Kinematic parameters related to functional capacity, fatigue, and breathlessness during the 6-min walk test in older adults with heart failure with preserved ejection fraction.

AIMS: This paper aims to assess kinematic parameters related to functional capacity, fatigue, and breathlessness during the 6-min walk test (6MWT) in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: A cross-sectional study was conducted in which adults 70 years or older with HFpEF were voluntarily recruited between April 2019 and March 2020. An inertial sensor was placed at the L3-L4 level and another on the sternum to assess kinematic parameters. The 6MWT was divided into two 3-min phases. Leg fatigue and breathlessness, assessed by the Borg scale, the heart rate (HR), and the oxygen saturation (SpO2), were measured at the beginning and the end of the 6MWT. The difference in kinematic parameters between the 6MWT two 3-min phases was also calculated. Bivariate Pearson correlations and subsequent multivariate linear regression analysis were performed. Seventy older adults with HFpEF (mean = 80.74 years old) were included. Kinematic parameters explained 81.00% of the functional capacity, 45.50% of the leg fatigue and 66.10% of the breathlessness variance. Moreover, kinematic parameters could explain 30.90% of the SpO2 variance at the end of the 6MWT. Kinematic parameters also explained 33.10% of the SpO2 difference between the beginning and end of 6MWT. Kinematic parameters explained neither the HR variance at the end of 6MWT nor the HR difference between the beginning and end. CONCLUSION: Gait kinematics from L3-L4 and sternum explain a part of the variance in subjective outcomes, assessed by the Borg scale, and objective outcomes such as functional capacity and SpO2. The kinematic assessment allows clinicians to quantify fatigue and breathlessness through objective parameters related to the patient's functional capacity. REGISTRATION: ClinicalTrials.gov NCT03909919.

Effectiveness of a cardiac rehabilitation program on biomechanical, imaging, and physiological biomarkers in elderly patients with heart failure with preserved ejection fraction (HFpEF): FUNNEL + study protocol.

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) have a low functional status, which in turn is a risk factor for hospital admission and an important predictor of survival in HFpEF. HFpFE is a heterogeneous syndrome and recent studies have suggested an important role for careful, pathophysiological-based phenotyping to improve patient characterization. Cardiac rehabilitation has proven to be a useful tool in the framework of secondary prevention in patients with HFpEF. Facilitating decision-making and implementing cardiac rehabilitation programs is a challenge in public health systems for HFpEF management. The FUNNEL + study proposes to evaluate the efficacy of an exercise and education-based cardiac rehabilitation program on biomechanical, physiological, and imaging biomarkers in patients with HFpEF. METHODS: A randomised crossover clinical trial is presented among people older than 70 years with a diagnosis of HFpEF. The experimental group will receive a cardiac rehabilitation intervention for 12 weeks. Participants in the control group will receive one educational session per week for 12 weeks on HFpEF complications, functional decline, and healthy lifestyle habits. VO2peak is the primary outcome. Biomechanical, imaging and physiological biomarkers will be assessed as secondary outcomes. Outcomes will be assessed at baseline, 12 weeks, and 24 weeks. DISCUSSION: Identifying objective functional parameters indicative of HFpEF and the subsequent development of functional level stratification based on functional impairment ("biomechanical phenotypes") may help clinicians identify cardiac rehabilitation responders and non-responders and make future clinical decisions. In this way, future pharmacological and non-pharmacological interventions, such as exercise, could be improved and tailored to improve quality of life and prognosis and reducing patients' hospital readmissions, thereby reducing healthcare costs. TRIAL REGISTRATION: NCT05393362 (Clinicaltrials.gov).

Effectiveness of a gamified digital intervention based on lifestyle modification (iGAME) in secondary prevention: a protocol for a randomised controlled trial.

INTRODUCTION: Combating physical inactivity and reducing sitting time are one of the principal challenges proposed by public health systems. Gamification has been seen as an innovative, functional and motivating strategy to encourage patients to increase their physical activity (PA) and reduce sedentary lifestyles through behaviour change techniques (BCT). However, the effectiveness of these interventions is not usually studied before their use. The main objective of this study will be to analyse the effectiveness of a gamified mobile application (iGAME) developed in the context of promoting PA and reducing sitting time with the BCT approach, as an intervention of secondary prevention in sedentary patients. METHODS AND ANALYSIS: A randomised clinical trial will be conducted among sedentary patients with one of these conditions: non-specific low back pain, cancer survivors and mild depression. The experimental group will receive a 12-week intervention based on a gamified mobile health application using BCT to promote PA and reduce sedentarism. Participants in the control group will be educated about the benefits of PA. The International Physical Activity Questionnaire will be considered the primary outcome. International Sedentary Assessment Tool, EuroQoL-5D, MEDRISK Instruments and consumption of Health System resources will be evaluated as secondary outcomes. Specific questionnaires will be administered depending on the clinical population. Outcomes will be assessed at baseline, at 6 weeks, at the end of the intervention (12 weeks), at 26 weeks and at 52 weeks. ETHICS AND DISSEMINATION: The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (RCT-iGAME 24092020). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and disseminated electronically and in print. TRIAL REGISTRATION NUMBER: NCT04019119.

Head-Mounted Display for Clinical Evaluation of Neck Movement Validation with Meta Quest 2.

Neck disorders have a significant impact on people because of their high incidence. The head-mounted display (HMD) systems, such as Meta Quest 2, grant access to immersive virtual reality (iRV) experiences. This study aims to validate the Meta Quest 2 HMD system as an alternative for screening neck movement in healthy people. The device provides data about the position and orientation of the head and, thus, the neck mobility around the three anatomical axes. The authors develop a VR application that solicits participants to perform six neck movements (rotation, flexion, and lateralization on both sides), which allows the collection of corresponding angles. An InertiaCube3 inertial measurement unit (IMU) is also attached to the HMD to compare the criterion to a standard. The mean absolute error (MAE), the percentage of error (%MAE), and the criterion validity and agreement are calculated. The study shows that the average absolute errors do not exceed 1° (average = 0.48 ± 0.09°). The rotational movement's average %MAE is 1.61 ± 0.82%. The head orientations obtain a correlation between 0.70 and 0.96. The Bland-Altman study reveals good agreement between the HMD and IMU systems. Overall, the study shows that the angles provided by the Meta Quest 2 HMD system are valid to calculate the rotational angles of the neck in each of the three axes. The obtained results demonstrate an acceptable error percentage and a very minimal absolute error when measuring the degrees of neck rotation; therefore, the sensor can be used for screening neck disorders in healthy people.

Ultrasonography Assessment Based on Muscle Thickness and Echo Intensity in Post-Polio Patients.

There is nospecific designed diagnostic test for post-poliomyelitis syndrome. The most important symptoms of this syndrome are new loss of muscle strength and more fatigue. Previous studies have investigated muscle ultrasound parameters to distinguish neuromuscular disease patients from healthy controls. The aim of this study was to investigate if muscle thickness and echo intensity measured by ultrasound can discriminate post-poliomyelitis syndrome patients from healthy controls. A total of 29 post-polio patients and 27 healthy controls participated in this cross-sectional study. Anthropometric measures, muscle thickness, echo intensity using B-mode ultrasound in rectus femoris and biceps brachii muscles, and muscle strength test data were collected. Muscle thickness in rectus femoris was significantly lower in post-poliomyelitis patients than in healthy controls, but not in biceps brachii. Echo intensity in rectus femoris and biceps brachii was higher in post-poliomyelitis syndrome patients than in healthy controls. Correlations were found between muscle thickness and strength in the upper and lower limbs. The results of the present study showed that muscle thickness in rectus femoris and echo intensity in rectus femoris and biceps brachii can discriminate post-poliomyelitis syndrome patients from healthy controls. A better assessment is possible because it can observe differences and relevant parameters in this clinical population.

Responsiveness of the new index muscular echotexture in women with metastatic breast cancer: an exercise intervention study.

Ultrasound imaging texture analyses may provide information on tissue homogeneity changes in metastatic breast cancer (MBC) through second-order analyzes based on the gray-level co-occurrence matrix. This study aimed to analyze the responsiveness and correlations of biomarkers of muscular and fat echotexture after an exercise intervention in women with MBC. A 12-week exercise intervention was conducted in 2019, including aerobic and strength training. Echotexture variables were obtained at baseline and after intervention from the quadriceps (Q) and biceps brachii and brachialis. Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means (P = 0.05; 95% CI). Data obtained from 13 MBC women showed significant differences in some echotexture variables after the intervention. QLQ-BR23 questionnaire correlated with several echotexture variables from muscle and subcutaneous fat. PFS-R scale correlated positively with the Q Subcutaneous Fat Non-Contraction Homogeneity (R = 0.43, P < 0.05). Q Muscle Non-Contraction Energy and Q Muscle Non-Contraction Textural Correlation explained 90% of the variance of QLQ-BR23. Some muscle and subcutaneous fat echotexture biomarkers showed good responsiveness after the exercise intervention. Additionally, some muscle and subcutaneous fat variables correlated with QLQ-BR23 and cancer-related fatigue measured by PFS-R scale in MBC patients.Trial registration: NCT03879096.

The role of progressive, therapeutic exercise in the management of upper limb tendinopathies: A systematic review and meta-analysis.

BACKGROUND: Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as an effective approach, but there is no consensus about the optimal progression criteria. OBJECTIVE: To compare progression criteria and effectiveness of isolated, progressive exercises in the management of upper limb tendinopathies. Additionally, to perform a meta-analysis of pain/function for the selected programs. DESIGN: Systematic Review and Meta-Analysis. METHOD: Database search of randomized-controlled-trials including progressive exercise was conducted in PubMed and Scopus until October 2020. Meta-analysis' inclusion criteria were: no data duplicity; 3-months follow-up; comparison between any type of progressive exercise program. Risk of bias was assessed with PEDro score, and level of evidence followed GRADE guidelines. Effect size was calculated with Cohen's d. RESULTS: Eleven studies were included. GRADE revealed low-quality evidence for meta-analysis of pain during activity (d = 0.29) and function (d = 0.33) at 3 months. Progression criteria were categorised into two divisions, being pain the central concept. Pain (rest/activity/night) and function improved significantly within-group, but between-group changes were heterogeneous. Meta-analysis regarding pain showed good homogeneity with significant, moderate effects (I2 = 20%; p = 0.005; mean d = 0.29); function yielded important heterogeneity with non-significant, moderate effects (I2 = 81%; p = 0.17; mean d = 0.33). CONCLUSIONS: Pain was the most frequent benchmark when modulating and progressing the exercises, although other criteria were found such as fatigue or self-perceived ability. Progressive exercise seems effective to manage upper limb tendinopathies, but the superiority of a progression criterion against others remains unclear. Low-quality evidence supported progressive exercise with eccentric components in adding a significant and moderate effect on pain/function at short-term.

Estimation of Functional Aerobic Capacity Using the Sit-to-Stand Test in Older Adults with Heart Failure with Preserved Ejection Fraction.

Background: The 6-Min Walking Test (6MWT) has been proposed to assess functional aerobic capacity in patients with heart failure, but many older adults with heart failure cannot complete it. The adequacy of the 5-repetition Sit-To-Stand (5-STS), a simpler test than 6MWT, to assess the functional aerobic capacity in older adults with heart failure has not been evaluated. Objectives: This study aimed to assess the usefulness of 5-STS in estimating maximal oxygen uptake (VO2 peak) in older adults with heart failure with preserved ejection fraction (HFpEF). Methods: A cross-sectional study was carried out. Patients 70 years and older with HFpEF were included. A bivariant Pearson correlation and subsequent multivariate linear regression analysis were used to analyze the correlations between the 5-STS and the estimated VO2 peak. Results: Seventy-six patients (80.74 (5.89) years) were recruited. The 5-STS showed a moderate and inversely correlation with the estimated VO2 peak (r = −0.555, p < 0.001). The 5-STS explained 40.4% of the variance in the estimated VO2 peak, adjusted by age, sex, and BMI. When older adults were stratified by BMI, the 5-STS explained 70% and 31.4% of the variance in the estimated VO2 peak in older adults with normal weight and overweight/obesity, respectively. Conclusions: The 5-STS may be an easy tool to assess functional aerobic capacity in older adults with HFpEF, especially for those with normal weight.

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors.

BACKGROUND: Central sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. AIMS: This study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. DESIGN: A single group pre-post intervention study was conducted. METHODS: Patients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. RESULTS: A total of 82 breast cancer survivors participated in the study. Pre-post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001). CONCLUSIONS: The current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

Design and implementation of a standard care programme of therapeutic exercise and education for breast cancer survivors.

BACKGROUND: Breast cancer survivors (BCS) face several symptoms and are at higher risk of weight gain following diagnosis. Current literature shows that both exercise and diet play a key role in recovery of BCS. However, there is a gap between current guidelines and the real-world context. The aim of this article is to describe the process behind a free, not-for-profit community-based therapeutic exercise and education programme (TEEP) for BCS in the clinical setting. METHODS: The "Onco-Health Club" (OHC) consists of therapeutic exercise (TE) intervention aimed at ameliorating cancer-related fatigue (CRF) and improving QoL and physical function. TE is supplemented with nutritional education, providing information about the Mediterranean diet. To this end, patients are recruited from an oncologist and are referred to a physiotherapist and a nutritionist for baseline assessment. TEEP consists of a 3-month intervention, delivered twice a week in a group format with 1 h of TE and 30 min of nutritional education. BCS then have a final assessment and are advised to continue with a healthy lifestyle. Data about referral, compliance and assessment were collected. RESULTS: From May 2017 to February of 2020, a total of 158 patients were recruited from 8 cohorts and 142 initially started the OHC. From 119 that joined the program, 96 patients were considered to have finished it with good adherence (assistance > 80%). BCS significantly improved their QoL, as well as upper and lower limb's function, and increased their level of physical activity. CRF tended to decrease (p = 0.005). CONCLUSIONS: This study obtained data on recruitment, compliance, and possible limitations of these kinds of programmes in a real-world context. Further research is needed in order to optimize patient engagement and compliance, as well as to determine the transferability of these programmes in the clinical setting. TRIAL REGISTRATION: NCT03879096, Registered 18th March 2019. Retrospectively registered.

Kinematic Parameters That Can Discriminate in Levels of Functionality in the Six-Minute Walk Test in Patients with Heart Failure with a Preserved Ejection Fraction.

It is a challenge to manage and assess heart failure with preserved left ventricular ejection fraction (HFpEF) patients. Six-Minute Walk Test (6MWT) is used in this clinical population as a functional test. The objective of the study was to assess gait and kinematic parameters in HFpEF patients during the 6MWT with an inertial sensor and to discriminate patients according to their performance in the 6MWT: (1) walk more or less than 300 m, (2) finish or stop the test, (3) women or men and (4) fallen or did not fall in the last year. A cross-sectional study was performed in patients with HFpEF older than 70 years. 6MWT was carried out in a closed corridor larger than 30 m. Two Shimmer3 inertial sensors were used in the chest and lumbar region. Pure kinematic parameters analysed were angular velocity and linear acceleration in the three axes. Using these data, an algorithm calculated gait kinematic parameters: total distance, lap time, gait speed and step and stride variables. Two analyses were done according to the performance. Student's t-test measured differences between groups and receiver operating characteristic assessed discriminant ability. Seventy patients performed the 6MWT. Step time, step symmetry, stride time and stride symmetry in both analyses showed high AUC values (>0.75). More significant differences in velocity and acceleration in the maximum Y axis or vertical movements. Three pure kinematic parameters obtained good discriminant capacity (AUC > 0.75). The new methodology proved differences in gait and pure kinematic parameters that can distinguish two groups according to the performance in the 6MWT and they had discriminant capacity.

Human motion capture for movement limitation analysis using an RGB-D camera in spondyloarthritis: a validation study.

A human motion capture system using an RGB-D camera could be a good option to understand the trunk limitations in spondyloarthritis. The aim of this study is to validate a human motion capture system using an RGB-D camera to analyse trunk movement limitations in spondyloarthritis patients. Cross-sectional study was performed where spondyloarthritis patients were diagnosed with a rheumatologist. The RGB-D camera analysed the kinematics of each participant during seven functional tasks based on rheumatologic assessment. The OpenNI2 library collected the depth data, the NiTE2 middleware detected a virtual skeleton and the MRPT library recorded the trunk positions. The gold standard was registered using an inertial measurement unit. The outcome variables were angular displacement, angular velocity and lineal acceleration of the trunk. Criterion validity and the reliability were calculated. Seventeen subjects (54.35 (11.75) years) were measured. The Bending task obtained moderate results in validity (r = 0.55-0.62) and successful results in reliability (ICC = 0.80-0.88) and validity and reliability of angular kinematic results in Chair task were moderate and (r = 0.60-0.74, ICC = 0.61-0.72). The kinematic results in Timed Up and Go test were less consistent. The RGB-D camera was documented to be a reliable tool to assess the movement limitations in spondyloarthritis depending on the functional tasks: Bending task. Chair task needs further research and the TUG analysis was not validated. Comparation of both systems, required software for camera analysis, outcomes and final results of validity and reliability of each test.

Ultrasound use in metastatic breast cancer to measure body composition changes following an exercise intervention.

Changes in body composition and muscle dysfunction are common in metastatic breast cancer (MBC). Ultrasound imaging (US) offers reliable information about muscle and fat tissue architecture (thickness) and quality (echo-intensity). This study aimed to analyze the responsiveness of thickness and echo-intensity and its possible relationship with functional and patient reported-outcomes (PRO) in MBC patients after an exercise intervention. A prospective study was conducted in 2019. A 12-week exercise program was performed, including aerobic exercise and strength training. Measurements were made at baseline and after intervention. Thickness and echo-intensity were obtained from the quadriceps and biceps brachii and brachialis (BB). Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means before and after the intervention (p = 0.05; 95% CI). Data from 13 MBC patients showed that some US muscle variables had significant differences after intervention. Best correlations were found between the quality of life questionnaire (QLQ-BR23) PRO and variables from BB muscle thickness in contraction (r = 0.61, p < 0.01), and Non-contraction (r = 0.55, p < 0.01). BB Muscle Non-contraction Thickness also explained 70% of QLQ-BR23 variance. In conclusion, muscle architecture biomarkers showed great responsiveness and are correlated with PRO after an exercise intervention in MBC patients.

Structural validity and reliability of the Spanish Central Sensitization Inventory in breast cancer survivors.

INTRODUCTION: One of the most widely used instruments to identify symptoms that may be related to central sensitization is the Central Sensitization Inventory (CSI). Although this instrument has been translated and validated in Spanish patients with chronic musculoskeletal pain, no psychometric analysis has been carried out in breast cancer survivors. The aim of this study was to perform a psychometric analysis of the Spanish version of the Central Sensitization Inventory (CSI-Sp) in Spanish breast cancer survivors. MATERIALS AND METHODS: A validation study was carried out in 183 breast cancer survivors. A psychometric analysis of internal consistency, factor structure, and test-retest reliability of the CSI-Sp was performed. Internal consistency was determined using Cronbach's alpha. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC) Type 2.1. Exploratory factor analysis was used to determine the internal structure of the questionnaire. RESULTS: The internal consistency was high (α = 0.91). The test-retest reliability was satisfactory with excellent values (ICC 2.1 = 0.95). The exploratory factor analysis yielded a one factor structure explaining the 33.88% of total variance. CONCLUSIONS: The CSI-Sp has demonstrated to be a psychometrically strong measure for assessing central sensitization symptoms in breast cancer survivors based on internal consistency, test-retest reliability, and structural validity. Further studies that analyze other measurement properties in different Spanish clinical populations are needed.

Differences in movement limitations in different low back pain severity in functional tests using an RGB-D camera.

Low back pain (LBP) can lead to motor control disturbance which can be one of the causes of reoccurrence of the complaint. It is important to improve our knowledge of movement related disturbances during assessment in LBP and to classify patients according to the severity. The aim of this study is to present differences in kinematic variables using a RGB-D camera in order to classify LBP patients with different severity. A cross-sectional study was carried out. Subjects with non-specific subacute and chronic LBP were screened 6 weeks following an episode. Functional tests were bending trunk test, sock test and sit to stand test. Participants performed as many repetitions as possible during 30 s for each functional test. Angular displacement, velocity and acceleration, linear acceleration, time and repetitions were analysed. Participants were divided into two groups to determine their different LBP severity with a k-means clusters according to the results obtained in Roland Morris questionnaire (RMQ). Comparing different severity groups based on RMQ score (high impact = 17.15, low impact = 7.47), bending trunk test obtained significative differences in linear acceleration (p = 0.002-0.01). The differences of total linear acceleration during the Sit to Stand test were significative (p = 0.004-0.02). Sock test showed not significative differences between groups (p > 0.05). Linear acceleration variables during Sit to Stand test and Bending trunk test were significatively different between the different severity groups. RGB-D camera system and functional tests can detect kinematic differences in different type of LBP according to the functionality. Trial registration: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.

Muscle activity and architecture as a predictor of hand-grip strength.

BACKGROUND: Grip strength is a powerful predictor of disability as well as a good indicator of physical activity. OBJECTIVES: This study aimed to relate ultrasound (US) and electromyography (EMG) simultaneously to maximum hand-grip strength during an isometric contraction. APPROACH: This is a cross-sectional study. Data acquisition was done with a dynamometer, US and EMG. Outcome variables included maximum strength during the hand-grip gesture, maximum muscle activity and change in muscle thickness. A non-linear regression analysis was performed to analyse the relationship between all outcome variables. MAIN RESULTS: A total of 38 subjects (18 men and 20 women) participated in the study. The mean results for hand-grip strength were 25.50 (SD 6.55) kg of maximum strength, a change in muscle thickness of 1.83 (SD 0.75) mm and an EMG activity of 499.29 (SD 224.20) µV. Hand-grip strength had a high correlation with muscle thickness (R 2 = 0.61) and EMG activity (R 2 = 0.95). The correlation between maximum muscle activity and change in muscle thickness was R 2 = 0.83. SIGNIFICANCE: The results of the present study demonstrate that this new method based on electromyographic activity and muscule architecture could be important in the development of the hand-grip test.

Therapeutic Physical Exercise Post-Treatment in Breast Cancer: A Systematic Review of Clinical Practice Guidelines.

Advances achieved in diagnosis and improvements in treatment for breast cancer have resulted in a favourable survival rate. Therapeutic physical exercise (TPE) is presented as an intervention strategy that seeks to improve the functional capabilities of the subject. To analyse if clinical practice guidelines recommend therapeutic physical exercise to reduce the adverse effects of treatment in breast cancer survivors, and on what level of scientific evidence are these recommendations based. This systematic review was prepared by searching nine electronic databases to identify eligible studies. Thirteen met the criteria for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE II) scale was used to analyse the quality of Clinical Practice Guideline (CPGs). The percentages obtained ranged between 30.07% and 75.70%. Specifically, the highest degree of evidence could be found in the application of TPE to offset adverse effects leading to effects such as: an increase in the quality of life, fatigue reduction, and reduction in body weight alterations. TPE is presented as an optimal intervention strategy to alleviate the negative effects that patients with breast cancer suffer as a result of the treatments received. The level of evidence that supports this claim is very strong for the majority of the side effects analysed. However, this evidence is not always included in the clinical practice guidelines.

Energy System Assessment in Survivors of Breast Cancer.

BACKGROUND: Survivors of breast cancer commonly report functional limitations, including cancer-related fatigue (CRF) and decreased aerobic capacity. One key gap is addressing the 3 energy systems (aerobic, anaerobic lactic, and alactic), requiring assessment to establish a baseline exercise intensity and duration. OBJECTIVE: This study examined the feasibility of energy system-based assessment, also providing descriptive values for assessment performance in this population. DESIGN: This was a cross-sectional study. METHODS: Seventy-two posttreatment survivors of breast cancer were recruited. Following a baseline musculoskeletal assessment, women attempted 3 energy system assessments: submaximal aerobic (multistage treadmill), anaerobic alactic (30-second sit-to-stand [30-STS]), and anaerobic lactic (adapted burpees). Heart rate (HR) and rating of perceived exertion (RPE) were recorded. Secondary outcomes included body composition, CRF, and upper- and lower-limb functionality. RESULTS: Seventy of 72 participants performed the 30-STS and 30 completed the adapted burpees task. HR and RPE specific to each task were correlated, reflecting increased intensity. Women reported low-moderate levels of CRF scores (3% [2.1]) and moderate-high functionality levels (upper-limb: 65.8% [23.3]; lower-limb: 63.7% [34.7]). LIMITATIONS: All survivors of breast cancer had relatively low levels of CRF and moderate functioning. Additionally, on average, participants were classified as "overweight" based on BMI. CONCLUSION: This study is the first to our knowledge to demonstrate feasibility of energy system assessment in survivors of breast cancer. Using a combination of HR and RPE, as well as baseline assessment of each energy system, clinicians may improve ability to prescribe personalized exercise and give patients greater ability to self-monitor intensity and progress.

Validation, Reliability, and Responsiveness Outcomes Of Kinematic Assessment With An RGB-D Camera To Analyze Movement In Subacute And Chronic Low Back Pain.

BACKGROUND: The RGB-D camera is an alternative to asses kinematics in order to obtain objective measurements of functional limitations. The aim of this study is to analyze the validity, reliability, and responsiveness of the motion capture depth camera in sub-acute and chronic low back pain patients. METHODS: Thirty subjects (18-65 years) with non-specific lumbar pain were screened 6 weeks following an episode. RGB-D camera measurements were compared with an inertial measurement unit. Functional tests included climbing stairs, bending, reaching sock, lie-to-sit, sit-to-stand, and timed up-and-go. Subjects performed the maximum number of repetitions during 30 s. Validity was analyzed using Spearman's correlation, reliability of repetitions was calculated by the intraclass correlation coefficient and the standard error of measurement, and receiver operating characteristic curves were calculated to assess the responsiveness. RESULTS: The kinematic analysis obtained variable results according to the test. The time variable had good values in the validity and reliability of all tests (r = 0.93-1.00, (intraclass correlation coefficient (ICC) = 0.62-0.93). Regarding kinematics, the best results were obtained in bending test, sock test, and sit-to-stand test (r = 0.53-0.80, ICC = 0.64-0.83, area under the curve (AUC) = 0.55-84). CONCLUSION: Functional tasks, such as bending, sit-to-stand, reaching, and putting on sock, assessed with the RGB-D camera, revealed acceptable validity, reliability, and responsiveness in the assessment of patients with low back pain (LBP). TRIAL REGISTRATION: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.

Inertial Sensors Embedded in Smartphones as a Tool for Fatigue Assessment Based on Acceleration in Survivors of Breast Cancer.

BACKGROUND: Cancer-related fatigue is a symptom commonly reported in survivors of breast cancer and is the most variable symptom. Besides questionnaires like PIPER to assess cancer-related fatigue, there is a need to objectively measure fatigue. OBJECTIVE: The aim of this study was to assess the physiological dimension of fatigue based on acceleration during a 30-second maximal sit-to-stand test. DESIGN: This was a cross-sectional study. METHODS: Linear acceleration from a smartphone placed on the sternum was recorded in 70 survivors of breast cancer. Fourth-degree polynomial adjustment from the acceleration signal to the vertical and anterior-posterior axis was calculated. The fatigue temporal cut-off point was detected as a change in the curve slope of the first maximum point of acceleration. RESULTS: Women were aged 51.8 (8.9) years with a body mass index of 25.4 (5.1) Kg/m2. They performed 23.6 (6.57) number of repetitions. The mean fatigue cut-off point from the total sample was 10.2 (3.1) seconds. LIMITATIONS: Further research should employ time-prolonged tests to study acceleration behavior beyond 30 seconds as well as include a physiological criterion that justifies the nonlinear saturation of the acceleration-based criterion. CONCLUSIONS: This study assessed fatigue through a low-cost and easy-to-use methodology during a functional and widely used test such as 30-second maximal sit-to-stand. This would allow clinicians to assess fatigue in a short-effort exercise to individualize exercise prescription dose, measure changes during intervention, and track fatigue objectively throughout survivorship.