, VT_(max), W_(max), and VO_(2max) in patients in the 3 subgroups of abnormal lung function were decreased(all P<0.05) compared with the control group. The VO_(2max) and AT decreased in the case group with the increase of the degree of pulmonary dysfunction(P<0.05). The FEV1%pred, MVV, maximal exercise minute ventilation and VT_(max) of the study subjects were positively correlated with VO_(2max) and AT(all P<0.01), but the BR had no correlation with VO_(2max) and AT(all P>0.05). CONCLUSION: The more serious the abnormal degree of pulmonary function in the patients with occupational pneumoconiosis, the more obvious the decline of their exercise ability, showing a dose-effect relationship.

Effect of exercise rehabilitation on exercise capacity and quality of life in children with bronchial asthma: a systematic review / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the effect of exercise rehabilitation on exercise capacity and quality of life in children with bronchial asthma.@*METHODS@#PubMed, Cochrane Library, Web of Science, EBSCO, China National Knowledge Infrastructure, Weipu Data, and Wanfang Data were searched for randomized controlled trials (RCTs) on the effect of exercise rehabilitation on children with bronchial asthma published up to February 2021. RevMan 5.3 was used to perform a Meta analysis.@*RESULTS@#A total of 14 studies were included, with 990 subjects in total. The Meta analysis showed that compared with the conventional treatment group, the exercise rehabilitation group had significantly better exercise capacity (distance covered in the 6-minute walk test: @*CONCLUSIONS@#Current evidence shows that exercise rehabilitation has a positive effect in improving exercise capacity and quality of life in children with bronchial asthma. Due to limited number and quality of studies included in the analysis, further research is needed.

Pulmonary rehabilitation in pulmonary alveolar proteinosis: a case report

Pulmonary alveolar proteinosis is a rare lung disease in which surfactant accumulates in the alveoli causing impairment of gas exchange, pulmonary circulation, restrictive lung functions, respiratory and muscular dysfunction. Pulmonary rehabilitation is a core aspect in the management of patients with chronic respiratory diseases. However so far there are no documented studies on the effects of pulmonary rehabilitation in pulmonary alveolar proteinosis. Here authors report the case of a 20 year old female diagnosed with pulmonary alveolar proteinosis and having considerable activity limitations. Pulmonary rehabilitation program of 24 weeks was designed for her after a thorough assessment. The 6-minute walk distance (6 MWD), forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), exercise induced desaturation (SPO2) and QOL were evaluated using the SF-36 questionnaire. All parameters were recorded pre, post and at a follow up at 6 months after pulmonary rehabilitation. The 6MWD, FVC, DLCO, exercise induced desaturation and QOL improved considerably after 24 weeks of PR. At a follow up at 6 months all measures expect the FVC remained maintained. The authors thus conclude that Pulmonary Rehabilitation is effective in improving the exercise capacity, lung functions and quality of life in pulmonary alveolar proteinosis.

Exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans: a systematic review / Capacidade de exercício em crianças e adolescentes com bronquiolite obliterante pós-infecciosa: uma revisão sistemática

ABSTRACT Objective: To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans. Data source: This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans." We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol. Data synthesis: Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality. Conclusions: Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.

RESUMO Objetivo: Avaliar a capacidade de exercício em crianças e adolescentes com bronquiolite obliterante pós-infeciosa. Fonte de dados: Trata-se de uma revisão sistemática por meio das bases de dados PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Physiotherapy Evidence Database (PEDro). Utilizou-se a seguinte estratégia de busca: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans". Foram selecionados estudos que avaliaram a capacidade de exercício por meio de testes máximos/submáximos em crianças e adolescentes com bronquiolite obliterante pós-infeciosa, sem qualquer outra doença associada. Buscaram-se artigos nos idiomas inglês, português e espanhol e sem restrições quanto ao período de publicação. A qualidade metodológica foi avaliada pelo protocolo da Agency for Health Care Research and Quality (AHRQ). Síntese dos dados: De um total de 81 artigos, apenas 4 foram incluídos nesta revisão. Os estudos totalizaram 135 participantes (121 com bronquiolite obliterante pós-infeciosa e 14 saudáveis), com tamanho amostral entre 14 e 58 sujeitos. Todos avaliaram a função pulmonar por meio da espirometria, observando um padrão ventilatório obstrutivo. Desses, 3/4 avaliaram o desempenho físico pelo teste de caminhada de seis minutos e 2/4 pelo teste de exercício cardiopulmonar. Os resultados desses testes foram comparados a um grupo controle (1/4), bem como apresentados em percentual do previsto e/ou em metros (3/4). Por fim, 3/4 dos estudos demostraram que a capacidade de exercício se encontra reduzida nessa população. Os estudos incluídos foram classificados com alta qualidade metodológica. Conclusões: Os achados do estudo demonstram que crianças e adolescentes com bronquiolite obliterante pós-infeciosa apresentam redução da capacidade de exercício.

Impact of sarcopenia on muscle strength and exercise capacity in elderly patients with chronic heart failure / 中华全科医师杂志

Objective To investigate the impact of sarcopenia on muscle strength and exercise capacity in elderly patients with chronic heart failure (CHF).Methods One hundred and sixteen inpatient aged ≥65 years with CHF were enrolled in the study.General clinical characteristics were collected with questionnaire;the appendicular skeletal muscle mass (ASM) was assessed with body composition analyzer;the arm muscle strength was measured and a 6m-walk test was performed.The sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) criteria.Simple regression analysis and logistic regression were used to analyze the correlation between sarcopenia and decreased muscle strength,exercise capacity in elderly CHF patients.Results Among 116 elderly CHF patients,sarcopenia was confirmed in 42 patients(36.2％).Patients with sarcopenia had poorer cardiac function and lower muscle strength,ASM and 6m-walking speed than patients without sarcopenia did(allP＜0.05).Simple regression analysis showed positive correlation between ASM and muscle strength in both groups.Logistic regression analysis showed that after adjustment for confounders,ASM reduction was an independent risk factor for reducedexercisecapacity(OR=0.158,95％CI:0.055-0.455,P＜0.05).Conclusion Sarcopenia is a common complication in elderly patients with CHF and may lead to decreased muscle strength and exercise capacity.

Metoprolol combined with moderate-intensity aerobic exercise improves skeletal muscle functional sympathol-ysis and the exercise capacity of mildly hypertensive men / 中华物理医学与康复杂志

Objective To investigate the effect of metoprolol and metoprolol combined with moderate inten-sity aerobic exercise on the sympathetic vasoconstriction response of skeletal muscle, functional sympatholysis and the exercise capacity of hypertensive men. Methods Thirty men with mild ( stage 1) essential hypertension were divi-ded into a drug group and an observation group. The drug group received only metoprolol while the observation group took metoprolol and performed aerobic exercise (intensity 50-70％ of VO2max, 30-45 min/time, 3-5 times/week) for 12 weeks. Before and after the experiment, the subjects' maximum oxygen uptake (VO2max), peak power (PP) as well as a rating of perceived exertion ( RPE) curve during exercise were determined using the graded exercise test. Forearm vascular conductance ( FVC) induced by the cold pressor test was measured using Doppler ultrasound at rest and during a handgrip exercise. Sympathetic vasoconstriction response was manifested by the rate of change in the conductance (％FVC) before and after the cold pressor test. Functional sympatholysis ( the ability of muscle contrac-tions to inhibit sympathetic vasoconstrictor response) was quantified using the difference in the ％FVC values (△％FVC) between the handgrip exercise and at rest. Results After the treatment,％FVC during the handgrip exercise was lower than at rest in the observation group.△％FVC had increased significantly, as had VO2max and PP. The RPE curve during a graded exercise test shifted to the right in the observation group, but there was no significant change in the other observations. In the drug group, PP had decreased significantly and the RPE curve had shifted to the left. Conclusion Metoprolol can better improve functional sympatholysis and enhance exercise capacity when it is com-bined with moderate intensity aerobic exercise. That will alleviate any exercise intolerance in men with mild hyperten-sion caused by taking metoprolol alone.

Correlation of exercise capacity with left ventricle diastolic function

Introduction: Exercise may be good for the heard but good diastolic function also appears to protect the capacity for exercise researchers found. Objectives: To correlate exercise capacity with the left ventricle diastolic function. Material and methods: The Study was conducted on 100 subjects at Haldiram and Moolchand Heart Centre, PBM Hospital, S.P. Medical College, Bikaner. First a resting echocardiography was performed to evaluate cardiovascular diastolic function. After echocardiography the subjects were underwent Bruce protocol treadmill test. Results: Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, those with resting diastolic dysfunction had substantially lower exercise capacity. Conclusion: Left ventricular diastolic function were independently associated with exercise capacity.

Correlation of exercise capacity with Cardiovascular systolic function

Introduction: The analysis of systolic function in echocardiography may be useful to explain the correlation between the presence of systolic function and maximal exercise capacity on exercise test. Objectives: To correlate exercise capacity with the cardiovascular systolic function. Material and methods: Necessary information as per our study was collected from the hospital record of the study participants undergoing routine measurements of systolic function by 2D echocardiography and exercise capacity (VO2max) by treadmill test using bruce protocol. Results: Karl Pearson correlation analysis showed that cardiovascular systolic functions in our group do not correlate with exercise capacity. There was no correlation between exercise capacity and end systolic volume index (r=-0.171, p<0.089), between exercise capacity and ejection fraction (r=0.069, p<0.495), between exercise capacity and fractional shortening (r=0.074, p<0.467), between exercise capacity and stroke volume index (r=-0.092, p<0.o.361), and cardiac index (r=-0.072, p<0.475) also showed no significant association with exercise capacity. Conclusions: Correlation analysis showed that cardiovascular systolic functions in our group do not correlate with exercise capacity.

Effects of different exercise modes on the exercise capacity and cognitive functioning of elderly persons with hypertension / 中华物理医学与康复杂志

Objective To observe the effect of aerobic exercise and resistance training on the exercise capacity and cognition of elderly persons with hypertension.Methods Eighty-four elderly persons with essential hypertension were randomly divided into an aerobic exercise (AE) group,a resistance training (RT) group and a sedentary control (SC) group,each of 28.The AE and RT groups received 12 weeks of aerobic exercise or resistance training respectively,while the SC group maintained their normal lifestyles.Before and after the experiment,maximum oxygen uptake (VO2max) and time and distance to exhaustion were evaluated using a treadmill and a 30 s Wingate test.Maximum voluntary contraction (MVC) of the quadriceps femoris was quantified using an isokinetic ergometer.Perception speed,mental arithmetic,spatial imaging,working memory and memory recall were tested using computer software.Results After the intervention,significant increases were observed in the average VO2max and the time and distance to exhaustion of the AE group.The RT group showed significant improvements in the 30 s Wingate test,as well as in their average MVC,peak power,mean power and fatigue index.The average systolic and diastolic pressure was reduced in both groups but the difference was not significant.Average perception speed,working memory and total score in the cognitive function test had however improved significantly in both groups.There was no significant inter-group difference.The SC group showed no significant changes.Conclusion Either aerobic exercise or resistance training can reduce the blood pressure and improve cognition for elderly persons with essential hypertension,though they have significantly different effects on the exercise capacity.

Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people?

Objective Investigate the differences in cardiopulmonary (CP) capacity and Quality of Life (QOL) between healthy elderly (≥ 65 years) with different TSH levels (< 1.0 and ≥ 1.0 μIU/mL) both within the normal range. Also, evaluate the effects of TSH elevation on CP test and QOL, by administering methimazole to subjects with initial lower-normal TSH, in order to elevate it to superior-normal limit. Materials and methods Initially, a cross-sectional study was performed to compare CP capacity at peak exercise and QOL (using WHOQOL-OLD questionnaire) between healthy seniors (age ≥ 65 years) with TSH < 1.0 μIU/mL vs. TSH ≥1.0 μIU/mL. In the second phase, participants with TSH < 1.0 μIU/mL were included in a non-controlled-prospective-interventional study to investigate the effect of TSH elevation, using methimazole, on QOL and CP capacity at peak exercise. Results From 89 elderly evaluated, 75 had TSH ≥ 1 μIU/mL and 14 TSH < 1 μIU/mL. The two groups had similar basal clinical characteristics. No difference in WHOQOL-OLD scores was observed between groups and they did not differ in terms of CP function at peak exercise. QOL and CP variables were not correlated with TSH levels. Twelve of 14 participants with TSH < 1.0 μIU/mL entered in the prospective study. After one year, no significant differences in clinical caracteristics, QOL, and CP variables were detected in paired analysis before and after methimazole intervention. Conclusions We found no differences in CP capacity and QOL between health elderly with different TSH levels within normal range and no impact after one year of methimazole treatment. More prospective-controlled-randomized studies are necessary to confirm or not the possible harm effect in normal low TSH.

Avaliação funcional respiratória e capacidade do exercício como fatores de risco para complicações pulmonares no pós- operatório de transplante hepático

Contextualização: O transplante hepático (TxH) é a atual terapia padrão para pacientes com insuficiência hepática irreversível aguda ou crônica. As complicações pulmonares no pós-operatório (CPP) são uma importante causa de morbidade e mortalidade no TxH. Objetivo: Avaliar a função respiratória e capacidade do exercício como fatores de risco independentes para complicações pulmonares no pós-operatório de transplante hepático.Métodos: Estudo de coorte prospectivo realizado no Hospital Universitário Walter Cantídio (HUWC) no período de dezembro de 2012 a janeiro de 2015 com pacientes candidatos ao transplante de fígado com uma amostra de 100 pacientes. Foram incluídos na pesquisa pacientes com idade entre 18 a 70 anos que não apresentavam encefalopatia hepática, dificuldades de locomoção nem limitações ortopédicas. Os pacientes foram submetidos a uma avaliação pré-operatória constando de avaliação clínica, exame físico e exames complementares [espirometria, força muscular inspiratória (PImáx) e expiratória (PEmáx) pela manovacuometria, teste da caminhada de 6 minutos (TC6’) e teste do degrau(TD6’)]. No pós-operatório (PO) foram vistos os dados intra-operatórios e dados pós operatórios como as complicações pulmonares. Além disso, o volume expiratório força dono 1 segundo – VEF1) e manovacuometria foram analisadas no 1º, 3º, 5º PO e 1 mês após a cirurgia. A capacidade do exercício foi avaliada somente no 1º mês de PO. O trabalho foi aprovado pelo comitê de ética e pesquisa do HUWC...

Background: Liver transplantation (LT) is the current standard therapy for patients with irreversible liver failure, both acute or chronic. Pulmonary complications postoperatively (CPP) are an important cause of disease in liver transplant recipients and contribute substantially to mortality. Objective: To evaluate the respiratory functional evaluation and exercise capacity as independent risk factors for pulmonary complications after liver transplantation. Methods: Prospective cohort study undertaken at the Hospital Universitário Walter Cantídio (HUWC) from December 2012 to January 2015 with patients who are candidates for liver transplantation in the HUWC a total sample of 100 patients. The study included patients aged 18 to 70 years without hepatic encephalopathy, walking difficulties, orthopedic impairments. The patients were submitted to a preoperative evaluation consisting of clinical assessment, physical examination and laboratory tests (spirometry, maximal inspiratory pressure (MIP) and expiratory (MEP) for the manometer, 6-minute walk test (6MWT) and 6- minute step test (6MST')). In the post-operative, intra-operative data and post-operative data such as pulmonary complications were studied. In addition, lung function (forced expiratory volume in 1 second –FEV1) and manometer were analyzed on the 1st, 3rd and 5th post-operative days. One month after surgery, patients were evaluated for respiratory functional capacity and exercise capacity. The Research Ethics Committee of HUWC approved the study...

Obesity and Hypertension in Association with Diastolic Dysfunction Could Reduce Exercise Capacity

BACKGROUND AND OBJECTIVES: Empirical evidence is lacking on the cumulative disease burden of obesity and hypertension and its impact on cardiac function and exercise capacity. The purpose of this study was to determine whether the presence of obesity and hypertension together was associated with cardiac dysfunction and exercise capacity. SUBJECTS AND METHODS: Using a retrospective study design, medical records were reviewed for echocardiographic and treadmill exercise stress test data. Subjects were grouped according to four categories: normal control, obese, hypertensive, or obese and hypertensive. RESULTS: Obese, hypertensive persons showed significantly lower Ea and E/A ratio and greater E/Ea ratio, deceleration time, left ventricular (LV) mass, and LV mass index compared to their counter parts (normal control, obese and/or hypertensive) (all p<0.05), after controlling for age and sex. After controlling for age and sex, significant differences in exercise capacity indices were found, with the obese group having shorter exercise time, lower metabolic equivalents, and lower maximal oxygen uptake than the normal control, hypertensive, or both groups (all p<0.05). The hypertensive or obese and hypertensive group had greater maximal blood pressure compared with the normal control group (all p<0.001). Obese and hypertensive persons were approximately three times more likely to have diastolic dysfunction (odd ratio=2.96, p=0.001), when compared to the reference group (normotensive, non-obese, or hypertensive only persons). CONCLUSION: Diastolic dysfunction was associated with obesity and/or hypertension. The cumulative risk of obesity and hypertension and their impact on diastolic dysfunction which could be modifiable could reduce exercise capacity.

In-hospital cardiac rehabilitation improves exercise capacity after cardiac surgery / 中华物理医学与康复杂志

Objective To explore the effect of an in-hospital cardiac rehabilitation program on exercise capacity after cardiac surgery.Methods Forty-two patients with valvular heart disease or coronary heart disease were recruited and randomly divided into a rehabilitation group (n=22) and a control group (n=20).Both groups were given preoperative education and breathing guidance on the basis of conventional clinical treatment,but the rehabilitation group was also provided with in-hospital cardiac rehabilitation after the operation.The two-minute stepping test (2-MST) and the left ventricular ejection fraction test (LVEF) were performed before and after the intervention for both groups.Their hospital stays were also compared.One month after discharge,the exercise capacity of both groups was followed-up by telephone using the Veterans-specific Activity Questionnaire (VSAQ).Results After the intervention,there was no significant difference in average LVEF between the two groups (53.73±9.29％ and 56.25± 11.01％ respectively).The average 2-MST stepping frequency of the rehabilitation group was significantly greater than the control group (79.41± 10.99 times and 71.25± 14.21 times respectively,P＜0.05).One month after discharge,the exercise capacity of the rehabilitation group was also significantly higher than the control group for (5.77± 1.46 METs versus 4.75± 1.34 METs,P＜0.05).Stepping frequency at discharge and exercise capacity at one month after discharge were both positively correlated to 2-MST stepping frequency at admission(r =0.869,P＜0.01;r=0.752,P＜O.01).The average hospital stay of the rehabilitation group was significantly shorter (by about 3 days) than the control group (15.59±3.08 days versus 18.45±3.63 days,P＜0.01).Conclusions In-hospital cardiac rehabilitation can significantly improve exercise capacity after cardiac surgery and reduce the length of hospital stays.The 2-minute step test is a simple and practical way to assess the exercise capacity of patients early after cardiac surgery.

The Nutrient Intakes and their Relationships with the Use of Diuretics, Symptom Severity and Physical Functioning in Heart Failure Patients / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to identify the differences in nutrient intake according to using diuretics, symptom severity and degree of physical functioning in heart failure patients. METHODS: A secondary data analysis was conducted by using baseline data of an intervention study for heart failure patients. In this study, 131 heart failure patients were included. Data were collected using medical records, NYHA (New York Heart Association functional classification) class, and 6-minute-walking test and 24-hour diet recall. Data were analyzed using descriptive statistics and Chi-square test by SPSS 21.0. Nutrient intake was assessed using CAN-pro 2.0. RESULTS: Majority of the participants consumed total calorie less than Estimated Energy Requirement (EER) and consumed carbohydrates more than 65% of their total calorie intakes. 24.4% of the participants consumed fat more than 30% of their total calorie intakes and 23.7% consumed saturated fat more than 7% of their total calorie intakes. 100.0% of the participants consumed protein less than 7% of their total calorie intakes and 73.3% of the participants consumed more than recommended intakes of sodium. More than 90.0% of the participants consumed less than adequate intakes of potassium (90.1%) and Vitamin D (91.6%), respectively. 100% and 62.6% of the participants consumed less than Estimated Average Requirement (EAR) of magnesium and Vitamin B1, respectively. Nutrient intakes in heart failure patients were different for potassium intake according to the usage of diuretics. The participants with symptom severity tended to intake protein less properly and the participants walking more than 300.0 m tended to intake sodium improperly high. CONCLUSIONS: The findings of this study indicated the need for screening nutrient intakes of heart failure patients. It is necessary to increase the intake of total calories and most nutrients and to restrict sodium intakes among heart failure patients.