Functional Exercise Capacity In Patients Research Articles

Use of One-minute Sit-to-stand Test to Predict Functional Exercise Capacity in Patients With Congenital Heart Disease

IntroductionField tests are commonly used as complements of cardiopulmonary exercise test (CPET) to evaluate the functional exercise capacity. The aims of this study were to validate the one-minute sit-to-stand test (STST) in congenital heart disease (CHD) children and to evaluate the possibility of predicting the peakVO2 using the STST in this paediatric population. MethodsChildren (8- to 18-year-old) followed for a CHD and performing CPET were recruited prospectively. Concomitantly, they performed STST. The heart rate (HR), oxygen saturation (SpO2), muscular fatigue and dyspnoea were recorded before (t0), immediately after (t1) and 1min after the end of the STST (t2). ResultsWe observed a poor but significant correlation between the STST and the peakVO2 (r=0.306; p=0.013). A significant difference between girls and boys were observed for peakVO2 (p<0.001), HR t0 (p=0.030), HR t1 (p=0.002) and HR t2 (p<0.001). The proposed model of prediction, including the number of STST, weight, height and age explains 37% of the predicted peakVO2 variance. ConclusionThe STST can provide relevant data on physical capacity in children with CHD. When CPET cannot be performed, we therefore propose an alternative equation using the STST as a surrogate of peakVO2 in CHD children.

A POTENTIAL PARAMETER FOR ASSESSMENT OF EXERCISE CAPACITY IN PATIENTS WITH IDIOPATHIC PULMONARY DISEASE

https://youtu.be/_jIKpatUoGA BACKGROUND A 6-minute walk distance (6MWD) is widely used to assess functional exercise capacity in patients with cardiac or pulmonary disease and is known to hold strong prognostic utility. However, previous studies have shown that bodyweight negatively affects the predictive accuracy of the 6MWD. 6-minute walk work (6MWORK = 6MWD X bodyweight) has been shown to be more strongly associated with clinical markers in patients with chronic obstructive pulmonary disease (COPD), however, this has not been investigated in patients with idiopathic pulmonary fibrosis (IPF). This study aims to determine whether 6MWORK has a stronger correlation with clinical parameters compared to 6MWD in male patients with IPF. METHODS Clinical data was retrospectively analyzed from 22 male patients with IPF. Linear correlations between lung function, 6MWORK and 6MWD were performed. RESULTS There was a positive correlation between 6MWD and forced expiratory volume in the first second (FEV1) (r=0.488, p=0.021), while a strong positive correlation existed between 6MWORK and FEV1 (r=0.558, p=0.007). There was also a strong positive correlation between 6MWORK and FEV1/forced vital capacity (FVC) ratio (r=0.564, p=0.006), while there was no correlation between 6MWD and FEV1/FVC (r=0.320, p=0.146). Moreover, when performing a linear regression analysis, the FEV1 (β=0.411, p&amp;lt;0.033) and FEV1/FVC (β=0.420, p&amp;lt;0.030) were significant unique contributors to 6MWORK. The model was statistically significant check(R-square=0.47, F(2, 19)=8.31, p&amp;lt;0.003). CONCLUSION 6MWORK appears to be more closely associated with clinical parameters in male patients with IPF compared to 6MWD. 6MWORK may better characterize the clinical status of patients with IPF. Further study is needed to investigate the ability of 6MWORK to predict clinical endpoints.

The effect of respiratory muscle training on respiratory muscle strength, diaphragm thickness/mobility, and exercise capacity in patients with systemic lupus erythematosus and associated shrinking lung syndrome.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can impact any organ in the body. The pathophysiology of shrinking lung syndrome (SLS), a rare pulmonary complication of SLE, remains unknown. The objective of the current case series was to investigate the effects of inspiratory muscle training (IMT) on diaphragm thickness/mobility, respiratory muscle strength, peripheral muscle thickness/strength, and functional exercise capacity in patients with SLE and associated SLS. Three patients with SLE were included in the case series. Respiratory muscle strength, peripheral muscle strength, peripheral muscle thickness, diaphragm muscle thickness, diaphragm muscle mobility, functional exercise capacity, and pulmonary function test were assessed. A significant improvement has been determined in respiratory muscle strength, functional exercise capacity, peripheral muscle strength, peripheral muscle thickness, diaphragm muscle thickness, and diaphragm muscle mobility. This is the first case series showing the beneficial effects of IMT on respiratory muscle strength, diaphragm thickness/mobility, peripheral muscle thickness/strength, and exercise capacity in patients with SLE.

Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

ObjectiveTo evaluate the adherence to treatment and efficacy of an eccentric-based training (ECC) program on peripheral muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DesignProspective, assessor-blinded, randomized controlled trial. SettingThe cardiopulmonary rehabilitation unit of a tertiary subacute referral center. ParticipantsThirty (N=30) stable inpatients (mean age 68±8 years; FEV1 44±18% of predicted) with COPD were included in the study. InterventionsInpatients were randomly assigned to 4 weeks of a combined endurance and resistance ECC (n=15) or conventional training (CON; n=15). Main Outcome MeasuresQuadriceps peak torque (PT) was the primary outcome measure for muscle function. Rate of force development (RFD), muscle activation and quality (quadriceps PT/leg lean mass), 6-min walk distance (6MWD), 4-meter gait speed (4mGS), 10-meter gait speed, 5-repetition sit-to-stand (5STS), dyspnea rate, and mortality risk were the secondary outcomes. Evaluations were performed at baseline and repeated after 4 weeks and 3 months of follow-up. ResultsQuadriceps PT, RFD, and muscle quality improved by 17±23% (P<.001), 19±24%, and 16±20% (both P<.05) within the ECC group. Besides, a significant between-group difference for RFD (56±94 Nm/s, P=.038) was found after training. Both groups showed clinically relevant improvements in 6MWD, 4mGS, dyspnea rate, and mortality risk, with no significant differences between groups. ConclusionCombined endurance and resistance ECC improved lower limbs muscle function compared with CON in inpatients with COPD. In contrast, ECC did not further improve functional performance, dyspnea, and mortality risk. ECC may be of particular benefit to effect on skeletal muscle function in patients with COPD.

Ventilation dynamics using a portable device coupled to the six-minute walk test in people with long-COVID syndrome: a preliminary study

ObjectiveTo investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS).ResultsSixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4–20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386–478) m, which corresponds to a value of 83% (78–97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO2peak) was 19 (14–37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (rs=-0.499, P = 0.039) and VO2peak (rs=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems.

Test Retest Reliability and Validity of 1-Minute Sit-to-Stand Test in Patients With Chronic Heart Failure.

The psychometric properties of the 1-minute sit-to-stand (1STS) test have not been investigated in patients with chronic heart failure (CHF). The aim of this study was to evaluate test-retest reliability, construct validity, and minimal detectable change of the 1STS test and to investigate the physiological response to the 1STS test in patients with CHF. Forty-three (43) patients with CHF were included. Demographic and clinical features were recorded. To investigate test-retest reliability, participants performed two 1STS tests on the same day. The correlations between the 1STS test and the 6-minute walk test (6MWT), functional class, pulmonary function, quadriceps muscle strength, and physical activity were investigated for validity. The physiological responses and symptom perception were assessed before and after both the 1STS test and 6MWT. Excellent test-retest reliability was found for the 1STS test, with an intraclass correlation of 0.932 (95% confidence interval 0.874-0.963). The minimal detectable change of the 1STST test was 3.7 repetitions. The 1STS test was correlated with 6MWT distance, age, functional class, pulmonary function, quadriceps muscle strength, and physical activity (p<0.05). The 1STS test showed similar changes to the 6MWT in physiological responses and symptom perception (p>0.05), except for leg fatigue (p=0.02). The 1STS test is reliable and valid in evaluating functional exercise capacity in patients with CHF. The 1STS test reveals similar cardiac demand to the 6MWT. The 1STS test may be considered an option when traditional tests are impractical in terms of space and time.

Reliability and Responsiveness of Endurance Shuttle Walk Test to Estimate Functional Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis.

The endurance shuttle walk test (ESWT) is a simple, acceptable, field-based test first established in 1999 to measure endurance exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to examine the reliability and responsiveness of ESWT in COPD. Of the 791 articles identified through electronic databases, 17 were included in this review. Qualitative and quantitative analyses were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and as per Consensus-Based Standards for the Selection of Health Status Measurements Instruments, the quality of the studies was graded as low for reliability and moderate for responsiveness. Qualitative analysis indicated inadequate evidence for the reliability of the ESWT in patients with COPD. The meta-analysis found strong evidence that ESWT was responsive to change following pulmonary rehabilitation with an estimated mean difference (ESWT time, seconds) 303.19 s (95% CI: 175.63-430.75; p< 0.001), ambulatory oxygen with a mean difference (ESWT time, seconds) 129.04 s (95% CI: 47.98-210.09; p = 0.002), and (ESWT mean distance, meters) 80.71 m (95% CI: 38.66-122.76; p < 0.001). The ESWT was also responsive to bronchodilation with a mean difference of 168.62 m (95% CI: 117.03-220.21; p < 0.001). Our findings suggest the strong potential of ESWT as a responsive test in COPD, but to draw a definitive conclusion regarding the reliability of the ESWT, further research is needed in this population.

Six-minute stepper test for evaluating functional exercise capacity in patients with sarcoidosis

BackgroundResearchers and clinicians may benefit from alternative tests that do not require large physical spaces or corridors for simply evaluating functional exercise capacity in the clinical practice. ObjectiveAim of this study was to investigate whether six-minute stepper test (6MST) is a valid tool for measuring functional exercise capacity in patients with sarcoidosis. MethodsThirty-six patients with sarcoidosis and 18 healthy controls were evaluated with 6MST and six-minute walk test (6MWT). Patients performed 6MST twice. Cardiovascular and symptom responses to tests including heart rate, blood pressure, SpO2, levels of dyspnea and fatigue were recorded. ResultsReceiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve of 0.74 for 6MST in identifying the patients and controls, indicating acceptable discriminative ability. Patients performed significantly worse in 6MST compared to controls (277±54 vs 349±87 steps; p<0.001). 6MST was able to explain 66% of variance in 6MWT (p<0.001), and there was a strong relationship between 6MWT and 6MST (r = 0.812). SpO2 responses to tests were similar, however, 6MST generated more severe heart rate, dyspnea and fatigue responses. Intraclass correlation coefficient calculated for initial and retest scores of 6MST was 0.990, indicating excellent test-retest reliability. However, there was a systematical improvement (∼4%) in retest 6MST scores. Conclusions6MST is a valid and reliable alternative test for measuring functional exercise capacity in sarcoidosis. 6MST may also help better testing the upper limits of cardiac system and physical endurance as it is more physically demanding than 6MWT.

Reliability and validity of the glittre activities of daily living test in fully ambulatory multiple sclerosis patients.

Evaluation of activities of daily living (ADL) and functional exercise capacity in patients with multiple sclerosis (pwMS) is crucial in demonstrating the effectiveness of interventions. To investigate the reliability and validity of the Glittre ADL Test in pwMS. Twenty-five pwMS and 26 healthy adults were included in this methodological study. The Glittre ADL Test was applied. Six-Minute Walk Test (6MWT) and Nottingham Extended Activities of Daily Living Index (NEADL) were applied for concurrent validity. Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Mini Balance Evaluation Systems Test (Mini BESTest), Multiple Sclerosis Quality of Life Scale-54 (MSQoL-54), and Five Times Sit-to-Stand Test (5 STST) were applied for construct validity. The Glittre ADL Test was repeated after 3-6days for test-retest reliability. The test-retest reliability of the Glittre ADL Test was excellent (ICC = 0.941). There was strong correlation of the Glittre ADL Test with 6MWT (rho = - 0.710, p < 0.001), NEADL (rho = - 0.841, p < 0.001), EDSS, (rho = 0.836, p = < 0.001), Mini BESTest (rho = 0.792, p < 0.001), and 5 STST scores (rho = 0.720, p < 0.001). There was a moderate correlation between the Glittre ADL Test and the physical health sub-item score of the MSQoL-54 (rho = - 0.591, p = 0.002). No correlation was found between the Glittre ADL Test and FSS (rho = 0.348, p = 0.096). There was a difference in the Glittre ADL Test results between the pwMS and the healthy adults (p = 0.001). The Glittre ADL Test has excellent reliability and strong construct and criterionvalidity for assessing functional exercise capacity and ADL in fully ambulatory pwMS. TRN: NCT04182269.

CORRELATION OF 6MWD WITH FEV1% &amp; DLCO% IN COPD PATIENTS

BACKGROUND: Chronic obstructive pulmonary disease is the third leading cause of death worldwide, causing 3.23 million deaths in 2019 according to WHO. Nearly 90% of COPD deaths in those under 70 years of age occur in low and middle income countries (LMIC). There may be a considerable nancial burden due to limitation of workplace and home productivity, and costs of medical treatment. Spirometry is used not only for conforming the diagnosis but also for grading the severity of COPD. 6MWD test has gained importance's in the assessments of functional exercise capacity in patients with COPD and other Respiratory diseases. Diffusion Capacity of the Lung for Carbon Monoxide (DLCO) has been employed as an additional investigation to aid in assessing the properties of gas transfer in many respiratory diseases. It is a hospital based cross sectional and analytic MATERIALS AND METHODS: al study performed over a period of 12 months (June 2021-june 2022) in the department of Respiratory medicine, Narayana medical college and hospital, Nellore, in 30 patients diagnosed with COPD and patients were subjected to 6MWD, spirometry and DLCO. RESULTS: Correlation between FEV1% &amp; DLCO%, FEV1% &amp; 6MWD and DLCO% &amp; 6MWD were done respectively. Among the rst correlation(FEV1% &amp; DLCO%) there is a statistically signicant moderate and strong positive correlation observed in severe and very severe patients respectively. Among the second correlation (FEV1% &amp; 6MWD) only in the whole sample there is statistically signicant moderate positive correlation observed. Among the third correlation (DLCO% &amp; 6MWD) only in severe patients of COPD there is a statistically signicant moderate positive correlation observed. There is a slightly greater correlation for DLCO% &amp; 6MWD compared to FEV1%. In CONCLUSION: severe COPD patients decline in 6MWD can be used to monitor the disease progression where as the decline in DLCO% can be used to keep track of the severe and very severe stages of COPD. Incorporating of DLCO in grading COPD severity can help as a marker of exercise capacity limitation.

Effect of Pursed Lip Breathing on Physiological Cost Index and Functional Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease

Background: Pursed lip breathing (PLB) is known to improve oxygenation by controlled ventilation. In COPD, PLB is adopted as a compensatory mechanism to maintain the patency of airways by creating a back pressure in airways. Objective: To find the effectiveness of Pursed lip breathing (PLB) on Physiological cost index (PCI) and functional exercise capacity in patients having COPD. Study design: This experimental study was carried out with one group pre test - post test design. Procedure: Thirty patients aged above 45 years and diagnosed as having mild and moderate COPD (as per GOLD staging) were assessed for their PCI and functional exercise capacity by six- minute walk test after their informed written consent. They were given 30 minutes of PLB training for 5 consecutive days. The post-interventional PCI and functional exercise capacity were reassessed. Results: The pre and post-intervention data of outcome measures was statistically analyzed using paired-t test. The results showed significant improvement in PCI and the functional exercise capacity. Conclusion: Pursed lip breathing was found to be more effective in improving Physiological Cost Index and six-minute walk performance in patients with mild to moderate COPD. Hence, it has been suggested to train pursed lip breathing voluntarily at early stages of COPD before the patient adopts it as compensatory mechanism on advanced stages

Prevalence of musculoskeletal pain and its impact on quality of life and functional exercise capacity in patients with pulmonary arterial hypertension

BackgroundIn pulmonary arterial hypertension (PAH), pathophysiological consequences of the disease and the drugs used to treat PAH may adversely affect musculoskeletal system. Aim of the study was to evaluate musculoskeletal pain prevalence and its impact on quality of life (QoL) and exercise capacity in PAH patients. Methods61 PAH patients were evaluated with Nordic Musculoskeletal Questionnaire (NMQ) for musculoskeletal pain presence, EmPHasis-10 and Minnesota Living with Heart Failure Questionnaire (MLHFQ) for QoL, 6-min walk test (6MWT) for functional exercise capacity and International Physical Activity Questionnaire- Short Form (IPAQ-SF) for physical activity participation. Results77% of PAH patients reported musculoskeletal pain. Pain prevalence was highest at low back (38%), followed by knees (36%), shoulders (36%) and neck (33%). Hemodynamic indicators of PAH severity were associated with pain presence in various parts of the body. Patients receiving any PAH-specific drug were more likely to experience pain compared to the patients whose drug therapy has not yet been initiated (RR = 1.6–2.0). Pain presence in neck, shoulder, low back and knees significantly correlated to worse QoL scores in both EmPHasis-10 and MLHFQ (p < 0.05). Pain presence in knees had the strongest influence on QoL, and it was the only significant correlate of 6MWT (r = −0.424) and IPAQ-SF (r = −0.264) (p < 0.05). ConclusionsMusculoskeletal pain is a common complaint in PAH patients, which significantly impairs QoL and physical functioning. Treatment strategies should include a more comprehensive assessment for musculoskeletal pain complaints of these patients and address pain presence accordingly, which may help providing a better management for PAH.

Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial

Objective To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. Design A prospective, randomized controlled trial. Setting A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. Intervention The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. Main measures The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. Results Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked (p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed (p = 0.363), lactate levels (p = 0.302), knee extensor strength (p = 0.117), handgrip strength (p = 0.882), global muscle strength (p = 0.104), electromyographic activity (p = 0.179) and Functional Independence Measure (p = 0.059). Conclusions Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

Test-retest reliability and validity of the 6 minute stepper test to evaluate functional exercise capacity in patients with ankylosing spondylitis.

The 6-minute stepper test (6MST) is a submaximal test that requires little space to assess exercise capacity compared to the 6-minute walk test (6MWT). The study aims to investigate the test-retest reliability and convergent validity of 6MST and to compare physiological responses, dyspnea, fatigue perception with 6MST and 6MWT in patients with ankylosing spondylitis (AS). To test the convergent validity of 6MST, 65 patients performed both 6MWT and 6MST on the first day and correlation between two tests were assessed with Pearson correlation test. In order to investigate the test-retest reliability of the 6MST, 32 of the 65 patients performed 6MST one week later and intraclass correlation coefficients (ICC) were calculated. Dyspnea and fatigue perception were analyzed with using Wilcoxon signed-rank test, physiological responses were analyzed using paired sample t-test. Excellent test-retest reliability was observed for 6MST (ICC: 0.988). There was a significant correlation between 6MST and 6MWT (r: 0.725, p < 0.001). Dyspnea and leg fatigue perception were significantly higher in 6MST (p < 0.05). Physiological responses and fatigue perception were similar in both 6MST and 6MWT (p > 0.05). This study demonstrated that the 6MST is reliable and valid method to evaluate exercise capacity in patients with AS. 6MST can be used to evaluate exercise capacity of patients with AS.

Nasal High-Flow Therapy during Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Background: Several studies have evaluated the effect of nasal high-flow (NHF) therapy to enhance exercise performance and tolerance in patients with chronic obstructive pulmonary disease (COPD); however, results are disparate. Objective: The aim of this systematic review and meta-analysis was to assess the effect of NHF therapy as an adjuvant to exercise training on functional exercise capacity in patients with COPD. Data Sources: An electronic search was performed in the following databases: PubMed, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, ScienceDirect, the Web of Science, OpenGrey, ClinicalTrials.gov, and European Respiratory Society and American Thoracic Society databases. Data Extraction: Two authors independently selected relevant randomized trials (parallel-group or crossover design), extracted data, assessed the risk of bias, and rated the quality of the evidence. Synthesis: Eleven studies were included, involving 408 participants (eight full papers and three conference abstracts). Most studies had a high risk of bias or other methodological limitations. The use of NHF therapy during a single session increased functional exercise capacity (standardized mean difference, 0.36 [95% confidence interval (CI), 0.03 to 0.69]; P = 0.03, heterogeneity [I2 = 83%]). When conference abstracts were included in the pooled analysis, the estimated effect did not change (P = 0.006). The use of NHF therapy throughout a pulmonary rehabilitation program (parallel-group randomized controlled trials) increased functional exercise capacity at 4-12 weeks compared with training without NHF therapy (standardized mean difference, 0.34 [95% CI, 0.00-0.68]; P = 0.05, heterogeneity [I2 = 18%]). Conclusions: There is very-low-quality to low-quality evidence that NHF therapy improves functional exercise capacity. Patient responses to NHF therapy were highly variable and heterogeneous, with benefits ranging from clinically trivial to worthwhile.

Walking training augments the effects of expiratory muscle training in Parkinson's disease.

To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W+RMT, n=15) and the RMT (n=15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15min of inspiratory muscle training and 15min of expiratory muscle training in both groups, and 15min of walking training in the W+RMT group in addition to RMT, twice per day, 5days/week, for a total of 8weeks at home. Training intensity was adjusted once per week for the groups at the hospital. Respiratory muscle strength and 6-min walking distance were significantly increased (p=.001), and UPDRS-III scores were significantly improved (W+RMT: p=.008 and RMT: p=.01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W+RMT group than in the RMT group (p=.007). Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Follow-up of functional exercise capacity in patients with COVID-19: It is improved by telerehabilitation

BackgroundThe impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic. MethodPatients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program. ResultsAt discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program. ConclusionsPatients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.

Does Duke Activity Status Index help predicting functional exercise capacity and long-term prognosis in patients with pulmonary hypertension?

BackgroundTo investigate the association of Duke Activity Status Index (DASI) with 6‐minute walk test (6MWT) and WHO-Functional Class (WHO-FC) in patients with pulmonary hypertension (PH), as well as exploring whether DASI can discriminate between the patients with better and worse long-term prognosis according to 400 m cut-off score in 6MWT. MethodsEighty-five medically stable PH patients who met eligibility criteria were included. All patients were evaluated using 6MWT and DASI. The prognostic utility of the DASI was assessed using univariate linear regression and receiver operating characteristic (ROC) curve analysis. ResultsThe DASI was an independent predictor for both 6MWT and WHO-FC, explaining 50% of variance in 6MWT and 30% of variance in WHO-FC class (p < 0.001). In addition, DASI significantly correlated to 6MWT (r = 0.702) and WHO-FC class (r = 0.547). The ROC curve analysis revealed that the DASI had a discriminative value for identifying the patients with better long-term prognosis (p < 0.001), with an area under ROC curve of 0.867 [95% CI = 0.782–0.952]. The DASI ≥26 was the optimal cut-off value for better long-term prognosis, having sensitivity of 0.74 and a specificity of 0.88. ConclusionsThe DASI is a valid tool reflecting functional exercise capacity in patients with PH. Considering its ability to discriminate between the patients with better or worse long-term prognosis, it may help identifying the patients at higher risk.

Effectiveness of Continuous Chest Wall Vibration With Concurrent Aerobic Training on Dyspnea and Functional Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

ObjectiveTo investigate the effects of continuous chest wall vibration with concurrent aerobic training in addition to a 4-week pulmonary rehabilitation program on dyspnea and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DesignRandomized, single-blind, placebo-controlled trial. SettingThe Cardiopulmonary Rehabilitation Unit of a tertiary referral subacute rehabilitation center. ParticipantsA sample of 146 consecutive patients with COPD (Global Initiative for Chronic Obstructive Lung Disease II-III-IV) were assessed for eligibility. The final sample of 40 patients (N=40) was randomized into 3 groups (intervention, sham intervention, control). InterventionsAll groups carried out 5 sessions per week for 4 weeks of standard pulmonary rehabilitation treatment. The 2 daily 30-minute sessions included aerobic training and resistance training or airway clearance techniques. The intervention group performed the aerobic training with the addition of continuous chest wall vibration applied during cycling, whereas the sham intervention group received continuous chest wall vibration as a placebo during cycling. Main Outcome MeasuresSix-minute walk distance (6MWD) and Barthel Index based on dyspnea (BID). ResultsA total of 36 participants completed the study (69±7 years; forced expiratory volume in 1 second percentage of predicted, 40.15%±15.97%). Intention to treat analysis showed no significant differences between groups for 6MWD and BID. However, the increase in 6MWD was a clinically important difference in the intervention group (42.57±43.87m, P=.003), with a moderate effect size (d=0.58). ConclusionsContinuous chest wall vibration with concurrent aerobic training in addition to a standard pulmonary rehabilitation program might improve functional exercise capacity compared with usual care, but there were no effects on dyspnea, respiratory muscle function, or quality of life in patients with COPD.

Abstract 13462: 6-minute Walk Test Variability May be Reduced by a Structured Training and Monitoring Program, Potentially Facilitating Detection of Treatment Effects

Background: The 6-minute walk test (6MWT) is well established for evaluation of functional exercise capacity in patients with conditions such as pulmonary hypertension, peripheral arterial disease and heart failure. Its popularity as an endpoint in heart failure trials has increased in parallel with health authority acceptance of the test as a measure of patients' function. Minimizing variability is key to the successful conduct and outcome of trials with 6MWT endpoints. We assessed the impact on walking distance variability of a structured training and monitoring program Methods: After systematically observing conduct of 6MWT worldwide, our core lab developed a multifaceted approach including inspection and standardization of the walking course, standardized training, review of the first 3 tests for each test administrator and random tests thereafter, standardized data collection methods, and assessment of intra-test inconsistencies with feedback. Variability of walking distance using this structured approach is descriptively compared with 6MWT data from the literature. Results: In a multicenter trial which used the structured program, the standard deviation (SD) of distance walked was 21.7% of the mean at baseline and 22.6% at Week 4 (Table). For comparison, we reviewed 2018-19 reports of 6MWT not utilizing this structured approach and identified 5 multicenter studies of patients with heart failure which reported mean and SD of distance walked (Table). Baseline distance walked ranged from 104 to 385 m (weighted mean 220.4 m); SD of distance walked ranged from 28% to 135% of distance walked (weighted mean 70.9%). Conclusion: Standardization of the 6MWT walking course, structured training of test administrators and monitoring of test quality may reduce test variability which could improve accuracy of treatment effect assessment and possibly require smaller sample sizes.