6-minute Walk Distance Research Articles

Multidisciplinary diagnosis and treatment model based on a retrospective cohort study: Pulmonary function and prognosis quality of life in severe COPD.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease worsening airflow limitation. To explore pulmonary function rehabilitation, life quality and prognosis in patients with severe COPD. Between February 2018 and August 2021, 150 patients with severe COPD cured in our hospital were arbitrarily assigned into the control group (n= 75) and study group (n= 75). The control group received routine treatment and the research group received multidisciplinary diagnosis and treatment. The body mass index, airflow obstruction, dyspnea and exercise (BODE), pulmonary function, the number of acute attacks, 6-minute walking distance (6MWD), Borg score and life quality were compared. There was no remarkable difference in BODE score before treatment (P> 0.05). During the 2- and 6-month following treatment, the BODE score of the study group was lower (P< 0.05). In the study group, FEV1 percentage of the predicted value, forced expiratory volume in one second (PPO-FEV1) and the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) in the first second were higher (P< 0.05). In the study group, there were fewer acute attacks (P< 0.05). After treatment, the 6MWD of the study group following 2- and 6-month treatment was higher (P< 0.05). The Borg scores of the study group at 2- and 6-months after treatment were lower (P< 0.05). There were no remarkable differences in the score of life quality before treatment (P> 0.05), however, the symptom score, activity score, influence score and total score of the study group were lower after the treatment (P< 0.05). The application of multidisciplinary diagnosis and treatment model can promote the rehabilitation of pulmonary function of patients with severe COPD, improve their prognosis, slow down the development of the disease and enhance their life quality.

Effects of SGLT2 inhibitors on cardiac function and health status in chronic heart failure: a systematic review and meta-analysis

PurposeNumerous clinical studies have explored sodium–glucose cotransporter 2 inhibitor (SGLT2i) in patients with chronic heart failure (CHF), with or without type 2 diabetes mellitus (T2DM), and SGLT2i were proved to significantly reduce CHF hospitalization, cardiovascular death, cardiovascular mortality, all-cause mortality and myocardial infarction in patients with or without T2DM. However, only a limited few have investigated the effects of SGLT-2i on HF disease-specific health status and cardiac function. This meta-analysis aims to assess the effects of SGLT2i on disease-specific health status and cardiac function in CHF patients.MethodsA comprehensive search was conducted of trials by searching in PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, and two Chinese databases (CNKI and Wanfang), Clinical Trials (http://www.clinicaltrials.gov) were also searched.ResultsA total of 18 randomized controlled trials (RCTs) involving 23,953 participants were included in the meta-analysis. The effects of SGLT2 inhibitors were compared with control or placebo groups in CHF with or without T2DM. The SGLT2 inhibitors group exhibited a significant reduction in pro b-type natriuretic peptide (NT-proBNP) levels by 136.03 pg/ml (95% confidence interval [CI]: −253.36, − 18.70; P = 0.02). Additionally, a greater proportion of patients in the SGLT2 inhibitors group showed a ≥ 20% decrease in NT-proBNP (RR = 1.45, 95% CI [0.92, 2.29], p = 0.072). However, no statistically significant difference was observed for the effects on B-type natriuretic peptide (BNP). The use of SGLT-2 inhibitors led to a noteworthy improvement in LVEF by 2.79% (95% CI [0.18, 5.39];P = 0.036). In terms of health status, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and 6-minute walk distance, SGLT2 inhibitors led to a significant improvement in KCCQ clinical summary (KCCQ-CS) score (WMD = 1.7, 95% CI [1.67, 1.73], P < 0.00001), KCCQ overall summary (KCCQ-OS) score (WMD = 1.73, 95% CI [0.94, 2.52], P < 0.00001), and KCCQ total symptom (KCCQ-TS) score (WMD = 2.88, 95% CI [1.7, 4.06], P < 0.00001). Furthermore, the occurrence of KCCQ-CS and KCCQ-OS score increases ≥ 5 points had relative risks (RR) of 1.25 (95% CI [1.11, 1.42], P < 0.00001) and 1.15 (95% CI [1.09, 1.22], P < 0.00001), respectively. Overall, SGLT2 inhibitors increased the 6-minute walk distance by 23.98 m (95% CI [8.34, 39.62]; P = 0.003) compared to control/placebo from baseline.ConclusionsThe SGLT2 inhibitors treatment offers an effective strategy for improving NT-proBNP levels, Kansas City Cardiomyopathy Questionnaire scores and 6-minute walk distance in CHF with or without T2DM. These findings indicate that SGLT2i improve cardiac function and health status in CHF with or without T2DM, and provide valuable guidance for clinicians making treatment decisions for patients with CHF.

Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal.

Self-management skills are important for patients with Chronic Obstructive Pulmonary Disease (COPD) who are responsible for their day to day care. Poor self-management behaviours have a significant influence on symptoms, functional impairments and quality of life. Evidence has shown that self-management interventions support patients to respond to changing symptoms and thereby make appropriate decisions regarding their self-management. This study aimed to find out the effect of self-management interventions in patients with COPD in terms of self-management practice, inhaler practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms. Quasi-experimental pre-test post-test design was carried out among patients with COPD attending respiratory units of Chitwan Medical College Teaching Hospital (CMC-TH), Nepal. Convenience sampling technique was used to select the 70 patients with COPD for the study. Baseline data was collected from the participants using (i) Semi-structured interview schedule for socio-demographic and clinical variables, (ii) COPD Self-Management Practice Questionnaire, (iii) Borg Dyspnoea Scale, and (iv) Six Minute Walking Distance (6MWD) Test (v) Pulmonary Function Test (PFT) and (vi) Observation Checklist. Self-management Intervention given was 2 ½ hour sessions per week for 6 weeks along with information booklets distribution. Participants were re-evaluated after 3 months of intervention using same tools. Data analysis was performed using IBMSPSS version 20.0 for window. Wilcoxon signed-rank test was performed to find the effectiveness of the self-management interventions on outcome parameters. Self-management interventions (2 ½ hour session per week for 6 weeks) elicited a statistically significant change on self-management practice (z = -7.215, p<0.001), inhaler practice (DPI practice z = -6.731, p<0.001, MDI practice, z = -1.816, p = 0.005), functional ability (z = -4.243, p<0.001), self-perceived dyspnoea (z = -4.443, p<0.001), COPD symptom burden (z = -7.009, p<0.001) and emotional symptoms (depression, z = -6.856, p<0.001, anxiety, z = -6.675, p<0.001) of patients with COPD. Self-management intervention acts as powerful equipment to improve self-management practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms of patients with COPD. Hence, clinician and policy maker need to plan and intervene the rehabilitation program for the patients with COPD to enhance the effectiveness of therapy, self-management practice and general longevity.

Effect of acupuncture and exercise rehabilitation on quality of life in acute coronary syndrome patients after percutaneous coronary intervention.

This study assessed the impact of acupuncture combined with exercise rehabilitation on the quality of life in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). In a retrospective study at the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, 114 post-PCI ACS patients were analyzed from March 2021 to June 2023. Fifty-five underwent exercise rehabilitation (control group), while 59 received both acupuncture and exercise rehabilitation (joint group). Propensity score matching reduced each group to 38 patients. Traditional Chinese Medicine (TCM) scores, 6-minute walk distance, cardiac function, and biochemical indices were evaluated pre- and post-intervention. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) measured quality of life changes, categorizing scores <24 as good and ≥24 as poor. Logistic regression identified factors affecting quality of life. The joint group showed significant improvements in TCM scores, 6-minute walk distance, left ventricular end-diastolic diameter, left ventricular ejection fraction, cardiac output, cardiac index, and levels of CK-MB, cTnT, and homocysteine compared to the control group (P<0.05). MLHFQ scores for physical limitations and disease symptoms decreased significantly in the joint group, with no marked changes in social relationship scores (P>0.05). Acupuncture alongside exercise rehabilitation significantly improves quality of life, cardiac function, and biochemical markers in ACS patients post-PCI, surpassing the effects of rehabilitation alone. This combination approach notably diminishes symptoms and improves daily functioning.

Effects of Isometric Quadriceps Muscle Exercise with Visual and Auditory Feedback at 1 Year after Total Knee Arthroplasty.

To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.

Efficacy of oral treprostinil for treating pulmonary arterial hypertension: a systematic review and meta-analysis.

Pulmonary arterial hypertension (PAH) is a progressive condition characterized by elevated blood pressure in the pulmonary arteries, leading to significant morbidity and mortality. Treprostinil, a synthetic analogue of prostacyclin, has emerged as a potential treatment option. The efficacy and safety of oral treprostinil in PAH patients remain subjects of ongoing research. Comprehensive literature searches were performed across multiple databases for studies assessing the efficacy and/or safety of treprostinil in PAH patients. Quality assessment and statistical analysis were performed using the Cochrane Collaboration's tool and Comprehensive Meta-Analysis software, respectively. From 680 records identified, four studies met the inclusion criteria. These studies demonstrated that oral treprostinil significantly improved exercise capacity as measured by the 6-minute walk distance (6MWD), with a mean difference of 13.13 m in favor of treprostinil, despite high heterogeneity. The analysis also showed an increased risk of adverse events leading to discontinuation in the treprostinil group (OR = 4.39) but a protective effect against clinical worsening (OR = 0.554). No significant impact on mortality was observed. Oral treprostinil offers a significant benefit in improving exercise capacity in PAH patients, with a potential role in delaying clinical worsening. However, the increased risk of adverse events necessitates careful patient management. These findings support the inclusion of oral treprostinil in the treatment strategy for PAH, underscoring the need for further research to optimize its use and understand its long-term impact on patient outcomes.Level of evidence: I.

Comparison of a Supervised Home-Based Tele-Rehabilitation with Center-Based Pulmonary Rehabilitation: Protocol for a Randomized Non-Inferiority Multicenter Study in Ningxia.

Pulmonary rehabilitation (PR) is an effective intervention for people with chronic obstructive pulmonary disease (COPD). However, fewer than 5% of eligible individuals receive pulmonary rehabilitation, largely due to limited by the accessibility of rehabilitation and difficulties associated with travel and transport. Supervised home-based tele-rehabilitation (SHTR) is an alternative model to center-based pulmonary rehabilitation. We will determine whether supervised home-based tele-rehabilitation is non-inferior to center-based pulmonary rehabilitation. The participants will undergo an 8-week rehabilitation program. Pulmonary rehabilitation comprises four main modules: exercise training, education, nutritional support, and psychological and behavioral interventions. We mainly focus on the module of exercise training and education. The education module includes information on exercise training, nutrition, and psychology, which are presented in an educational booklet provided to each participant. Blinded assessors will evaluate the outcomes at baseline, post-intervention, and 6 months after the intervention. The primary outcome is the change in the 6-minute walking distance. Secondary outcomes will assess changes in the patients' 1-minute sit-to-stand test, maximal inspiratory pressure (MIP), scales (CAT, mMRC, HAD), diaphragm ultrasound (TD, DE, DIF), changes in extrathoracic muscle volume and mass, completion rate of patient exercise prescriptions, occurrence of adverse events, as well as disease exacerbation and rehospitalization rates after rehabilitation and during the 6-month follow-up. In order to improve the accessibility of pulmonary rehabilitation and patient-related outcomes, it is necessary to propose an alternative model of pulmonary rehabilitation. This trial will establish whether a supervised home-based tele-rehabilitation is not inferior to traditional center-based pulmonary rehabilitation. Chinese Clinical Trial Registry ChiCTR2300076969. Registered on October 25, 2023.

Investigating the efficacy of pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in the treatment of patients with acute myocardial infarction

This study aimed to examine the effectiveness of an integrated pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in treating patients with acute myocardial infarction (AMI). 114 patients with AMI who were treated at our hospital within one year of the collaborative treatment model’s implementation were selected as the observation group (January 2022 to December 2022). A random selection of 114 cases treated using the conventional model from January 2020 to December 2020 was chosen as the control group. Control patients received conventional treatment, while observation patients received an integrated pre-hospital and in-hospital treatment. Comparisons of effects were made between the two treatment models for AMI patients. The observation group showed significantly lower first medical contact (FMC) to balloon dilation (FMC-to-B), door-to-balloon (D-to-B), and chest pain onset to admission times than the control group. Across both groups, 99.12% of pre-hospital electrocardiography (ECGs) were completed (113/114), and a significantly higher proportion of patients with Killip class ≥II at immediate admission was observed in the observation group (p &lt; 0.05). Observation group showed significantly higher Left Ventricular End-Systolic Volume (LVESV) and Left Ventricular End-Diastolic Volume (LVEDV) than control group (p &lt; 0.05) one month after surgery. The 6-minute walking distance (6MWD) of the observation group was significantly longer than the control group, and the time taken for the 10-meter walking test was significantly shorter (p &lt; 0.05). A significantly lower incidence rate of hospitalization complications occurred in the observation group (p &lt; 0.05). The integrated pre-hospital and in-hospital treatment platform connected with 120-ambulance showed beneficial outcomes for AMI patients, significantly reducing treatment delay, improving postoperative cardiac function, and reducing postoperative complications, making it worthwhile for promotion in AMI clinical treatment.

Assessment of frailty and its predictors in chronic obstructive pulmonary disease.

Frailty represents a state of risk in which a relatively small stressor results in a disproportionate decline in health status. This study aims to determine the prevalence of frailty among patients with COPD in the Indian population and its associated risk factors. A descriptive cross-sectional study was conducted in 150 COPD patients. Frailty was assessed using the frailty phenotype method. The mean age (SD) of the study population was 60.59 (5.9) years with 88.67% males and 53.33% ex-smokers. The prevalence of frailty was 51.33% (n = 77). Most of the frail patients belonged to GOLD group D (66.23%) (P < 0.0001). Post-bronchodilator FEV1(%) was lowest in the frail group (40 [36-47]%) (P < 0.0001). Risk of frailty significantly correlated with smoking pack years (1.036; 1.001-1.074), history of 1 exacerbation in last year (6.810; 2.036-22.779), post-bronchodilator FVC(%) (0.955; 0.926-0.985), post-bronchodilator FEV1(%) (0.940; 0.913-0.968), distance covered in 6-minute walk test [0.975; 0.965-0.986] and dyspnoea severity [1.044; 1.024-1.063]. In multivariate regression, 6-minute walk distance and GOLD group B were the independent predictors of frailty in COPD. The prevalence of frailty in Indian patients with COPD was 51.33%. Six-minute walk distance is an important predictor of frailty. Early identification of frailty will lead to prompt intervention and rehabilitation.

Effects of Thoracoscopic Right Upper Lobe Apical Segmentectomy on Exercise Capacity and Quality of Life in Early-Stage NSCLC Patients.

Thoracoscopic lobectomy (TL) is an effective surgical approach for resecting tumor lesions in patients with early non-small cell lung cancer (NSCLC). However, TL may result in damage to normal lung tissue, potentially impacting prognosis. Thoracoscopic right upper lobe apical segmentectomy (TS) has been proposed as an alternative to improve surgical outcomes, but its impact on exercise capacity and quality of life remains unclear. This study aimed to investigate the effect of TS on exercise capacity and quality of life in patients with early-stage NSCLC. A retrospective analysis was conducted on the clinical data of 120 patients with early-stage NSCLC who underwent surgical treatment in Shangyu People's Hospital of Shaoxing between August 2020 and August 2023. The patients were divided into two groups based on the surgical approach: the TL group (n = 66) and the TS group (n = 54). The primary objective was to compare surgery-related indicators and the overall incidence of complications between the TS group and the TL group. Additionally, changes in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum ventilatory volume (MVV), 6-minute walking distance (6MWD), and European Organization for Research and Treatment of Cancer quality of life (EORTC QLQ-C30) scores were evaluated before and after operation. The TS group showed significantly reduced intraoperative blood loss, chest drainage, and hospital stay compared to the TL group (p < 0.05). However, there was no significant difference in the operation time and the number of lymph node dissections between the two groups after operation (p > 0.05). FVC, FEV1, MVV, and 6MWD values of the two groups were significantly lower than those before operation (p < 0.05). However, FVC, FEV1, MVV, and 6MWD in the TS group were significantly higher than those in the TL group (p < 0.05). The scores of roles, emotion, cognition, social function, and total health status in the two groups after operation were significantly higher than those before operation, and the scores of physical functions, shortness of breath, diarrhea, fatigue, pain, cough and insomnia were significantly lower than those before operation (p < 0.05). Compared to the TL group, the TS group showed higher scores of physical, social function dimensions, and total health status, as well as lower scores of fatigues, shortness of breath, insomnia, and pain (p < 0.05). TS treatment has less surgical trauma and a lower risk of complications for patients with early-stage NSCLC, which is beneficial for promoting postoperative recovery, reducing lung function damage and improving the quality of life of patients.

The 6-Minute Stepper Test cannot be used to assess the functional exercise capacity in healthy children from 6 to 12 Years Old

Background: Background: Assessing functional exercise capacity in children has become increasingly important. This capacity may be assessed by different tests including submaximal test. The gold standard submaximal test in children is the six-minute walking test (6MWT). The main aim of this study was to establish the concurrent validity of the six-minute stepper test (6MST) to assess the functional exercise capacity. The secondary objectives were to compare the change in cardiorespiratory parameters between 6MST and 6MWT, and to determine the feasibility of the 6MST in healthy children. Methods: 53 healthy children were included in this crossover randomized trial. Subjects underwent the 6MST and 6MWT in a random order. The primary outcome was the number of steps during 6MST and the 6-minute walking distance (6MWD). The secondary outcomes were the pulse oxygen saturation and heart rate. Results: 6MWD and number of steps were not correlated (r=0.103; p=0.46). There was a significantly greater increase (p&lt;0.001) in pulse heart rate values during the 6MWT than the stepper test (46.8 ± 17.5%vs31.1 ± 18.3%). Moreover, no correlation between heart rate changes was found in both tests (r=0.139; p=0.32). Pulse oxygen saturation was clinically unchanged in both tests. All children were able to complete the 6MST. Conclusion: We were not able to demonstrate the concurrent validity of the 6MST to assess the functional exercise capacity. Moreover, 6MST and 6MWT have different cardio-pulmonary demands. However, we found that the 6MST is feasible in healthy children from 6 to 12 years old.

Refined balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension - reference center experience.

Chronic thromboembolic pulmonary hypertension (CTEPH), characterized by thromboembolic changes affecting the pulmonary bed, leads to ventricular function deterioration and premature death. The introduction of balloon pulmonary angioplasty (BPA) has significantly improved the prognosis of CTEPH patients. The authors of this article decided to summarize the experience of the BPA program, conducted between 2014 and 2022, at the reference center. Among 111 CTEPH patients, 55 were included in the analysis. A total of 226 sessions were performed, with a significant percentage of intravascular imaging and pressure catheter use. Mean pulmonary pressure decreased significantly from 42 (22-66) to 26.5 mm Hg (11-54) (p < 0.05). Pulmonary vascular resistance and natriuretic peptide concentration decreased from 6.67 (1.66-14) to 3.295 Wood units (1.09-11.11), respectively, and from 1934 (60-16963) to 296 (21-9901) ng/ml (p < 0.05). There was also an improvement in the functional class (WHO) from 2.85 ±0.61 to 2.15 ±0.62 and an increase in the 6-minute walking distance from 300 ±131 to 367 ±154 m (p < 0.05). There were no in-hospital deaths or within 30 days of the procedure. Arterial damage occurred during nine sessions (n = 9/226, 4%), while 0.9% (n = 2/226) were complicated by acute right ventricular failure. Post-reperfusion pulmonary edema (RPE 0 - none) was observed in almost 90% of the sessions, grade 1 to 3 RPE occurred in 10.2%, and grade 4 RPE was not noted. BPA programs conducted in experienced centers are a safe and effective treatment option for inoperable CTEPH patients.

Evaluation of the HEAL™ing Mental Health program: A prospective cohort study of short-term changes from a physical activity and lifestyle education program for people with mental health disorders living in rural Australia.

This study aimed to evaluate short-term outcomes of the HEAL™ing Mental Health program, an 8-week intervention for change in functional, behavioural and physiological health and wellbeing designed for people living with mental health conditions in rural or regional areas of Australia. A prospective cohort study was completed, reporting on 19 items (pre-program) and 15 (post-participation change), organised across seven domains. Participants took part in an Accredited Exercise Physiologist/Nurse led supervised group exercise (60 minutes) and healthy lifestyle education program (60 minutes). Separate linear mixed models with restricted maximum likelihood were used to examine the primary research question considering the effect of the program on: walking (min/week); planned, incidental and total physical activity (min/week); sitting time; active days; fruit and vegetable intake; body mass index; waist circumference; blood pressure; 6 minute walk distance; 30 second sit-to-stand; psychological distress symptoms; and stage of behaviour change. There were 99 participants (31 males, 68 females) out of 117 participants completed more than 50% of program sessions. Twelve of 15 measures achieved their desired target change and a statistically significant change toward the desired outcome was reported for 14 of 15 measures. Positive results were obtained for participants completing more than 50% of sessions, suggesting that HEAL™ ing Mental Health program is effective to increase physical activity and healthy lifestyle choices in individuals who self-report a mental health disorder.

ЛЕЧЕНИЕ ЛЕГОЧНОЙ ГИПЕРТЕНЗИИ У ПАЦИЕНТОВ С СЕРПОВИДНОКЛЕТОЧНОЙ АНЕМИЕЙ С ИСПОЛЬЗОВАНИЕМ СИЛДЕНАФИЛА

Pulmonary hypertension is a common complication of sickle cell disease associated with hemolysis, impaired bioavailability of nitric oxide, and high mortality. The aim of the study is to evaluate the safety and efficacy of selective pulmonary vasodilators and antiproliferative drugs in this risk group. Materials and methods. After optimizing sickle cell therapy to stabilize fetal hemoglobin levels, we evaluated the safety and efficacy of sildenafil in 9 patients with sickle cell disease and pulmonary hypertension. Results. Sildenafil therapy (mean duration 6 ± 1 month) reduced estimated pulmonary systolic pressure [50 ± 4-41 ± 3 mmHg; 9 mmHg difference, 95% confidence interval (CI): 0.3-17, P = 0.043] and increased the 6-minute walking distance (384 ± 30 to 462 ± 28 m; 78 m difference, 95% CI: 40-117, P = 0.0012). Transient headaches were observed in two patients and transient eyelid edema in four patients. The three men in the study did not have any episodes of priapism. Two of them received chronic exchange transfusions, and one had erectile dysfunction. Conclusions. Patients with sickle cell disease and pulmonary hypertension have significant limitations in physical activity. Walking for 6 minutes may be a valid endpoint in this population. Sildenafil therapy is safe and improves pulmonary hypertension and physical performance. Additional phase I studies in men with sickle cell disease are needed, followed by a placebo-controlled phase II/III to evaluate the safety and efficacy of sildenafil therapy in patients with sickle cell disease and pulmonary hypertension.

The association between objectively measured preoperative light-intensity physical activity and postoperative ambulation in patients with gastrointestinal cancer.

[Purpose] To clarify the association between preoperative physical activity and postoperative ambulation based on physical activity intensity, and independent of functional capacity and depression, in patients with gastrointestinal cancer. [Participants and Methods] Seventy patients who underwent surgery for primary colorectal or gastric cancer were enrolled. Preoperative moderate-to-vigorous-intensity physical activity, light-intensity physical activity, and sedentary behavior were assessed using an accelerometer. The primary outcome was the days to postoperative first ambulation (capable of independently and continuously walking 150 m). Functional capacity and depression, as confounders, were evaluated by measuring the 6-minute walk distance and using the Hospital Anxiety and Depression Scale. [Results] Of the 70 patients, 28 had insufficient accelerometer data, and 42 were included in the analysis. Preoperative light-intensity physical activity, but not moderate-to-vigorous-intensity physical activity and sedentary behavior, was negatively associated with the days to postoperative first ambulation, after adjusting for age, preoperative functional capacity, and preoperative depression. [Conclusion] Preoperative light-intensity physical activity was associated with the days to postoperative ambulation independently of age, functional capacity, and depression. Hence, predicting delayed ambulation by preoperative light-intensity physical activity in patients with gastrointestinal cancer may be useful.

Comparison of cardiac magnetic resonance imaging, functional and haemodynamic variables in pulmonary arterial hypertension: insights from REPAIR.

Measures that can detect large treatment effects are important for monitoring therapeutic effectiveness. The 2022 European Society of Cardiology/European Respiratory Society guidelines highlight the importance of imaging in monitoring disease status and treatment response in pulmonary arterial hypertension (PAH). Are the standardised treatment effect sizes (STES) of cardiac magnetic resonance imaging (cMRI) comparable with functional and haemodynamic variables? REPAIR (ClinicalTrials.gov: NCT02310672) was a prospective, multicentre, single-arm, open-label, 52-week phase 4 study evaluating the effect of macitentan 10 mg, with or without a phosphodiesterase 5 inhibitor (PDE5i), on right ventricular (RV) remodelling, cardiac function and cardiopulmonary haemodynamics. Both cMRI and functional assessments were performed at screening and at weeks 26 and 52; haemodynamic measurements were conducted at screening and week 26. In this post hoc analysis, STES were estimated using the parametric Cohen's d and non-parametric Cliff's delta tests. At week 26, large STES (Cohen's d) were observed for 10 of the 20 cMRI variables assessed, including the prognostic measures of RV and left ventricular stroke volume and RV ejection fraction and the haemodynamic trial end-point, pulmonary vascular resistance; medium STES were observed for 6-min walk distance (6MWD). The STES were consistent in treatment-naïve patients and those escalating therapy and maintained at week 52. Similar results were obtained using the non-parametric Cliff's delta method. The treatment effect of macitentan, alone or in combination with a PDE5i, was comparable for several cMRI and haemodynamic variables with prognostic value in PAH, and greater than that of 6MWD in patients with PAH, highlighting the emerging relevance of cMRI in PAH.

Reference Values in the 6-Minute Walk Test in Chilean Children Aged 3-10Years and Relationship With Cardiometabolic Risk.

The aim of this study was to evaluate the performance of healthy Chilean children aged 3-10years in the 6-minute walking test (6MWT) and cardiometabolic risk variables and to determine sex- and age-specific reference values. This study involved 1165 healthy children (age = 6.36 [1.70]y old). The 6MWT was used to evaluate exercise performance. Furthermore, anthropometric measures were collected, like weight, height, body mass index, waist circumference, and skin folds. Resting heart rate and blood pressure (BP) were also evaluated. The prevalence of overweight and obesity was 35.0% and 25.4% in preschoolers and 29.0% and 36.2% in school-age children, respectively, showing significant differences (P < .05) between age groups. The distance walked (6-min walk distance) increased significantly year on year at ages from 3 to 10years. According to the regression analysis, 6MWT performance was positively related to age, systolic BP, and height, whereas it was negatively related to ∑4 skinfold fat, resting heart rate, diastolic BP, and waist circumference. This study provides a reference equation and an age- and sex-adjusted percentile curve to assess the predicted 6MWT performance in a cohort of prepubertal Chilean children. The 6-minute walk distance depends mainly on age; however, other variables, such as resting heart rate, BP, skinfold fat, and waist circumference, add significant information and should be taken into account.

폐이식 수혜자에 대해 적용한 장기간 호흡재활프로그램의 효과

Purpose: The purpose of this study was to provide long-term pulmonary rehabilitation program (PR) to lung transplant recipients for more than a year and verify their effectiveness.&#x0D; Methods: A 52-year-old female patient who had bilateral lung transplantation received an outpatient PR 3 times a week for a total of 97 weeks. The PR applied was composed of aerobic exercise, strength exercise, breathing exercise, flexibility exercise, and home exercise education. Evaluation was performed on the participant at 3, 6, 9, 12, and 24 months after surgery. For each period, the following parameters were determined: 6-minute walk distance (6MWD), grip strength, respiratory muscle strength, lung function, peak cough flow rate, skeletal muscle mass (SMM), and skeletal muscle index (SMI).&#x0D; Results: The 6MWD increased up to 12 months following surgery, and exercise-induced hypoxemia occurred only 3 months following surgery. The grip strength increased up to 12 months after surgery and decreased at 24 months after surgery. The MIP increased up to 12 months after surgery, and the MEP increased until 24 months after surgery. The FVC increased up to 12 months following surgery and FEV1 increased up to 24 months following surgery. PCF increased up to 12 months after surgery. Body weight also increased steadily until 24 months postoperatively. SMM and SMI increased up to 12 months after surgery, and SMI decreased at 24 months following surgery.&#x0D; Conclusion: It is essential that the PR for lung transplant recipients be applied intensively in less than 12 months after surgery, and the goal of the PR should be configured for the purpose of management in more than 12 months following surgery.

Respiratory Function, Physical Capacity, and Metabolic Syndrome Components in Combustible Cigarettes and Heated Tobacco Products Users: a Five-Year Follow-Up Cohort Study

Purpose: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and is the fourth leading cause of death in Kazakhstan. Cigarette smoking is a prevalent risk factor for COPD. While quitting smoking is the preferred way to reduce COPD risk, literature suggests that heated tobacco products (HTP) might be a better option for people who cannot quit smoking. The aim of this paper was to analyze the long-term effects of shifting to HTP use in long- term smokers compared to continued combustible cigarettes (CC) use. Patients and methods: A cohort of 1200 participants (393 HTP and 807 CC) aged 40-59 years with a minimum of 10 pack-year smoking history were recruited and followed for five years. The functional outcomes compared between HTP, CC users and No-Smokers (NS, people who stopping smoking) included: (1) COPD Assessment Test (CAT); (2) post-bronchodilator lung function; (3) 6-minute walking distance (6MWD) test; and (4) metabolic syndrome components. Multivariable linear mixed models (MIXED) were used to compare functional outcomes between visits and to test associations between health outcomes and smoking type (HTP vs. CC vs. NS) over time. Results: Out of 1200 participants 830 (466 CC users, 248 HTP users and 116 No-Smokers) remained in the study by the fifth year of follow up. Linear mixed models showed HTP use was associated with better CAT scores and HDL cholesterol level compared to CC users. Lung function (FVC) decrease was significantly less in HTP users. FEV, 6MWD, waist circumference, fasting blood glucose, triglycerides and diastolic blood pressure significantly changes over time, but without between-group difference in dynamic. Conclusion: This study demonstrated that HTP users experienced it to a significantly lesser decrease in lung function by FVC compared to CC users over time (in time dependent model), while demonstrating better stable levels in other functional outcomes. The results of this study suggest that HTP might be a less deleterious alternative compared to CC in people with long history of CC use and who cannot quit smoking.

Structural and functional remodeling of the heart in hypertensive patients with COVID-19: assessmentof changes at the end of hospitalization period and during a 1-month follow-up

COVID-19 is often accompanied by the long-term persistence of symptoms, the risk of which depends on the severity and duration of the acute phase, as well as existing comorbidities. Cardiac dysfunction is one of the possible mechanisms of impaired functional status of patients. While clinically manifest systolic heart failure is a rare phenomenon in such a situation, minor alterations in the structural and functional state of the heart may be contributing to persistence of general symptoms such as dyspnea, fatigue, and reduced work capacity.The aim – to study the role of hypertension in the formation of structural and functional changes of the heart during hospitalization for COVID-19, and the dynamics of detected changes in the early period after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % female) underwent a comprehensive transthoracic echocardiographic examination 1-2 days before discharge and after 31 days of follow-up. The control group included 88 subjects matched by age, sex, height, weight, and existing comorbidities. The studied parameters included morphometry of the cardiac chambers, indices of longitudinal systolic function and diastolic filling of the ventricles; the participants were also performing a 6-minute walk test.Results. Geometric changes of the heart in hospitalized patients with COVID-19 at the time of discharge included an increase in absolute (10.1±1.5 vs 9.1±0.9 mm, p&lt;0.001) and relative LV walls thickness (0.45±0,07 vs 0.39±0.04, p&lt;0.001), indices of LV myocardial mass (38.1±8.9 vs 33.9±5.8 g/m2.7, p&lt;0.001) and left atrial volume index (28.6±6.6 vs 25.1±4.9 ml/m2, p&lt;0.001), as well as a decrease in LV global longitudinal strain (-17.5±2.4 vs -18.6±2.2 %, p&lt;0.001) and diastolic filling parameters (e’ – 9.2±2.2 vs 11.3±2.6 cm/s, p&lt;0.001; E/e’ – 7.5±1.8 vs 6.8±1.7, p=0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted in normotensive patients, resulting in a high prevalence of concentric LV geometry (78 % and 43 %, respectively, p&lt;0.001 between groups and vs controls), mainly type I diastolic dysfunction (51 % and 25 %, p&lt;0.001 between groups and vs control), as well as abnormal values of global longitudinal strain (32 % and 19 %, p=0.027 between groups, p&lt;0.001 vs control), which persisted during a short observation period. The increase in the reached % of individually predicted 6-minute walk distance was 11.2±7.5 in hypertensive participants vs 12.8±7.6 in normotensives, p&gt;0.05.Conclusions. Patients with COVID-19 at the end of hospitalization period were characterized by a high prevalence of LV concentric geometry and diastolic dysfunction, as well as minor decrease in its longitudinal systolic function, which were more pronounced in the presence of concomitant hypertension and did not improve during the first month after discharge.