6-minute Walk Test Research Articles

Evaluation of a six-minute walk test in the DE50-MD canine model of Duchenne muscular dystrophy and its effect on blood-borne biomarkers

Background Duchenne muscular dystrophy (DMD) is a fatal muscle wasting disease caused by mutations in the dystrophin gene resulting in cycles of muscle degeneration, inflammation and regeneration. The 6-minute walk test (6MWT) is a key functional outcome measure for DMD patient clinical trials and has been adapted for use in animal models of the disease. The DE50-MD dog model of DMD closely reflects the DMD patient phenotype prior to loss of ambulation. For pre-clinical trials using this model, functional outcome measures must be established. Methods This longitudinal study compared distance walked in a 6MWT by DE50-MD and WT control dogs and assessed the utility of the 6MWT as a functional biomarker. Dogs underwent two 6MWTs conducted approximately 48-hours apart, at 3, 6, 9, 12, 15 and 18 months of age. In addition, we evaluated the stability of selected blood-borne biomarkers in 12-month old DE50-MD and WT dogs 0, 3, 6, 24 and 48 hours following a 6MWT. Results DE50-MD dogs exhibited significantly shorter 6-minute walk distance (6MWD) than WT dogs at all timepoints (P<0.05), with no difference in 6MWD between the first and second 6MWT. C-C motif chemokine ligand 2 (CCL2), myomesin-3 (MYOM3) and myostatin (MSTN) were biomarkers of the DE50-MD phenotype that remained unchanged in DE50-MD dogs following the 6MWT, while creatine kinase (CK) activity significantly increased 3-hours following the test in DE50-MD dogs but remained unchanged in WT dogs. Conclusions The 6MWT effectively discriminates DE50-MD from WT dogs aged 3-18 months and a single 6MWT is sufficient for future studies. Serum MYOM3, CCL2 and MSTN are good biomarkers of the DE50-MD phenotype that are unaffected by this relatively low level exertion.

Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity

Study Design. Prospective cohort study. Objective. To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up. Summary of Background Data. In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial. Methods. A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist. Results. All domains of the SRS-22 improved the most in the first 6 months after surgery (P <0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P <0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P <0.01) and almost reached a plateau 1 year postoperatively. Conclusions. Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications. Level of Evidence. 3

Abstract 4147647: Effects on Cognition, Sleep, Quality of life and Exercise Capacity of a 12-week Tele-yoga Intervention in Persons with Heart Failure - Results from 3 and 6 Months Follow-up

Background and Objectives: Yoga may be a promising form of mind-body rehabilitation for patients with long term illness. Digitally delivered yoga increases access to participation but has not previously been evaluated in the heart failure population. The aim of this study was to examine the effects of tele-yoga on cognition, sleep, health-related quality of life and exercise capacity in persons with heart failure. Methods: The Tele-yoga study (ClinicalTrials.gov, ID: NCT 03703609) was a parallel two-arm randomised controlled trial (RCT) with 1:1 distribution to an intervention and control group. Study participants were randomised to tele-yoga including live-streamed group-yoga for 60 minutes twice weekly during 12 weeks and yoga individually for 10 minutes/day using an app, or to a control group receiving individual exercise advice. Cognition (Montreal Cognitive Assessment: MoCA), sleep (minimal insomnia symptom scale; MISS), health-related quality of life (EQ-5D VAS) and sub-maximal exercise capacity (6 minute walk test; 6MWT) were assessed at baseline, after 3 and 6 months. Linear mixed model with random intercept for patients as the random effect and group-time interaction along with age was taken as the fixed effects to analyse outcomes. Results: A total of 311 participants were included (tele-yoga n=156 and active controls n=155), mean age 66 years, 70% men. Adherence to the group yoga was very good. The linear mixed models showed a significant change in cognition, health-related quality of life and exercise capacity favouring the tele-yoga group. No significant differences between the groups were seen regarding sleep. When analysing the fixed effects of all outcomes, age, group assignment and time-points interaction had significant effects on EQ-5D VAS score, 6MWT distance and MoCA scores. For EQ-5D VAS the tele-yoga group performed significantly better than the control group at 3 months, but not at 6 months. For the 6MWT distance, the tele-yoga group performed better than the control group at 3 months, but not at 6 months. The tele-yoga group had significantly higher MoCA scores than the control group at both 3 and 6 months. Conclusion: This adequately powered RCT showed that digitally delivered mind-body training in the format of group and individual yoga during 12 weeks lead to an improvement in cognition, quality of life and exercise capacity at the end of the intervention. The effect was sustained for cognition also after 6 months.

Abstract 4137264: Subclassification of Peripheral Artery Disease Based on Muscle Force: Leg Failure with Reduced Muscle Force and Leg Failure with Preserved Muscle Force

Introduction: All claudicating patients with peripheral artery disease (PAD) exhibit leg failure, as evidenced by distinct walking impairment. However, based on a detailed evaluation of leg biomechanics, some claudicating patients maintain preserved leg muscle strength, while others demonstrate reduced strength. In this study, we aim to compare the clinical and physiological characteristics of the two groups. Methods: Fifty-four claudicating patients were categorized into two groups: leg failure with preserved muscle force (LEF-PF) versus leg failure with reduced muscle force (LEF-RF), based on the peak torque (PT) from performing maximum isometric plantar flexion contractions on a Biodex system. All patients underwent history and physical exam, measurement of leg hemodynamics, walking performance and quality of life, and gastrocnemius biopsy to evaluate the histology and biochemistry of the affected leg muscles. We used independent samples T test and chi-square test to compare the two groups. Results: LEF-PF (N=19, PT 92±15 Nm) and LEF-RF (N=35, PT 49±13 Nm) had similar demographic and comorbidity profiles. While ankle-brachial index didn't differ between the two groups, during the reactive hyperemia test, ankle pressure of LEF-RF dropped more significantly (p=0.021) upon occlusion release and took longer to recover (p=0.023). Both groups performed similarly on the Gardner Treadmill test, but LEF-PF performed better in the 6-Minute Walking test (p=0.062). LEF-PF also trended towards higher scores on the modified falls efficacy scale (p=0.056). Histologically, gastrocnemius muscle from LEF-PF had larger myofibers, while biochemically, they exhibited lower mitochondrial respiratory activity dependent on complex-II compared to LEF-RF. Conclusion: Our study presents a novel approach to understanding the physiology of claudication, focusing on the strength of the ischemic muscles. Despite comparable demographics and hemodynamics at rest, notable differences separate the two groups during stress-induced hemodynamics, walking performance, myofiber histology, and mitochondrial biochemistry. Further investigations are necessary to elucidate the underlying mechanisms behind the differences in muscle strength among patients with claudication. Such insights may enhance our understanding of PAD physiology and potentially correlate with variations in mortality rates, progression to more advanced PAD stages, and responses to different therapeutic interventions.

Abstract 4118724: Validity of a NYHA Classification Guide with Six Minute Walk Test Outcomes

Background: The New York Heart Association (NYHA) classification is a subjective tool that is commonly used in clinical practice to assess symptoms and functional capacity of patients with heart failure (HF). Correct assignment of NYHA is essential to facilitate evidence-based management. Research Question: What is the validity of the CLASS-HF Guide compared to the 6-minute walk test (6MWT)? Purpose: To examine the validity of the new investigator-developed CLASS-HF guide to assist in appropriate assignment of NYHA Class relative to the 6MWT. Methods: A multi-site, cross-sectional study in three cardiology clinical sites (two specializing in HF) recruited 103 patients in various classes and stages of HF. Providers assigned patients their NYHA Classification using the CLASS-HF guide. Patients then performed the 6MWT with test staff blinded to the assigned NYHA class. Exertion, dyspnea, and walk distance were captured post-test. The validity of the guide-assisted classification was then examined for convergent validity with 6MWT outcomes. Data analysis was performed with correlations, ANOVA, and multivariable regression. Results: Of the 103 total participants, 65.1% were male, 18.4% were non-White, with an average age of 66.0 ± 15.5 years old. A little less than one-third (30.1%) had HFpEF (LVEF ≥ 50%). Provider-assigned NYHA Class was 22.3% I, 38.8% II, 35.0% III and 3.9% IV. The average distance walked during the 6MWT by class was: 367.1 ± 85.6 m for I, 343.7 ± 104.7 m for II, 261.6 ± 73.9 m for III, and 184.6 ± 114.0 m for IV. Convergent validity of NYHA class with Borg exertion (Spearman’s r = .546, p < .001) and dyspnea ( r = .504, p < .001) was strong. A statistically significant inverse correlation was found between NYHA assigned class and meters walked during the 6MWT ( r = -.469, p < .001), with significant mean differences (ANOVA F (3,99) = 10.72, p < .001) in distance walked for: NYHA Class I vs. III ( md = 105.5 m), I vs. IV ( md = 182.6 m), II vs. III ( md = 82.1 m), II vs. IV ( md = 159.2 m). Increasing NYHA class remained significantly associated with lower 6MWT distance ( F (3,90)=5.22, p = .002) in multivariable regression (Adj. R -squared= .575) controlling for age, sex, race/ethnicity, diagnosis, site, Borg exertion and dyspnea, and 6MWT stopping/pausing. Conclusion: Validity evidence was found for NYHA class assignment after use of the CLASS-HF guide with respect to 6MWT distance and post-test perceived exertion and dyspnea.

Abstract 4124506: Short Physical Performance Battery as a Marker of Severity and Predictor of Clinical Outcomes in Transthyretin Amyloid Cardiomyopathy (ATTR-CM)

Background: ATTR-CM has an age dependent prevalence and is a disorder that almost exclusively affects older adults. Objective evaluations of function are critical to assessing and managing ATTR-CM in older adults. The short physical performance battery (SPPB) is a valid measure of functional capacity that predicts morbidity and mortality in older adults but its utility in ATTR-CM remains unknown. Aims/hypothesis: To establish SPPB as a useful marker of disease severity and predictor of outcomes in ATTR-CM. We hypothesized that SPPB scores would correlate with validated markers of ATTR-CM severity and improve clinical prediction. Methods: This is a retrospective analysis of patients referred to the Columbia University Cardiac Amyloid Program. Patients were stratified into low (SPPB 0-6), moderate (7-9), and high (10-12) cohorts based on initial SPPB score and baseline characteristics were compared between groups. Cox proportional hazard models and Kaplan Meier (KM) curves were generated to assess associations with mortality as well as a composite of death and cardiovascular (CV) hospitalization in follow-up. Results: A total of 263 patients, age 78 years (IQR 73, 84), 86% male, 22% with ATTRv (variant) and 78% with ATTRwt (wild type) were studied. SPPB showed no limitation in 59%, mild limitation in 33%, and severe limitation in 8%. Lower SPPB was associated (p <0.05) with older age, prior stroke/TIA, shorter 6-minute walk test, elevated NT-proBNP and HS-troponin, worse quality of life metrics on Kansas City Cardiomyopathy Questionnaire, more advanced NYHA and Mayo stages, and higher Columbia scores. On multivariate regression (adjusted for age, sex, genotype, NYHA), SPPB was independently associated with the composite of mortality and CV hospitalization, with each point increase corresponding to 13% lower incidence of the outcome (HR 0.87, p=0.01). Chair stands score, one of three SPPB subdomains, was independently associated with the composite and mortality. KM curves showed significant association with SPPB and both the composite and mortality (Fig. 1). Conclusions: SPPB score is a marker of ATTR-CM severity, associated with validated biomarkers and staging systems, and independently predicts clinical outcomes.

Study protocol of an exercise and nutrition intervention for ovarian cancer patients during and after first-line chemotherapy (BENITA) - a randomized controlled trial

Abstract Background In ovarian cancer frequently reported side effects are muscle wasting and malnutrition, leading to frailty, decreased health-related quality of life (HRQoL), and cancer-related fatigue (CRF). Both often begin during first-line chemotherapy and develop progressively into a refractory state, if left untreated. Method Primary objective is to evaluate effectiveness of a newly developed app-based exercise and nutrition program under non-standardized conditions of clinical routine. We hypothize that patients who receive an individually tailored exercise and nutrition program for six months will have improved physical performance compared to patients who receive usual care. This is a multicenter randomized controlled open-label trial comparing an intervention group receiving a six-month exercise and nutrition intervention and a control group receiving usual care. Primary endpoint is the change in 6-Minute Walk Test (6MWT) from baseline to T2 (26 weeks after baseline) as a measure of physical functioning. Secondary endpoints include patients’ utilization and adherence to the nutrition program (MEDAS), their malnutrition risk (NRS2002), as well as patients’ HRQoL (see Table 1). Using the two-sample t-test with a two-sided type I error of 5% and 80% power, a medium effect size of Cohen’s d = 0.50 can be demonstrated with a minimum of 128 participants (64 per group). With a conservatively estimated dropout rate of 30%, 182 patients will be recruited. Patients who are included must be over 18 years of age, be diagnosed with ovarian cancer, cancer of fallopian tubes, or peritoneal cancer, FIGO stages II-IV, receive surgery and chemotherapy (adjuvant or neoadjuvant). Exclusion criteria are an ECOG status greater than 2, inadequate proficiency in German, or physical or mental impairments hindering the implementation of the program or execution of study procedures. Discussion In case of success, the project contributes in the long term to (i) improving medical care (diagnosis, psychoeducation, patient orientation, and empowerment), (ii) reducing the burden of disease and promoting physical autonomy for patients, and (iii) being incorporated into relevant guidelines. Trial registration The study was registered at ClinicalTrials.gov (NCT06250686).

The minimally clinically important difference in the 2-minute walk test for people in the subacute phase after a stroke

ABSTRACT Background The 2-Minute Walk Test (2MWT) is a simple and reliable test used by clinicians to assess gait function in people with stroke (pwST). No studies established the minimal clinically important difference (MCID) of the 2MWT. Objective To determine the MCID of the 2MWT in subacute pwST using data from a longitudinal cohort study. Methods PwST within 180 days of stroke onset were recruited from the Italian National Health System (NHS) rehabilitation services across the country. Participants underwent physical therapy to improve balance and gait according to their specific needs. The 2MWT was used to assess gait performance at the beginning (T0) and after a minimum of 10 rehabilitation sessions (T1). The Global Perceived Effect (GPE), Activities-specific Balance Confidence Scale (ABC) and the ABC_gait were used to assess balance confidence and the perceived effect of the intervention at T1. Results 51 pwST (69 ± 12 years; 66.7% males) were included in the analysis. Statistically significant improvements were observed in 2MWT, ABC, and ABC_gait scores after rehabilitation using the Wilcoxon signed-rank test. Using an anchor-based approach the receiver operating characteristic (ROC) curves were calculated to establish the MCID. The MCID of the 2MWT was 31 meters with an Area under the curve (AUC) = 0.74 [0.60–0.89], a specificity of 71% and a sensitivity of 63%. Conclusions An improvement of 31 meters on the 2MWT can be considered clinically significant in subacute pwST undergoing rehabilitation. This study provides valuable insights for clinicians to assess walking performance in pwST and determine clinically meaningful changes post-rehabilitation.

Effect of Baduanjin exercise on acute myocardial infarction in patients with anxiety and depression after percutaneous coronary intervention: A randomized controlled trial

Background: Acute myocardial infarction (AMI) is the most severe type of coronary heart disease and patients often require percutaneous coronary intervention (PCI). However, anxiety and depression are common complications of PCI. Methods: This study conducted a prospective randomized controlled trial to investigate the effectiveness of Baduanjin exercise in improving cardiac function and alleviating symptoms of anxiety and depression in patients who underwent PCI for AMI. Patients with AMI (n = 120) who underwent PCI at the Cardiology Department of The First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2020 and June 2021 were included. Participants were divided into a control group (moderate intensity walking) and a Baduanjin exercise group. The treatment period was 8 weeks, with follow-ups at weeks 4 and 8. Improvement of cardiac structure and function indices was measured by echocardiography. Physical function was assessed using the 6-minute walk test. Mental state was assessed using the Seattle Angina Questionnaire, Hamilton Anxiety Scale, and Hamilton Depression Scale before and after exercise. Results: Compared to the control group, the Baduanjin exercise group showed improvement in change in left ventricular end-diastolic diameter (–1.0 ± 3.4 vs –2.3 ± 2.7 mm, respectively; P = .02), left ventricular ejection fraction (6.8 ± 4.2 vs 4.5 ± 4.3%, respectively; P = .002), angina stability (42.5 ± 31.7 vs 33.3 ± 29.7, respectively; P = .11), 6-minute walk test (118.4 ± 49.1 vs 88.3 ± 40.2 m, respectively; P < .001), and Hamilton Anxiety Scale (6.7 ± 2.6 vs 5.3 ± 2.6, respectively; P = .003), and Hamilton Depression Scale (7.6 ± 4.1 vs 4.8 ± 2.1, respectively; P < .001) scores. Conclusions: Baduanjin exercise for 8 weeks improved the cardiac function and mental state of patients with anxiety and depression after PCI for AMI. Through this study, we aim to provide reliable evidence in support of the beneficial effects of Baduanjin exercise on cardiac function and anxiety–depression, contributing to evidence-based medicine.

Acceptability and utility of a broad test battery to evaluate physical functioning and frailty in community-based settings for people experiencing homelessness and addiction–Findings from the LEAP trials

BackgroundPhysical function deficits and frailty are commonly reported in people experiencing homelessness and addiction. Typically, geriatric, or general physical performance measures are employed to evaluate these constructs. Objectives and settingWe aimed to investigate the feasibility of a broad test battery to evaluate physical functioning and frailty in a non-geriatric community-based population of people experiencing homelessness and addiction. Design and methodsPhysical function and the presence of frailty was evaluated using combined data from two linked low-threshold exercise pre-post intervention studies (LEAP I and II). ParticipantsSeventy-four participants attending an open-access day-service centre (18 to 65 years) were evaluated. Participants with acute confusion or behavioural issues, or major medical condition precluding safe participation were excluded. InterventionA broad test battery was performed which evaluated physical functioning and frailty. Main outcome measuresOutcome measures included were the Short Physical Performance Battery, Single Leg Stance, Chair Stand Test, 10 m and 2 minute Walk Tests, limb circumference, dynamometry, Clinical Frailty Scale, SHARE-Frailty Instrument, numerical pain rating and Short Form-12. ResultsTest completion was 100% for all outcomes except pain rating (81% and 79% for LEAPI and II, respectively), and balance and walking tests (95% and 93% in LEAP II). A ceiling effect was detected for the Short Physical Performance Battery. ConclusionHigh feasibility of the test batteries was demonstrated. An optimised test battery was proposed based on findings. This has important implications for clinicians working in inclusion health settings. Clinical Trial Registration NumberClinical Trials.gov: NCT05700305. Contribution of the Paper•This paper proposes a suitable test battery to enable clinicians to evaluate physical functioning and frailty in people experiencing homelessness and addiction challenges in community settings.•There is a paucity of research evaluating outcome measures for this population and no core outcome set has been reported.•This test battery would allow the effect of treatment and targeted interventions to be evaluated in this marginalised population.

The optimal treatment duration for inspiratory muscle strengthening exercises in stroke patients: a double-blinded randomized controlled trial

ABSTRACT Background Little is known about the ideal duration of inspiratory muscle training in stroke patients. Objective The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients. Methods This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks. Results Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period. Conclusion For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.

DESEMPENHO FÍSICOS EM IDOSOS SEDENTÁRIOS

In the study with 30 sedentary elderly individuals between 60 and 80 years of age, physical and functional capacity tests were performed. In the 6-Minute Walk Test, the elderly individuals aged 60 to 69 years walked an average of 4 meters, while those aged 70 to 79 and 80 years walked 5 and 6 meters, respectively. In the Lawton Scale, which assesses independence in instrumental activities, most elderly individuals showed a need for help, showing that dependence increases with age. In the Katz Scale, 37% of the elderly individuals aged 60 to 69 years, 43% of those aged 70 to 79 years and 20% of those aged 80 years maintained independence in basic self-care activities.

Exercise-Based Telerehabilitation for Heart Failure Patients Declining Outpatient Rehabilitation - A Randomized Controlled Trial.

Purpose: Cardiac rehabilitation participation rates are low despite strong recommendations, and many chronic heart failure patients remain physically inactive. Rural living, long travel distance, costs, age, and frailty might be factors explaining this. To increase cardiac rehabilitation uptake, we designed an exercise-based randomized controlled telerehabilitation trial enabling chronic heart failure patients unable or unwilling to participate in outpatient cardiac rehabilitation to exercise at home. Aim was to evaluate the long-term effects of telerehabilitation on physical activity levels.Methods and results: CHF patients (n = 61) with reduced (≤40%), mildly reduced (41-49%), or preserved ejection fraction (≥50%) were randomized (1:1) to telerehabilitation (n = 31) with an initial 3-month group-based high-intensity exercise telerehabilitation program or control (n = 30), with regular follow-up visits over a 2-year period. All participants attended a "Living with heart failure" course. Outcomes were measures of physical activity, peak oxygen uptake, 6-minute walk test distance, quality of life, morbidity, and mortality. We found no significant differences between groups for long-term changes in moderate to vigorous activity (MVPA) or peak oxygen uptake from baseline to the 2-year follow-up. Nor quality of life differed between groups, but both groups had significant within-group improvements in score on the Minnesota living with heart failure questionnaire (p = 0.000) and improvement in EQ-5D VAS score was significant (p = 0.05) in the telerehabilitation group.Conclusions: Telerehabilitation performed as home-based real-time high-intensity exercise sessions provided by videoconferencing for participants unable or unwilling to participate in standard outpatient cardiac rehabilitation did not affect long-term physical activity levels or physical capacity as expected. Still, a positive effect on health-related quality of life was seen in both groups.

Exploring the Impact of Instrument-Assisted Soft Tissue Mobilization on Functional Measures and Quality of Life in Knee Osteoarthritis Patients: A Randomized Controlled Trial

Background: Knee osteoarthritis (KOA) is a prevalent disabling condition characterized by pain, stiffness, and functional limitations, significantly impacting quality of life, particularly among older adults. Instrument-assisted soft tissue mobilization (IASTM) is a technique that has shown promise in reducing pain and increasing the range of motion. Objectives: This study aimed to investigate the effects of IASTM on functional measures and quality of life in KOA patients. Methods: Thirty participants with unilateral KOA were randomized into IASTM and sham groups. The intervention consisted of four sessions over two weeks, combining IASTM with exercise therapy. Functional performance was assessed using the 6-minute walking test (6MWT) and the timed up and go test (TUG). Quality of life was evaluated using the 36-item short-form health survey (SF-36) and the Lequesne Algofunctional Index (LAI) Questionnaires. Results: A mixed ANOVA revealed significant improvements in functional performance in both groups after treatment in the 6MWT (P < 0.001) and TUG (P = 0.003) tests. Significant improvements were observed in the SF-36 subgroups for physical functioning (P = 0.002), role limitations due to physical problems (P < 0.001), energy/vitality (P < 0.001), pain (P < 0.001), and total score (P < 0.001). There was also a significant time*group interaction effect for role limitations due to emotional problems (P = 0.005), with the IASTM group showing improvement after treatment while the sham group experienced a decline. The LAI questionnaire also indicated significant improvements in both groups (P < 0.001) after treatment. Conclusions: Both IASTM and sham interventions, combined with exercise therapy, led to improvements in functional measures and quality of life. However, the IASTM group exhibited a more pronounced positive trend in the 6MWT and TUG tests, as well as a significant interaction effect for emotional role limitations. These findings suggest that while exercise alone can improve function and quality of life, the addition of IASTM may further enhance these outcomes, supporting its integration into KOA management strategies to improve activities of daily living and overall quality of life.

Evaluate the Clinical and Laboratory Manifestations of Children With Type 6 of Mucopolysaccharidosis Before and After Enzyme Therapy: A Quasi-Experimental One Group Study

The purpose of this study is to evaluate the clinical and laboratory manifestations of children with mucopolysaccharidosis type 6 before and after enzyme therapy. In this quasi-experimental study, 8 patients with MPS-6 referred to the pediatric endocrinology department of Imam Reza Hospital in Mashhad were followed up for 12 months. The level of urinary glycosaminoglycan was measured to check the response to the treatment. The range of motion of the shoulder and elbow joints was evaluated using a goniometer, and abdominal ultrasound was performed to check the size of the liver and spleen in the midclavicular line. The 6-minute walking test and the 3-minute stair climbing test were performed for the patients at the mentioned times. The height and weight of the patients were also measured, and echocardiography was performed. Then patients underwent weekly enzyme treatment. One of the patients (seventh patient) was excluded from the study. Patients were treated with enzyme from the beginning of the study. The patients were evaluated at 12 months later. Statistical analysis showed that changes in urinary GAG level, height, weight, changes in 6-minute walk and range of motion (extension and flexion) of the shoulder were significant (P<0.05). Changes in liver and spleen size compared to height, climbing stairs, corneal opacity and heart changes after 12 months of enzyme therapy were not significant. It is suggested that even though this method of treatment is not definitive, that can be continued to improve the current condition of the patient.

Do measures of central sensitization relate to movement-evoked pain in people with chronic low back pain? A longitudinal prospective study

BackgroundOne of the most frequent complaints among people with musculoskeletal pain is pain during physical activity, commonly referred to as movement-evoked pain. It is suggested to be associated with quantitative sensory testing measures of central pain process in individuals with musculoskeletal pain. ObjectiveTo investigate the predictive association between movement-evoked pain scores and measures of central sensitization in patients with chronic nonspecific low back pain. The secondary aim was to determine whether changes in movement-evoked pain scores are associated with changes in measures of central sensitization. MethodsIn this longitudinal prospective study, 50 participants with chronic low back pain were included. Pain pressure thresholds, temporal summation of pain, descending pain modulation, and the central sensitization index were assessed as measures of central sensitization. Movement-evoked pain was evaluated using the Back Performance Scale and a 5-minute walk test. ResultsMeasures of central sensitization, specifically pressure pain thresholds and temporal summation, demonstrated predictive associations with movement-evoked pain measures. In response to treatment, improvements in movement-evoked pain were associated with improvements in measures of central sensitization (i.e., pressure pain thresholds and temporal summation) and improved pressure pain thresholds in the plantar toe significantly predict movement-evoked pain measures experienced during the 5-minute walk test. ConclusionsThese results imply that movement-evoked pain is related to processes related to central modulation of pain in patients with nonspecific chronic low back pain.

Efficacy and safety of Qishen Yiqi dropping pills combined with modern medicine for coronary heart disease with ischemic heart failure: A systematic review and meta-analysis.

Qishen Yiqi dropping pills combined with modern medicine have been widely used as a treatment for coronary heart disease with ischemic heart failure. Currently, there have been no robust studies addressing the efficacy and safety of Qishen Yiqi dropping pills combined with modern medicine for coronary heart disease with ischemic heart failure. Therefore, this systematic review and meta-analysis are conducted to fill in the gaps mentioned above. This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies published from inception to April 17, 2023, in the 5 electronic databases: PubMed, The Cochrane Library, EMBASE, CNKI, and the Wanfang database were comprehensively searched. Weighted mean difference was used as the effect size for the continuous variables. Pooled odd ratios are presented if the results are binary variables. Additionally, we performed subgroup and sensitivity analyses to examine the source of heterogeneity. The funnel plot and the Egger test were used to estimate publication bias. This meta-analysis included 46 studies involving 5843 participants. There is a significant difference in clinical efficacy, the 6-minute walk test (weighted mean difference = 50.10; 95% CI 28.19 to 72.02; I2 = 98.9%, P = .000), the indexes of ultrasonic cardiogram, blood biochemical indexes, and adverse effects (odds ratios = 0.46; 95% CI 0.29 to 0.75; I2 = 35.9%, P = .142). The sensitivity analysis and publication bias have demonstrated the robustness of the results (P = .702). Qishen Yiqi dropping pills combined with modern medicine could significantly improve clinical efficacy without incasement adverse effects. Further studies are required to identify the more comprise efficacy and safety results.

Comparison of commercial smart watch and universal pulse oximeter on heart rate, oxygen saturation, and distance covered using the 6-minute walk test: A cross-sectional study

Comparison of commercial smart watch and universal pulse oximeter on heart rate, oxygen saturation, and distance covered using the 6-minute walk test: A cross-sectional study

The one-minute sit-to-stand test is an alternative to the 6-minute walk test in patients with atrial fibrillation: A cross-sectional study and ROC curve analysis

BackgroundThe one-minute sit-to-stand test (1STST) is an easy-to-administer, space and time-saving test for determining functional exercise capacity in cardiac disease. This study aimed to investigate the 1STSt-test-retest reliability and convergent validity and compare its physiological responses to the six-minute walk test (6MWT) in patients with Atrial fibrillation (AF). MethodsForty-five patients with AF were included in this study. Functional exercise capacity was evaluated using the 1STST and 6MWT. For assessing test-retest reliability, the intraclass correlation coefficient and Bland-Altman plots were utilised. Convergent validity was determined by correlation analysis 1 STST and 6MWT, age, European Heart Rhythm Association score, ejection fraction, and quality of life. The cut-off point of 1STST was defined using ROC analysis. ResultsWith an intraclass correlation coefficient value of 0.975 [95 % confidence interval (CI) 0.954–0.986], the 1STST demonstrated excellent-test-retest reliability. Physiological responses after tests were similar in the 1STST and 6MWT (p > 0.05). The number of 1STST repetitions was strongly associated with 6MWT distance (r = 0.809; p < 0.001). A cut-off value of ≤13 repetitions in the number of 1STST repetitions was defined as functional impairment related to an increased risk of clinical events [sensitivity: 100 %, specificity: 84.6 %; AUC:0.94; 95 % CI 0.82 to 0.98; p < 0.001]. ConclusionsThe 1STST is a reliable and valid assessment tool that produced comparable hemodynamic responses to the 6MWT in patients with AF. Considering its feasibility and time efficiency, healthcare professionals can use the 1STST rather than the 6MWT test to measure functional exercise status in a constrained environment for this patient group.

How to evaluate exertional breathlessness using normative reference equations in research.

Breathlessness is a common, distressing and limiting symptom in people with advanced disease, but is challenging to assess as the symptom intensity depends on the level of exertion (symptom stimulus) during the assessment. This review outlines how to use recently developed normative reference equations to evaluate breathlessness responses, accounting for level of exertion, for valid assessment in symptom research. Published normative reference equations are freely available to predict the breathlessness intensity response (on a 0-10 Borg scale) among healthy people after a 6-minute walking test (6MWT) or an incremental cycle cardiopulmonary exercise test (iCPET). The predicted normal values account for individual characteristics (including age, sex, height, and body mass) and level of exertion (walk distance for 6MWT; power output, oxygen uptake, or minute ventilation at any point during the iCPET). The equations can be used to (1) construct a matched healthy control dataset for a study; (2) determine how abnormal an individual's exertional breathlessness is compared with healthy controls; (3) identify abnormal exertional breathlessness (rating>upper limit of normal); and (4) validly compare exertional breathlessness levels across individuals and groups. Methods for standardized and valid assessment of exertional breathlessness have emerged for improved symptoms research.