A pilot observational study to identify reference values for the 6-minute walk test in Brazilian people with hypertension / Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46-59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Resumo Introdução A hipertensão arterial sistêmica (HAS) é respon-sável por 9,5 milhões de mortes na população mundial. Con-dições do estilo de vida, incluindo a inatividade física, são importantes fatores de risco modificáveis no desenvolvimento da HAS. Desse modo, o exercício físico tem se mostrado eficaz no controle da HAS e, antes da prescrição, o teste de caminhada de seis minutos (TC6) tem sido comumente utilizado para ava-liar a capacidade física. Objetivo Propor valores de referência para o teste de TC6 em brasileiros com HAS. Métodos Realizou-se um estudo observacional transversal com 302 hipertensos (62,61 + 10,93 anos) admitidos em um programa de reabilitação cardíaca. Os participantes foram divididos em diferentes quartis de idade e submetidos ao TC6. Os dados de distância percorrida foram comparados entre os quartis e ajustados por análise de regressão linear múltipla. Resultados Os hipertensos caminharam 388,07 + 115,03 m durante o TC6. Não encontrou-se diferença significativa entre os gêneros. No entanto, quando comparados os quartis de idade, para a faixa etária de 46 a 59 anos, as mulheres caminharam menos do que os homens. As comparações intragrupo mostraram que a distância percorrida no TC6 diminuiu com o aumento da idade, tanto em homens quanto em mulheres. Conclusão O presente estudo fornece valores de referência para o TC6, tanto para homens quanto para mulheres brasileiras de diferentes faixas etárias. Esses dados podem ser um parâmetro importante para futuros estudos clínicos, estratégias de prevenção e intervenção clínica.

Post-COVID-19 functional capacity assessed with ring and walk tests: cross-sectional study / Capacidade funcional pós-COVID-19 com teste de argola e de caminhada: estudo transversal

Abstract Introduction COVID-19 can cause persistent symptoms even in mild cases, such as fatigue and dyspnea, which can reduce functional capacity and make it difficult to perform activities of daily living. Objective To compare functional capacity using the pegboard and ring test and the six-minute walk test responses in post-COVID-19 patients according to the ventilatory support used. Methods Cross-sectional study including 40 adults of both sexes after SARS-CoV2 infection between June 2020 and June 2021, with assessment of functional capacity using the pegboard and ring test (upper limbs) and the six-minute walk (lower limbs). Those who reported comprehension deficit or neuromuscular disease were excluded. All participants were evaluated between 15 and 90 days after the onset of symptoms, diagnosed by nasal swab and classified according to the ventilatory support used during the infection. Results The mean age of the participants (n = 40) was 54.30 (±12.76) years, with BMI 28.39 (±4.70) kg/m2 and pulmonary involvement in 51.49 (±17.47)%. A total of 37 participants were hospitalized with a stay of 14.33 (±15.44) days, and 30% were previously immunized, while 7.5% reached the predicted distance covered. The average achieved was 46.44% (398.63 ± 130.58 m) in the distance covered and 39.31% (237.58 ± 85.51) in the movement of rings. Participants who had invasive mechanical ventilation (n = 10) had the worst functional capacity in both tests 265.85 ± 125.11 m and 181.00 ± 90.03 rings, compared to 472.94 ± 88.02 m and 273.25 ± 66.09 rings in non-invasive ventilation (n = 8), 410.32 ± 90.39 m and 257.68 ± 62.84 rings in oxygen therapy (n = 19), 569.00 ± 79.50 m and 203.00 ± 169.00 rings when there was no hospitalization (n = 3). Conclusion Participants who required invasive mechanical ventilation had worse functional capacity, 46% of what was expected in the walk test and 39% of what was expected in the pegboard and ring test.

Resumo Introdução A COVID-19 pode causar sintomas per-sistentes mesmo nos casos leves, como fadiga e dispneia, que podem reduzir a capacidade funcional e a realização das atividades de vida diária. Objetivo Comparar a avaliação da capacidade funcional a partir do teste da argola e caminhada dos 6 minutos pós-COVID-19 con-forme o suporte ventilatório utilizado. Métodos: Estudo transversal com 40 adultos, de ambos os sexos, pós-infecção por SARS-CoV2 entre julho/2020 e julho 2021, com avaliação da capacidade funcional pelos testes da argola (membros superiores) e caminhada (membros inferiores) de 6 minutos. Todos os participantes foram avaliados entre 15 e 90 dias do princípio dos sintomas, diagnosticados por swab nasal, e classificados conforme o suporte ventilatório utilizado durante a infecção. Resultados A média de idade dos participantes (n = 40) foi 54,30 (±12,76) anos, índice de massa corporal 28,39 (±4,70) kg/m2 e acometimento pulmonar em vidro fosco 51,49 (±17,47)%. Trinta e sete participantes foram hospitalizados com permanência de 14,33 (±15,44) dias, 30% previamente imunizados; 7,5% atingiram o predito da distância percorrida. A média alcançada foi de 46,44% (398,63 ± 130,58 m) na distância percorrida e 39,31% (237,58 ± 85,51) em movimento de argolas. Os participantes que utilizaram ventilação mecânica invasiva (n = 10) apresentaram pior capacidade funcional em ambos os testes: 265,85 ± 125,11 m e 181,00 ± 90,03 argolas comparado a 472,94 ± 88,02 m e 273,25 ± 66,09 argolas em ventilação não invasiva (n = 8), 410,32 ± 90,39m e 257,68 ± 62,84 argolas em oxigenoterapia (n = 19), 569,00 ± 79,50 m e 203,00 ± 169,00 argolas sem internação (n = 3). Conclusão Os participantes que necessitaram de ventilação mecânica invasiva apresen-taram pior capacidade funcional, com 46% do esperado no teste de caminhada e 39% no teste de argola de 6 minutos.

Adherence to heart rate training zones in an exercise training program in adults with coronary artery disease

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and relationship between trained intensity and functional capacity. Methods: Retrospective study led with medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50 ­60% of heart rate reserve, increasing monthly to 70 ­80% by the third month. Spearman's test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg­RPE). Adherence was classified as 'below' when HRTZ was not achieved in any phase of the program, 'intermediate' when HR was within the HRTZ for one or two months, and 'above' when HR was at or higher than HRTZ two months. Improvement was tested with t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. Trained intensity did not go below 8.6% of the prescribed minimal threshold of HRTZ. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg­RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume incardiovascular rehabilitation programs.

Prueba de caminata de 6 minutos: del sujeto normal a la obesidad mórbida / Six minute walk test: from normal to morbid obesity subject

Resumen Introducción: La obesidad mórbida se asocia a alteraciones de la capacidad de caminar, sin embargo se desconoce cómo es el comportamiento de la prueba de caminata de 6 minutos en sujetos con incrementos del índice de masa corporal (IMC). Objetivo: Describir el comportamiento de la prueba de caminata de 6 minutos en sujetos con IMC normal hasta la obesidad mórbida. Métodos: Mediante un diseño transversal analítico se estudiaron sujetos de ambos sexos de 18 a 60 años con IMC: normal (18.5-24.9 kg/m2), sobrepeso (25-29.9 kg/m2), obesidad (30-39.9 kg/m2), obesidad mórbida (> 40 kg/m2). Se les realizó prueba de caminata de 6 minutos, se acotaron variables demográficas y antecedentes personales patológicos. Se analizaron las categorías de IMC con ANOVA de una vía y ajuste de Bonferroni y los sexos con prueba t, ambos para grupos independientes y correlaciones de Pearson para las diversas variables. Una p < 0.05 fue considerada estadísticamente significativa. Resultados: Se estudiaron 480 sujetos de ambos sexos en cuatro grupos. Edad: hombres 43 ± 11 y mujeres 45 ± 10 años. Porcentaje diabetes mellitus (6.7%), hipertensión arterial (18.3%). Metros caminados hombres vs. mujeres por IMC (normal: 483 ± 56 vs. 449 ± 61; sobrepeso: 471 ± 55 vs. 441 ± 44; obesidad: 455 ± 70 vs. 421 ± 47; obesidad mórbida: 443 ± 49 vs. 403 ± 54; p < 0.05). Correlación IMC-metros caminados r: -0.446 (p < 0.0001). Conclusiones: Los metros caminados en la prueba de caminata de 6 minutos disminuyeron conforme incrementó el IMC. El sexo masculino caminó más metros en todas las categorías.

Abstract Introduction: Morbid obesity is associated with alterations in the ability to walk, however, the behavior of the 6-minute walk test in subjects with increases in body mass index is unknown. Objective: To describe the behavior of the 6-minute walk test in subjects with normal body mass index to morbid obesity. Methods: Through an analytical cross-sectional design, subjects of both genders from 18 to 60 years old with body mass index were studied: Normal (BMI: 18.5-24.9); overweight (BMI: 25-29.9); obesity (BMI: 30-39.9); morbid obesity (BMI: > 40) kg/m2. A 6-minute walk test was performed, demographic variables and pathological personal history were delimited. BMI categories were analyzed with one-way ANOVA and Bonferroni adjustment, and gender with t-test, both for independent groups, and Pearson's correlations for the various variables. Results: 480 subjects of both genders were studied in four groups. Age: men 43 ± 11 and women 45 ± 10 years old. Percentage diabetes mellitus (6.7%), arterial hypertension (18.3%). Meters walked men vs. women by body mass index (normal: 483 ± 56 vs. 449 ± 61; overweight: 471 ± 55 vs. 441 ± 44; obesity: 455 ± 70 vs. 421 ± 47; morbid obesity: 443 ± 49 vs. 403 ± 54, p < 0.05). Correlation body mass index-meters walked: r: -0.446 (p < 0.0001). Conclusions: Meters walked in the 6-minute walk test decreased as body mass index increased. The male gender walked more meters in all categories.

Six-minute walk test for assessment of work capability in patients with chronic obstructive pulmonary disease: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is a systemic disorder causing morbidity, disability, and mortality throughout the world. Although, spirometry parameters have been used for decades to diagnose COPD as well as to grade the severity of this disease, others factors such as the BMI, degree of inflation, and exercise capacity have become important outcome measures for extra-pulmonary manifestations. The 6-min walk test (6MWT) is considered as a simple test to assess the functional capacity of COPD patients. The aim of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Aims and Objectives: The objective of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Materials and Methods: A cross-sectional comparative study was conducted on thirty COPD patients and thirty control subjects. All the subjects were investigated through history taking, clinical examination, spirometry, and 6MWT in the Department of Physiology, R.G. Kar Medical College and Hospital, Kolkata. Statistical analysis was done by SPSS version-21. Results: The values of the spirometry parameters were significantly reduced in cases than in the controls (P < 0.05). The values of 6-min walk distance as well as 6-min work (6MWORK) were also significantly reduced in cases than in the controls (P = 0.0023 and P = 0.0028, respectively). A strong positive correlation was found between forced vital capacity and 6MWORK (r = 0.556), BMI, and 6MWORK (r = 0.84) in patients of COPD. Conclusion: Our study substantiates that 6MWT can be implemented in our set up to assess the work capability and thus to predict morbidity in patients of COPD.

Relationship between Body Surface Area and Pulmonary Functions in Patients of Silicosis

Background and objective: Silicosis is one of the oldest occupational lung diseases. However, there are very few studies identifying the anthropometric variables associated with silicosis. The present study aimed at studying the association between body surface area (BSA), pulmonary function indices, and 6-minute walk distance (6MWD) in patients with silicosis. Materials and methods: The study was conducted on 102 male patients of silicosis. Height and weight were measured to calculate BSA. Spirometry and 6 minute-walk tests were performed. Data were analyzed using EPI info V 7 software. Student's t-test of significance (ANOVA) was applied to test the difference between means. Results: There are no significant changes found in the 6-minute walk distance with years of exposure and BSA. Statistically significant lower values of pulmonary function indices were observed in patients with BSA <1.6 sq m. Statistically significant higher values of forced expiratory volume in the first second and forced vital capacity were observed in patients with BSA >1.9 sq m in all categories of exposure. Conclusion: In conclusion, patients of silicosis with >1.9 sq m BSA had higher values of pulmonary function indices. Large body size may be of value in protection from developing occupational lung disease.

Predictors of reduced incremental shuttle walk test performance in patients with long post-COVID-19 / Preditores de desempenho reduzido no teste de caminhada incremental em pacientes com pós-COVID-19 longa

ABSTRACT Objective: One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. Methods: We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. Results: Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = −7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). Conclusions: In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

RESUMO Objetivo: Uma das limitações comuns após a pneumonia por COVID-19 é a diminuição da capacidade de exercício. A identificação dos fatores que afetam a capacidade de exercício e a avaliação dos pacientes em risco são importantes para determinar a estratégia de tratamento. Este estudo foi conduzido para determinar os preditores de diminuição da capacidade de exercício em pacientes pós-COVID-19 longa. Métodos: Foi investigada a associação da capacidade de exercício medida pelo incremental shuttle walk test (ISWT, teste de caminhada incremental) com idade, sexo, variáveis espirométricas, força muscular respiratória e periférica, qualidade de vida, fadiga, escala hospitalar de ansiedade e depressão, envolvimento na radiografia de tórax e status de atendimento. Os pacientes foram divididos em três grupos: pacientes ambulatoriais, pacientes internados e pacientes em UTI. A análise de regressão foi utilizada para determinar quais parâmetros eram preditores significativos da capacidade de exercício. Resultados: Dos 181 pacientes incluídos no estudo, 56 (31%) eram do sexo feminino. O ISWT médio em porcentagem dos valores previstos (ISWT%prev) foi de 43,20% em toda a amostra, enquanto foi de 52,89%, 43,71% e 32,21% nos grupos de pacientes ambulatoriais, internados e em UTI, respectivamente. A análise de regressão linear mostrou que os preditores de diminuição do ISWT%prev foram sexo (b = 8,089; p = 0,002), pontuação na escala mMRC (b = −7,004; p ≤ 0,001), CVF%prev (b = 0,151; p = 0,003), e força de preensão manual (b = 0,261; p = 0,030). Conclusões: Em pacientes pós-COVID-19 longa, sexo, percepção de dispneia, padrão restritivo da função respiratória e diminuição da força muscular periférica são preditores de redução da capacidade de exercício que persiste três meses após COVID-19. Nesse contexto, sugerimos que a reabilitação pulmonar pode ser uma terapia importante para pacientes pós-COVID-19.

Early Six-Minute Walk Test May Predict Midterm Outcomes Following Coronary Artery Bypass Grafting

ABSTRACT Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. Methods: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. Results: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). Conclusion: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

Curative effect of capreomycin in adjuvant treatment of multidrug-resistant pulmonary tuberculosis and its effect on quality of life and immune function / 中国热带医学

@#Abstract: Objective To investigate the efficacy of capreomycin adjuvant therapy for multidrug-resistant pulmonary tuberculosis (MDR-TB) and its effect on quality of life and immune function. Methods Eighty-eight elderly pulmonary tuberculosis patients admitted to Affiliated Hospital of Hebei University from October 2019 to October 2020 were selected and divided into two groups according to the random number table method. The control group (n=44) used 4-6Am-Mfx（Lfx）-Pto-Cfz-Z-Hhigh-dose-E/5 Mfx（Lfx）-Cfz-Z-E, the research group (n=44) used capreomycin on the basis of the control group. The 6-Minute Walk Test (6MWT) measured value/predicted value and quality of life [36-Item Short Form Health Survey Questionnaire (SF-36)] scores, safety evaluation results, chest CT cavity and lesion absorption rate and sputum culture turned negative were compared between the two groups, and the serum procalcitonin (PCT) expression levels and immune function were detected before and after treatment. Results The 6MWT measured value/predicted value of the research group and control group before the treatment were (0.48±0.11) and (0.64±0.13), which were significantly higher than corresponding (0.51±0.12) and (0.58±0.14) after treatment (t=6.23, 2.520, P<0.05), the measured/expected value of 6MWT increased in both groups after treatment. Compared with the same group before treatment, the SF-36 scores for each dimension increased in both groups after treatment (P<0.01). The expression levels of serum PCT in the research group and control group before the treatment were (0.37±0.09) ng/mL and (0.12±0.03) ng/mL versus (0.36±0.11) ng/mL and (0.21±0.06) ng/mL after treatment (t=17.480, 7.940, P<0.01). Compared with the same group before treatment, serum PCT expression levels decreased in both groups after treatment. Compared with the same group before treatment, CD3+, CD4+ and CD4+/CD8+ were elevated in both groups after treatment (P<0.05 or P<0.01); after treatment, CD3+, CD4+, and CD4+/CD8+ were significantly higher in research group compared to the control group (t=4.21, 8.02, 2.04, P<0.05). The absorption rate of chest CT cavity and lesions and negative rate of sputum culture in the research group were 88.64% (39/44) and 81.82% (36/44), which were significantly higher than corresponding 63.64% (28/44) and 61.36% (27/44) in the control group (P<0.05). Conclusions　Capreomycin can improve the quality of life of MDR-TB patients, extend the 6-minute walking distance, and regulate serum PCT expression levels and immune function, to promote the absorption of chest CT cavity and lesions, and sputum culture to turn negative, and the security is acceptable.

Effects of Cardiac Resynchronization Therapy on a Six-minute Walk Test, Maximal Inspiratory Pressure and Peak Expiratory Flow in Patients with Heart Failure: A Longitudinal Study

Abstract Background: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure. Objective: To evaluate the response of CRT in maximal inspiratory pressure (MIP), peak expiratory flow (PEF), and exercise tolerance as determined by the six-minute walk test (6MWT) in patients with HF. Methods: This study used the 6MWT and Manovacuometer to assess functional capacity in relation to activities of daily living, in which fatigue and dyspnea are common. Results: After six months of CRT, this study identified improvements in the 6MWT, p<0.05; MIP, p=0.01; and PEF, p=0.03. Conclusion: After CRT, this study showed a significant improvement in MIP, PEF, and exercise tolerance. However, further studies are warranted to demonstrate the relevance of these findings.

Autonomic response of older women to the submaximal effort in the six-minute walk test: a cross-sectional study / Resposta autonômica de mulheres idosas ao esforço submáximo do teste de caminhada de seis minutos: um estudo transversal / Respuesta autonómica de ancianas al esfuerzo submáximo en la prueba de paso de seis minutos: un estudio transversal

ABSTRACT This cross-sectional study aimed to evaluate the autonomic response of older women in the six-minute walk test. In total, 32 women aged 60 years or older without a diagnosed health problem were evaluated during the six-minute walk test. To monitor the autonomic response, the following variables were considered: heart rate, systolic and diastolic blood pressure, respiratory rate, and perceived exertion. These variables were compared during rest, effort, and recovery. This study also sought a correlation between autonomic function variables and performance in the test and perceived exertion. Results showed that the effort made by older women in the six-minute walk test induces an autonomic response resulting in increased heart rate and systolic and diastolic blood pressure; however, the respiratory rate remained unchanged during the test. Diastolic blood pressure remained high during recovery. No correlation was found neither between perceived exertion and cardiovascular physiological response nor between distance covered and variation of the autonomic response or level of physical conditioning. Therefore, the effort spent in the six-minute walk test promotes an autonomic response in older women, increasing cardiovascular stress without increasing ventilation. In this context, the Borg scale was not representative of cardiovascular stress during the test.

RESUMO O objetivo deste estudo foi investigar a resposta autonômica de idosas ao esforço do teste de caminhada de 6 minutos (TC6M). Realizou-se um estudo transversal a partir da avaliação de 32 idosas, sem problemas de saúde diagnosticados, com 60 anos ou mais, durante o TC6M. Para o monitoramento da resposta autonômica, foram consideradas as seguintes variáveis: frequência cardíaca, pressão arterial sistólica e diastólica, frequência respiratória e percepção de esforço. Essas variáveis foram comparadas durante o período de repouso, esforço e recuperação. Buscou-se também correlação entre as variáveis da função autonômica e o desempenho no teste e a percepção de esforço. Os resultados demonstraram que o esforço gerado no TC6M induz uma resposta autonômica que leva ao aumento da frequência cardíaca e da pressão arterial sistólica e diastólica em mulheres, porém a frequência respiratória permaneceu inalterada durante o teste. A pressão arterial diastólica permaneceu elevada durante a recuperação. Não houve correlação entre a percepção de esforço e a resposta fisiológica cardiovascular apresentada, nem entre a distância percorrida e a variação da resposta autonômica ou o nível de condicionamento físico. Concluiu-se que o esforço despendido no TC6M promove uma resposta autonômica em idosas, intensificando o estresse cardiovascular sem aumentar a ventilação. Nesse contexto, a escala de Borg não foi representativa do estresse cardiovascular durante o teste.

RESUMEN El objetivo de este estudio fue investigar la respuesta autonómica de ancianas al esfuerzo en la prueba de paso de 6 minutos (6MWT). Se realizó un estudio transversal con la participación de 32 ancianas, de 60 años o más, sin problemas de salud diagnosticados durante la 6MWT. Para monitorear la respuesta autonómica, se consideraron las siguientes variables: frecuencia cardíaca, presión arterial sistólica y diastólica, frecuencia respiratoria y esfuerzo percibido. Se compararon estas variables durante el período de reposo, esfuerzo y recuperación. También se buscó una correlación entre las variables de función autonómica y rendimiento en la prueba y el esfuerzo percibido. Los resultados mostraron que el esfuerzo producido en la 6MWT genera una respuesta autonómica que conduce a un aumento de la frecuencia cardíaca y de la presión arterial sistólica y diastólica en las mujeres, pero la frecuencia respiratoria se mantuvo sin cambios durante la prueba. La presión arterial diastólica se mantuvo alta durante el período de recuperación. No hubo correlación entre el esfuerzo percibido y la respuesta fisiológica cardiovascular presentada, tampoco entre la distancia recorrida y la variación de la respuesta autonómica o el nivel de condicionamiento físico. Se concluyó que el esfuerzo realizado en la 6MWT generó una respuesta autonómica en las ancianas al intensificar el estrés cardiovascular pero sin aumentar la ventilación. En este contexto, la escala de Borg no fue significativa para el estrés cardiovascular durante la prueba.

Rehabilitación cardiorrespiratoria en hipertensión pulmonar: experiencia en un centro de referencia / Cardiorespiratory rehabilitation in pulmonary hypertension: experience in a reference center

RESUMEN Introducción: La hipertensión pulmonar (HP) abarca un grupo heterogéneo de enfermedades que genera discapacidad y aumento de la morbimortalidad. La rehabilitación cardiorrespiratoria (RC) es un recurso terapéutico subutilizado en esta condición. Objetivo: Estimar los efectos de un programa de RC en una prueba de caminata de campo y en la calidad de vida de pacientes con diagnóstico de HP de los grupos I y IV. Materiales y Métodos: Los pacientes fueron evaluados antes y después de la intervención mediante la prueba de caminata de 6 minutos (PC6M) y el Saint George's Respiratory Questionnaire (SGRQ). El programa de RC consistió en 8 semanas de ejercicios supervisados con modalidad institucional. Resultados: Se incluyeron 19 pacientes con diagnóstico de HP precapilar por cateterismo cardíaco derecho, 18 mujeres (94,7%) con una media de edad de 45,5 ± 14,3 años. Trece (68,4%) presentaron HP del grupo I, y 6 (31,6%) HP del grupo IV. Se observaron cambios estadísticamente significativos en la PC6M (diferencia de medias -DM- 31 ± 27,3 metros; p <0,001), y en el SGRQ (DM 8,2 ± 10,2; p<0,01). No se reportaron eventos adversos graves durante el programa. Conclusiones: Nuestro estudio sugiere que un programa de RC supervisado en pacientes con HP podría mejorar la distancia caminada y la calidad de vida.

ABSTRACT Background: Pulmonary hypertension (PH) comprises a heterogeneous group of diseases resulting in disability and increased morbidity and mortality. Cardiopulmonary rehabilitation (CR) is a therapeutic resource not widely used in this condition. Objective: The aim of this study was to evaluate the effects of a CR program on a walking test and on the quality of life in patients with group 1 and group 4 PH Methods: Patients were evaluated before and after the intervention with the six-minute walk test (6MWT) and Saint George's Respiratory Questionnaire (SGRQ). The program consisted of 8 weeks of supervised exercises within the institution. Results: Nineteen patients with precapillary PH diagnosed by right heart catheterization were included; 18 were women (94.7%) with a mean age of 45.5±14.3 years. Thirteen (68.4%) patients had group 1 PH and 6 (31.6%) had group 4 PH. There were statistically significant changes in the 6MWT [mean difference (MD) 31±27.3 m; p<0.001], and in the SGRQ (MD 8.2±10.2; p<0.01). No adverse events were reported during the program. Conclusions: Our study suggests that a supervised CR program in patients with PH could improve the distance walked and the quality of life.

Intervenção fisioterapêutica sobre a força de preensão manual e capacidade funcional em pacientes pós-COVID-19 / Physiotherapeutic intervention on handgrip strength and functional capacity in postCOVID-19 patients / Intervención fisioterapéutica sobre la fuerza de agarre manual y capacidad funcional en pacientes post-COVID-19

Objetivo: analisar os efeitos da intervenção fisioterapêutica na força de preensão manual e na capacidade funcional em pacientes pós-COVID-19. Método: estudo de coorte retrospectivo, realizado em prontuários de pacientes pós-COVID-19 atendidos em na clínica escola do curso de fisioterapia na Universidade de Passo Fundo, entre março e novembro de 2021. Valores relacionados a dinamometria manual e ao teste de caminhada de seis minutos (TC6min) foram extraídos antes e após a reabilitação cardiopulmonar. Resultado: foram analisados 16 pacientes, com idade média de 49,81±13,79 anos. Após a intervenção, houve aumento significativo nos valores da dinamometria manual nas mulheres (mão direita p=0,014; mão esquerda p=0,041) e nos homens (mão direita p=0,008; mão esquerda p=0,007), assim como, no TC6min (p=0,033). Houve diferença entre o valor pré-intervenção do TC6min e o valor previsto do TC6min (p=0,006). Esta diferença não foi observada na comparação entre o valor pósintervenção do TC6min e o valor previsto do TC6min (p=0,073). Conclusão: os participantes apresentam comprometimento da força de preensão manual e da capacidade funcional, sendo que a intervenção fisioterapêutica pode melhorar esses aspectos.

Objective: to analyze the effects of physiotherapeutic intervention on handgrip strength and functional capacity in post-COVID-19 patients. Method: retrospective cohort study, carried out in medical records of post-COVID-19 patients treated at the school clinic of the physiotherapy course at the University of Passo Fundo, between March and November 2021. Values related to manual dynamometry and the six-minute walk test (6MWT) were extracted before and after cardiopulmonary rehabilitation. Results: 16 patients were analyzed, with a mean age of 49.81±13.79 years. After the intervention, there was a significant increase in the values of manual dynamometry in women (right hand p=0.014; left hand p=0.041) and in men (right hand p=0.008; left hand p=0.007), as well as in the 6MWT ( p=0.033). There was a difference between the pre-intervention value of the 6MWT and the predicted value of the 6MWT (p=0.006). This difference was not observed in the comparison between the post-intervention value of the 6MWT and the predicted value of the 6MWT (p=0.073). Conclusion: participants have compromised handgrip strength and functional capacity, and physical therapy intervention can improve these aspects.

Objetivo: analizar los efectos de intervención fisioterapéutica sobre la fuerza de agarre manual y capacidad funcional en pacientes post-COVID-19. Método: estudio de cohorte retrospectivo, realizado en prontuarios de pacientes post-COVID-19 atendidos en la clínica escolar del curso de fisioterapia de la Universidad de Passo Fundo, entre marzo y noviembre de 2021. Valores relacionados con la dinamometría manual y el reloj de seis minutos la prueba de marcha (6MWT) se extrajo antes y después de la rehabilitación cardiopulmonar. Resultados: se analizaron 16 pacientes, con una edad media de 49,81±13,79 años. Después de la intervención, hubo un aumento significativo en los valores de la dinamometría manual en mujeres (mano derecha p=0,014; mano izquierda p=0,041) y en hombres (mano derecha p=0,008; mano izquierda p=0,007), así así como en el PM6M (p=0,033). Hubo una diferencia entre el valor previo a la intervención de la 6MWT y el valor predicho de la 6MWT (p = 0,006). Esta diferencia no se observó en la comparación entre el valor postintervención de la 6MWT y el valor predicho de la 6MWT (p=0,073). Conclusión: los participantes han comprometido la fuerza de prensión manual y la capacidad funcional, y la intervención de fisioterapia puede mejorar estos aspectos.

Características y correlación entre distancia recorrida y la fuerza de agarre manual en peruanos que padecieron COVID-19

RESUMEN Fundamento: el mundo aún vive un gran problema de salud pública, el Sars-Cov-2 causa la enfermedad COVID-19, que produce principalmente infecciones respiratorias, con disnea, tos, fiebre e intolerancia al ejercicio; deja una gama de deficiencias con secuelas físicas a corto y largo plazo, que afectan la condición física y la fuerza de agarre de mano. Objetivo: determinar características, así como relación entre la distancia recorrida y la fuerza de agarre manual en pacientes que padecieron COVID-19. Métodos: estudio descriptivo, correlacional, transversal, realizado en el Centro de Rehabilitación Respiratoria Privado, de Lima, entre enero y marzo del año 2021. Participaron 88 pacientes mayores de 20 años, hemódinamicamente estables, con 30 días de evolución después del alta. Fueron evaluados con la prueba de caminata de 6 minutos (C6M) y fuerza de agarre medida con dinamómetro Camry. Resultados: la edad media fue 61,7±14,5. El grupo más afectado fue el mayor de 50 años. El sexo masculino, tiempo de internamiento en Unidad de Cuidados Intensivos e índice de masa corporal fueron factores influyentes en los pacientes que padecieron COVID-19. Se evidenció relación entre la distancia recorrida y la fuerza de agarre, p<0,05, rho=-0,236. La distancia recorrida fue de 504,44±56,30 y la fuerza de agarre 27,21±5,50. Conclusiones: existe correlación entre la fuerza de agarre de mano baja y normal y la distancia recorrida en los pacientes que han padecido COVID-19.

ABSTRACT Background: The world is still experiencing a major public health problem, Sars-Cov-2 causes the disease COVID-19, which mainly produces respiratory infections, with dyspnea, cough, fever and exercise intolerance; It leaves a range of deficiencies with short and long-term physical sequelae, affecting physical fitness and hand grip strength. Objective: determine characteristics, as well as the relationship between the distance traveled and the manual grip strength in patients who suffered from COVID-19. Methods: descriptive, correlational, cross-sectional study, carried out at the Private Respiratory Rehabilitation Center, in Lima, between January and March 2021. 88 patients over 20 years of age, hemodynamically stable, with 30 days of evolution after discharge participated. They were evaluated with the 6-minute walk test (C6M) and grip strength measured with a Camry dynamometer. Results: la edad media fue 61,7±14,5. El grupo más afectado fue el mayor de 50 años. El sexo masculino, tiempo de internamiento en Unidad de Cuidados Intensivos e índice de masa corporal fueron factores influyentes en los pacientes que padecieron COVID-19. Se evidenció relación entre la distancia recorrida y la fuerza de agarre, p<0,05, rho=-0,236. La distancia recorrida fue de 504,44±56,30 y la fuerza de agarre 27,21±5,50. Conclusions: existe correlación entre la fuerza de agarre de mano baja y normal y la distancia recorrida en los pacientes que han padecido COVID-19.

Correlation Of Spirometry And Six Minute Walk Test (6MWT) In Patients Of Stable COPD

Background: Spirometryis the GOLD standard for the diagnosis of COPD. This test also grades the severity of the disease which helps in the management of patients.Many times Spirometry is not available in remote areas. In these situations 6MWT can be done. 6 minute walk test (6MWT) is a simple test to assess patient’s functional capacity (ability for day to day activities).Material And Methods:A prospective study was conducted in the department of Respiratory Medicine, AMC MET MEDICAL COLLEGE, L.G. HOSPITAL, AHMEDABAD for 6 months from date of Confirmation of IRB.The patient who was a confirmed and stable case of COPD and who gave consent was taken for the study.Conclusion:The 6MWT plays a major role in measuring the functional status and disease tolerance of COPD patients.Also, it is observed that as severity of FEV1 increses 6MWD decreses.This suggests that in the absence of spirometry 6MWT is a reasonable tool for the assessment of disease severity and functional status in COPD Patients.

Application of MOTOmed in stepped individualized rehabilitation intervention of older adult patients with post-stroke hemiplegia / 中国基层医药

Objective:To investigate the application effects of MOTOmed in stepped individualized rehabilitation intervention of older adult patients with post-stroke hemiplegia.Methods:A total of 130 older adult patients with post-stroke hemiplegia who received treatment in the Affiliated People's Hospital of Ningbo University from June 2019 to June 2021 were included in this study. They were randomly assigned to undergo either stepped individualized rehabilitation intervention with MOTOmed training system (observation group, n = 65) or routine rehabilitation intervention (control group, n = 65) for 1 month. Before and after intervention, the Fugl- Meyer Assessment score, Berg Balance Scale score, Functional Ambulation Category scale score, modified Ashworth scale score, and modified Barthel Index, Self-Perceived Burden Scale score, nerve growth factor, brain-derived neurotrophic factor and neurotrophin 3 levels were compared between the two groups. Results:After intervention, Fugl-Meyer Assessment and Berg Balance Scale scores in the observation groups were (75.48 ± 6.54) points and (48.55 ± 5.18) points, which were significantly greater than (72.55 ± 6.33) points and (46.50 ± 4.79) points in the control group ( t = 2.59, 2.34, both P < 0.05). Functional Ambulation Category scale score in the observation group was significantly higher than that in the control group [(3.22 ± 0.43) points vs. (3.05 ± 0.39) points, t = 2.36, P < 0.05). Modified Ashworth scale score in the observation group was significantly lower than that in the control group [(1.23 ± 0.24) points vs. (1.33 ± 0.26) points, t = 2.27, P < 0.05). Modified Barthel Index score in the observation group was significantly higher than that in the control group [(59.32 ± 5.18) points vs. (57.33 ± 4.92) points, t = 2.24, P < 0.05]. There was no significant difference in Self-Perceived Burden Scale score between the two groups ( t = 1.64, P > 0.05). Nerve growth factor level in the observation group was significantly higher than that in the control group [(12.93 ± 2.31) ng/L vs. (12.06 ± 2.29) ng/L, t = 2.15, P < 0.05]. There were no significant differences in brain-derived neurotrophic factor and neurotrophin 3 levels between the two groups ( t = 0.91, 1.25, both P > 0.05). Conclusion:The stepped individualized rehabilitation intervention with MOTOmed training system can greatly improve the limb function, balance ability, walking ability and self-care ability, reduce muscle tension, and increase nerve growth factor level in older adult patients with post-stroke hemiplegia, which are conducive to the rehabilitation and prognosis of post-stroke hemiplegia.

Factors associated with early step count of patients after total knee arthroplasty: A prospective cohort study

BACKGROUND@#Research has indicated that early postoperative step counts are below the recommended levels for health-enhancing physical activity after total knee arthroplasty (TKA). This study aimed to evaluate the effects of preoperative individual characteristics, pain, physical function, and psychological factors on early postoperative physical activity, as measured by step counts, in 137 patients scheduled for TKA.@*METHODS@#Patients were preoperatively assessed for individual characteristics (age, sex, body mass index, employment status, smoking and drinking habits, long-term care insurance), pain, range of motion, muscle strength, timed 10-m walk test performance, pain catastrophizing scale (PCS) scores (rumination, helplessness, and magnification), and pain self-efficacy. The daily step count was analyzed 4 weeks postoperatively. Multivariate regression analysis was performed to analyze the relationships between postoperative step counts and individual characteristics, pain, physical function, and psychological factors. @*RESULTS@#Step counts were significantly influenced by preoperative PCS magnification scores (β= -0.31, p= 0.01) and the category of long-term care insurance (β= -0.24, p= 0.02).@*CONCLUSIONS@#Preoperative evaluation of the long-term care insurance category and PCS magnification score may aid in predicting early postoperative step counts in patients receiving TKA, which may, in turn, improve clinical management during the early stages of treatment.

Comparing cardiac function and structure and their relationship with exercise capacity between patients with stable COPD and recent acute exacerbation: a cross-sectional study / Comparação da função e estrutura cardíaca e sua relação com a capacidade de exercício entre pacientes com DPOC estável e exacerbação aguda recente: estudo transversal

ABSTRACT Objective: Patients with COPD are prone to cardiac remodeling; however, little is known about cardiac function in patients recovering from an acute exacerbation of COPD (AECOPD) and its association with exercise capacity. The aim of this study was to evaluate the cardiac function and structure and to compare their relationship with exercise capacity in patients with a recent AECOPD and patients with clinically stable COPD. Methods: This was a cross-sectional study including 40 COPD patients equally divided into two groups: recent AECOPD group (AEG) and clinically stable COPD group (STG). Echocardiography was performed to assess cardiac function and chamber structure. The six-minute walk distance (6MWD) and the Duke Activity Status Index (estimated Vo2) were used in order to assess exercise capacity. Results: No significant differences in cardiac function and structure were found between the groups. The 6MWD was associated with early/late diastolic mitral filling velocity ratio (r = 0.50; p < 0.01), left ventricular posterior wall thickness (r = −0.33; p = 0.03), and right atrium volume index (r = −0.34; p = 0.04), whereas Vo2 was associated with right atrium volume index (r = −0.40; p = 0.02). Conclusions: Regardless of the clinical condition (recent AECOPD vs. stable COPD), the cardiac function and structure were similar between the groups, and exercise capacity (determined by the 6MWD and Vo2) was associated with cardiac features.

RESUMO Objetivo: Pacientes com DPOC são propensos a remodelamento cardíaco; no entanto, pouco se sabe sobre a função cardíaca em pacientes em recuperação de exacerbação aguda da DPOC (EADPOC) e sua associação com a capacidade de exercício. O objetivo deste estudo foi avaliar a função e estrutura cardíaca e comparar sua relação com a capacidade de exercício em pacientes com EADPOC recente e pacientes com DPOC clinicamente estável. Métodos: Estudo transversal com 40 pacientes com DPOC divididos igualmente em dois grupos: grupo EADPOC recente (GEA) e grupo DPOC clinicamente estável (GCE). Realizou-se ecocardiografia para avaliar a função cardíaca e a estrutura das câmaras. A distância percorrida no teste de caminhada de seis minutos (DTC6) e o Duke Activity Status Index (Vo2 estimado) foram utilizados para avaliar a capacidade de exercício. Resultados: Não foram encontradas diferenças significativas na função e estrutura cardíaca entre os grupos. A DTC6 apresentou associação com a razão entre as velocidades de enchimento diastólico mitral precoce e tardia (r = 0,50; p < 0,01), a espessura da parede posterior do ventrículo esquerdo (r = −0,33; p = 0,03) e o índice de volume do átrio direito (r = −0,34; p = 0,04), enquanto o Vo2 apresentou associação com o índice de volume do átrio direito (r = −0,40; p = 0,02). Conclusões: Independentemente da condição clínica (EADPOC recente vs. DPOC estável), a função e estrutura cardíaca eram semelhantes entre os grupos, e a capacidade de exercício (determinada pela DTC6 e pelo Vo2) apresentou associação com as características cardíacas.