Lung Transplant Rehabilitation-A Review.

BACKGROUND: Both lung transplant recipients and candidates are characterised by reduced training capacity and low average quality of life (QoL). This review investigates the impact of training on exercise ability and QoL in patients before and after lung transplant. METHODS: Searches were conducted from the beginning to 7 March 2022 using the terms "exercise," "rehabilitation," "lung transplant," "exercise ability," "survival," "quality of life" and "telerehabilitation" in six databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL, Nursing and Allied Health, and Scopus. The inclusion criteria were studies evaluating the effects of an exercise training programme concurrent with lung transplantation as well as patients and candidates (>18 years old) through any lung diseases. The term "lung transplant rehabilitation" was used to refer to all carefully thought-out physical activities with the ultimate or intermediate objective of improving or maintaining physical health. RESULTS: Out of 1422 articles, 10 clinical- and 3 telerehabilitation studies, candidates (n = 420) and recipients (n = 116) were related to the criteria and included in this review. The main outcome significantly improved in all studies. The 6-min walk distance, maximum exercise capacity, peak oxygen uptake, or endurance for constant load rate cycling improved measuring physical activity [aerobic exercises, breathing training, and aerobic and inspiratory muscle training sessions (IMT)]. Overall scores for dyspnoea improved after exercise training. Furthermore, health-related quality of life (HRQOL) also improved after aerobic exercise training, which was performed unsupervised or accompanied by breathing sessions. Aerobic training alone rather than combined with inspiratory muscle- (IMT) or breathing training enhanced exercise capacity. CONCLUSION: In conclusion, rehabilitation programmes seem to be beneficial to patients both preceding and following lung transplantation. More studies are required to determine the best training settings in terms of time scale, frequency, and work intensity in terms of improving exercise ability, dyspnoea, and HRQOL.

Psychometric Validation of Senior Perceived Physical Literacy Instrument.

Aim: To validate the Senior Perceived Physical Literacy Instrument (SPPLI). Methods: In the pilot study, we refined the Perceived Physical Literacy Instrument (PPLI, Cronbach's α = 0.94, initially designed for adults) into SPPLI using internal reliability, content validity, and construct validity results. A total of 341 older adults recruited from community centers in Southern Taiwan participated in the study. A principle component analysis (PCA) identified three components of SPPLI. Results: Eleven items were captured from the 18-item PPLI as the SPPLI (Cronbach's α = 0.90). SPPLI exhibits three components: attitude toward physical activity, physical activity ability, and sociality around physical activity. Significant differences were discovered in physical activity ability by educational attainment (p < 0.05) and in all three components by stage of exercise (maintenance vs. non-maintenance) (p < 0.05). The SPPLI possesses proper reliability and validity to assess physical literacy among older adults. Conclusions: This instrument is suggested for physical literacy assessments in physical activity programs to assess the needs of older adults and/or the effectiveness of an intervention program that aims to improve the attitude, ability, and sociality of physical activity.

Effect of Transcranial Pulsed Current Stimulation on Fatigue Delay after Medium-Intensity Training.

The purpose of this study was to investigate the effect of transcranial pulsed current stimulation (tPCS) on fatigue delay after medium-intensity training. Materials and Methods: Ninety healthy college athletes were randomly divided into an experimental group (n = 45) and control group (n = 45). The experimental group received medium-intensity training for a week. After each training, the experimental group received true stimulation of tPCS (continuous 15 min 1.5 mA current intensity stimulation). The control group received sham stimulation. The physiological and biochemical indicators of participants were tested before and after the experiment, and finally 30 participants in each group were included for data analysis. Results: In the experimental group, creatine kinase (CK), cortisol (C), time-domain heart rate variability indices root mean square of the successive differences (RMSSD), standard deviation of normal R-R intervals (SDNN), and frequency domain indicator low frequency (LF) all increased slowly after the intervention. Among these, CK, C, and SDNN values were significantly lower than those in the control group (p < 0.05). Testosterone (T), T/C, and heart rate variability frequency domain indicator high frequency (HF) in the experimental group decreased slowly after the intervention, and the HF value was significantly lower than that in the control group (p < 0.05). The changes in all of the indicators in the experimental group were smaller than those in the control group. Conclusion: The application of tPCS after medium-intensity training enhanced the adaptability to training and had a significant effect on the maintenance of physiological state. The application of tPCS can significantly promote the recovery of autonomic nervous system function, enhance the regulation of parasympathetic nerves, and delay the occurrence of fatigue.

Effect of empagliflozin on exercise ability and symptoms in heart failure patients with reduced and preserved ejection fraction, with and without type 2 diabetes.

AIMS: The EMPERIAL (Effect of EMPagliflozin on ExeRcise ability and HF symptoms In patients with chronic heArt faiLure) trials evaluated the effects of empagliflozin on exercise ability and patient-reported outcomes in heart failure (HF) with reduced and preserved ejection fraction (EF), with and without type 2 diabetes (T2D), reporting, for the first time, the effects of sodium-glucose co-transporter-2 inhibition in HF with preserved EF (HFpEF). METHODS AND RESULTS: HF patients with reduced EF (HFrEF) (≤40%, N = 312, EMPERIAL-Reduced) or preserved EF (>40%, N = 315, EMPERIAL-Preserved), with and without T2D, were randomized to empagliflozin 10 mg or placebo for 12 weeks. The primary endpoint was 6-minute walk test distance (6MWTD) change to Week 12. Key secondary endpoints included Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and Chronic Heart Failure Questionnaire Self-Administered Standardized format (CHQ-SAS) dyspnoea score. 6MWTD median (95% confidence interval) differences, empagliflozin vs. placebo, at Week 12 were -4.0 m (-16.0, 6.0; P = 0.42) and 4.0 m (-5.0, 13.0; P = 0.37) in EMPERIAL-Reduced and EMPERIAL-Preserved, respectively. As the primary endpoint was non-significant, all secondary endpoints were considered exploratory. Changes in KCCQ-TSS and CHQ-SAS dyspnoea score were non-significant. Improvements with empagliflozin in exploratory pre-specified analyses of KCCQ-TSS responder rates, congestion score, and diuretic use in EMPERIAL-Reduced are hypothesis generating. Empagliflozin adverse events were consistent with those previously reported. CONCLUSION: The primary outcome for both trials was neutral. Empagliflozin was well tolerated in HF patients, with and without T2D, with a safety profile consistent with that previously reported in T2D. Hypothesis-generating improvements in exploratory analyses of secondary endpoints with empagliflozin in HFrEF were observed.

The effects of combining aerobic training with resistance training on the heart rate and exercise capacity of persons with obstructive sleep apnea / 中华物理医学与康复杂志

Objective:To explore the effect of individualized aerobic training combined with resistance training on heart rate recovery and exercise capacity among patients with obstructive sleep apnea syndrome (OSAS) and explore possible mechanisms.Methods:Forty middle-aged patients with moderate to severe OSAS were randomly assigned to an observation group (OG, n=20) or a control group (CG, n=20). Both groups were given routine health guidance and motor training, while the OG additionally underwent individualized aerobic exercise training at 60%~75% of their peak power and resistance training loaded at 60%~80% of their ten-times maximum repetition figure. The training was three times a week for 3 months. Both groups underwent cardiopulmonary exercise testing and polysomnography before and after the 12-week intervention. The changes in their sleep apnea hypopnea index (AHI), oxygen desaturation index (ODI) and lowest oxygen saturation (L-SAO 2) were collected. Exercise capacity indicators such as peak oxygen uptake (VO 2peak), peak power, anaerobic threshold and sitting heart rate recovery (HRR) 1, 2 and 3 minutes after the test were recorded (denoted as HRR-1, HRR-2 and HRR-3). Results:There were no significant differences between the two groups in any of the measurements before the intervention. Afterward the average AHI, ODI and L-SAO 2 values of the observation group had all improved significantly compared with those before the training and compared with the control group′s values after the training. After the training, the VO 2peak and peak power of the observation group had also improved significantly compared with before the training and compared with the control group. HRR-1, HRR-2 and HRR-3 were all significantly higher in the observation group than before the training and higher than the control group′s values after the training. Conclusion:Combining aerobic and resistance training can improve the exercise ability and heart rate of middle-aged patients with moderate to severe OSAS, and also reduce the severity of their OSAS to some extent.

Effects of phellinus igniarius crude polysaccharides on sporting ability and free radical metabolism of skeletal muscle in mice suffering passive smoking / 中国组织工程研究

BACKGROUND: Cigarette smoke contains a large number of types of oxygen free radicals and cytotoxic components. Passive smoking will impair respiratory and cardiovascular system functions, and result in oxidative damage of skeletal muscle and decreased exercise ability. OBJECTIVE; To investigate the effect of phellinus igniarius crude polysaccharides on the exercise capacity and free radical metabolism of skeletal muscle in mice suffering passive smoking, so as to provide ideas for the prevention and treatment of peroxidative damage of skeletal muscle and depression of exercise capacity in rats suffering passive smoking. METHODS: Twenty-one male Kunming mice were randomly assigned to three groups: Gavage with phellinus igniarius crude polysaccharides and suffering passive smoking (phellinus group), gavage with distilled water and suffering passive smoking (control group), and only gavage with distilled water (blank group). After 4 consecutive weeks, the mice were forced to take an exhausted swimming, and sacrificed subsequently. Exhausted swimming time was recorded. The bilateral gastrocnemius muscle tissues were obtained, in which the vitality of superoxide dismutase, catalase, glutathion reductase and Ca2+-Mg2+-ATP and Na+-K+-ATP activity, and the concentration of malonaldehyde were measured. RESULTS AND CONCLUSION: (1) The swimming time of mice in the control group was shorter than that in the blank group (P 0.6, P 0.6, P < 0.05), and negatively correlated with the concentration of malonaldehyde (r < -0.6, P < 0.05). (5) In summary, phellinus igniarius crude polysaccharides can improve the antioxidative enzyme activity of skeletal muscle, inhibit lipid peroxidation reaction, and thus increase exercise ability of mice suffering passive smoking. The study was approved by the Ethical Committee of Jiangxi Normal University, approval No. 201703.

Congenital exercise ability ameliorates muscle atrophy but not spinal cord recovery in spinal cord injury mouse model.

Spinal cord injury (SCI) can cause loss of mobility in the limbs, and no drugs, surgical procedures, or rehabilitation strategies provide a complete cure. Exercise capacity is thought to be associated with the causes of many diseases. However, no studies to date have assessed whether congenital exercise ability is related to the recovery of spinal cord injury. High congenital exercise ability (HE) and low congenital exercise ability (LE) mice were artificially bred from the same founder ICR mice. The HE and LE groups still exhibited differences in exercise ability after 13 generations of breeding. Histological staining and immunohistochemistry staining indicated no significant differences between the HE and LE groups on recovery of the spinal cord. In contrast, after SCI, the HE group exhibited better mobility in gait analysis and longer endurance times in the exhaustive swimming test than the LE group. In addition, after SCI, the HE group also exhibited less atrophy than the LE group, and no inflammatory cells appeared. In conclusion, we found that high congenital exercise ability may reduce the rate of muscle atrophy. This result can be applied to sports science and rehabilitation science as a reference for preventive medicine research.

Correlation between heart rate variability and exercise ability in patients with cardiac syndrome X / 中国实用内科杂志

OBJECTIVE: To investigate whether heart rate variability(HRV) can assess exercise ability in patients with cardiac syndrome X(CSX). METHODS: A total of 246 subjects(55.2 ± 12.2 years, 68.3% male), who were diagnosed with CSX by the positive exercise stress test and normal coronary angiogram in Cardiovascular Department of the Second Affiliated Hospital of Harbin Medical University from March 2016 to August 2017 were enrolled. The 24-hour dynamic ECG monitoring was used to analyze HRV for long-time frequency domain analysis. The HRV power spectrum index included total power(TP),very low frequency(VLF), low frequency(LF) and high frequency(HF). RESULTS: VLF, LF and TP, but not LF/HF, were higher in the patients with good exercise capacity(≥90% of the age predicted maximal heart rate). After accounting for age, sex, systolic blood pressure and heart rate, VLF, LF and TP remained significantly associated with good exercise capacity. In addition, increased VLF, LF and TP were also associated with increased exercise duration, rate-pressure product, and heart rate recovery. In subgroup analysis, VLF, LF and TP demonstrated similar predictive values related to exercise capacity across various subpopulations, especially in the young. CONCLUSION: In patients with CSX, HRV is independently associated with exercise capacity, and is an independent predictor of ischemic tolerance in CSX patients, which can be used as an important index for evaluating the exercise ability of CSX patients.

Association of Foot Structure with the Strength of Muscles that Move the Ankle and Physical Performance.

The human foot plays an important role in supporting body weight, maintaining postural balance, and absorbing ground reaction forces. Although many studies have indicated that a causal relationship exists between foot structure and alterations in lower extremity kinematics, there is little evidence regarding the possible association of foot structure with strength of muscles that move the ankle and physical performance. A total of 67 adult men with a mean age of 51.19 ± 8.82 years participated in this study. Foot structural parameters were assessed using a 3-dimensional foot scanner. Strength of muscles that move the ankle was measured with a dynamometer. Physical performance items, including agility, force, and proprioception, were also measured. We found that all the measured parameters of the length, width, girth, and height of the foot were positively correlated with the strength of plantarflexion, dorsiflexion, eversion, and inversion (r ranged from 0.26 to 0.57; p < .05). Moreover, all or part of the parameters of the length, width, and girth of the foot but not the height and angles of the foot were correlated significantly with vertical jump, stepping forward and backward, and stepping side to side (r ranged from 0.25 to 0.44; p < .05). These findings indicate a weak-to-moderate association between foot structure and the strength of muscles that move the ankle, as well as physical performance. We therefore suggest that a larger foot may have greater muscle strength of the ankle joint and better physical performance.

The progress of long-term outcomes in survivors of acute respiratory distress syndrome / 天津医药

Along with the development of critical care medicine and the advances in respiratory support,the short-term mortality of acute respiratory distress syndrome (ARDS) has significantly decreased, and many patients have survived. Then the long-term outcomes of survivors of ARDS is getting more and more attention. ARDS survivors can have complete recovery of pulmonary function, but they might continue to present sequelae including physical impairment (muscle weakness and limited activities), cognitive impairment and psychologic problem (anxiety, depression, post-traumatic stress disorder) over five years, called as post intensive care syndrome, resulting in a decline in quality of life and increasing the burden of family and medical resource consumption. For ARDS patients, some factors have a significant impact on the long-term outcomes of survivors, including pre-ARDS health status (such as comorbidity, obesity, functional independence, mental health status), lifestyle (such as smoking) and the relevant variables during their stay in ICU (such as delirium, corticosteroids, opioids, acquired muscle weakness, hypoxemia). Identifying the modifiable risk factors for long-term outcomes of ARDS patients, and taking timely intervention measures have important significance for decline of post-ARDS dysfunction. It is unclear whether interventions in ICU or post-ICU can effectively improve long-term outcomes in ARDS survivors, and further investigation and validation are required.

Advance in Neuromuscular Electrical Stimulation on Skeletal Muscle in Patients with Chronic Obstructive Pulmonary Disease(review) / 中国康复理论与实践

Neuromuscular electrical stimulation(NMES)is one of the electrotherapy that exerts a low-frequency current over the targeted nerves and muscles to induce skeletal muscle contractions to treat skeletal muscle dysfunction in patients.As an alternative rehabilitation modality,NMES is essential for patients with chronic obstructive pulmonary disease(COPD) who are unable to participate in conventional rehabilitation program.NMES could effectively improve the skeletal mus-cle strength,endurance,exercise capacity and quality of life of the patients with COPD.It may be related to remodeling skeletal muscle structure,reducing oxidative stress in skeletal muscle,and improving balance of skeletal muscle protein metabolism.

Content Determination of Phenylpropanoids and Enhancing Exercise Ability of Effective Fractions in Pedicularis densispica.

BACKGROUND: Most researches were focused on chemical constituents and bioactivities of Pedicularis. However, there were a few reports on simultaneous determination of the series phenylpropanoids compounds in Pedicularis by High Performance Liquid Chromatography (HPLC). OBJECTIVE: To establish an HPLC method for simultaneous determination of salidroside, verbascoside, iso-verbascoside, leucoseptoside A, jionoside D and martynoside in Pedicularis densispica (PD), and to assess the enhancing exercise ability of effective fractions of phenylpropanoids (EFP). MATERIALS AND METHODS: The separation was performed on C18 column with step-wise gradient elution with water (A)-methanol (B) as the mobile phase at a flow rate of 1.0 mL/min, with detection wavelength at 275 nm (0-4 min) and 330 nm (4-40 min). The EFP were obtained from extracts of PD by resin gradient dilution. The enhancing exercise ability of EFP was exerted in exhaustive swimming and anoxia endurance tests in vivo. RESULTS: The contents of six marker compounds had good linear relationship in the ranges of 2.10-8.40, 13.60-54.40, 0.93-3.72, 0.53-2.12, 1.50-6.00, 0.37-1.28, respectively, and the average recoveries of the six phenylpropanoids were all in the range of 98-103%. Total contents of phenylpropanoids in EFP were more than 60%. Three medicine groups of exhaustive swimming and anoxia endurance time were higher than those of the water group. CONCLUSION: The analytical method is reliable, simple and accurate, and can be used for the comprehensive quality control of PD. This experiment suggests that PD has the effect of promoting the recovery and elimination of fatigue and improving the exercise capacity. SUMMARY: A simple, practical and low-cost RP-HPLC method has been developed for the simultaneous determination of six marker phenylpropanoids in Pedicularis densispica.Three effective fractions of phenylpropanoids groups of exhaustive swimming and anoxia endurance time were higher than those of the water group.The separation was performed on C18 column with stepwise gradient elution with water-methanol. The enhancing exercise ability was exerted in exhaustive swimming and anoxia endurance tests in vivo.This plant has the effect of promoting the recovery and elimination of fatigue and improving the exercise capacity. Abbreviation used: PD: Pedicularis densispica, EFP: Effective fractions of phenylpropanoids, DAD: Diode array detector, HPLC: High performance liquid chromatography, LOD: Limits of detection, LOQ: Limits of quantification, RSD: Relative standard deviation, BV: Bed volumes.

Comparison of tests for measuring maximal exercise ability in elite swimmers.

The purpose of this study was to compare of tests for measuring maximal exercise ability in elite swimmers. The high-school male elite swimmers (n=17) were performed maximal exercise ability tests. The experimental method consisted of a crossover design at 1-week intervals with the swimming tests (field test, water VAMEVAL test, 200-m test, and 400-m test) in random order. It measured the heart rate, ratings of perceived exertion (RPE), and lactate level by physiological factors, and swimming velocity (SV), stroke rate (SR), and stroke length (SL) by mechanical factors. The change of SV, SR, and SL in swimming tests was no significantly different. To compare tests, however, the lactate level and RPE in 200-m test was higher than water VAMEVAL test. The RPE of the 200-m and 400-m tests were higher than the field test and the water VAMEVAL test. Correlations showed between the field test and the 400-m test in heart rate and RPE. Moreover, a correlation observed between the field test and 200-m test in heart rate. In this study, 200-m and 400-m tests were suit to apply the test methods for establishing the exercise intensity appropriate for the underwater training of swimmers.

Differences in Adolescent Physical Fitness: A Multivariate Approach and Meta-analysis.

Physical fitness can be defined as a set of components that determine exercise ability and influence performance in sports. This study investigates the genetic and environmental influences on individual differences in explosive leg strength (vertical jump), handgrip strength, balance, and flexibility (sit-and-reach) in 227 healthy monozygotic and dizygotic twin pairs and 38 of their singleton siblings (mean age 17.2 ± 1.2). Heritability estimates were 49% (95% CI 35-60%) for vertical jump, 59% (95% CI 46-69%) for handgrip strength, 38% (95% CI 22-52%) for balance, and 77% (95% CI 69-83%) for flexibility. In addition, a meta-analysis was performed on all twin studies in children, adolescents and young adults reporting heritability estimates for these phenotypes. Fifteen studies, including results from our own study, were meta-analyzed by computing the weighted average heritability. This showed that genetic factors explained most of the variance in vertical jump (62%; 95% CI 47-77%, N = 874), handgrip strength (63%; 95% CI 47-73%, N = 4516) and flexibility (50%; 95% CI 38-61%, N = 1130) in children and young adults. For balance this was 35% (95% CI 19-51%, N = 978). Finally, multivariate modeling showed that the phenotypic correlations between the phenotypes in current study (0.07 < r < 0.27) were mostly driven by genetic factors. It is concluded that genetic factors contribute significantly to the variance in muscle strength, flexibility and balance; factors that may play a key role in the individual differences in adolescent exercise ability and sports performance.

A comparison between heart rate and heart rate variability as indicators of cardiac health and fitness.

Quantification of cardiac autonomic activity and control via heart rate (HR) and heart rate variability (HRV) is known to provide prognostic information in clinical populations. Issues with regard to standardization and interpretation of HRV data make the use of the more easily accessible HR on its own as an indicator of autonomic cardiac control very appealing. The aim of this study was to investigate the strength of associations between an important cardio vascular health metric such as VO2max and the following: HR, HRV indicators, and HR normalized HRV indicators. A cross sectional descriptive study was done including 145 healthy volunteers aged between 18 and 22 years. HRV was quantified by time domain, frequency domain and Poincaré plot analysis. Indirect VO2max was determined using the Multistage Coopers test. The Pearson correlation coefficient was calculated to quantify the strength of the associations. Both simple linear and multiple stepwise regressions were performed to be able to discriminate between the role of the individual indicators as well as their combined association with VO2max. Only HR, RR interval, and pNN50 showed significant (p < 0.01, p < 0.01, and p = 0.03) correlations with VO2max. Stepwise multiple regression indicated that, when combining all HRV indicators the most important predictor of cardio vascular fitness as represented by VO2max, is HR. HR explains 17% of the variation, while the inclusion of HF (high frequency HRV indicator) added only an additional 3.1% to the coefficient of determination. Results also showed when testing the normalized indicators, HR explained of the largest percentage of the changes in VO2max (16.5%). Thus, HR on its own is the most important predictor of changes in an important cardiac health metric such as VO2max. These results may indicate that during investigation of exercise ability (VO2max) phenomena, quantification of HRV may not add significant value.

Study of supervised aerobic exercise on physical activity, quality of life and psychological status in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective To evaluate the efficacy of medical supervised aerobic exercise on physical activity, quality of life and psychological status in patients with systemic lupus erythematosus (SLE). Methods SLE patients who fulfilled ACR criteria were recruited and divided into 2 groups: exercise group (n=24) and control group (n=25). The patients in the exercise group were supervised to have aerobic exercises. The intensiveness of exercise was determined by 20%-40% of maximum heart rate reservation. Visual analog scale (VAS), SLE disease activity index (SLEDAI) score, physical working capacity (PWC170), SF-36 and profile of mood states (POMS) of the two groups were used to evaluate the changes at the baseline, 1 month, 3 months and 6 months after this study. Results The 2 groups were homogeneous and comparable in disease activity at baseline. 1, 3 and 6 months after the study, the VAS, PWC170, POMS and SF -36 of SLE patients were improved in certain degrees in both groups, while the improvement of VAS (P<0.05), PWCITO (P< 0.01 ) and social function of SF-36 (P<0.05) of exercise group were significantly more evident than those of the control group in 6 months after study without any impact on disease condition. There was a high negative correlation between VAS and 5 categories of POMS (r=-6.26~-0.393, P<0.01 ) and a more relevant positive association between VAS and 2 categories of POMS (r=0.534~0.611, P<0.01). Conclusion The data demonstrate that the supervised aerobic exercise can ameliorate physical capacity, improve quality of life and psychological and emotional status in the state SLE patients without aggravating disease per se.

The effect of the nutritional supplementation in eliminating sport fatigue / 肠外与肠内营养

Sport fatigue affects exercise ability of human being.A number of experiments of animals and humans have proved that the rational usage of nutritional supplementation will eliminate the fatgue caused by over-exerise,and improve exerise ability.This review is about the effect of the nutritional supplementation in eliminating sport fatigue.