Composición Corporal y Capacidad Física en Pacientes con COVID-19 Hospitalizados en una Unidad de Cuidados Intensivos / Body Composition and Physical Capacity in Patients with COVID-19 Hospitalized in a Intensive Care Unit

Las unidades de cuidados intensivos (UCI) y agudos han sido los contenedores del avance de la pandemia por COVID-19. Sin embargo, la estadía prolongada en esta unidad puede repercutir sobre la composición corporal (CC) y la capacidad derealizar ejercicio de los pacientes. El objetivo de esta investigación fue determinar si existe relación entre composición corporal (CC) y la prueba de caminata en 6 minutos (PC6m). Se reclutaron 17 personas (8 mujeres y 9 hombres). Se tomaron las siguientes medidas: PC6m, se consideró su distancia recorrida (DRPC6m) y su velocidad (VelPC6m). Las variables de CC medidas fueron índice de masa corporal (IMC), masa grasa (MG), masa libre de grasa (MLG) y masa magra (MM). La DRPC6m sólo mostró relación significativa con la MM corporal (MMC). Por otra parte, la VelPC6m tuvo una relación significativa con la MMC. Además de esto, la MLG del miembro inferior derecho y la MLG del miembro inferior izquierdo mostraron una relación con la VelPC6m (r=0,422; p=0,041 y r=0,417; p=0,025, respectivamente). También la MM del miembro inferior derecho y la MM del miembro inferior izquierdo se relacionaron significativamente con la VelPC6m (r=0,422; p=0,030 y r=0,420; p=0,042). En conclusión, existe relación entre composición corporal y VelPC6m. Esto permitiría aproximarse de manera rápida al nivel de funcionalidad con la que ingresa un paciente a un programa de rehabilitación.

SUMMARY: The intensive care units (ICU) and acute care units have been the containers for the advance of the COVID-19 pandemic. However, prolonged stay in this unit can impact patients' body composition (WC) and ability to exercise. This research aimed to determine if there is a relationship between body composition (BC) and the 6-minute walk test (6mWT). 17 people were recruited (8 women and 9 men). The following measurements were taken: 6mWT, its distance traveled (6mWTDT) and its speed (6mWTS) were considered. The WC variables measured were body mass index (BMI), fat mass (FM), fat-free mass (FFM), and lean mass (LM). 6mWTDT only showed a significant relationship with body LM (BLM). On the other hand, 6mWTS had a significant relationship with BLM. In addition to this, the FFM of the right lower limb and the FFM of the left lower limb showed a relationship with 6mWTS (r=0.422; p=0.041 and r=0.417; p=0.025, respectively). Also, the LM of the right lower limb and the LM of the left lower limb were significantly related to the 6mWTS (r=0.422; p=0.030 and r=0.420; p=0.042). In conclusion, there is a relationship between body composition and 6mWTS. This would allow us to quickly approach the level of functionality with which a patient enters a rehabilitation program.

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.

Cardiovascular changes during the six-minute walk test in COPD patients / Alterações cardiovasculares durante o teste de caminhada de seis minutos em pacientes com DPOC

Abstract Introduction Specialised literature demonstrates that chronic obstructive pulmonary disease (COPD) has patho-physiological changes that impair cardiac autonomic function and the ability of the cardiovascular system to respond to stimuli. Objective To analyze the correlation between heart rate (HR), peripheral oxygen saturation (SpO2), functional and pulmonary capacity in patients with COPD during the six-minute walk test (6MWT) before and after the pulmonary rehabilitation program (PRP). Methods This is a descriptive and retrospective study, with collection carried out in the PRP database of a university in Vale dos Sinos, Brazil. Results: The sample consisted of 216 patients, classified as having severe COPD, with a predominance of males (57.4%), with a mean age of 65.4 ± 7.9 years. The results showed that at the pre-PRP moment, the HR at the end of the test showed a strong negative correlation (p < 0.01) with SpO2 obtained at the end of the test, and forced expiratory volume in the first second (FEV1). At the post-PRP moment, the HR at the end of the test was strongly negatively cor-related with SpO2 and FEV1 positively, weakly (p < 0.05) with the sensation of dyspnea at the end of the test, and strongly with the distance covered in the 6MWT (6MWD). Conclusion The correlations between HR, FEV1, 6MWD, dyspnea and SpO2 were confirmed, making it evident that as the variables change, HR changes occur to meet the metabolic, oxygenation and ventilatory demands.

Resumo Introdução A literatura evidencia que a doença pulmonar obstrutiva crônica (DPOC) possui características fisiopatológicas que prejudicam a função autonômica cardíaca e a capacidade do sistema cardiovascular em responder aos estímulos. Objetivo Analisar a correlação entre a frequência cardíaca (FC), saturação periférica de oxigênio (SpO2) e capacidade funcional e pulmonar em pacientes com DPOC durante o teste de caminhada seis minutos (TC6), antes e após programa de reabilitação pulmonar (PRP). Métodos Trata-se de um estudo descritivo e retrospectivo, com coleta realizada no banco de dados do PRP de uma universidade do Vale dos Sinos. Resultados A amostra foi composta por 216 pacientes com DPOC grave, com média de idade de 65,4 ± 7,9 anos e predominância do sexo masculino (57,4%). Os resultados evidenciaram que no momento pré-PRP, a FC ao final do teste apresentou correlação negativa forte (p < 0,01) com a SpO2 obtida ao final do teste e volume expiratório forçado no primeiro segundo (VEF1). No momento pós-PRP, a FC ao final do teste se correlacionou negativamente de maneira forte com a SpO2 e VEF1, positivamente de forma fraca (p < 0,05) com a sensação de dispneia pós-teste e forte com a distância percorrida no TC6 (DTC6). Conclusão As correlações entre FC, VEF1, DTC6, dispneia e SpO2 foram confirmadas, ficando evidente que à medida que ocorrem alterações das variáveis, acontecem modificações na FC para suprir a demanda metabólica, ventilatória e de oxigenação.

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.

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.

A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study / 生物医学工程学杂志

In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

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.

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.

Cardiorespiratory function of patients with adolescent idiopathic scoliosis / Função cardiorrespiratória de pacientes com escoliose idiopática do adolescente / Función cardiorrespiratoria de pacientes con escoliosis idiopática del adolescente

ABSTRACT Objective: Adolescent idiopathic scoliosis (AIS) is a spinal deformity that can cause cardiorespiratory dysfunction, contributing to decreases in tolerance for aerobic exercise (TAE) and in functionality. The objective is to assess the TAE and lung capacity of patients who underwent corrective AIS surgery in the pre- (PRE) and postoperative (POST) periods. Methods: Sixty individuals, PRE (n=30, age: 18.5±2.4 years) and POST (n=30, age: 24.5±4.5 years), participated in the study. The forced vital capacity (FVC), the forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio, as well as the maximum inspiratory and expiratory pressure were verified. The TAE was assessed by the distance travelled in the 6-minute walk test (6MWT), together with blood pressure, heart rate, respiratory rate and peripheral oxygen saturation measured at the beginning and at the end of the test. Results: A mild restrictive pattern in lung function and reduced expiratory muscle strength were observed in both groups, but with no difference between the PRE and POST groups. No difference was found between the PRE (534±67.1 m) and POST (541± 69.5 m) groups for the distance travelled in the 6MWT, though both were below the predicted percentage (82.8±10.0% and 84.8±10.9%, respectively). Hemodynamic and respiratory changes caused by the 6MWT were observed, except for the peripheral oxygen saturation. Conclusion: The results suggest that even after surgical correction, patients with AIS continue to have low TAE. Level of evidence III; Therapeutics Study - Investigation of Treatment Results / Case-control study.

RESUMO Objetivo: A escoliose idiopática do adolescente (EIA) é uma deformidade da coluna que pode ocasionar disfunções cardiorrespiratórias, contribuindo para a diminuição da tolerância ao exercício aeróbio (TEA) e da funcionalidade. O objetivo é avaliar a TEA e a capacidade pulmonar em pacientes no pré (PRÉ) e pós-operatório (PÓS) de correção da EIA. Métodos: Participaram 60 indivíduos PRÉ (n = 30, idade: 18,5 ± 2,4 anos) e PÓS (n = 30, idade: 24,5 ± 4,5 anos). A capacidade vital forçada (CVF), o volume expiratório forçado no primeiro segundo (VEF1) e a razão VEF1/CVF, assim como as pressões inspiratória e expiratória máximas, foram verificados. A TEA foi avaliada pela distância percorrida no teste de caminhada de 6 minutos (TC6), acompanhado de medidas de pressão arterial, frequência cardíaca, frequência respiratória e saturação periférica de oxigênio no início e no final do teste. Resultados: Um padrão restritivo leve na função pulmonar e força da musculatura expiratória reduzida foram observados em ambos os grupos, mas sem diferença entre PRÉ e PÓS. Não foi encontrada diferença entre PRÉ (534 ± 67,1 m) e PÓS (541 ± 69,5 m) para a distância percorrida no TC6, abaixo do predito para ambos os grupos (82,8 ± 10,0% e 84,8 ± 10,9%, respectivamente). Foram observadas alterações hemodinâmicas e respiratórias provocadas pelo TC6, exceto para a saturação periférica de oxigênio. Conclusões: Os resultados sugerem que mesmo após a correção cirúrgica os pacientes com EIA continuam apresentando baixa TEA. Nível de evidência III; Estudos terapêuticos - Investigação dos Resultados do Tratamento / Estudo de caso-controle.

RESUMEN Objetivo: La escoliosis idiopática del adolescente (EIA) es una deformidad de la columna que puede causar disfunciones cardiorrespiratorias, contribuyendo para la disminución de la tolerancia al ejercicio aeróbico (TEA) y de la funcionalidad. El objetivo es evaluar la TEA y la capacidad pulmonar en pacientes en el pre (PRE) y postoperatorio (POS) de corrección de la EIA. Métodos: Participaron 60 individuos PRE (n=30, edad: 18,5±2,4 años) y POS (n=30, edad: 24,5±4,5 años). Fueron verificadas la capacidad vital forzada (CVF), el volumen espiratorio forzado en el primer segundo (VEF1) y la razón VEF1/CVF, así como las presiones inspiratoria y espiratoria máximas. La TEA fue evaluada por la distancia recorrida en el test de caminata de 6 minutos (TC6), acompañado de mediciones de presión arterial, frecuencia cardíaca, frecuencia respiratoria y saturación de oxígeno al inicio y al final del test. Resultados: Fueron observados un patrón restrictivo leve y fuerza muscular espiratoria reducida en ambos grupos, pero sin diferencia entre PRE y POS. No fue encontrada diferencia entre PRE (534 ± 67,1 m) y POS (541 ± 69,5 m) para la distancia recorrida en el TC6, por debajo de los predicho para ambos grupos (82,8 ± 10,0% y 84,8 ± 10,9%, respectivamente). Se observaron alteraciones hemodinámicas y respiratorias provocadas por el TC6, excepto para la saturación periférica de oxígeno. Conclusiones: Los resultados sugieren que incluso después de la corrección quirúrgica, los pacientes con EIA continúan presentando baja TEA. Nivel de evidencia III; Estudios Terapéuticos - Investigación de los Resultados del Tratamiento / Estudio de caso-control.

Reference Equation for the Six-Minute Walk Test in Brazilian Patients with Obesity

Abstract Background: Obesity has repercussions on functional capacity (FC). The six-minute walk test (6MWT) is a useful tool for assessing submaximal FC, and the distance reached at 6 minutes of walking (D6MW) is a relevant prognostic marker. Objective: This paper aims to establish a reference equation for the distance predicted in 6MWT in obese Brazilian subjects. Methods: This study included 460 patients (306 women), with a body mass index (BMI) > 30 kg/m2, 71% (328) of whom presented a grade III obesity (BMI ≥ 40 Kg/m²) and were evaluated with 6MWT. Heart rate, blood pressure, oxygen saturation and Borg scale perception of effort were recorded before and after the 6MWT. For statistical analysis, Kolmogorov-Smirnov tests, an unpaired T-Test, Pearson's correlation, and multiple linear regression were used, together with a significance level set at p<0.05. Results: Gender, age, and BMI were significantly correlated with D6MW and were identified by multiple linear regression as the best predictors of the D6MW. Together, they explain 48.7% of the D6MW variance for obese Brazilian subjects. Based on these findings, an equation was proposed - D6MW = 930.138 + (27.130 x Genderfemales = 0; males = 1) − (5.550 x BMI kg/m2) − (4.442 x Age years). When the average of the D6MW obtained with the above equation was compared to the average calculated with the equations described in medical literature for healthy and obese individuals, the latter tended to overestimate the D6MW. Conclusion: The proposed reference equation exhibited better assessment of FC in obese Brazilian patients, providing proper subsidies for the follow up ofinterventions in this population..

Analysis of the efficacy of torasemide combined with levocarnitine in the treatment of chronic heart failure / 中国临床药理学与治疗学

AIM: To explore the efficacy of torasemide combined with levocarnitine in the treatment of chronic heart failure (CHF). METHODS: From July 2018 to July 2020, 75 patients with CHF were recruited and randomly assigned into the control group (37 cases) and the study group (38 cases) according to the random number table method. The control and study groups were treated with levocarnitine and the combination of levocarnitine and torasemide, respectively. The clinical efficacy of the two groups was evaluated. The ventricular remodeling indexes and 6-minute walk test (6MWT) distance were compared between the two groups before and after treatment. The serum levels of serum galectin-3 (Gal-3), interleukin-33 (IL-33), hypersensitive C-reactive protein (hs-CRP), and the plasma concentrations of N terminal pro B type natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) were determined. RESULTS: (1) After treatment, the total clinical effective rate of the study group (92.11%) was higher than that of the control group (72.97%) (P<0.05). (2) The diastolic interventricular septal thickness (IVST) and diastolic left ventricular posterior wall thickness (LVPWT) were decreased following the treatment in both groups (P<0.05), whereas the treatment led to the increases of the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) in both groups (P<0.05). Compared with those in the control group, IVST and LVPWT in the study group were lower (P<0.05), and LVMI and LVEF were higher (P<0.05). (3) The levels of serum Gal-3, IL-33 and hs-CRP in the two groups were decreased after treatment (P<0.05); compared with those in the control group, the levels of serum Gal-3, IL-33 and hs-CRP were reduced to a greater extent in the study group (P<0.05). (4) Compared with that before treatment, 6MWT distance in both groups increased after treatment (P<0.05); the improvement in the study group was more significant relative to those in the control group (P<0.05). (5) Compared with before treatment, the expression levels of plasma NT-proBNP and BNP in the two groups were decreased after treatment (P<0.05); the reduction of plasma NT-proBNP and BNP levels in the study group was greater than the control group (P<0.05). CONCLUSION: Torasemide combined with levocarnitine is more effective than levocarnitine monotherapy in the treatment of CHF and can significantly improve ventricular remodeling index and motor function, reduce serum inflammation, and enhance cardiac function with definite curative effect.

Analysis of morbid obese women aerobic potential / Análisis del potencial aeróbico de obesas mórbidas

Abstract Introduction: nowadays, with the increase of world obesity and the numbers of morbidly obese people, a concerning public health problem that is difficult to solve rises up. Objective: to analyse the physiological responses after the 6-minute walk tests and maximum stress test in the arm cycle ergometer in morbidly obese pre-bariatric surgery women. Methods: fifteen level III obesity women aged 35.6 ± 6.6 years took part in this experiment. Firstly, they went through an anamnesis and body composition analysis; secondly, they were submitted to a 6-minute walk test and a maximum stress test in arm cycle ergometer on alternate days. Results: patients were able to perform the maximum stress test and showed better aerobic potentials in the arm cycle ergometer than in the 6-minute walk test. No significant differences were found between SPO2 and diastolic blood pressure between the moments of rest and after the tests, neither in the systolic blood pressure after the 6-minute walk test and the values of rest and post 5 minutes in the maximum stress test. The main differences found were between the maximum systolic blood pressure in the cycle ergometer test and the other moments and the heart rate after the tests and the heart rate at rest. Conclusion: the maximum stress test in arm cycle ergometer is a safe method that allows greater requirement and control applied to the heart system than in the 6-minute walk test. In addition, it allows the development of a more individualized aerobic training and prescription of aerobic physical exercise program.

Resumen Introducción: Actualmente, con el aumento de la obesidad en el mundo y del número de obesos mórbidos se evidencia un problema de salud pública de difícil resolución. Objetivo: analizar las respuestas fisiológicas tras las pruebas de caminata de 6 minutos y de esfuerzo máximo en cicloergómetro de brazos en obesas mórbidas precirugía bariátrica. Métodos: se evaluaron 15 mujeres con obesidad grado III con edad media de 35,6 ± 6,6 años, las cuales participaron inicialmente de una anamnesis con el análisis de la composición corporal y posteriormente participaron en días alternos de la prueba de 6 minutos de caminata y del mismo, prueba de esfuerzo máximo en cicloergómetro de brazos. Resultados: las pacientes lograron realizar la prueba de esfuerzo máximo y demostraron mejores potenciales aeróbicos en el cicloergómetro de brazos que en la prueba de caminata. No se encontraron diferencias significativas entre la SPO2 y la presión arterial diastólica entre los momentos de reposo y después de las pruebas y también en la presión arterial sistólica posterior a la prueba de caminata y los valores de reposo y después de 5 minutos en la prueba de esfuerzo máximo. Las principales diferencias se observaron entre la presión arterial sistólica máxima en la prueba en cicloergómetro y los otros momentos y en la frecuencia cardiaca después de las pruebas y las frecuencias cardiacas en reposo. Conclusión: la prueba de esfuerzo máximo en cicloergómetro de brazos es un método seguro que posibilita mayor exigencia y control aplicado al sistema cardíaco que en la prueba de caminata. Adicionalmente, permite un programa de entrenamiento y una prescripción del ejercicio físico aeróbico más individualizados.

Analysis of Motor Function in Patients with Duchenne Muscular Dystrophy / 中国康复理论与实践

Objective To analyze the differences of motor function between Chinese patients with Duchenne muscular dystrophy (DMD)and normal children,and to explore the changes of motor function in Chinese DMD patients. Methods From April,2016 to August,2017,155 DMD patients(DMD group)and 24 normal boys(control group)were given 6-minute walk test,timed rise from floor test,4-stair test,and 9 meters walking time test. Results The 6-minute walk distance(6MWD)was lower in DMD group than in the control group(t=-9.534,P<0.001), and the 9 meters walking time was higher in DMD group than in the control group(t=-7.460,P<0.001).There was no significant difference in 6MWD and 9 meters walking time between two groups at the age of 6.0 to 6.9 years(P>0.05);however,the difference was significant after seven years old(t>2.648,P<0.001).The completion times of timed rise from floor test and 4-stair test group were distributed between 1.95 to 27.27 seconds and 1.18 to 19.17 seconds,respectively,in DMD group.The 6MWD decreased from 7.0 years old,and 9 meters walking time increased from 7.2 years old.The completion time of timed rise from floor test increased from 5.2 years old, and the completion time of 4-stair test increased from 5.5 years old. Conclusion The motor function of Chinese DMD patients is worse than normal children at the same age.The age nodes of the movement indicators are different in DMD patients.The timed rise from floor test and the 4-stair test are earlier affected by the disease.

Level of Physical Exercise Capacity, Respiratory Muscle Strength and Peak Expiratory Flow Rate in Healthy Adolescents.

Introduction: The maturation of respiratory system in children leads to changes in value of respiratory parameters like peak expiratory flow rate (PEFR), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and 6-minute walk distance (6MWD). Accurate analysis and clinical decisionmaking in disease state require reference values for different ages. The current study was undertaken to study pulmonary function and exercise capacity in children and adolescents. Materials and methods: After obtaining Institutional Ethical approval and parental informed consent, 262 subjects aged 9 to 15 years were recruited for the study. They were divided into two age groups, i.e., preadolescent (9-12 years) and early adolescent (13-15 years). Demographic details including age, sex, height, weight, and body mass index (BMI) were noted. Physical activity rating (PAR) scale was used to denote physical activity levels. Peak expiratory flow rate was measured using standard Mini-bell peak flow meter (PFM). The parameters MIP and MEP was measured using micro respiratory pressure meter, and 6-minute walk test (6MWT) was performed as per American Thoracic Society (ATS) guidelines. Results: A significant difference was noted between the two groups in PEFR, MIP, MEP, and 6MWD (p = 0.00). Age showed a strong positive correlation with PEFR (r = 0.613, p = 0.000), MIP (r = 0.676, p = 0.000), and MEP (r = 0.658, p = 0.00) whereas showed a strong negative correlation with 6MWD (r = -0.605, p = 0.00). Height showed a strong positive correlation with MEP (r = 0.720, p = 0.000) whereas a strong negative correlation with 6MWD (r = -0.42, p = 0.00). Weight showed a weak negative correlation with 6MWD (r = -0.328, p = 0.00). Gender difference was noticeable in 6MWD and PEFR (p = 0.00) but not in MIP (p = 0.45) and MEP (p = 0.44). Almost 22.10% of early adolescents were overweight compared to only 7.7% seen in preadolescent group. Conclusion: PEFR and respiratory muscle strength was higher in early adolescents as compared to pre-adolescents. However, exercise capacity reflected by 6 MWD was found to be lower in early adolescents in comparison to pre-adolescents. These findings could be used while interpreting the outcome measures utilized while treating patients and for goal setting in cardiopulmonary rehabilitation in clinical practice.

Evaluation of functional capacity and level of physical activity in adolescent and adult patients with cystic fibrosis / Avaliação da capacidade funcional e do nível de atividade física em pacientes adolescentes e adultos com fibrose cística

The objective of the present study was to compare the functional capacity and level of physical activity between adolescent and adult patients with cystic fibrosis (CF) and healthy individuals. The six-minute walk test (6MWT) was used to evaluate functional capacity and the International Physical Activity Questionnaire (IPAQ - long version) was applied to assess physical activity level. This study included 31 patients with CF (11 males and 20 females) and 31 healthy individuals. Patients with CF had significantly lower values of body mass index (BMI), pulmonary function parameters, physical activity level, six-minute walking distance (6MWD) and peripheral oxygen saturation (SpO2). Comparing patients using a cut-off point of 500m, there were no significant differences in the classification of physical activity level assessed by the IPAQ questionnaire. Among patients with CF who walked less than 500m, there were significantly lower values of peak expiratory flow (PEF), PEF (%), SpO2 after 6MWT and distance walked in the 6MWD. It could be concluded that patients with CF practice physical activity at lower levels than healthy individuals, when compared by the IPAQ questionnaire.

O objetivo deste estudo foi comparar a capacidade funcional e o nível de atividade física de pacientes adolescentes e adultos com fibrose cística (FC) e indivíduos sadios. Para a avaliação da capacidade funcional foi utilizado o teste de caminhada de 6 minutos (TC6M) e para a verificação do nível de atividade física, foi utilizado o Questionário Internacional de Atividade Física (IPAQ ­ versão longa). Participaram do estudo 31 indivíduos com FC (11 do sexo masculino e 20 do sexo feminino) e 31 indivíduos sadios. Os pacientes com FC apresentaram valores significativamente mais baixos de índice de massa corporal (IMC), parâmetros de função pulmonar, nível de atividade física, distância percorrida no teste de caminhada de 6 minutos e saturação periférica de oxigênio (SpO2). Comparando os pacientes através ponto de corte 500m, não houve diferenças significativas na classificação do nível de atividade física avaliada pelo questionário. Nos pacientes com FC que caminharam abaixo de 500m, observaram-se valores significativamente menores de pico de fluxo expiratório (PFE), PFE(%), SpO2 após TC6M e distância percorrida no teste de TC6M (DTC6M). Podemos concluir com este estudo que indivíduos com FC praticam atividade física com intensidades mais baixas que indivíduos sadios quando comparados pelo IPAQ.

Effects of aerobic exercise on 6-minute walk distance and serum level of omentin-1 in hemodialysis patients / 天津医药

Objective To explore the effects of aerobic exercise on 6-minute walk distance and serum level of omentin-1 in maintenance hemodialysis (MHD) patients. Methods A total of 89 MHD patients (MHD group) in the 5th Central Hospital of Tianjin were included in the study from December 2013 to November 2014. Patients were randomly divided into two groups:routine treatment group (n=43) and aerobic exercise treatment group (aerobic exercise group, n=46). Fifty healthy subjects were selected as normal control group. Both groups received the same hemodialysis and regular treatments, and the aerobic exercise group received 6-month interdialytic aerobic exercise, and the routine group did not take any exercise intervention. The 6-minute walk distances (6MWDs),body mass,height and blood pressure were recorded, and serum levels of omentin-1, C-reactive protein (CRP), blood routine test and biochemistry test were determined in two groups. The relationship between 6 MWDs, age, CRP, left ventricular ejection fraction (LVEF) and omentin-1 were analyzed. Results The serum levels of omentin-1 and CRP weresignificantly higher, LVEF was significantly lower, in MHD group than those of healthy control group (P<0.01). After 6 months of aerobic exercise, 6MWDs, LVEF, hemoglobin and serum level of omentin-1 were significantly increased than those before treatment in aerobic exercise group. The 6MWDs, LVEF and hemoglobin were significantly increased after treatment than routine group. The levels of CRP, fasting glucose and blood pressure were significant decreased after treatment. The levels of CRP, fasting glucose and systolic blood pressure were decreased in treatment group than those of routine group. Before treatment, 6MWDs was negatively related with age and CRP, and positively related with LVEF and serum level of omentin-1 in MHD patients (r=-0.418,-0.229, 0.252 and 0.234, P<0.05). Conclusion Aerobic exercise can significantly increase values of 6MWDs, LVEF, hemoglobin and serum level of omentin-1, and reduce values of CRP, fasting blood glucose and systolic blood pressure in MHD patients. Aerobic exercise can improve physical performance,heart function and micro inflammatory state, thereby reduce cardiovascular events and mortality risk in MHD patients.

The Effectiveness of Self-efficacy and Education Intervention for Exercise Adherence of Patients with Chronic Stable Heart Failure / 中国康复理论与实践

Objective To evaluate the effectiveness of exercise rehabilitation intervention by using self-efficacy theory on patients with chronic stable heart failure, and to provide evidences for rehabilitation nursing of patients. Methods Using the method of randomized con-trolled studies, 132 patients with chronic stable heart failure from Nanshitou Street and Shayuan Street communities in Haizhu, Guangzhou, Guangdong were randomly divided into two groups according to the community's name. The patients in the intervention group received self-efficacy and education intervention while the control group received health education only. The patients' exercise self-efficacy scores and six minute walk distances were separately measured by exercise self-efficacy scale and six minute walk test before and after interven-tion. Results The scores of exercise self-efficacy and six minute walk distances increased more significantly in the intervention group than in the control group after intervention (P<0.01). Conclusion Self-efficacy and education intervention can effectively improve the exercise self-efficacy and six minute walk distance of patients with heart failure.

Effect of semi dose of tiotropium on lung function in severe chronic obstructive pulmonary disease / 中国医师进修杂志

Objective To evaluate the efficacy of 9 μ g tiotropium inhalation once daily in patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods One hundred seventy-one patients with moderate to severe COPD were divided into two groups by random digits table methods:86 patients in test group who used 9 μ g tiotropium powder inhaler once daily,and 85 patients in control group who used the recommended dose 18 μ g once daily,both for 6 months.Patients' pulmonary function and 6-minute walk test were measured before treatment,3 months after treatment and 6 months after treatment.Results Two groups were compared 6 months after treatment.The level of forced expiratory volume in first second(FEV1) in the control group increased an average of (0.21 ± 0.12) L,and the rising rate was (19.31 ± 10.61)％.The level of FEV1 in test group increased (0.22 ±0.13) L,and the rising rate was (19.25 ± 11.52)％.The level of forced vital capacity (FVC) in control group increased an average of (0.22 ±0.10) L,and the rising rate was (11.63 ±5.31)％.The level of FVC in test group increased (0.23 ± 0.15) L,and the rising rate was (11.62 ± 6.45)％.The distance of 6-minute walk test in control group increased an average of (29.24 ± 11.92) m after treatment for 6 months,and the rising rate was (18.30 ± 3.77)％.The distance of 6-minute walk test in test group increased an average of (29.14 ± 11.89) m,and the rising rate was (18.20 ± 3.85)％.The number of acute exacerbations and rehospitalizations in two groups at these period had no significant difference (P ＞ 0.05).As for the test group,though the number of acute exacerbations and rehospitalizations decreased,there were no significant differences (P ＞ 0.05).Conclusions The effect of inhalation therapy of 9 μ g tiotropium once daily is more or less the same with that of 18 μ g once daily.

The Effectiveness of Self-efficacy and Education Intervention for Exercise Adherence of Patients with Chronic Stable Heart Failure / 中国康复理论与实践

@#Objective To evaluate the effectiveness of exercise rehabilitation intervention by using self-efficacy theory on patients with chronic stable heart failure, and to provide evidences for rehabilitation nursing of patients. Methods Using the method of randomized controlled studies, 132 patients with chronic stable heart failure from Nanshitou Street and Shayuan Street communities in Haizhu, Guangzhou, Guangdong were randomly divided into two groups according to the community's name. The patients in the intervention group received self-efficacy and education intervention while the control group received health education only. The patients' exercise self-efficacy scores and six minute walk distances were separately measured by exercise self-efficacy scale and six minute walk test before and after intervention. Results The scores of exercise self-efficacy and six minute walk distances increased more significantly in the intervention group than in the control group after intervention (P<0.01). Conclusion Self-efficacy and education intervention can effectively improve the exercise self-efficacy and six minute walk distance of patients with heart failure.

Anemia in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in Bangladesh.

Background: Chronic obstructive pulmonary disease (COPD) is usually associated with polycythemia. It is assumed that systemic inflammatory components of COPD can interfere with erythropoietin and can result in anemia of chronic disease which will impair the functional capacity of these patients and also increase morbidity and mortality. Objective: To evaluate anemia status in COPD patients. Materials and Methods: This cross-sectional study was conducted in clinically stable 50 COPD patients in the outpatient department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July to December 2011. The demographic characteristics, smoking habit, duration of disease, types and severity of anemia, BMI and results of 6-minute walk test were recorded. Results: Out of 50 COPD patients, 76% were male and 24% were female. Among them 32% patients were anemic, 20% were polycythemic and 48% patients had normal hemoglobin. Among the anemic patients with COPD, 87% were male and 13% were female,75% were mildly anemic and 4% moderately anemic, 62.5% had normocytic and 37.5% had microcytic anemia. Conclusion: Anemia in COPD patients is often overlooked and underestimated. Clinicians should be aware of the presence of anemia in patients with COPD so that appropriate treatment could be initiated to improve the quality of life and prognosis.