Compliance with a personalised home exercise programme in chronic low back pain patients after a multidisciplinary programme: A pilot randomised controlled trial.

Background: Chronic low back pain (CLBP) is a very common problem throughout the world. One treatment possibility is the multidisciplinary programme (MP) in a rehabilitation centre, which provides intensive rehabilitation through physical exercise to quickly improve the patient conditions. Patients nevertheless do not always continue the exercises when they return home. This study thus evaluated compliance with a personalised home-based programme for CLBP patients post-MP. Methods: A randomised controlled single-blind trial was conducted. Thirty patients were randomised into two groups and participated in an MP for 4 weeks. They were then given an exercise booklet for home rehabilitation. In addition, each patient in the experimental group constructed a personalised exercise programme with a physiotherapist. The control group was only encouraged to continue the exercises at home. To assess therapeutic compliance, both groups were asked to document each completed exercise in a logbook. In addition, pain intensity, flexibility, muscle endurance, activity limitations, participation restrictions, and beliefs about physical activity were assessed at the beginning and end of the MP and again after 12 weeks at home. Results: Compliance was good for all activities in both groups, but there were no significant differences between groups. All participants improved on the criteria by the end of MP, and both groups maintained the improvements in most of the criteria at 3-month follow-up. Conclusion: This study showed the effectiveness of an MP for CLBP in the short and medium term. However, future research should focus on longer-term compliance.

[Vocal cord dysfunction in athletes: Interest of rehabilitation to effort]. / Dysfonction des cordes vocales chez le sportif : intérêt du reconditionnement à l'effort.

INTRODUCTION: Vocal Cord Dysfunction (VCD) is a syndrome characterized by paradoxical adduction of the vocal folds during breathing. Its non-specific clinical manifestations frequently lead to misdiagnosis and delay in its treatment. The treatment of VCD is not pharmacological but rehabilitative and remains poorly appreciated. OBSERVATION: In this clinical case we describe a 16-year-old female judoka who presented with effort intolerance associated with occasional dyspnea, which had suddenly worsened over the preceding few months so that in now produced sudden respiratory difficulty, mainly during intense and sudden efforts. After a period where her symptoms were confused with asthma, she was diagnosed with exercise-induced VCD. Her treatment was aimed to: (a) rehabilitate respiratory mechanics in order to eliminate abdominal-thoracic asynchrony, (b) rehabilitate naso-nasal breathing, (c) train her to control abdominal-diaphragmatic breathing at rest and then during effort, (d) train her to use ventilatory control as soon as prodromal symptoms appear in order to prevent the development of stridor or complete closure of the vocal folds (at rest and then progressively during exercise). CONCLUSION: Following the implementation of these rehabilitation strategies to correct her ventilatory and dyskinetic issues, the patient no longer develops respiratory discomfort during exercise, including during judo competitions.

[Assessment of muscular toxicity due to chemotherapy by cardio-pulmonary exercise testing]. / Évaluation de la toxicité musculaire de la chimiothérapie lors d'une épreuve fonctionnelle à l'exercice.

INTRODUCTION: Cardio-pulmonary exercise testing (CPET) is frequently used to assess aerobic capacity, to evaluate respiratory tolerance and to provide prognostic information. Therefore, CPET is often incorporated in the preoperative assessment of cancer patients. This clinical case report presents the preoperative assessment of a patient before thoracic surgery, in whom an important decrease of aerobic capacity was noted, possibly because of muscular toxicity linked to chemotherapy. CASE REPORT: This clinical case concerns a fit, 66-year-old man with a large cell carcinoma of the bronchus. He had received 2 cycles of adjuvant chemotherapy. Subsequently, a left pneumonectomy had been proposed and preoperative assessment performed. CPET showed no further increase in oxygen uptake after the first ventilatory threshold, in spite of increases in carbon dioxide output, minute ventilation and heart rate. Moreover, maximal oxygen uptake was low and there was a decrease of oxygen pulse at maximal effort. CONCLUSION: We suggest that the limitation of effort was due to a limitation of muscular oxygen extraction, which could be explained by possible muscular toxicity due to chemotherapy.

Impact of a walking program of 10,000 steps per day and dietary counseling on health-related quality of life, energy expenditure and anthropometric parameters in obese subjects.

PURPOSE: The aim of this pilot study was to assess the impact of a physical activity program of walking 10,000 steps per day along with monthly dietary counseling on the body composition, biological parameters, resting energy expenditure (REE) and health-related quality of life (HRQoL) of obese individuals. METHODS: Thirty-five obese adults (26 women; age: 39.2 ± 13.4 years, body mass, BM: 104.1 ± 18.7 kg and body mass index, BMI: 38.3 ± 6.6 kg m-2) followed a walking program (instructions were provided so that the participants increase their walking distance by 1000 steps each week, until to perform at least 10,000 steps per day) and received qualitative dietary advice (cookbook presenting numerous recipes with low calories and dietary advices was provided) for 6 months. Before and after the intervention, anthropometric (BM, BMI, waist and hip circumferences, fat mass: FM and lean body mass: LBM) and biological data (total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride and glucose concentrations), REE and HRQoL (including eight dimensions and two summaries) were assessed. RESULTS: After the intervention, BM (difference: 3.8 kg or 3.7 %), BMI (difference: 1.4 kg m-2 or 3.7 %), hip circumference (difference: 4.6 cm or 4.3 %), FM in kg (difference: 4.0 kg or 8.9 %) and FM in percentage of BM (difference: 1.6 kg or 6.1 %) were significantly decreased, whereas number of steps (difference: 7579 steps or 135 %), LBM in percentage of BM (difference: 2.6 kg or 4.5 %) and REE (difference: 78 kcal d-1 or 4.8 %) were significantly increased (p < 0.05). Moreover, two HRQoL subdimension scores (physical functioning and physical component summary; increase by 15.3 and 4.6, respectively, p < 0.05) and anxiety (reduction by 1.2, p < 0.05) were also significantly improved. Conversely, the biological data showed no significant change (p > 0.05). CONCLUSION: Walking 10,000 steps per day in association with dietary counseling improved anthropometric data, REE, the physical domains of HRQoL and anxiety in obese adults.

Greater effects of high- compared with moderate-intensity interval training on cardio-metabolic variables, blood leptin concentration and ratings of perceived exertion in obese adolescent females.

This study examined the effects of high- vs. moderate-intensity interval training on cardiovascular fitness, leptin levels and ratings of perceived exertion (RPE) in obese female adolescents. Forty-seven participants were randomly assigned to one of three groups receiving either a 1:1 ratio of 15 s of effort comprising moderate-intensity interval training (MIIT at 80% maximal aerobic speed: MAS) or high-intensity interval training (HIIT at 100% MAS), with matched 15 s recovery at 50% MAS, thrice weekly, or a no-training control group. The HIIT and MIIT groups showed improved (p < 0.05) body mass (BM), BMI Z-score, and percentage of body fat (%BF). Only the HIIT group showed decreased waist circumference (WC) (p = 0.017). The effect of exercise on maximal oxygen uptake (VO2max) was significant (p = 0.019, ES = 0.48 and p = 0.010, ES = 0.57, HIIT and MIIT, respectively). The decrease of rate-pressure product (RPP) (p < 0.05, ES = 0.53 and ES = 0.46, HIIT and MIIT, respectively) followed the positive changes in resting heart rate and blood pressures. Blood glucose, insulin level and the homeostasis model assessment index for insulin decreased (p < 0.05) in both training groups. Significant decreases occurred in blood leptin (p = 0.021, ES = 0.67 and p = 0.011, ES = 0.73) and in RPE (p = 0.001, ES = 0.76 and p = 0.017, ES = 0.57) in HIIT and MIIT, respectively. In the post-intervention period, blood leptin was strongly associated with %BF (p < 0.001) and VO2max (p < 0.01) in the HIIT and MIIT groups, respectively, while RPE was strongly associated with BM (p < 0.01) in the HIIT group. The results suggest that high-intensity interval training may produce more positive effects on health determinants in comparison with the same training mode at a moderate intensity.

Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients.

INTRODUCTION: Exercise tolerance testing is an integral part of the pulmonary rehabilitation (PR) management of patients with chronic obstructive pulmonary disease (COPD). The 6-minute stepper test (6MST) is a new, well-tolerated, reproducible exercise test, which can be performed without any spatial constraints. OBJECTIVE: The aim of this study was to compare the results of the 6MST to those obtained during a 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) in a cohort of COPD patients. METHODS: Ninety-one COPD patients managed by outpatient PR and assessed by 6MST, 6MWT, and CPET were retrospectively included in this study. Correlations between the number of steps on the 6MST, the distance covered on the 6MWT, oxygen consumption, and power at the ventilatory threshold and at maximum effort during CPET were analyzed before starting PR, and the improvement on the 6MST and 6MWT was compared after PR. RESULTS: The number of steps on the 6MST was significantly correlated with the distance covered on the 6MWT (r=0.56; P<0.0001), the power at maximum effort (r=0.46; P<0.0001), and oxygen consumption at maximum effort (r=0.39; P<0.005). Performances on the 6MST and 6MWT were significantly improved after PR (570 vs 488 steps, P=0.001 and 448 vs 406 m, respectively; P<0.0001). Improvements of the 6MST and 6MWT after PR were significantly correlated (r=0.34; P=0.03). CONCLUSION: The results of this study show that the 6MST is a valid test to evaluate exercise tolerance in COPD patients. The use of this test in clinical practice appears to be particularly relevant for the assessment of patients managed by home PR.

A specific prediction equation is necessary to estimate peak oxygen uptake in obese patients with metabolic syndrome.

PURPOSE: The aims were to: (1) compare peak oxygen uptake ([Formula: see text]peak) predicted from four standard equations to actual [Formula: see text]peak measured from a cardiopulmonary exercise test (CPET) in obese patients with metabolic syndrome (MetS), and (2) develop a new equation to accurately estimate [Formula: see text]peak in obese women with MetS. METHODS: Seventy-five obese patients with MetS performed a CPET. Anthropometric data were also collected for each participant. [Formula: see text]peak was predicted from four prediction equations (from Riddle et al., Hansen et al., Wasserman et al. or Gläser et al.) and then compared with the actual [Formula: see text]peak measured during the CPET. The accuracy of the predictions was determined with the Bland-Altman method. When accuracy was low, a new prediction equation including anthropometric variables was proposed. RESULTS: [Formula: see text]peak predicted from the equation of Wasserman et al. was not significantly different from actual [Formula: see text]peak in women. Moreover, a significant correlation was found between the predicted and actual values (p < 0.001, r = 0.69). In men, no significant difference was noted between actual [Formula: see text]peak and [Formula: see text]peak predicted from the prediction equation of Gläser et al., and these two values were also correlated (p = 0.03, r = 0.44). However, the LoA95% was wide, whatever the prediction equation or gender. Regression analysis suggested a new prediction equation derived from age and height for obese women with MetS. CONCLUSIONS: The methods of Wasserman et al. and Gläser et al. are valid to predict [Formula: see text]peak in obese women and men with MetS, respectively. However, the accuracy of the predictions was low for both methods. Consequently, a new prediction equation including age and height was developed for obese women with MetS. However, new prediction equation remains to develop in obese men with MetS.

Validity and reliability of the session-RPE method for quantifying training load in karate athletes.

AIM: To test the construct validity and reliability of the session rating of perceived exertion (sRPE) method by examining the relationship between RPE and physiological parameters (heart rate: HR and blood lactate concentration: [La --] ) and the correlations between sRPE and two HR--based methods for quantifying internal training load (Banister's method and Edwards's method) during karate training camp. METHODS: Eighteen elite karate athletes: ten men (age: 24.2 ± 2.3 y, body mass: 71.2 ± 9.0 kg, body fat: 8.2 ± 1.3% and height: 178 ± 7 cm) and eight women (age: 22.6 ± 1.2 y, body mass: 59.8 ± 8.4 kg, body fat: 20.2 ± 4.4%, height: 169 ± 4 cm) were included in the study. During training camp, subjects participated in eight karate--training sessions including three training modes (4 tactical--technical, 2 technical--development, and 2 randori training), during which RPE, HR, and [La -- ] were recorded. RESULTS: Significant correlations were found between RPE and physiological parameters (percentage of maximal HR: r = 0.75, 95% CI = 0.64--0.86; [La --] : r = 0.62, 95% CI = 0.49--0.75; P < 0.001). Moreover, individual sRPE was significantly correlated with two HR--based methods for quantifying internal training load ( r = 0.65--0.95; P < 0.001). The sRPE method showed the high reliability of the same intensity across training sessions (Cronbach's α = 0.81, 95% CI = 0.61--0.92). CONCLUSION: This study demonstrates that the sRPE method is valid for quantifying internal training load and intensity in karate.

The influence of karate practice level and sex on physiological and perceptual responses in three modern karate training modalities.

OBJECTIVE: The aim of the present study was to examine the influence of karate practice level (national vs international level) and sex (women vs men) on physiological and perceptual responses in three modern karate training modalities (tactical-technical (TT), technical-development (TD), and randori). METHOD: The study included 18 karatekas participating in an eight-session training camp of four TT, two TD, and two randori. During each session, the percentage of maximal heart rate (HR), blood lactate concentration [La(-)], and rating of perceived exertion (RPE) were assessed. RESULTS: The main results showed that the percentage of maximal HR was significantly higher in women than in men regardless of practice level or training modality (70.3 ± 4.1 vs 66.2 ± 6.3, respectively). Moreover, [La(-)] and RPE were significantly lower in international-level karatekas compared with their national-level counterparts whatever the sex or training modality ([La(-)] = 11.4 ± 2.6 vs 8.3 ± 2.4 mmol · L(-1) and RPE = 3.6 ± 1.2 vs 4.3 ± 1.5, respectively). Last, physiological and perceptual responses were significantly higher during randori in comparison with TT and TD for both sexes. CONCLUSION: The combination of [La(-)] and RPE thus seems to be a good indicator for discriminating between national- and international-level karatekas, and randori seems to be an effective means to reproduce official karate sparring.

Epidemiologic study of young soccer player's injuries in U12 to U20.

AIM: The aim of this study was an epidemiological report of the injuries to young soccer players from pretraining centres (12 to 15 years: U12-U15) and training centres (16 to 20 years: U16-U20). METHOD: Over 3 years, 618 injuries were analysed, concerning an average of 137 players per season (66 and 71 players in U12-U15 and U16-U20, respectively). The injuries were diagnosed by a physician. Numerous injury-related information were documented: player, player's age category, date of the injury, site of the injury, injured side, type of injury, circumstances: training vs. match and contact vs non-contact, number of days of play missed, severity, and player's position. RESULTS: The injury rate was higher in matches than in training sessions. Non-contact injuries accounted for 77.0% of the injuries for U12-U15 and 65.6% for U16-U20. The injuries were mainly to the thigh and hip in pretraining players (23.3% and 19.0%, respectively), and to the thigh and ankle in training players (32.1% and 20.3%, respectively). Contact injuries occurred more frequently during matches, presumably because of the higher intensity of play. The analysis of match injuries by position indicated that for U12-U15, during the matches, lateral defenders were injured most often: 30.4%. For U16-U20, axial midfielders and axial defenders were most subject to injuries during the matches (26.6% and 23.1%, respectively). CONCLUSION: These results may help to improve the programming of training. Between the first and third seasons of this study, a decrease in injuries during both matches and training sessions: from 174 to 107 (decrease of 38.5%).

[Blood lactate three minutes after a graded exercise test: a criterion of maximal exercise in patients with COPD]. / Lactatémie trois minutes après une EFX : un critère de maximalité chez le patient BPCO.

INTRODUCTION: The graded exercise test (GXT) is used to measure the exercise capacity of patients with chronic obstructive pulmonary disease (COPD). To do this GXT must be maximal (exhaustive). However, the value of the blood lactate at the GXT endpoint [La(-)max] or after a recovery period of three minutes [La(-)recovery], to confirm that the GXT is maximal, remains controversial. The purpose of the present study is to determine a threshold of [La(-)max] and/or [La(-)recovery], which confirms the exhaustiveness of GXT in patients with COPD. METHODS: Thirty-six patients with COPD performed a GXT until exhaustion on a cycle ergometer. During the GXT cardiorespiratory parameters, [La(-)max] and [La(-)recovery] were measured. When at least three out of five of the most frequently used criteria to confirm exhaustion were met, GXT was considered as maximal. Conversely, GXT was considered as sub-maximal when less three criteria were observed. The receiver operating characteristic (ROC) curves were analyzed. RESULTS: For [La(-)max] the areas under the ROC curve and the areas under the diagonal were not significantly different (P=0.16). For [La(-)recovery] the ROC curve inflected itself at 5.8mmol/L (sensitivity=0.92 and specificity=0.56). CONCLUSIONS: It was not possible to use [La(-)max] to confirm exhaustion in our population. However, [La(-)recovery]<5.8mmol/L may help to confirm non-exhaustion during GXT in patients with COPD. Below this blood lactate threshold 93% patients performed a sub-maximal GXT.

Relevance of the measure of perceived exertion for the rehabilitation of obese patients.

The most common tool used for measuring effort perception is the rating scale of perceived exertion (RPE) developed by Borg. This scale is also used for various outcomes in the general population. The validity and reliability of this scale have already been reported in obese patients. However, the relevance of measuring perceived exertion in obese patients is still poorly known. This review of the literature presents the Borg RPE scale (i.e., validity, reliability and recommendations) and its main advantages during graded exercise tests (e.g., comparison of physical capacity, predicting physiological variables, verifying exhaustion and exercise safety) and rehabilitation programs (e.g., individualized exercise intensity, evaluation of the impact of a rehabilitation program and even determining the perceptual preference) in obese patients. This review of the literature underlines the relevance and usefulness of the Borg RPE scale, which is still underused in obese patients. However, additional studies are still necessary before using this scale routinely in all obese patients (regardless of the severity of their obesity or associated complications).

Self-regulation of exercise intensity by estimated time limit scale.

The purpose of this study was to evaluate the validity of the estimated time limit scale (ETL), which deals with a subjective prediction of how long the current exercise intensity can be maintained, for regulating exercise intensity using typical estimation-production procedure. Thirty-six male athletes performed a continuous incremental test and two discontinuous tests with randomized workloads (estimation tests at 65, 75, 85 and 95% of the maximal power output, and production tests: subjects have to use the ETL values which were collected for each power during the estimation test in order to manually product the corresponding workload). The intraclass correlation coefficient for the power output between estimation and production tests is good for exercises at 75, 85 and 95% MAP (0.81, 0.85 and 0.96, respectively). Moreover, mean differences both for power output and cardiorespiratory data were not significantly different between estimation and production tests for exercises at 85 and 95% MAP. Consequently, the validity to prescribe an exercise intensity from the ETL scale is attested in these athletes particularly for high exercise intensities on cycloergometer.

Knowledge of the endpoint: effect on perceptual values.

The main purpose of this study was to examine the influence of knowledge of running length (i.e., duration or distance), or the lack of it (unknown endpoint) on the ratings of perceived exertion and estimated time to exhaustion. Fourteen men were recruited for this study. Participants performed 3 tests of a similar intensity (90 % maximal aerobic velocity) and length (100 % Tlim/Dlim). However, the exercise length was differently expressed. This was either unknown or defined in terms of duration or distance. The tests with a known length were performed in a counterbalanced order. During the tests, ratings of perceived exertion, estimated time to exhaustion, and heart rate were measured then compared by using 2-way analysis of variance for repeated measures. The results show that the ratings of perceived exertion, estimated time to exhaustion, and heart rate increased significantly with exercise duration (p < .001). Moreover, the ratings of perceived exertion were significantly different between the test with an unknown running endpoint and that with a known running distance at 40, 60 and 80 % Tlim (p < .05). Therefore, athletes perceived the run as being easier during the test with an unknown running endpoint compared to the test with a known running distance. Consequently, knowledge of running length influenced the ratings of perceived exertion probably due to teleoanticipation.

[Effects of intermittent walk program on the body mass and composition in obese women]. / Effets d'un programme de marche intermittente sur la masse et la composition corporelles de femmes obèses.

UNLABELLED: The obese patients adhere weakly to rehabilitation programs; therefore the expected gains are often disappointing. This is possibly linked to the monotony of constant velocity exercises frequently proposed. Consequently, other less monotonous exercises such as the intermittent walk may be more appropriated. OBJECTIVES: The main objectives of this study were to determine if the obese women prefer a constant velocity walk or an intermittent walk, and to analyze the effects of a rehabilitation program based on the intermittent walk. MATERIALS AND METHODS: Twenty obese women were recruited. To determine the preferred walk modality, 10 obese women performed a constant velocity walk and an intermittent walk (with a similar duration and velocity) on a treadmill. The preferred walk modality was determined by lower ratings of perceived exertion. Then, these same 10 women participated in a rehabilitation program of 10 weeks (three days per week) consisting of intermittent walks. The 10 other women did not participate in a training program. RESULTS: The ratings of perceived exertion were not significantly different between the two walk modalities. However, the women who participated in a training program increased their maximal distance during a 6 min walking test and they have stabilized theirs anthropometric data. Meanwhile, the untrained women have increased their body mass, body mass index and percentage of body fat. CONCLUSION: The obese patients preferred similarly the constant velocity walk and the intermittent walk, and a rehabilitation program based on an intermittent walk is effective in avoiding the obesity aggravation.

Influence of instructions on perceptually-based ratings.

The purpose of this study was to examine the influence of the expected running duration or distance on ratings of perceived exertion (RPE) and estimated time limit (ETL) values. Thirty-nine males performed an incremental test to measure their maximal aerobic velocity (MAV). Then, the subjects realised a constant velocity test (90 % MAV) to determine their time limit (Tlim) and distance limit (Dlim). Three homogenous groups were made up. Subsequently, all the groups performed 2 similar tests: a test at 90 % MAV for 80 % Tlim and a test at 90 % MAV for 80 % Dlim, each group with different instructions: group 1 (G1) was expected to maintain the velocity for 60 % Tlim (and Dlim), while group 2 (G2) and group 3 (G3) received instructions to maintain this velocity for 80 and 100 % Tlim (and Dlim), respectively. During these tests, RPE and ETL values were collected and compared by using a three-way repeated measures ANOVA. The statistical analysis revealed no significant group or test effect on RPE and ETL (p > .05). As a consequence, in this present study, it seems that the exercise instructions have not influenced significantly the hardness of effort (i.e., RPE) and the subjective estimation of endurance (i.e., ETL).

Validity and reliability of perceptually-based scales during exhausting runs in trained male runners.

The purposes of this study were to test the validity of a recent scale based on the estimation of a time of exhaustion (entitled Estimated Time Limit scale) to predict a time limit (Tlim) and to regulate exercise intensity and to investigate the reliability of the Estimated Time Limit scale and the Ratings of Perceived Exertion (RPE) scale. 14 male runners performed one incremental test, one constant velocity test at 85% of Maximal Aerobic Velocity (MAV), one constant duration test and one retest of 15 min. on an outdoor track. The difference between Estimated Time Limit values obtained during the incremental test at 85% MAV and measured Tlim values during the constant velocity test were examined, the velocities at ETL = 13 (i.e., 15 min.) obtained during the incremental test were compared with measured velocities during the constant duration test or the retest (only the best performance was used), and RPE and Estimated Time Limit values during the constant duration test were compared with those measured during retest. The results have shown a nonsignificant correlation between Estimated Time Limit values at 85% MAV and measured Tlim values during constant velocity test. There was a significant correlation (p < .02, r = .64) between velocities at ETL= 13 and measured velocities. However, the slope and y intercept value of this regression were significantly different from those of the identity line. There was no significant difference between constant duration test and retest for the values of RPE and Estimated Time Limit with high correlations (between r = .77 and .99 for RPE scale, and r = .74 and .99 for Estimated Time Limit scale). Moreover, the regression lines were close to the identity line. The RPE and Estimated Time Limit scales are reliable, but the lack of validity for the Estimated Time Limit scale suggests that more studies must be performed before using this scale to predict Tlim and regulate exercise intensity in male runners.

Randomized trial of subcutaneous low-molecular-weight heparin CY 216 (Fraxiparine) compared with intravenous unfractionated heparin in the curative treatment of submassive pulmonary embolism. A dose-ranging study.

BACKGROUND: We compared the efficacy and safety of different dosages of a low-molecular-weight heparin, CY 216 D (Fraxiparine), in the treatment of submassive pulmonary embolism with unfractionated heparin in a prospective, randomized, dose-finding study. METHODS AND RESULTS: The primary outcome was the evolution of pulmonary vascular obstruction. We enrolled 101 patients. Four patient groups were formed: standard heparin by continuous intravenous infusion (group 1) and Fraxiparine subcutaneously 400, 600, and 900 anti-Xa Institute Choay units/kg, respectively (groups 2, 3, and 4). Inclusions were stopped prematurely in groups 3 and 4 because of the incidence of major bleedings. At day 8, the improvement of the pulmonary vascular obstruction and the major bleedings were similar in groups 1 and 2. CONCLUSIONS: The Fraxiparine dosage of 400 anti-Xa Institute Choay units/kg is as effective and safe as unfractionated heparin in the treatment of submassive pulmonary embolism.