Functional Exercise Capacity Research Articles

A feasibility randomized controlled trial of a community-level physical activity strategy for older adults with motoric cognitive risk syndrome.

The motoric cognitive risk syndrome (MCR) is a syndrome characterized by subjective memory complaints and slow walking speeds that can identify older adults at increased risk for developing Alzheimer's disease or a related dementia (ADRD). To date, the feasibility of community-based physical activity (PA) programs for improving outcomes in MCR have yet to be examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) comparing 24-weeks of PA to a healthy aging education (HE) control intervention delivered within the infrastructure of an urban senior center in Greater Boston (clincaltrials.gov identifier: NCT03750682). An existing senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit, of whom 29 met the MCR criteria and 25 were randomized to PA or HE (mean age: 74.4 ± 7years; BMI: 32.4 ± 7kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1m/s; SPPB score 4.8 ± 1.9). Due to the Covid-19 pandemic the study was stopped prematurely. Participants could successfully adhere to the study interventions (overall attendance rate: PA: 69% vs. HE:70% at study termination). Participants also successfully completed baseline and follow-up study assessments that included a computerized cognitive testing battery and objective tests of physical performance and functional exercise capacity. No study-related adverse events occurred. Notable trends for improved cognitive performance, gait speed and 6-min walk distance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs of PA that may help to preserve the independence of vulnerable older adults at high risk for ADRD in community-based settings.

Cerebral Hypoxia During Intermittent Hypoxic-Hyperoxic Training (IHHT): A Case Study Using Cerebral Oximetry Based on Time-Domain Near-Infrared Spectroscopy.

In intermittent hypoxia-hyperoxia training (IHHT), air is inhaled through a mask, with the O2 content of the air varying at intervals. IHHT is used in sports training (e.g. to improve exercise tolerance), but also in medical-therapeutic applications (e.g. to improve cognitive performance and functional exercise capacity in geriatric patients). We aimed to evaluate the ability of a novel time-domain near-infrared spectroscopy (TD-NIRS) device to measure the effects of IHHT on cerebrovascular oxygenation and haemodynamics. One subject (41years old, male, athlete, colleague of the authors) performed an IHHT session as part of his regular training. In parallel, systemic physiological activity (arterial oxygenation (SpO2) and pulse rate (PR)) as well as cerebrovascular oxygenation (StO2) and haemodynamics (total haemoglobin concentration, [tHb]) were measured. For the measurement of StO2 and [tHb], a TD-NIRS device (NIRSBOX, PIONIRS, Italy) was employed. The TD-NIRS device uses two diode lasers (685 nm and 830nm) as light sources and a solid-state light detector. The optode of the TD-NIRS device was placed over the left prefrontal cortex of the subject. The IHHT session had a total duration of 32minutes and consisted of four cycles of hypoxia (5min, O2: 10%) followed by hyperoxia (3min, O2: 34%). The IHHT session caused significant changes in SpO2, HR, StO2 and [tHb]. The hypoxia/hyperoxia challenges resulted in a decrease in SpO2 from 97% to ~70% and decrease in StO2 from ~70 to ~60%. During the hypoxia intervals, HR increased from ~50 to ~60, while [tHb] increased only moderately (from ~64 to ~66μM). The case study presented here demonstrates the feasibility of the novel TD-NIRS device to measure changes in cerebrovascular haemodynamics and oxygenation during an IHHT session. It was observed that an intense IHHT session causes significant cerebral hypoxia (decrease of StO2 by 10 percentage points). In contrast, cerebral haemodynamics (as indicated by changes in [tHb]) were only weakly influenced. Our study shows that IHHT can have a significant effect on the oxygen supply in the head, which should be taken into account in future applications of IHHT to prevent possible pathophysiological reactions that could be triggered by it.

Improving Respiratory Outcomes: The Role of Soft Tissue Manipulation in Enhancing Pulmonary Function for COPD Patients: A Narrative Review

Introduction: COPD is the most prevalent respiratory disease to be studied and employing a variety of treatment techniques to deal with. Soft tissue manipulation is one such technique which decreases muscle tone that helps to achieve better compliance and hence improved respiratory functions and functional capacity in COPD patients. Aim: To determine effect of soft tissue manipulation on pulmonary function among Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: The following searches were performed in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane and Google Scholar from years 2015-2024 with the keywords, “Soft tissue manipulation”, “COPD”, “Visceral manipulation” and “Pulmonary Function”. After probing these databases out of 5,240 articles only five studies were found to be in line with the aim, where the participants were both male and female with moderate to severe COPD according to GOLD criteria, aged from 45 to 80 years. Results: One pilot study and four randomised controlled trials were included in this review. These studies employed soft tissue manipulation over Diaphragm, Costal, Pectoralis, Scalene, Trapezius muscles ranging from 4 weeks to 24 weeks intervention for COPD patients and the results so reaped were that the technique helps improve pulmonary functions (Residual volume, Forced vital capacity, Forced expiratory volume, Total lung capacity, Functional exercise capacity, FEV1/FVC ratio) in COPD patients. Conclusion: Soft tissue manipulation has been proven to have a positive impact on the pulmonary functions in COPD patients.

Using PAH-SYMPACT to assess quality of life in patients with pulmonary hypertension associated with chronic lung disease.

Chronic lung disease (CLD) is the second leading cause of pulmonary hypertension (PH) and is associated with significant morbidity and mortality. Although PH associated with CLD (PH-CLD) leads to impaired health-related quality of life (HRQOL), there are no validated tools to assess HRQOL in PH-CLD. The Pulmonary Arterial Hypertension-Symptoms and Impact Questionnaire (PAH-SYMPACT) is an HRQOL instrument aimed at assessing the symptoms and impact of PH on overall function and well-being. We performed a single-center prospective cohort study using PAH-SYMPACT scores to compare symptoms, exercise capacity and HRQOL in patients with PAH and PH-CLD. One hundred and twenty-five patients (99 patients with idiopathic/heritable PAH and 26 with PH-CLD) completed the PAH-SYMPACT questionnaire which consists of 22 questions that assess HRQOL across four domains: cardiopulmonary (CP) symptoms, cardiovascular (CV) symptoms, physical impact (PI), and cognitive/emotional (CE) impact. Higher scores indicate worse HRQOL. We compared patients with PAH and PH-CLD using a Wilcoxon rank sum or chi-squared test as appropriate. Multivariate linear regression analysis was used to assess the relationship between PH classification and SYMPACT scores. Compared to PAH, patients with PH-CLD were older, more likely to use oxygen and had worse functional class and exercise capacity. While there was no significant difference between the two groups in CP, CV, or CE domain scores, patients with PH-CLD had significantly worse PI scores by univariate (1.79 vs. 1.13, p < 0.001) and multivariate analysis (1.61 vs. 1.17, p = 0.02) and overall worse SYMPACT scores (1.19 vs. 0.91, p = 0.03). In conclusion, patients with PH-CLD have worse HRQOL as assessed by the PAH-SYMPACT questionnaire versus patients with PAH. Although PAH-SYMPACT has not been validated in PH-CLD, the results of this study can guide clinicians in understanding the symptoms and impact of PH-CLD relative to PAH.

The one-minute sit-to-stand test: A practical tool for assessing functional exercise capacity in patients with COPD in routine clinical practice.

Background: Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. Objectives: To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. Methods: Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after threemonths of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. Results: The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, p = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, p < .0001), VO2max (r = 0.50, p = .0006) and maximal work rate (r = 0.52, p = .0003). Weak correlations were observed with QF (r = 0.33, p = .03) and step count (r = 0.38, p = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, p = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, p = .002), QF (r = 0.48, p = .003) and VO2max (r = 0.41, p = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. Conclusion: The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.

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

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

Assessment of the feasibility of 1-min sit-to-stand test in evaluating functional exercise capacity in interstitial lung disease patients.

Six-min walk test (6MWT) is widely used exercise test for the evaluation of interstitial lung disease (ILD). However, the long test duration and need for long and flat surface hinder its routine use. One-min sit-to-stand test (1-STST) is devoid of such limitations, but has been scarcely evaluated. The study was conducted to evaluate the performance of 1-STST by correlating it with 6MWT in ILD patients. Stable ILD patients were prospectively enrolled. After initial spirometry, all patients performed 6MWT and 1-STST following the standard recommendations. Exercise capacity and physiological parameters (heart rate, pulse oxygen saturation, blood pressure and dyspnea [modified Borg scale]) including peripheral oxygen saturation (SpO2) were correlated after the tests using Pearson correlation, Intraclass correlation coefficient (ICC) and kappa (κ) coefficient. The results showed that the mean age of the patients (n=60) was 58.8±11.5 years (male:female=1:1). Repetitions after 1-STST showed significant correlation with 6MWT (r=0.48; P<0.001). Changes in the physiological variables were similar (P>0.05) with good consistency (ICC=0.68-0.95) between 6MWT and 1-STST. Both lowest SpO2 and difference in SpO2 also showed good agreement (ICC=0.86; 95% confidence interval [CI], 0.77-0.92 and ICC=0.68; 95% CI, 0.47-0.81 respectively) and significant correlation (r=0.76 and r=0.52, respectively). 1-STST and 6MWT were consistent in identifying patients having oxygen desaturation ≥4% (κ=0.56; 96% CI, 0.30-0.82). The results demonstrated that the performance of 1-STST was consistent with 6MWT in terms of exercise capacity and change in physiological parameters. 1-STST can be a valid alternative to 6MWT in the assessment of ILD patients, especially in peripheral health centers.

Exploring the Impact of Combined Thai Yoga and Elastic Band Exercise on Physical Fitness and Exercise Capacity in Older Patients with Type 2 Diabetes

Study purpose. Although it is acknowledged that exercise can positively affect both physical and biochemical markers in older individuals with type 2 diabetes (T2DM), there are still uncertainties about the specific impacts of combining Thai yoga with an elastic band exercise in this population. The objective of the study was to assess the impact of a 12-week program involving Thai yoga combined with an elastic band exercise on the physical fitness and functional exercise capacity among older individuals with T2DM. Materials and methods. A total of 42 participants, consisting of 20 men and 22 women with T2DM and a mean age of 64.6±3.6 years, were randomly assigned to two groups: the control group and the exercise group. The exercise group engaged in a daily regimen of Thai yoga combined with an elastic band exercise for 40 minutes, 5 days a week, over a 12-week period. In contrast, the control group maintained their regular routines. Physical fitness and functional exercise capacity were assessed both before and after the 12-week intervention. Results. The exercise group showed significant reductions in body weight (58.7±11.9 vs. 58.0±12.0 kg), body mass index (24.2±3.0 vs. 23.9±3.0 kg/m2), waist circumference (33.6±3.6 vs. 33.1±3.6 in), and waist-hip ratio (0.90±0.06 vs. 0.89±0.06) (p &lt; 0.001). Additionally, there were notable improvements in physical fitness parameters, including hand grips, back strength, leg strength (p &lt; 0.01), and trunk flexibility (p &lt; 0.001). Functional exercise capacity, indicated by the 6-minute walk test and estimated peak oxygen consumption (p &lt; 0.01), also improved significantly. Conclusions. Thai yoga combined with an elastic band exercise enhances physical fitness and functional exercise capacity in older individuals with T2DM. This improvement has the potential to enhance their cardiopulmonary performance. Consequently, this exercise regimen is considered a health alternative for older individuals with T2DM.

Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study

ObjectiveThe objective of this study is to compare the effectiveness of lower limb low-load blood flow restriction training (LL-BFRT) with high-load strength training (HL-ST) as part of an outpatient pulmonary...

Effect of exercise training on functional capacity, muscle strength, exercise capacity, dialysis efficacy and quality of life in children and adolescents with chronic kidney disease: a systematic review and meta-analysis.

To synthesize the effect of exercise training on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and quality of life (QOL) in children and adolescents with CKD. PubMed/Medline, Scopus, PEDro, Web of Science, CINAHL, Cochrane, and Embase were searched from inception to September 30, 2023. Randomized control trials (RCTs) and clinical trials that assessed the effect of exercise training programs on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and QOL in children and adolescents with CKD were included. Random effect model and meta-regression were used for the meta-analysis. Four clinical trials and three RCTs were included. The results showed that exercise training improves strength, but meta-analysis did not show a significant effect of exercise on functional capacity (WMD: 1.02; 95% CI: - 0.14 to 2.18; p = 0.083) and QOL (WMD: 8.00; 95% CI: - 3.90 to 19.91; p = 0.187). Subgroup analysis revealed that more than 25 sessions and 45min per session of intervention, a PEDro score of more than 5, and being younger than 12years of age had a large effect on functional capacity and QOL results. Due to the limited number of studies that reported the effect of exercise on dialysis efficacy and exercise capacity, the findings were inconclusive. Exercise training could benefit children and adolescents with CKD by increasing their strength. Longer exercise interventions may be beneficial for improving functional capacity and QOL. Future well-designed RCTs should overcome the existing limitations using adequate sample sizes and longer exercise durations.

Effect of Bicycle Ergometer Training and Nordic Walking Training on Improving Functional Exercise Capacity in Asthma Patients.

Introduction Asthma is a chronic respiratory condition characterized by inflammation of the airway leading to breathlessness. Exercise training has been recognized as a valuable component in the management of asthma, enhancing lung function and overall well-being. Bicycle ergometer training and Nordic walking are two distinct forms of exercise that have been shown to improve cardiovascular fitness and respiratory function. Despite the potential benefits of these exercises, limited research directly compares their efficacy in improving functional capacity specifically in asthma patients. The study thus aims to address this gap by providing personalized, tailored exercise programs for asthma patients. Methods A single-blinded experimental study using a simple random sampling method was conducted. A sample of 40 subjects was recruited for the study based on inclusion and exclusion criteria and were assigned into two groups. Group A subjects were trained with a bicycle ergometer and Group B subjects were trained with Nordic walking. The intervention was given to both groups for 12 weeks. The outcome measures used were the six-minute walk test, Modified Borg Scale, and Mini Asthma Quality of Life Questionnaire. Results A baseline analysis of outcome measures was done, which was followed up by a post-test analysis after 12 weeks. Pre-test and post-test data were compared using a paired t-test.Intergroup analysis was done by an independent t-test. Both groups showed significant improvement in post-test results. On comparing the two groups, Group A showed significant improvement as compared to Group B. Conclusion The study concludes that bicycle ergometer training is effective in improving functional capacity and enhancing the quality of life in asthma patients.

Mind-body therapies adjuvant to chemotherapy improve quality of life and fatigue in top cancers: A systematic review and meta-analysis

BackgroundBreast, lung and colorectal cancers are 3 of the top 4 most common cancers worldwide. Their treatment with chemotherapy often results in adverse effects on quality of life, fatigue and functional exercise capacity amongst patients. Mind-body therapies, including yoga, Tai chi and Qigong, are commonly used as complementary and alternative therapies in cancer. This meta-analysis evaluates the effects of yoga, Tai chi and Qigong in alleviating the adverse effects of chemotherapy. MethodsVarious databases were systematically interrogated using specific search terms, returning 1901 manuscripts. Removal of duplicates, irrelevant studies, those lacking available data and applying inclusion/exclusion criteria reduced this number to 9 manuscripts for inclusion in the final meta-analyses. Mean differences were calculated to determine pooled effect sizes using RStudio. ResultsThis is the first systematic review and meta-analysis to demonstrate significant improvements in fatigue for colorectal cancer patients undergoing chemotherapy with a reduction of −1.40 (95 % CI: −2.24 to −0.56; p = 0.001) observed in mind-body therapy intervention groups. ConclusionYoga, Tai chi and Qigong could all be implemented alongside adjuvant therapies to alleviate the adverse effects on colorectal cancer patient fatigue during chemotherapy treatment. Review registrationThis systematic review and meta-analysis is registered on InPlasy: registration number INPLASY202390035; doi: https://doi.org/10.37766/inplasy2023.9.0035.

Lower 6-minutes walk test result and presence of cardiovascular risk factors linked to healthcare facility visits of pilgrims: the importance of fitness in hajj pilgrimage

Abstract Background Hajj pilgrimage, a mandatory religious practice for the Muslims, is a physical rite attributed heavily on the fitness of the participants due to increased workload in performing its activities. The 6-minutes walk test is a simple assessment to predict candidates’ fitness level. Objective We sought to determine the association between pilgrim candidate fitness level, determined by 6-minutes walk test result during predeparture preparation, as well as pre-existing potential risk factors of hajj pilgrim participants. Method In this retrospective cohort, we obtained the data of 2022 pilgrimage participants from Indonesian Ministry of Religious Affairs, consisting of demographic characteristics, anthropometric indexes, medical history, physical examination, and functional exercise capacity predicted by 6-minute walk test conducted during pre-departure preparation. Baseline demographic, bivariate tests for each variable, and multivariate test were analyzed by IBM SPSS 26. Result There was significant correlation between age of ≥60 (p &amp;lt; 0.001), hypertension (p &amp;lt; 0.001), diabetes mellitus (p &amp;lt; 0.001), 6-minutes walk test (p &amp;lt; 0.001), smoker status (p = 0.008), high LDL-C (p = 0.026), obesity (p =0.033), female sex (p = 0.043) and healthcare visit episode of pilgrims. The risk ratio value for low result group of 6-minutes walk test (&amp;lt; 500 meters) against outpatient incidence during hajj period was 1.08 (95% CI; 1.04 -1.12). It indicated that the inability of reaching &amp;gt;500 meters in 6-minutes walk test is related to outpatient incidence by 1.08 times. Conclusion There is a slight increase in healthcare visit incidence in pilgrims with low result of 6-minutes walk test. The 6-minutes walk test, a simple and reproducible assessment of fitness level, may provide useful information to improve preparation of pilgrimage.

Abstract 12149: Vericiguat May Improve Conduit Vessel Function and Exercise Functional Capacity in Heart Failure With Reduced Ejection Fraction

Background: The treatment of heart failure with reduced ejection fraction (HFrEF) has advanced considerably in recent years with the advent of novel agents; however, limitations, such as blood pressure and renal dysfunction, limit the number of patients who can benefit from this treatment in practice. Vericiguat, a novel heart failure treatment, has been found to be efficacious in patients with HFrEF while maintaining a good safety profile. Unfortunately, its mechanisms remain largely unknown. Objective and Methods: A total of 11 patients with HFrEF who were determined to be inadequately treated underwent right heart catheterization, echocardiography, flow-mediated dilatation (FMD) testing, 6-min walking distance (6MWD) test, and blood sampling at a median interval of 70 ± 13 days before and after vericiguat treatment. Results: Participating patients were 73 ± 9.3 years old with a mean of 2.5 repeated heart failure hospitalizations, ejection fraction (EF) of 31.2% ± 8.7%, BNP of 328.7 ± 282, and New York Heart Association classification of mostly II. No significant changes in systolic blood pressure or pulse rate were observed before and after vericiguat introduction (115 ± 64 vs. 105 ± 52 mmHg and 70 ± 5 vs. 75 ± 12 bpm; P = 0.533 and 0.960, respectively). No significant changes in the mean pulmonary artery pressure and pulmonary artery wedge pressure were also observed before or after drug administration (19 ± 5 vs. 17 ± 10 mmHg and 7 ± 5 vs. 9 ± 3 bpm; P = 0.177 and 0.240 respectively). However, cardiac output was significantly increased and vascular resistance was significantly decreased after vericiguat treatment (4.0 ± 1.0 vs. 4.3 ± 1.1 L/min and 1719 ± 462 vs. 1467 ± 377 dynes·sec·cm-5; P = 0.016 and 0.002, respectively). FMD test results improved significantly after treatment (4.5 ± 5% vs. 8.1± 8%: P = 0.027), with the 6MWD increasing significantly by 42 m (311 ± 100 vs. 353 ± 50 m; P = 0.035). BNP also decreased significantly, whereas eGFR remained unchanged (317 ± 274 vs. 221.5 ± 200 pg/mL and 51.7 ± 21 vs. 51.5 ± 25.3 mL/min/1.73 m 2 ; P = 0.015 and 0.967, respectively). Conclusion: Vericiguat may improve exercise tolerance by improving vascular endothelial function and cardiac output.

Anatomical/Physiological Correlates of Functional Capacity in Adults With Repaired and Nonsevere Coarctation of the Aorta

BackgroundThere is limited data regarding the interplay of anatomic and physiologic parameters with exercise capacity in adults with native or recurrent nonsevere coarctation of the aorta (CoA). ObjectivesThe objective of this study was to use exercise stress echocardiography and cardiac magnetic resonance imaging to identify anatomic and physiologic correlates of exercise capacity in these patients. MethodsWe conducted a single-center retrospective analysis of 54 adults with nonsevere CoA (repaired or unrepaired) followed at our institution between 2015 and 2020. Resting coarctation gradients were obtained using echocardiography. Exercise gradients and functional capacity were assessed using exercise stress echocardiography. Aorta anatomy was obtained using magnetic resonance imaging. ResultsCoarctation-to-diaphragm ratio correlated with minutes of exercise (r = 0.56, P < 0.01) and metabolic equivalents (r = 0.49, P < 0.01). These relationships remained significant after controlling for use of beta-blockers, valvular disease, and type of coarctation repair. Minutes of exercise correlated with mean resting gradients (r = −0.39, P < 0.05). Coarctation-to-diaphragm ratio correlated with peak and mean resting gradients (r = −0.34, P < 0.05; r = −0.48, P < 0.01). Patients with coarctation-to-diaphragm ratio ≤0.7 achieved fewer metabolic equivalents (11.1 ± 1.9 vs 12.8 ± 2.2, P < 0.05) and minutes of exercise (10.3 ± 2.0 vs 12.6 ± 2.7, P < 0.05). ConclusionsIn patients with nonsevere native or recurrent CoA, reduced exercise capacity is correlated with coarctation severity by anatomic size and gradients. Those with a coarctation-to-diaphragm ratio ≤0.7 may represent a subset of patients with nonsevere CoA whose clinical symptoms are only elicited with exercise stress testing. Exercise stress testing and cross-sectional imaging may help identify those who could be considered for earlier coarctation intervention.

Developing a home-based pulmonary rehabilitation programme for patients with chronic respiratory diseases in Malaysia: A mixed-method feasibility study.

The COVID-19 pandemic has underscored the importance of remote healthcare and home-based interventions, including pulmonary rehabilitation, for patients with chronic respiratory diseases (CRDs). It has also heightened the vulnerability of individuals with underlying respiratory conditions to severe illness from COVID-19, necessitating exploration and assessment of the feasibility of delivering home - pulmonary rehabilitation (home-PR) programmes for CRD management in Malaysia and other countries. Home-based programmes offer a safer alternative to in-person rehabilitation during outbreaks like COVID-19 and can serve as a valuable resource for patients who may be hesitant to visit healthcare facilities during such times. We aimed to assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia. We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a home-PR programme. Following centre-based assessment, patients performed the exercises at home (five sessions/week for eight weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes Walking Test (6MWT) and Health-Related Quality-of-Life (HRQoL) (COPD Assessment Test (CAT)) at baseline and post-PR at nine weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback on the home-PR programme. The interviews were audio recorded, transcribed verbatim, and analysed thematically. We included 30 participants; two withdrew due to hospitalisation. Although 28 (93%) adhered to the full programme, only 11 (37%) attended the post-PR assessment because COVID-19 movement restrictions in Malaysia at that time prevented attendance at the centre. Four themes emerged from the qualitative analysis: involvement of family and caregivers, barriers to home-PR programme, interactions with peers and health care professionals, and programme enhancement. Despite the COVID-19 pandemic, the home-PR programme proved feasible for remote delivery, although centre-based post-PR assessments were not possible. Family involvement played an important role in the home-PR programme. The delivery of this programme can be further improved to maximise the benefit for patients.

Evaluation of functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers: a comparative study

BackgroundElectronic cigarettes or e-cigarettes have gained significant popularity as an alternative to traditional combustible tobacco smoking particularly among the youth. Although there is a growing prevalence of e-cigarette usage, the effects on cardiovascular function and physical capacity have not been adequately studied. The toxic products in combustible tobacco cigarettes negatively impact functional exercise capacity. However, the available data regarding the effect of e-cigarette use on functional exercise capacity are scarce. Thus, in the current study, we aimed to evaluate the functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers.ResultsThis comparative, cross-sectional study was conducted on 105 healthy volunteers. Participants were assigned into three study groups each consisting of 35 participants: chronic e-cigarette users, combustible cigarette smokers, and a non-smoker control group. Basal demographic and clinical data were similar in all groups. Mean heart rates and respiratory rates were significantly higher among e-cigarette smokers and combustible cigarette smokers compared to non-smoker controls (p < 0.001). Chronic e-cigarette users and combustible cigarette smokers had shorter 6-MWT distances compared to non-smokers (508.3, 488, and 616.6 m, respectively, p < 0.001). Borg scale scores after performing the six-minute walking test were significantly higher in chronic e-cigarette users and combustible cigarette smokers groups compared to non-smokers, where perceived exertion (4.9, 5.5, 2.1, respectively, p < 0.001), dyspnea (5.7, 6.5, 0.1, respectively, p < 0.001) and leg fatigue (4.2, 5.4, 1.4, respectively, p < 0.001).ConclusionIn this cross-sectional study, significant evidence demonstrates that e-cigarette use is not harmless. This was particularly presented in apparently healthy e-cigarette users in comparison to the healthy non-smoker control group. Chronic e-cigarette use is associated with reduced functional capacity compared to non-smoker controls. This was signified by decreased 6MWT walking distances, higher Borg scale scores, and lower oxygen saturation percentages among the chronic electronic cigarette users as compared to non-smoker controls after performing the six-minute walking test. All the evaluated parameters in the current study were similarly reduced among both the e-cigarette users group and the combustible cigarette smokers group compared to non-smokers with no statistically significant differences between both smoker groups.

Influence of home-based pulmonary rehabilitation program among people with interstitial lung disease: A pre-post study

ABSTRACT Introduction Access to interstitial lung disease programs may not be available in rural settings. Home-based pulmonary rehabilitation (PR) programs have been proposed as an alternative to hospital-based programs. Method Forty participants with ILD underwent a structured unsupervised home-based pulmonary rehabilitation program from September 2020 to September 2022. Quality of life was assessed using St. George Respiratory Questionnaire (SGRQ) and functional capacity using 6-minute walk test (6MWT). The outcome measures were assessed at baseline and 4 weeks post-unsupervised home-based PR program. Result We recruited 40 participants with ILD. There was statistically significant improvement in the 6-minute walk distance (353.8 m and 368 m, effect size – 0.5, p ≤ .001) and quality of life using SGRQ total score (38.6 and 42.35, effect size – 2.5, p ≤ .001) between before and after receiving home-based PR among all 40 participants with ILD. Conclusion Four weeks of home-based PR program, using minimal resources, deliver short-term improvements in functional exercise capacity and quality of life among ILD participants. Our home-based PR program resulted in a quarter percentage improvement in functional capacity, and we believe that if consistency is maintained, it will result in similar changes corresponding to the already established Minimal Clinically Important Difference (MCID) of 35 m.

Core outcome set for pulmonary rehabilitation of patients with COPD: results of a modified Delphi survey

IntroductionThere is high heterogeneity of outcomes and measures reported in pulmonary rehabilitation (PR) trials of people with chronic obstructive pulmonary disease (COPD). This hinders study comparability and benchmarking of PR....

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.