The Bed Bridge Test: a new functional test for hospital inpatients - a feasibility and measurement study.

PURPOSE: To develop and assess the Bed Bridge Test's (BBT) feasibility, safety, and clinimetric properties and evaluate functional capacity in hospitalised patients. MATERIALS AND METHODS: This feasibility and measurement study examined four BBT versions, including the timed-limited at 30 and 60 s and repetition-limited at 5 and 10 times, in hospitalised patients in a university hospital in Brazil. Ninety-two functionally stable patients with respiratory, gastrointestinal, or post-surgical conditions participated. Participants completed the BBT versions in a random order. BBT concurrent criterion validity was evaluated using the Short Physical Performance Battery (SPPB), Sit-to-Stand (STS) test, and Functional Status Score (FSS). RESULTS: The participants were 51 ± 17 years old, 60% female, and 66% with clinical conditions. All participants completed the BBT versions without adverse events. Test-retest reliability was good-excellent (intraclass correlation coefficient >0.87) for all BBT versions, with acceptable agreement parameters and minimal detectable changes. The time-limited versions of the BBT might be affected by a ceiling effect. Floor effects were minimal for all BBT versions. BBT showed moderate associations with SPPB and STS and weak associations with FSS. CONCLUSIONS: The BBT is feasible and has promising measurement properties.

The Bed Bridge Test (BBT) offers a valuable solution for healthcare professionals by addressing the limitations of existing functional tests, providing a straightforward assessment of functional capacity for both the patient and the assessor.The BBT has demonstrated excellent feasibility and safety, as all eligible participants completed its various versions without adverse events, indicating its potential utility across diverse patient populations.The BBT exhibits good to excellent reliability, indicating its reproducibility in clinical settings.The BBT has validated its effectiveness by exhibiting robust correlations with established functional tests such as the Short Physical Performance Battery (SPPB) and Sit-to-Stand (STS) test.

Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review.

This paper presents a rapid review of the literature for the components, benefits, barriers, and facilitators of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) people in-home and community-based settings. seventy-six studies were included: 57 home-based pulmonary rehabilitation (HBPR) studies and 19 community-based pulmonary rehabilitation (CBPR) studies. The benefits of HBPR on exercise capacity and health-related quality of life were observed in one-group studies, studies comparing HBPR to usual care, and studies comparing to hospital-based pulmonary rehabilitation, although the benefits were less pronounced in the latter. HBPR reduced hospital admissions compared to usual care and was more cost-effective than hospital pulmonary rehabilitation. Most HBPRs were designed with low-density or customized equipment, are minimally supervised, and have a low intensity of training. Although the HBPR has flexibility and no travel burden, participants with severe disease, physical frailty, and complex comorbidities had barriers to complying with HBPR. The telerehabilitation program, a facilitator for HBPR, is feasible and safe. CBPR was offered in-person supervision, despite being limited to physical therapists in most studies. Benefits in exercise capacity were shown in almost all studies, but the improvement in health-related quality of life was controversial. Patients reported the benefits that facilities where they attended the CBPR including social support and the presence of an instructor. They also reported barriers, such as poor physical condition, transport difficulties, and family commitments. Despite the minimal infrastructure offered, HBPR and CBPR are feasible, safe, and provide clinical benefits to patients with COPD. Home and community settings are excellent opportunities to expand the offer of pulmonary rehabilitation programs, as long as they follow protocols that ensure quality and safety following current guidelines.

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study / Valores normativos e equação de referência para o teste do degrau de seis minutos para avaliar a capacidade funcional de exercício: um estudo multicêntrico

ABSTRACT Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = −0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = −0.22), waist circumference (r = −0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.

RESUMO Objetivo: Estabelecer valores normativos e uma equação de referência para o número de degraus subidos no teste do degrau de seis minutos (TD6) em adultos saudáveis, bem como avaliar a confiabilidade do teste e da equação. Métodos: Estudo transversal multicêntrico com 468 voluntários saudáveis (faixa etária: 18-79 anos) recrutados na comunidade geral em seis laboratórios de pesquisa em diferentes regiões do Brasil, um país de dimensões continentais. O TD6 foi realizado duas vezes (com 30 min de intervalo entre uma e outra), e foram avaliadas variáveis clínicas, demográficas e funcionais. Uma amostra independente composta por 24 voluntários foi avaliada para testar a equação de referência a posteriori. Resultados: O número de degraus subidos apresentou excelente confiabilidade teste-reteste [coeficiente de correlação intraclasse = 0,96 (IC95%: 0,95-0,97)], e a média de degraus subidos foi de 175 ± 45, sendo 14% maior no sexo masculino. O melhor desempenho no teste correlacionou-se com as seguintes variáveis: idade (r = −0,60), sexo (r = 0,28), peso (r = 0,13), estatura (r = 0,41), IMC (r = −0,22), circunferência da cintura (r = −0,22), circunferência da coxa (r = 0,15), CVF (r = 0,54) e nível de atividade física (r = 0,17; p < 0,05 para todos). Na análise de regressão, idade, sexo, estatura e peso explicaram 42% da variabilidade do TD6. Foram estabelecidos valores normativos para o TD6 de acordo com a idade e o sexo. Não houve diferença entre os valores do TD6 na amostra independente e os valores previstos (157 ± 29 vs. 161 ± 25 degraus subidos; p = 0,47; 97% dos valores previstos). Conclusões: Os valores normativos e a equação de referência para o TD6 neste estudo parecem adequados para predizer com precisão o desempenho físico funcional em adultos no Brasil.

Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis.

OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI -0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis

SUMMARY OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI −0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Effects of whole-body electromyostimulation on function, muscle mass, strength, social participation, and falls-efficacy in older people: A randomized trial protocol.

BACKGROUND: Resistance training has a positive impact on functional capacity and muscle mass in the elderly. However, due to physical limitations or a simple aversion against regular exercise, a majority of the elderly do not reach the recommended exercise doses. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient, and smooth training technology on physical function, fat-free mass, strength, falls-efficacy, and social participation of the elderly. METHODS: The present study is a randomized, parallel group clinical trial approved by the Ethics Committee of our Institution. Sixty-six volunteers (age ≥ 60 years) will be recruited from the geriatric outpatient department in a tertiary hospital and primary care units and randomized into two groups: WB-EMS group or active control group (aCG). The WB-EMS or aCG protocol will consist of 16 sessions for 8 consecutive weeks, twice per week. The primary outcomes will be maximal isometric knee extension (IKE), functional lower extremity strength, fat-free mass, gait speed, and risk of falls measured before and after intervention. The secondary outcomes will be social participation and falls-efficacy assessed before and after the intervention and at three and six months of follow-up. Participant's satisfaction with and awareness of electrical stimulation therapy will also be assessed immediately after the 8-week intervention. DISCUSSION: Patients receiving WB-EMS exercises are believed to have better outcomes than those receiving conventional, more time-consuming resistance exercises. Hence, innovative, time-efficient, joint-friendly, and highly individualized exercise technologies (such as WB-EMS) may be a good choice for the elderly with time constraints, physical limitations, or little enthusiasm, who are exercising less than the recommended amounts for impact on muscle mass, strength, and function.

Performance, metabolic, hemodynamic, and perceived exertion in the six-minute step test at different heights in a healthy population of different age groups

Abstract Aim: This study aimed to compare the performance, metabolic, hemodynamic, and perceived exertion during the 6-minute step test (6MST) conducted with different step heights in healthy subjects and also to compare the performance between different age groups for each step height. The association between age, body mass index, level of physical activity, and lower limb measurements with performance were also evaluated. Methods: This is a cross-sectional study. Anthropometric measures, physical performance, and cardiovascular stress were evaluated during a self-paced 6MST with different step heights in healthy subjects in the age group of 18-59. All the participants underwent three-step tests (15 cm, 20 cm, and 30 cm) on the same day, in a randomized order. Results: Forty participants (20 men and 20 women) performed the tests. The performance in the test for the highest step was significantly lower compared to the step with the lowest height (152 ± 24 vs. 173 ± 27 and 184 ± 33; p < 0,05). The estimated peak oxygen consumption (VO2peak) increased by ∼2.5 mL.kg−1·min−1 with the increase in step height. Hemodynamic variables, such as percent of maximum heart rate (%HRmáx), and systolic blood pressure increased as the step height increased. There was a fair correlation between performance and the level of physical activity in the test with a step height of 15 cm and 20 cm. Conclusion: A higher step height caused greater cardiovascular stress, without exceeding the submaximal levels of the test, indicating that the 6MST can be used as an accurate instrument for evaluating aerobic capacity in healthy individuals.