Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia.

Individuals with schizophrenia display substantial deficits in social functioning (SF), characterized by chronic, lifelong presentations. Yet, at present there are few effective interventions to enhance SF in this population. Emerging evidence from studies of clinical populations that display similar SF deficits suggests that aerobic exercise (AE) may improve social skills. However, this putative impact has not been investigated in schizophrenia. Employing a single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive 12 weeks of Treatment-As-Usual (TAU; n = 17) or TAU + AE (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed an evaluation of aerobic fitness (VO2max) as well as self-, informant-, and clinician-reported SF measures at baseline and after 12 weeks. Twenty-six participants completed the study (79%; TAU = 13; AE = 13). At follow-up, the AE participants improved their VO2max by 18.0% versus - 0.5% in the controls (group x time interaction, F1,24 = 12.88; p = .002). Hierarchical stepwise regression analyses indicated improvements in VO2max significantly predicted enhancement in SF as indexed by self-, informant-, and clinician-reported measures, predicting 47%, 33%, and 25% of the variance, respectively (controlling for baseline demographics, medications, mood symptoms, and social networks). Compared to the TAU group, AE participants reported significant improvement in SF (23.0% vs. - 4.2%; group × time interaction, F1,24 = 7.48, p = .012). The results indicate that VO2max enhancement leads to improvements in SF in people with schizophrenia. Furthermore, low VO2max represents a modifiable risk factor of SF in people with schizophrenia, for which AE training offers a safe, non-stigmatizing, and nearly side-effect-free intervention.

Titrated oxygen requirement and prognostication in idiopathic pulmonary fibrosis.

The supplemental oxygen flow rate is a common bedside measure of gas exchange impairment. We aimed to determine whether a titrated oxygen requirement (TOR) predicted mortality in idiopathic pulmonary fibrosis (IPF). We examined 104 adults with IPF enrolled in a prospective cohort study and a validation cohort of 151 adults with a variety of interstitial lung diseases (ILDs). The TOR was defined as the lowest oxygen flow rate required to maintain an oxyhaemoglobin saturation of 96% while standing. Cox proportional hazards models and time-dependent receiver operating characteristic curves were used to examine survival time. A higher TOR was associated with a greater mortality rate independent of forced vital capacity and 6-min walk test results in IPF (adjusted hazard ratio (per 1 L·min(-1)) 1.16, 95% CI 1.06-1.27). The TOR was at least as accurate as pulmonary function and 6-min walk testing at predicting 1-yr mortality. Findings were similar in other ILDs. The TOR is a simple, inexpensive bedside measurement that aids prognostication in IPF.

An assessment of pulmonary function testing and ventilatory kinematics by optoelectronic plethysmography.

New advances in computer processing and imaging have allowed the development of innovative techniques to assess lung function. A promising methodology is optoelectronic plethysmography (OEP). OEP evaluates ventilatory kinematics through the use of infrared imaging. Markers are placed, and images read on the chest, back and abdomen of subjects. Currently, this system is used mainly in research settings, but in the future may have broad applicability to patient populations such as very young children, patients with neuromuscular disease and patients who cannot be tested with classical spirometry testing. This paper presents the history and development of OEP, along with a summary of the OEP methodology, a discussion of research findings and results to date, as well as application and limitations.

Exercise training favourably affects autonomic and blood pressure responses during mental and physical stressors in African-American men.

Aerobic exercise is a powerful mechanism by which cardiovascular and autonomic parameters may be improved. We sought to quantify the extent of benefit that could be achieved by a short-term monitored exercise regimen on several autonomic parameters during recognized mental and physical stressors in young normotensive African-American men matched for a family history of hypertension, a group at high risk for the development of hypertension. Autonomic modulations were derived using spectral decomposition of the electrocardiogram and beat-to-beat blood pressures (BPs). Arterial compliance was obtained using contour analysis of the radial artery pulse wave. The analysis of variance revealed that compared with a matched sedentary control group, aerobic capacity of the trained group significantly increased by 16%. Autonomic modulations, arterial compliance and BP responses significantly improved during some of the stressors, whereas no such improvements were seen in the control group. Attenuated responses, mediated through a favourable shift in sympathovagal balance and enhanced arterial compliance, provide mechanistic evidence of how certain variables may be improved due to aerobic conditioning in a population at high risk for the development of hypertension.

Racial and ethnic disparities in survival in lung transplant candidates with idiopathic pulmonary fibrosis.

Minority patients have worse outcomes than nonminority patients in a variety of pulmonary diseases. We aimed to compare the survival of Black and Hispanic patients to that of others with idiopathic pulmonary fibrosis (IPF). We performed a retrospective cohort study of patients with IPF who were evaluated for lung transplantation at our center. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare survival between groups. Black and Hispanic patients had spirometry, lung volumes and diffusion capacity that were similar to others, but had worse exercise capacity. Minority patients had a significantly increased risk of death compared to others independent of transplantation status (hazard ratio = 3.3, 95% CI 1.2-8.9, p = 0.02). Differences in exercise capacity, pulmonary hemodynamics and socioeconomic factors appeared to account for some of the differences in survival. Black and Hispanic patients with IPF had an increased risk of death following referral for lung transplantation. This finding may be due to differences in disease progression and/or differences in access to medical care among minority patients. Future studies should confirm our findings in a larger cohort. The elimination of racial and ethnic disparities in outcome should be a priority for clinicians and researchers in this field.

Exercise, cardiovascular disease, and chronic heart failure.

UNLABELLED: In addition to patients with coronary artery disease, high-risk patients with severe congestive heart failure can benefit from rehabilitation. Traditionally, such patients were excluded from rehabilitation, but resistive exercise, higher-intensity programs, and interval training have now been safely conducted. Emerging data indicate that exercise training results in a number of improved physiologic and psychologic indices, including neural control, quality of life, exercise tolerance, ventricular function, skeletal muscle physiology, peripheral blood flow, and endothelial function. This review explores these beneficial outcomes through an assessment of therapeutic approaches, with special emphasis on the unique clinical characteristics of patients with congestive heart failure. OVERALL ARTICLE OBJECTIVE: To describe the benefits and the evolving role of cardiac rehabilitation for patients with congestive heart failure.

Oxygen supplementation and cardiac-autonomic modulation in COPD.

STUDY OBJECTIVES: Patients with COPD have an increased sympathetic modulation and reduced baroreflex sensitivity (BRS). Therefore, we studied the effects of breathing 31% supplemental oxygen (SuppO(2)) on autonomic modulation in a group of COPD patients. DESIGN: We measured autonomic modulation before and during the administration of SuppO(2) on 51 patients with COPD using time-frequency analysis of R-R intervals and BP before and after intervention. This was done via a counterbalanced crossover design. The BRS index was determined using the sequence method. RESULTS: Significant differences were seen in oxygen saturation levels following breathing with SuppO(2) ([mean +/- SD] 96.4+/-1.5%) when compared to those seen after breathing with compressed air (CA) (92.8+/-2.9%; p<0.0001). Significant increases were seen in the natural log-transformed high-frequency modulation (HFln) (SuppO(2), 10.8+/-1.3 natural logarithm [ln] ms(2)/Hz; CA, 10.6+/-1.3 ln ms(2)/Hz; p<0.028) and BRS (SuppO(2), 3.3+/-2.2 ms/mm Hg; CA, 2.8+/-1.8 ms/mm Hg) following the supplemental oxygen treatment (p<0.015). The low-frequency/high-frequency ratio of heart rate variability revealed significant differences between the two treatments (SuppO(2), 2.7 +/-1.2; CA, 3.1+/-1.3; p<0.008). The analysis of BP variability data revealed significant decreases in the HFln (CA, 6.9+/-1.0 mm Hg(2)/Hz; SuppO(2), 6.5+/-1.2 mm Hg(2)/Hz; p<0.0001). Hemodynamic data also revealed a decrease in mean heart rate after breathing SuppO(2) compared with that after breathing CA (CA, 87.3+/-13.3 beats/min; SuppO(2), 85.0+/-12.4 beats/min; p<0.0004). The arterial pulse pressure significantly decreased when breathing SuppO(2) compared with that when breathing CA (CA, 57.2+/-13.5 mm Hg; SuppO(2), 53.3+/-13.0 mm Hg; p<0.0023). CONCLUSION: Oxygen supplementation in COPD patients significantly and favorably alters autonomic modulation.