Cardiorespiratory Functional Capacity Research Articles

The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis.

The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = -0.782, p < 0.001), ASDAS and SR (r = -0.548, p = 0.03), and ASDAS and VO2peak (r = -0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA.

391. PREHABILITATION DURING NACT IN ESOPHAGEAL CANCER CARE—A FEASIBILITY STUDY

Abstract Background Esophageal cancer bears a high disease burden with elevated morbidity and mortality. Treatment of esophageal adenocarcinoma (EAC) includes Neoadjuvant Chemotherapy (NACT) followed by surgical resection and subsequent adjuvant chemotherapy (ACT). This treatment triad effectively weakens already ill patients. Prehabilitation, a preoperative intervention designed to optimize patients through exercise, nutrition, and psychology, is understudied in this malignancy. Given limited prehabilitation resources at many hospitals, efficacy of home-based programs vs traditional supervised programs was investigated. Methods Patients diagnosed with EAC underwent a multimodal prehabilitation intervention and were blindly randomized to either supervised exercise or home-based exercise. The study was considered feasible if patients complied to 70% of the program. Compliance was measured by number of completed exercise sessions and adherence to nutritional advice and supplementation. Safety was measured by occurrence of adverse events. Cardiorespiratory fitness was measured by cardiopulmonary exercise testing (CPET). Functional capacity was measured by 6-minute walking test (6MWT), Sit-to-Stand and Hand Grip Strength. Quality of Life was measured by ESAS and FACT-E. All patients underwent assessment at baseline, preoperatively and 8 weeks postoperatively. Results 44 patients were enrolled, supervised (n = 23) and home-based (n = 21). Average age was 64, BMI 27.9 kg/m2 and 68% underwent an Ivor Lewis esophagectomy. There were no significant differences between groups at baseline. Overall adherence to the program by the supervised group was 72% and 77% by the home-based group. Exercise allocation was not linked to adherence (p = 0.45). There were 2 non-serious adverse events recorded during this trial: one bout of syncope and one of light headedness during exercise. There is a relative maintenance or even improvement of cardiorespiratory fitness, functional capacity and QoL during NACT throughout the preoperative period. Conclusion Prehabilitation is an effective and safe intervention in esophageal cancer patients undergoing NACT. Home-based programs seem to provide similar benefits to supervised programs. This allows for wider implementation of prehabilitation in hospitals which do not have dedicated outpatient clinics for this purpose. Buffering functional decline during treatment is a triumph in a population that usually suffers. However, larger trials investigating prehab’s effect on post operative complications and QoL are needed.

Efficacy and Safety of Hybrid Comprehensive Telerehabilitation (HCTR) for Cardiac Rehabilitation in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Cardiovascular disease (CVD) is a serious condition that poses threats to patients' quality of life and life expectancy. Cardiac rehabilitation is a crucial treatment option that can improve outcomes for CVD patients. Hybrid comprehensive telerehabilitation (HCTR) is a relatively new approach. In the context of pandemics, HCTR can minimize the risk of cluster infections by reducing hospital visits while delivering effective rehabilitation care. This study is aimed at assessing the efficacy and safety of HCTR as a secondary prevention measure for CVD patients compared to usual rehabilitation care. We searched PubMed, Embase, The Web of Science, The Cochrane Library, and PsychINFO for all related studies up to January 20, 2023. Two reviewers independently screened the titles and abstracts of potentially eligible articles based on the predefined search criteria. Data were analyzed using a comprehensive meta-analysis software (RevMan5.3). Eight trials, involving 1578 participants, were included. HCTR and usual rehabilitation care provide similar effects on readmission rates (odds ratio (OR) = 0.90 (95% CI 0.69-1.17), P = 0.43) and mortality (odds ratio (OR) = 1.06 (95% CI 0.72-1.57), P = 0.76). Effects on Short Form-36 Health Status Questionnaire (SF-36) score were also similar (SMD: 1.32 (95% CI-0.48-3.11), P = 0.15). Compared with usual rehabilitation care, HCTR can improve peak oxygen uptake (VO2 peak) (SMD: 0.99 (95% CI 0.23-1.74), P = 0.01) and 6-minute walking test (6MWT) (SMD: 10.02 (95% CI 5.44-14.60), P < 0.001) of patients. Our findings indicate that HCTR is as effective as traditional rehabilitation care in reducing readmission rates and mortality and improving quality of life in patients with CVD. However, HCTR offers the added advantage of improving VO2 peak and 6MWT, measurements of cardiorespiratory fitness and functional capacity, respectively. These results suggest that HCTR can be a safe and effective alternative to traditional rehabilitation care, offering numerous benefits for CVD patients. Clinical Study Registration Number. This trial is registered with NCT02523560 and NCT02796404.

Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial

BackgroundLong-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a...

The Effect of High-Intensity Interval Training in People With Respiratory Disease: A Review Study

Background and Aims Exercise training is an important intervention in the pulmonary rehabilitation of adults with chronic respiratory diseases. High-intensity exercise is challenging for these patients. Thus, interval exercise has received much attention as a suitable option for optimizing a tolerable load during exercise. This study aimed to investigate the effects of high-intensity interval training (HIIT) on peak power, peak oxygen uptake, functional capacity, and health-related quality of life in people with chronic respiratory diseases. Methods In this study, the related studies were collected and examined from Google Scholar, PubMed, and Science Direct databases. Results A total of 14 randomized controlled trials were selected based on the study subject. The results demonstrated that HIIT and continuous training in adults with chronic obstructive pulmonary disease (COPD) led to significant improvement in peak power, peak oxygen uptake, and 6-minute walk test (6MWT) or 12-minute walk test (12MWT) distance and health-related quality of life and there was no significant difference between the two groups. And HIIT, compared to no exercise training, showed greater significant changes. Few studies have examined HIIT in patients with cystic fibrosis, with different results. We found no studies investigating the effect of HIIT on non-cystic fibrosis bronchiectasis and interstitial lung diseases. Conclusion studies confirm the positive effect of HIIT on cardiorespiratory fitness, exercise capacity, functional capacity, and health-related quality of life in people with COPD. In other respiratory diseases, more studies are needed to investigate the effects of HIIT.

Long-Term Effect of COVID-19 on Lung Imaging and Function, Cardiorespiratory Symptoms, Fatigue, Exercise Capacity, and Functional Capacity in Children and Adolescents: A Systematic Review and Meta-Analysis.

The long-term sequela of COVID-19 on young people is still unknown. This systematic review explored the effect of COVID-19 on lung imaging and function, cardiorespiratory symptoms, fatigue, exercise capacity and functional capacity in children and adolescents ≥ 3 months after infection. A systemic search was completed in the electronic databases of PubMed, Web of Science and Ovid MEDLINE on 27 May 2022. Data on the proportion of participants who had long-term effects were collected, and one-group meta-analysis were used to estimate the pooled prevalence of the outcomes studied. 17 articles met the inclusion criteria, presented data on 124,568 children and adolescents. The pooled prevalence of abnormalities in lung imaging was 10% (95% CI 1-19, I2 = 73%), abnormal pulmonary function was 24% (95% CI 4-43, I2 = 90%), chest pain/tightness was 6% (95% CI 3-8, I2 = 100%), heart rhythm disturbances/palpitations was 6% (95% CI 4-7, I2 = 98%), dyspnea/breathing problems was 16% (95% CI 14-19, I2 = 99%), and fatigue was 24% (95% CI 20-27, I2 = 100%). Decreased exercise capacity and functional limitations were found in 20% (95% CI 4-37, I2 = 88%) and 48% (95% CI 25-70, I2 = 91%) of the participants studied, respectively. Children and adolescents may have persistent abnormalities in lung imaging and function, cardiorespiratory symptoms, fatigue, and decreased functional capacity between 3 to 12 months after infection. More research is needed to understand the long-term effect of COVID-19 on young people, and to clarify its causes and effective management.

Postural balance, muscle strength and functional capacity on the severity level of chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent and progressive airflow obstruction. It is a lung disease with systemic manifestations, which contributes to an increase in morbidity and mortality in the elderly. The greater the severity of the disease, more muscle loss occurs, especially the quadriceps muscle, leading to decreased resistance to exercise, increased fatigue, and dyspnea to small efforts. The presence of COPD is associated with an increased risk of falls, and patients with COPD have a greater imbalance when compared with subjects of the same age without the disease. To investigate whether the different degrees of severity of COPD interfere in the balance, muscle strength, and functional capacity of the patients. Methods: 25 individuals diagnosed with COPD (COPD-G) and 32 individuals without pulmonary disease (CG - Control Group) were assessed. Both groups were submitted to anamnesis, spirometry, dynamometry, manovacuometry, Incremental Shuttle WaIking Test (ISWT), load testing for one repetition maximum (1RM), balance platform assessment, Stair-Climbing Test (SCT) and 6 Minutes Walk Test (6MWT). The variables obtained were compared using the t-test. For comparison between groups, a one-way ANOVA was used. Results: The comparison between the two groups showed a difference in the result of the ISWT, 6MWT and SCT. When compared between groups in different degrees of severity, there was a difference only in SCT between CG and severe COPD-G. There was no significant difference in strength and postural balance. Conclusion: Cardiorespiratory functional capacity is impaired in individuals with COPD and is more evident in the severe stage of the disease. The balance, the strength of the respiratory muscles, upper and lower limbs are similar in the mild, moderate, and severe stages.

Cardiorespiratory fitness is a risk factor for lower-limb and back injury in law enforcement officers commencing their basic training: a prospective cohort study

ABSTRACT We aimed to report the epidemiology of lower-limb and lumbosacral injuries in Police Force recruits. We performed a cohort study of Police Force recruits undergoing a six-month training program with prospective injury data collected between 2018 and 2021. Cardiorespiratory fitness was quantified by the beep-test and police-specific-functional-capacity was quantified using a specifically designed physical performance evaluation (PPE) tool. Injury frequency and prevalence were reported. Fifteen percent (n = 180) of study Police Force recruits (n = 1,181) sustained a lower-limb or lumbosacral injury. The six-month training program significantly improved cardiorespiratory fitness (p < 0.001) and functional capacity (p < 0.001). Increased cardiorespiratory fitness at baseline decreased injury risk (OR = 0.8, 95%CI: 0.66–0.97, p = 0.019). Injury rates decreased over time and females were injured significantly earlier than males (HR = 0.70, 95%CI: 0.52 to 0.95, p = 0.021). Interventions that can pre-condition Police Force recruits prior to the commencement of their basic physical training may reduce the number of lower-limb and lumbosacral injuries.

Comparative effect of incentive spirometry and diaphragm breathing to functional capacity in COVID-19 patient in an isolated ward

Background: COVID-19 affects the multiorgan system, mostly the respiratory system. Symptoms might vary from upper respiratory manifestation to acute respiratory distress syndrome, with the main feature being impairment of gas exchange. This pulmonary impairment might lead to a decrease in functional capacity, which cause activity limitation. Thus, COVID-19 patient requires the right pulmonary rehabilitation strategy to improve pulmonary function and prevent further pulmonary complications. This study aimed to compare the effectiveness of incentive spirometry and diaphragm breathing exercise on cardiorespiratory functional capacity in COVID-19 patients. Methods: Subjects were divided into two groups of breathing exercises, the incentive spirometry group and the diaphragm breathing exercise group. They performed breathing exercises for 5 days, and the functional capacity was measured by a test named 4-meter gait time test (4MGT) and 30 sit-to-stand test (30STS). The test was taken before and after performing breathing exercises. Results: These two respiratory exercises significantly affected the functional capacity in a good manner (p &lt; 0.05). The incentive spirometry had improved 30STS (P = 0.763) and 4MGT results (P = 0.674), as well as diaphragm breathing exercise did to 30STS (P = 0.456) and 4MGS (P = 0.441). Conclusion: In conclusion, diaphragm breathing exercises and incentive spirometry improved the functional capacity of COVID-19 patients. However, incentive spirometry showed a larger effect on 30STS and 4MGT compared to diaphragm breathing exercises.

Respiratory and functional tests in the assessment and prognosis of patients with chagas disease

Chagas disease causes an important impact on cardiorespiratory system, functional and working capacity of the patient. Performing a functional assessment on these individuals becomes essential, since the impact of physical limitation is an important factor that is related with other life domains, such as risk of cardiovascular events in a brief period and risk of death. The goal of this work was to perform a literature review to present the evaluative and prognostic value of main valid respiratory and functional tests in patients with Chagas disease, as well as their applicability and reproducibility. A literature search was performed from 1981 to 2020 in Scielo, Pubmed/Medline, Science Direct, Scopus and Web of Science databases. Only complete studies published in English, Portuguese or Spanish were analyzed which specifically discussed the respiratory and functional tests used in patients with Chagas disease. In total, 544 articles were retrieved of which 35 were eligible. The main functional tests approached were Cardiopulmonary Exercise Testing, Incremental Exercise Testing and Six-Minute Walk Test. Several studies show themselves as useful markers for predicting quality of life, mortality and functional impairment, in addition to other patients’ characteristics. Several tests can be used to assess the respiratory and functional impact to patients’ health, as well as its relationship with important domains of their lives. KEY WORDS: Chagas disease; Chagas cardiomyopathy; exercise test; respiratory function tests; prognosis.

Effects of two different inspiratory muscle training devices on respiratory muscle strength, cardiopulmonary functional capacity, and quality of life of COPD patients

Inspiratory muscle weakness is one of the complications of chronic obstructive pulmonary disease (COPD). This condition has been minimized by inspiratory muscle training (IMT). Still, different IMT devices need to be compared to identify the best option. Objective: To evaluate the effects of two IMT devices on respiratory muscle strength, cardiorespiratory functional capacity, and life quality of COPD patients. Method: Before and after the IMT protocol, 17 patients were submitted to manovacuometry, six-minute walk test (6MWT), and questionnaire from the Saint George Hospital in Respiratory Disease (SGRQ) for inspiratory muscle strength, cardiorespiratory functional capacity, and life quality assessments, respectively. Afterwards, they were divided into two groups to perform IMT for four weeks, one by Threshold® IMT (IMTG) and the other by POWERbreathe® Classic (PG). Results: Maximal inspiratory pressure increased significantly from -62.00±16.03 to -75.55±22.84 cmH2O in IMTG, and from -56.00±22.01 to -71.25±27.67 cmH2O in PG. The distance covered in the 6MWT clinically increased with both IMTG and PG. The SGRQ answers showed improvements in all domains evaluated for both groups. However, the intergroup results showed no statistically significant differences. Conclusion: Both IMT devices increased inspiratory muscle strength, improved life quality, and optimized cardiorespiratory functionality in COPD patients. None was superior to the other for the analyzed parameters.

The Effect Of Adipose Tissue Distribution On Aerobic Capacity In Male Overweight Subjects

It has been demonstrated that the predominantly abdominal fat distribution compared withperipheral fat mass decrease the lipids oxidation rates during exercise in normal weight and obese woman. PURPOSE: The aim of this study was to investigate the impact of a low vs high ratio of android to gynoid body fat mass on: 1) cardiorespiratory functional capacity (CFC) and 2) ventilatory thresholds in overweight male subjects (OMS). METHODS: Forty two recreationallyactive men (between 2 - 6 h/week of physical activiy) with a mean age of 34.0 + 6.3 wereallocated in two groups: lower android to gynoid L(A/G) ratio (n=19; A/G ratio= 0.85+ 0.14);and the other group with higher H(A/G) ratio (n=23; A/G ratio=1.16+ 0.13). The maximal cardiorespiratory exercise test (Cortex, Metalyzer IIIB, Lipizieg, Germany) was performed on a treadmill using a ramp protocol with workoload (1 km/h) increment every 1 minute in order to determine maximal oxygen consumption (VO2 max), ventilatory anaerobic threshold (VAT), and respiratory compensation point (RCP). A dual X-ray absorptiometry (DXA) was used (GEMedical Systems Lunar, Madison, USA) to measure body composition: total mass, fat mass and skeletal muscle index. Android and gynoid fat were measured, and the ratio between them was calculated (A/G ratio). RESULTS: Regarding body composition the L-A/G showed lower values than H- A/G group for android to gynoid ratio (0.85 + 0.14 vs. 1.16 + 0.13, respectively, p=0.01).In addition, the L-A/G group showed lower values to fat mass index (6.6 + 2.8 vs. 8.5 + 2.4 Kg/m2respectively, p=0.04). No differences (p>0.05) were observed between L-A/G than H-A/G to skeletal muscle index (20.2 + 2.5 vs.18.9 + 1.3 Kg/m2, respectively) and body mass index (27.6+ 2.3 vs. 28.6 + 1.4 Kg/m2 respectively, p=0.13). Regarding CFC, the L-A/G showed greater values to VO2 max (44.4 + 5.4 vs. 37.9 + 5.8 ml/kg/min, respectively, p=0.001). In addition, the L-A/G presented greater values to VO2 at VAT (27.7 + 5.3 vs. 23.5 + 6.1 ml/kg/min, p=0.03) and RCP (40.0 + 7.7 vs. 33.5 + 6.5 ml/kg/min, p=0.01) compared to H-A/G. CONCLUSION: Our findings indicate that body fat distribution with predominantly android fat mass reduces aerobic capacity in OMS. Furthermore, these results suggest that OMS with lower A/G ratio show greater skeletal muscle oxidative capacity during exercise.

Effects of two different inspiratory muscle training devices on respiratory muscle strength, cardiopulmonary functional capacity, and quality of life of COPD patients

Introduction: Inspiratory muscle weakness is one of the complications of chronic obstructive pulmonary disease (COPD). This condition has been minimized by inspiratory muscle training (IMT). Still, different IMT devices need to be compared to identify the best option. Objective: To evaluate the effects of two IMT devices on respiratory muscle strength, cardiorespiratory functional capacity, and life quality of COPD patients. Method: Before and after the IMT protocol, 17 patients were submitted to manovacuometry, six-minute walk test (6MWT), and questionnaire from the Saint George Hospital in Respiratory Disease (SGRQ) for inspiratory muscle strength, cardiorespiratory functional capacity, and life quality assessments, respectively. Afterwards, they were divided into two groups to perform IMT for four weeks, one by Threshold® IMT (IMTG) and the other by POWERbreathe® Classic (PG). Results: Maximal inspiratory pressure increased significantly from -62.00±16.03 to -75.55±22.84 cmH2O in IMTG, and from -56.00±22.01 to -71.25±27.67 cmH2O in PG. The distance covered in the 6MWT clinically increased with both IMTG and PG. The SGRQ answers showed improvements in all domains evaluated for both groups. However, the intergroup results showed no statistically significant differences. Conclusion: Both IMT devices increased inspiratory muscle strength, improved life quality, and optimized cardiorespiratory functionality in COPD patients. None was superior to the other for the analyzed parameters.

Submaximal Walking Tests: A Review of Clinical Use

ABSTRACT Though graded exercise testing is the gold standard for assessing cardiorespiratory fitness, submaximal exercise testing is also useful to assess cardiorespiratory status and functional capacity when maximal testing is not feasible. Submaximal walking tests are advantageous as they have less risk, lower cost, require less time and equipment, and walking is a familiar activity that is easy to do in most environments. A number of submaximal walking tests exist for both overground and treadmill walking. Regression equations to predict V̇o2max values based on walking time, distance, and other variables that influence exercise tolerance have been developed for some submaximal tests, including the Rockport Fitness Walking Test and the Single-Stage Treadmill Walk Test. The 6-Minute Walk Test is a common test used in clinical populations to predict prognosis and assess change in functional capacity after intervention. Determining which submaximal walking test to use depends on purpose and setting, subject characteristics, equipment availability, space, and time. This review will provide clinicians with an overview of submaximal walking test protocols and provide reference equations and minimal clinically important difference values to interpret results.

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study.

Purpose To evaluate the influence of previous levels of physical activity on hemodynamic, vascular, ventilatory, and functional outcomes after coronavirus disease 2019 (COVID-19) hospitalization. Methods Sixty-three individuals with COVID-19 had their clinical status and previous levels (12 month) of physical activity (Baecke Questionnaire of Habitual Physical Activity) assessed at hospital admission. Individuals were then allocated to lower levels of physical activity (ACTLOWER; N = 22), intermediate levels of physical activity (ACTINTERMEDIATE; N = 22), or higher levels of physical activity (ACTHIGHER; N = 19) groups, according to tertiles of physical activity. Resting hemodynamic (heart rate and brachial/central blood pressures) and vascular (carotid-femoral pulse wave velocity, augmentation index, and brachial artery flow-mediated dilation) variables, pulmonary function (spirometry), respiratory muscle strength (maximal respiratory pressures), and functional capacity (handgrip strength, five-time sit-to-stand, timed-up and go, and six-minute walking tests) were measured at 30 to 45 days after hospital discharge. Results ACTLOWER showed lower levels (P < 0.05) of forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation, and maximal expiratory pressure than ACTHIGHER. ACTLOWER also had lower (P = 0.023) walking distance (~21%,) and lower percentage of predicted walking distance (~20%) at six-minute walking test during follow-up than ACTINTERMEDIATE. However, hemodynamic and vascular variables, handgrip strength, five-time sit-to-stand, and timed-up and go were not different among groups. Conclusion ACTLOWER showed impaired ventilatory parameters and walking performance when compared with ACTHIGHER and ACTINTERMEDIATE, respectively. These results suggest that previous levels of physical activity may impact ventilatory and exercise capacity outcomes 30 to 45 days after COVID-19 hospitalization discharge.

Abstract 13852: Key Value of Inspiratory Muscle Performance and Training in a Home-Based Program to Improve Functional Capacity in Older Heart Failure Patients

Introduction: Patients with heart failure (HF) often have reduced exercise tolerance. Exercise training has putative value but is often limited by poor adherence or the effects of frailty. Baseline inspiratory muscle performance (IMP) may predict exercise limitation, and inspiratory muscle training (IMT) may have important clinical benefit, including offsetting the metaboreflex which may improve functional capacity by reducing sympathetic peripheral vasoconstriction induced by respiratory fatigue. We hypothesize that low IMP is an important predictor of exercise performance in older adults with HF and that IMT may be an effective home-based training program. Methods: Thirty-four male patients with HF (age and left ventricular ejection fraction of 69±7 years and 37±11%, respectively) were randomized into IMT (n=11) or aerobic and/or strength training (AST; n=23) for a 12-week home-based program. IMT was performed progressively from 50-85% of maximal inspiratory pressure (MIP) with the PrO 2 device (Smithfield, RI) which tracked data and adherence for comparison to AST regimens of cycle ergometry/walking and strength training individually advanced to achieve moderate to high intensities. Study endpoints included MIP, peak oxygen uptake (VO 2 ), 6-minute walk distance (6MWD), 30-second sit-to-stand (STS), grip strength, and leg strength (endurance, 1-rep max, and power). Results: IMT was well-tolerated with greater adherence (92±10% vs 79±34%) and a significantly greater MIP rise (25.3±25.0% vs 3.6±11.0%, p&lt;0.05). Baseline MIP greater than the median of 66 cmH 2 O across all exercise forms (n=18) was associated with significantly greater baseline and post-intervention peak VO 2 (16.4±5.0 vs 12.9±3.9 and 17.5±5.3 vs 13.4±3.1, p&lt;0.05) and was significantly correlated positively to change in 6MWD, STS, grip strength, and leg strength (r=0.352-0.504, p&lt;0.05). Conclusion: Home-based IMT significantly improved IMP and greater baseline IMP was associated with greater cardiorespiratory fitness, functional capacity, and trainability in older HF patients due likely to metaboreflex attenuation and greater adherence. Further study is needed to assess IMP and IMT performed alone or combined with AST regimens to address the growing HF population.

The Incremental Shuttle Walk Test

The Incremental Shuttle Walk Test

Implementing Exercise in Standard Cancer Care (Bizi Orain Hybrid Exercise Program): Protocol for a Randomized Controlled Trial.

BackgroundDespite the established benefits of regular exercise for patients with cancer to counteract the deleterious effects of the disease itself and treatment-related adverse effects, most of them do not engage in sufficient levels of physical activity and there is a paucity of data on the integration of efficacious exercise programs that are accessible and generalizable to a large proportion of patients with cancer into routine cancer care.ObjectiveWe intend to examine the effects attributable to the implementation of a community-based exercise program on cardiorespiratory functional capacity and quality of life for patients with cancer.MethodsThis will be a hybrid study. In the first experimental phase, patients diagnosed with any type of cancer will be randomized into two parallel groups. One group immediately performs Bizi Orain, a 3-month supervised exercise program (3 times a week), in addition to behavioral counseling in a primary health care setting; the other is a reference group that starts the exercise program 3 months later (delayed treatment). In the second observational phase, the entire cohort of participants will be followed-up for 5 years. Any person diagnosed with cancer in the previous 2 years is eligible for the program. The program evaluation involves the uptake, safety, adherence, and effectiveness assessed after completion of the program and with follow-ups at 3, 6, 12, 24, 36, 48, and 60 months. The primary outcomes of the experimental study, to be compared between groups, are improved physical function and quality of life, whereas overall survival is the main objective of the prospective study. To analyze the association between changes in physical activity levels and overall survival, longitudinal mixed-effects models will be used for repeated follow-up measures.ResultsA total of 265 patients have been enrolled into the study since January 2019, with 42 patients from the hematology service and 223 from the oncology service.ConclusionsBizi Orain is the first population-based exercise program in Spain that will offer more insight into the implementation of feasible, generalizable, and sustainable supportive care services involving structured exercise to extend survival of patients with cancer, improve their physical function and quality of life, and reverse the adverse effects of their disease and related treatments, thereby reducing the clinical burden.Trial RegistrationClinicalTrials.gov NCT03819595; http://clinicaltrials.gov/ct2/show/NCT03819595International Registered Report Identifier (IRRID)DERR1-10.2196/24835

The Importance Of Physical Exercise In Cardiorespiratory Fitness In Active Breast Cancer Patients

In the last ten years, there has been a strong and increasing interest in the role of physical exercise in breast cancer (BC) patients demonstrating that physical exercise may control and reduce treatments side effects improving their quality of life, reducing fatigue and depression levels, improving their cardiorespiratory fitness (CRF), functional capacity and strength. CRF is a value associated with better survival in BC patients. However, there is no knowledge about if active survivors could achieve similar values of CRF than active healthy women and the impact of a sedentary behaviour in these groups of women. PURPOSE: To stablish the role of physical exercise in CRF measured by V02 max in active breast cancer women (Act-BCW) compared to healthy women (HW) METHODS: Ninety two women were divided in four different groups: sedentary breast cancer women (Sed-BCW), active breast cancer women (Act-BCW), sedentary healthy women (Sed-HW) and active healthy women (Act-HW). All of them carried out a battery of six physical test. RESULTS: In terms of VO2, it was observed significant differences between all the groups (p < 0,05) except Act-HW and Act-BCW. (0,753). V02 values were: 42,11 ± 3,63 (Act-BCW), 36,26 ± 4,46 (Sed-BCW) 41,69 ± 4,31 (Act-HW) 34,56 + 5,72 (Sed-HW). Means differences, CI 95% and significance are shown in table 1.Table 1. Mean differences, CI 95% and significance in VO2 between groups.CONCLUSIONS: Act-BCW could achieve same values in V02 max that Act-HW, but also, they could achieve even higher values. For this reason, it is crucial to promote the practice of physical activity in breast cancer patients, (at least 150 minutes/week) because their fitness capacity improves considerably, and this is related with better survival.

Effectiveness of physical exercise for people with chronic diseases: the EFIKRONIK study protocol for a hybrid, clinical and implementation randomized trial

BackgroundChronic illnesses are the leading cause of morbidity and mortality and threaten the sustainability of healthcare systems worldwide. There is limited evidence in terms of the best modality and intensity of physical activity for improving cardiorespiratory capacity and quality of life in patients with chronic conditions. The objective of the EfiKroniK study is to estimate the common effect of innovative, individualized and supervised physical exercise, on cardiorespiratory functional capacity and quality of life across people with different chronic conditions.Methods/designThis is a multicentre clinical trial with a type I hybrid effectiveness-implementation design, including 370 patients each with one of four different chronic illnesses: solid cancer, blood cancer, chronic obstructive pulmonary disease or schizophrenia. Patients will be randomly divided into two parallel groups, stratified by illness type. Patients in both groups will receive a standard healthy life prescription (PVS, from the Spanish “Prescribe Vida Saludable”) and additionally, the EfiKroniK group will be prescribed a physical exercise programme tailored to each patient in terms of intensity in each session. The primary outcome variables will be cardiorespiratory functional capacity and quality of life. The secondary outcome variables will be signs and symptoms, psychological and social factors and specific laboratory parameters. We will also analyse the dose-response effect of the physical exercise programme. Qualitative variables will describe patients’ perception of the utility and suitability of the EfiKroniK programme, as well as their expectations and satisfaction, identifying barriers to and facilitators of the EfiKroniK implementation process through discussion groups. The study will be carried out on an intention-to-treat basis, comparing changes throughout the 1-year follow-up between groups, adjusting for baseline, by performing mixed-effect analysis of covariance. We will estimate the effect of time on repeated measures in each subject and changes in the EfiKroniK and PVS groups over time.DiscussionThe study will provide the data necessary to allow us to prescribe physical exercise in a similar way to a drug and as a key part of the treatment of chronic illnesses within our healthcare system.Trial registrationNCT03810755.Date and version identifier: October 9, 2020. Version2.0.