Determinants and Prediction Equations of Six-Minute Walk Test Distance Immediately After Cardiac Surgery.

Background: To date, there is no reference for a 6-min walk test distance (6-MWD) immediately after cardiac surgery. Therefore, this study aimed to identify the determinants and to generate equations for prediction reference for 6-MWD in patients immediately after cardiac surgery. Methods: This is a cross-sectional study of the 6-min walk test (6-MWT) prior to participation in the cardiac rehabilitation (CR) program of patients after coronary artery bypass surgery (CABG) or valve surgery. The 6-MWT were carried out in a gymnasium prior to the CR program immediately after the cardiac surgery. Available demographic and clinical data of patients were analyzed to identify the clinical determinants of 6-MWD. Results: This study obtained and analyzed the data of 1,509 patients after CABG and 632 patients after valve surgery. The 6-MWD of all patients was 321.5 ± 73.2 m (60-577). The distance was longer in the valve surgery group than that of patients in the CABG group (327.75 ± 70.5 vs. 313.59 ± 75.8 m, p < 0.001). The determinants which significantly influence the 6-MWD in the CABG group were age, gender, diabetes, atrial fibrillation, and body height, whereas in the valve surgery group these were age, gender, and atrial fibrillation. The multivariable regression models generated two formulas using the identified clinical determinants for patients after CABG: 6-MWD (meter) = 212.57 + 30.47 (if male gender) - 1.62 (age in year) + 1.09 (body height in cm) - 12.68 (if with diabetes) - 28.36 (if with atrial fibrillation), and for patients after valve surgery with the formula: 6-MWD (meter) = 371.05 + 37.98 (if male gender) - 1.36 (age in years) - 10.61 (if atrial with fibrillation). Conclusion: This study identified several determinants for the 6-MWD and successively generated two reference equations for predicting 6-MWD in patients after CABG and valve surgery.

Aerobic exercise prescription in heart failure patients with cardiac resynchronization therapy.

Exercise for heart failure patients had been shown to be beneficial in improving functional status, and was reviewed to be safe. In cases of advanced heart failure, Cardiac Resynchronization Therapy (CRT) is a promising medical option before being a heart transplant candidate. CRT itself is a biventricular pacing device, which could detect electrical aberrance in the failing heart and provide a suitable response. Studies have shown that exercise has clear benefits toward improving an overall exercise capacity of the patients. Despite its impacts, these randomized clinical trials have varying exercise regime, and until now there has not been a standardized exercise prescription for this group of patients. The nature of CRT as a pacemaker, sometimes with defibrillator, being attached to a heart failure patient, each has its own potential exercise hazards. Therefore, providing detailed exercise prescription in adjusting to the medical condition is very essential in the field of physical medicine and rehabilitation. Being classified as a high-risk patient group, exercise challenges for the complex heart failure with CRT patients will then be discussed in this literature review, with a general aim to provide a safe, effective, and targeted exercise regime.

Gait turning patterns in chronic ischemic stroke males and its relationship to recovery: A cross-sectional study.

INTRODUCTION: Impaired turning patterns have been considered as 1 factor which potentially leads to disability in chronic stroke patients. Mobility comprises 80% of the chief disability, and would eventually lead to falls. Expanded Timed Up and Go (ETUG) is an effective mobility assessment method. It utilizes video recording to analyze the conventional Time Up and Go (TUG) Test components, which includes turning pattern analysis. METHODS: Six healthy males without stroke history and 21 chronic ischemic stroke males (divided into subjects with or without the presence of flexor synergy pattern subgroups) capable of independent ambulation were recruited from Neurology and Medical Rehabilitation Department outpatient clinic. ETUG tests were recorded for each subject and were analyzed thoroughly using a computer program. RESULTS: Timed Up and Go time was significantly different between the 3 groups (P = .001). As compared to control, and synergy absent group, median turning time was highest in chronic stroke patients with presence of flexor synergy by 2786 ms (P = .002), but was not significantly different in percentage ETUG (14%, P = .939). Further analysis revealed that Brunnstrom stage and number of steps taken for turning significantly affect TUG duration. Other factors such as hemiparetic side, or body height were not significantly associated. DISCUSSION: The presence of flexor synergy would significantly affect turning time, this would then correlate to the disability of shifting body's center of gravity, as a part of the Stroke core set of International Classification of Functioning, Disability, and Health (ICF).Therefore, stroke patients need to have early ambulatory training regarding pivoting motion rather than solely focusing on straight walking. Instead of hemiparetic side, it is possible that overall turning time is affected by coordination and orientation capability, signifying the importance of cortical plasticity.

Obesity is associated with reduced disc height in the lumbar spine but not at the lumbosacral junction.

STUDY DESIGN: Cross-sectional, community-based study. OBJECTIVE: To investigate the relationships between obesity, disc height, and low back pain in the lumbosacral spine. SUMMARY OF BACKGROUND DATA: Although obesity is a recognized risk factor for low back pain, our understanding of the mechanisms for this is limited. The evidence for an association between obesity and spinal structural changes is also conflicting. METHODS: Seventy-two participants from a community-based study of musculoskeletal health underwent magnetic resonance imaging from the T12 vertebral body to the sacrum. Disc height was measured from L1-L2 to L5-S1. Body mass index was measured and low back pain in the previous 2 weeks was assessed. RESULTS: The mean and total lumbar disc heights were reduced in obese individuals compared with nonobese individuals (mean height (standard error):1.04 (0.03) cm vs. 1.14 (0.02) cm, P = 0.01; total height (standard error):4.16 (0.11) cm vs. 4.57 (0.10) cm, P = 0.01), after adjusting for age, sex, and height. Although obesity was associated with reduced disc heights at the L1-L2 and L3-L4 levels, there were no significant relationship at the lumbosacral junction (mean difference (95% confidence interval [CI]):0.10 (-0.14 to 0.16) cm, P = 0.89). Both mean and total lumbar disc heights were negatively associated with recent pain after adjusting for age, sex, and height (mean height: mean difference (95% CI):0.09 (0.02-0.17) cm, P = 0.02; total height: mean difference (95% CI): 0.37 (0.07-0.66) cm, P = 0.02). However, these relationships were no longer significant when we also adjusted for weight (mean height; mean difference (95% CI):0.07(-0.009 to 0.15) cm, P = 0.08; total height: mean difference (95% CI):0.28 (-0.04 to 0.60) cm, P = 0.08). There were no significant relationships between disc height and recent pain at the lumbosacral junction. CONCLUSION: Obesity was associated with reduced disc height in the lumbar spine, but not at the lumbosacral junction, suggesting these joints may have different risk factors. There was also evidence for an inter-relationship between obesity, lumbar disc height, and recent pain, suggesting that structural changes have a role in back pain and may in part explain the association between obesity and back pain.