Function Exercise Test Research Articles

Cardiac dysfunction in dialysing adults with end-stage kidney disease is associated with exercise intolerance: A pilot observational study.

People with end-stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in-centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in-centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.

Perioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review.

Women have classically been excluded from the development of normal data and reference ranges, with pregnant women experiencing further neglect. The incidence of Caesarean section in pregnant women, and of general operative management in young women (both pregnant and non-pregnant), necessitates the formal development of healthy baseline data in these cohorts to optimise their perioperative management. This systematic review assesses the representation of young women in existing reference ranges for several functional exercise tests in common use to facilitate functional assessment in this cohort. Existing reference range data for the exercise tests the Six Minute Walk Test (6MWT), the Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary Exercise Testing (CPET) in young women of reproductive age were assessed using the MEDLINE (Ovid) database, last searched December 2023. Results were comparatively tabulated but not statistically analysed given underlying variances in data. The role of exercise testing in the perioperative period as an assessment tool, as well as its safety during pregnancy, was evaluated using 65 studies which met inclusion criteria. There is a significant lack of baseline data regarding these tests in this population, especially amongst the pregnant cohort, which limits the application of exercise testing clinically.

Guidance and standard operating procedures for functional exercise testing in cystic fibrosis.

Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.

WS01.02 The current state of play regarding exercise testing in cystic fibrosis: co-development with the community

Objectives: Functional exercise testing of people with cystic fibrosis (CF) in clinical practice still lacks global standardisation in both choice of test and test conduct. A representative group from the European CF Society Exercise Working Group (ECFS-EWG), including members from the Physiotherapy Special Interest Group (PhySIG), are aiming to develop guidance and standard operating procedures for an agreed selection of exercise tests, that allow for the comprehensive functional evaluation of people with CF.

Lessons Learned from 28 Hospitals and City Agencies: Pediatric Disaster Exercise

Introduction:Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. The NYC PDC conducted a functional exercise testing surge, communications, and secondary transport. Participants included 28 NYC hospitals, the NYC Fire Department-Emergency Medical Services (FDNY-EMS), NYC Emergency Management (NYCEM), NYC DOHMH and the NYC Medical Reserve Corps (MRC).Method:The hospitals and agencies participated in group and individual planning meetings. Scenario-driven, operations-based activities challenged participants to employ their facility's existing pediatric surge and secondary transport plans during an event. The exercise assessed: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing. Internal and external evaluators assessed the exercise performance.Results:An After-Action Report was written based on information from evaluation data, site-specific and group hot-washes, and an after-action conference. Strengths included meaningful improvement of plans before/after the exercise and doubling pediatric critical care capacity through the implementation of the exercise objectives. Challenges included: gaps in communication/patient tracking, lack of sufficient sub-specialty support, the need for "babysitters” and inadequate supplies of blood products and ventilators.Conclusion:Conducting a multi-hospital and agency pediatric specific exercise demonstrated current planning and produced lessons learned to address planning and training gaps that can improve citywide planning and capabilities during future full-scale exercise and real-time events.

Three-month follow-up after severe COVID-19 infection: are chest CT results associated with respiratory outcomes and respiratory recovery in COVID-19 patients?

BackgroundCT Severity Score (CT-SS) can be used to assess the extent of severe coronavirus disease 19 (COVID-19) pneumonia. Follow-up CT-SS in patients surviving COVID-19-associated hyperinflammation and its correlation with respiratory parameters remains unknown. This study aims to assess the association between CT-SS and respiratory outcomes, both in hospital and at three months after hospitalization.MethodsPatients from the COVID-19 High-intensity Immunosuppression in Cytokine storm Syndrome (CHIC) study surviving hospitalization due to COVID-19 associated hyperinflammation were invited for follow-up assessment at three months after hospitalization. Results of CT-SS three months after hospitalization were compared with CT-SS at hospital admission. CT-SS at admission and at 3-months were correlated with respiratory status during hospitalization and with patient reported outcomes as well as pulmonary- and exercise function tests at 3-months after hospitalization.ResultsA total of 113 patients were included. Mean CT-SS decreased by 40.4% (SD 27.6) in three months (P < 0.001). CT-SS during hospitalization was higher in patients requiring more oxygen (P < 0.001). CT-SS at 3-months was higher in patients with more dyspnoea (CT-SS 8.31 (3.98) in patients with modified Medical Council Dyspnoea scale (mMRC) 0–2 vs. 11.03 (4.47) in those with mMRC 3–4). CT-SS at 3-months was also higher in patients with a more impaired pulmonary function (7.4 (3.6) in patients with diffusing capacity for carbon monoxide (DLCO) > 80%pred vs. 14.3 (3.2) in those with DLCO < 40%pred, P = 0.002).ConclusionPatients surviving hospitalization for COVID-19-associated hyperinflammation with higher CT-SS have worse respiratory outcome, both in-hospital and at 3-months after hospitalization. Strict monitoring of patients with high CT-SS is therefore warranted.

Assessment of Partial Pressure of Carbon Dioxide during Incremental Exercise Test, in Patients with Chronic Obstructive Pulmonary Disease

Purpose: Respiratory pump failure in COPD patients can lead to CO2 retention during exercise, but little is known about the factors determining CO2-levels during exercise in COPD patients. The aim of this study is to investigate the pattern of TcPCO2 in COPD patients during exercise and factors driving this CO2 response. Patients and methods: 24 COPD patients (age 66(8) y, FEV1 43(18) %pred, TcPCO2 at rest 37(4) mmHg, oxygen users 6/24) performed lung function and cardiopulmonary exercise test (CPET). During CPET TcPCO2 was measured continuously and in O2 users the CPET was performed with supplemental oxygen. Results: At baseline, 16 patients were normocapnic (TcPCO2 35-45 mmHg) and 8 hypocapnic (TcPCO2&lt;35 mmHg). At the end of the CPET, 9 patients were normocapnic, 2 showed hypocapnia and 10 were hypercapnic. CO2-retention (∆TcPCO2 &gt;4mmHg) was observed in 18 patients. ∆TcPCO2 correlated significantly with VeMax (r=-.64; p=.004), FEV1 %predicted (r = -.53; p = .008), RV %predicted (r = .54; p = .007), RV/TLC (r = .56; p = .005), sRAW (r =.61; p = .005), sGAW (r = -.60; p = .002), and maximal TcPCO2 (r=.63; p&lt;.001), but did not correlate with baseline TcPCO2 (r = -.08; p = .728). Furthermore, baseline TcPCO2 correlated with the maximal TcPCO2 (r = 0.67; p &lt; .001). Conclusion: The CO2-response of COPD-patients during CPET is heterogeneous with 10/24 developing hypercapnia. This study revealed that the lung mechanics are the most important factor correlating with CO2 retention during exercise while ∆TcPCO2 was not associated with baseline TcPCO2.

The Effects of Verbal Encouragement and Compliments on Physical Performance and Psychophysiological Responses During the Repeated Change of Direction Sprint Test.

The general and sports psychology research is limited regarding the difference between the effects of verbal encouragement (VE) or compliment methods during high-intensity functional exercise testing. The purpose of this study was to explore the effects of VE and compliments on the performance of the repeated change-of-direction (RCOD) sprint test. A total of 36 male students in secondary school participated voluntarily in the study. They were divided equally into three homogeneous groups [VE group, compliment group (CG), and control group) and performed a standardized one repetition RCOD. The RCOD (6 × 20 m with 25-s active recovery) test consisted of a 100°change in the direction at every 4 m. Outcomes included performance indices (fast time, average time, and total time), rating of perceived exertion (RPE), and feeling scale scores. VE and the compliment increased the performance indices and RPE compared with the control group. In conclusion, VE during the exercise testing would be more beneficial for optimal performance and RPE compared with the compliment and control groups. However, the moods, during RCOD, reproduce more positively during compliment conditions than the VE and control groups.

Case series: 3D printed orthopedic brace combined with traditional manipulative physiotherapy to treat new-onset scoliosis in adults.

IntroductionNew-onset scoliosis in adults is different from that in congenital and idiopathic scoliosis. We applied personalized custom 3D printed orthopedic braces combined with traditional manipulative physiotherapy to treat adult patients with new-onset scoliosis and observed the effectiveness of the treatment.Patient concernsNine patients aged 20–52 years presented with unequal height of hips and asymmetrical waist. One shoulder was obviously protruding or enlarged compared to the other; when lying on the bed, the legs were not equal in length, and when bending down, the back was not equal on the left and right.DiagnosisNew-onset scoliosis.InterventionsApplication of individual customized 3D printing brace combined with traditional treatment. Evaluation of clinical efficacy after treatment, including functional exercise test (FMS) before and after treatment, ability of daily living (ADL), visual analog pain score (VAS), and scoliosis angle (Cobb angle).OutcomesThe total effective treatment rate was 100.00% (9/9). The VAS score, Cobb angle of the spine, FMS test, and ADL test were significantly improved compared with those before treatment.ConclusionThe customized 3D printed orthopedic brace combined with traditional techniques to treat scoliosis and innovatively combined human bionic technology with traditional medicine to achieve the continuity and precise correction of scoliosis treatment is a clinically effective technique.

Electrical activity of expiratory muscles in type 2 diabetes mellitus

Aim. To study the functional state of the expiratory muscles in patients with type 2 diabetes mellitus on the basis of changes in their electrical activity when using a functional test with a static expiratory effort. Materials and methods. 47 patients with type 2 diabetes mellitus and 40 patients without disorders of carbohydrate metabolism were examined. To study the electrical activity of the expiratory muscles, surface electromyography (EMG) of the external oblique abdominal muscle (OAM), rectus abdominis muscle (RAM), and internal intercostal muscles (IIM) was performed using a functional test with a static expiratory effort. Results. When performing a functional test with a static expiratory effort in both groups, a decrease in the frequency and an increase in the amplitude of EMG was observed, however, in patients with type 2 diabetes mellitus, these changes were less pronounced. There were also differences in the dynamics of changes in EMG indicators. In patients with type 2 diabetes mellitus, the decrease in the frequency of EMG OAM began from 10 seconds of the test, IIM – from 15 seconds, in the comparison group – from 5 and 10 seconds, respectively. The OAM EMG amplitude in the main group did not change significantly, in the comparison group it increased from 5 seconds of expiratory effort. At the 10th second of the test, the amplitude index of the EMG OAM in patients with type 2 diabetes mellitus was 10.4% lower (p=0.027) than in the comparison group, and at the 15th second – by 10.5% (p=0.033). Conclusion: The change in the electrical activity of the expiratory muscles in patients with type 2 diabetes mellitus is due to the slowed down dynamics of the frequency-amplitude characteristics of the EMG OAM, uncompensated IIM fatigue, as well as lower values of the OAM EMG amplitude when performing a functional exercise test with a static expiratory effort.

Does branched-chain amino acid supplementation improve pulmonary rehabilitation effect in COPD?

BackgroundMuscle wasting is frequent in chronic obstructive lung disease (COPD) and associated with low branched-chain amino acids (BCAA). We hypothesized that BCAA supplementation could potentiate the effect of a pulmonary rehabilitation program (PRP) by inducing muscular change. Materials and methodsSixty COPD patients (GOLD 2–3) were involved in an ambulatory 4-week PRP either with BCAA oral daily supplementation or placebo daily supplementation in a randomized double-blind design. Maximal exercise test including quadriceps oxygenation measurements, functional exercise test, muscle strength, lung function tests, body composition, dyspnea and quality of life were assessed before and after PRP. ResultsFifty-four patients (64.9 ± 8.3 years) completed the protocol. In both groups, maximal exercise capacity, functional and muscle performances, quality of life and dyspnea were improved after 4-week PRP (p ≤ 0.01). Changes in muscle oxygenation during the maximal exercise and recovery period were not modified after 4-week PRP in BCAA group. Contrarily, in the placebo group the muscle oxygenation kinetic of recovery was slowed down after PRP. ConclusionThis study demonstrated that a 4-week PRP with BCAA supplementation is not more beneficial than PRP alone for patients. A longer duration of supplementation or a more precise targeting of patients would need to be investigated to validate an effect on muscle recovery and to demonstrate other beneficial effects.

Study on the utility and efficacy of clinical and instrumental tests in the follow-up of COVID-19 patients

Introduction: The disease caused by the SARS-CoV-2 virus (COVID-19) frequently leads to serious complications and prolonged hospitalizations requiring effective care after discharge. Aim of the study: Aim of this study was to identify feasible and cost-effective predictors of outcome among clinical characteristics, functional status, laboratory, echocardiographic and lung ultrasound data of COVID-19 patients. Material and methods: Patients affected by COVID-19 who experienced a prolonged hospitalization due to a severe form of the disease and that have been discharged from the COVID-19 rehabilitation unit (RU) were prospectively enrolled between April 6th and May 22nd, 2020. All the patients underwent a 6-minute walk test (6MWT) at the 30-day follow-up. Baseline characteristics, laboratory, functional exercise tests, echocardiographic and lung ultrasound (LUS) data collected between hospitalization, admission to RU, discharge from RU and follow-up were compared. Correlations with the predicted distance covered at the 6MWT (6MWD) were made. Results: 40 patients met inclusion criteria and presented to follow-up (13 women [32.5%] and 27 men [67.5%]; mean age 66 ± 10 years). Among all variables analysed, only functional tests at discharge showed a remarkable correlation with the 6MWD. Significant improvement in lung ultrasound score (LUSS) was also observed however without correlation with 6MWD. Conclusions: functional tests at discharge from RU identified patients with different 30-day outcomes that could deserve a stricter long-term follow-up. This may help in planning a personalized follow-up. The costs and effort were minimal. The severity of the acute phase did not significantly influence functional recovery. LUS was useful to identify subclinical lung damage and its evolution over time, however without clear functional correlation.

Research on denoising algorithm of thoracic impedance signal for respiratory monitoring during running exercise

Pulmonary Function Exercise Test (PFET) or Cardio Pulmonary Exercise Test (CPET) using spirometer, as a method for early detection of pulmonary dysfunction or an effective supplement method to conventional pulmonary function test, has considerable clinical significance. However, the spirometer that uses air flowmeter to measure exhale/inhale air flowrate and flow velocity, increases respiratory resistance and is not comfortable for using during physical exercise. Thoracic impedance is sensitive to pulmonary ventilation and has no disturbance to human airway, hence is more suitable for respiratory monitoring, nevertheless it is influenced by many other factors, such as body movement during running exercises. In this paper, we first analyze the characteristics of thoracic impedance collected during running exercise, then put forward a wpsTID (wavelet and polynomial smoothing methods based Thoracic Impedance Denoising) algorithm to remove high-frequency alternating noises and motion artifacts to obtain clean thoracic impedance information that varies only with the pulmonary ventilation. The wpsTID algorithm is compared with a few other denoising algorithms using synthetic thoracic impedance data that containing known noises, and demonstrated to have the best performance in retaining respiratory information from the original signal and suppressing noises, which lays a foundation for the undisturbed monitoring of pulmonary ventilation during running with impedance method. Finally, the wpsTID algorithm is further verified with thoracic impedance signals of healthy volunteers measured during different kinds of motions.

Corticosteroids and pulmonary rehabilitation reducing long-term morbidity in a patient with post-COVID-19 pneumonitis: A case study.

BackgroundWhilst research efforts have focussed on treatment during the acute phase, little work has focussed on the long‐term sequelae of COVID‐19 infection. This case described a patient who remained symptomatic several weeks after discharge from hospital with what was diagnosed as a COVID‐19 infection. There were significant deficits shown in his functional exercise testing, his pulmonary functions testing and there was evidence of fibrotic changes on his radiology.MethodsAs part of a multidisciplinary clinic, he was started on steroids and a tailored pulmonary rehabilitation course over a course of 6–8 weeks. Thereafter, his exercise testing, pulmonary function tests and radiology were all repeated to see progress.ResultsOn completing the course of corticosteroids and concurrent personalised pulmonary rehabilitation, there was a dramatic improvement in the patient's symptom severity, radiology and pulmonary function. The most significant improvement noted was in his exercise testing, namely a 6‐min walk test and 1 min of sit‐to‐stands. Before treatment, he had a Medical Reserch Council (MRC) score of 2, and after it returned to his baseline of 0.DiscussionUsing corticosteroids and exercise training that allowed quantitative evaluation throughout the stages of recovery was a valuable tool to gauge progress and response to treatment. These therapies present opportunity to prevent the development of irreversible pulmonary fibrosis that could prove to be a major breakthrough in reducing long‐term morbidity and improving the quality of life of those affected.

Association of physical function and performance with peak VO2 in elderly patients with end stage kidney disease.

Physical function is impaired in end stage renal disease (ESRD). Various instruments have been used to assess the functional capabilities and health status of patients with ESRD, but it is not known which has the best association with peak VO2. To assess the association between functional measures in ESRD. Thirty nine elderly ESRD patients were evaluated with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing (CPET), 6-min walk (6MWT), sit-to-stand test (STS), Veterans Specific Activity Questionnaire (VSAQ), upper and lower body strength, pulmonary function tests, and body composition determined by dual X-ray absorptiometry. The association between performance on these functional tools, clinical variables, and exercise test responses was assessed, and a non-exercise test multivariate model was developed to predict peak VO2. Peak VO2 was modestly related to VSAQ score (r = 0.59, p < 0.01), indices of upper and lower body strength (r = 0.45, p < 0.01 for both), and FEV1 (r = 0.51, p < 0.01). Functional and quality of life questionnaires were generally poorly related to one another and to peak VO2. In a multivariate model, 6MWT performance, forced expiratory volume in 1s (FEV1), and VSAQ score were the best predictors of peak VO2, yielding a multiple R = 0.82, accounting for 67% of the variance in peak VO2. Exercise capacity can be reasonably estimated using non-exercise test variables in patients with ESRD, including a symptom questionnaire (VSAQ), 6MWT and FEV1. ClinicalTrials.gov identifier: NCT01990495. Registered Nov 21, 2013.

Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort

BackgroundMore than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear.Research QuestionWhat are the major long-term pulmonary sequelae in critical patients who survive COVID-19?Study Design and MethodsConsecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging.ResultsOne hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay.InterpretationThree months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.

Egzersiz Testinin Ekshale Karbon Monoksit Oranı Üzerindeki Akut Etkisi

Objective: The aim of this study is to analyze the acute effect of exercise on the rate of exhaled carbon monoxide (CO) in healty young smokers. Material and Methods: Twenty four male smokers were included in the study. Pulmonary functions of the participants were evaluated by spirometer forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak flow rate (PEF) and forced expiratory flow at 25 to 75% of FVC (FEF 25%-75%). Exercise testing was performed by using bicycle ergometer. Maximal load, maximum oxygen uptake (VO2max), rest and maximal heart rate were recorded. CO levels before and after the test were mesured with portable breath CO monitor. CO levels and changes were assessed and compared on the exercise test day and rest day (without exercise test). Results: 25% of the participants have dyspnea, 20.8% have cough and 50% have sputum complaints. The results of the pulmonary function test and exercise test of young healthy smokers are as follows: % FEV1=89.7±9.9, % FEV1/FVC=87.4±8.2, % PEF=77.4±9.5, mean rest heart rate=94.8±9.8 bpm, mean maximal heart rate=170.3±9.7 bpm and mean VO2max=30.9±6.5 mL/min/kg. There is a statistically significant difference between the first and the second CO values of the participants measured on both days (p<0.001). There is a significant difference between the mean change of CO on the exercise test day and rest day (p<0.001). Conclusion: Our results show that smoking causes respiratory symptoms, impaired cardiopulmonary responses to exercise and increased CO level and exercise increases to the exhaled CO rate in young and healthy male.

Which functional outcome measures can we use as a surrogate for exercise capacity during remote cardiopulmonary rehabilitation assessments? A rapid narrative review.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has seen many cardiopulmonary rehabilitation services delivering programmes remotely. One area of concern is how to assess exercise capacity when a supervised exercise test is not possible. The aim of this review was to examine the relationship between functional exercise tests and recommended exercise tests for cardiopulmonary rehabilitation.MethodsA rapid narrative review was carried out. Searches were conducted by two of the study authors. The study had the following features. Participants: adults, all with long-term conditions; intervention: any/none; outcome: Duke activity status index (DASI), sit to stand (STS, 30 s, 1 min and 5 repetitions), short physical performance battery (SPPB), 4-metre gait speed (4MGS) or step test (Chester/others) AND directly compared to one of the recommended exercise tests for cardiopulmonary rehabilitation: 6-min walk test (6MWT), incremental shuttle walk test (ISWT) or cardiopulmonary exercise test (CPET) in terms of reporting agreement/correlation; Study design: primary research only, controlled trials or observational studies.ResultsSixteen articles out of 249 screened were included (n=2271 patients). Overall, there were weak–strong correlations for the included tests with a recommended exercise test (r=0.38–0.85). There were few reported issues with feasibility or safety of the tests. However, all tests were supervised in a clinical setting. The test that had the highest correlation with the field walking test was the 4MGS with the ISWT (r=0.78) and with the 6MWT (r=0.85).DiscussionThe 4MGS has the highest correlation with routine measures of exercise tolerance. However, it may be difficult to standardise in a remote assessment or to prescribe exercise from. Clinicians should strive for face-to-face standardised exercise tests where possible to be able to guide exercise prescription.

Inspiratory muscle training did not improve exercise capacity and lung function in adult patients with Fontan circulation: A randomized controlled trial.

Patients with Fontan circulation have no subpulmonary ventricle and a passive pulmonary perfusion. Considerable percentage of the pulmonary blood flow is driven by pressure shift due to respiration. Impairments in respiratory musculature strength are associated with a reduced exercise capacity. This study investigated the effect of a daily six months inspiratory muscle training (IMT) on exercise and lung capacity in adult Fontan patients. After a lung function and cardiopulmonary exercise test (CPET), 42 Fontan patients (50% female; 30.5±8.1years) were randomized into either an intervention group (IG), or a control group (CG). The IG performed a telephone-supervised, daily IMT of three sets with 10-30 repetitions for six months. After six months of IMT, the IG did not improve in any exercise and lung capacity parameter compared to CG. VO2peak (ΔVO2peak: IG: 0.05 [-1.53; 1.33] ml/kg/min vs. CG: -0.50 [-1.20; 0.78] ml/kg/min; p=.784) and FVC (ΔFVC: IG: 0.07 [-0.16; 0.22] l vs. CG:-0.05 [-0.24; 0.18] l; p=.377) remained unchanged, while FEV1 trended to improve (ΔFEV1: IG: 0.05 [-0.07; 0.13] l vs. CG: -0.10 [-0.19; 0.03] l; p=.082). Only oxygen saturation at rest improved significantly (ΔSpO2: IG: 1.50 [-0.25; 3.00] % vs. CG: -0.50 [-1.75; 0.75] %; p=.017). A daily six months IMT did not improve exercise and lung capacity and lung volumes in Fontan patients.

Impacts of Concurrent Cognitive Challenge on Aerobic Performance During Graded Exercise

IntroductionBoth sport and tactical performance relies on one’s ability to complete high levels of physical exercise simultaneously engaging in complex cognitive tasks (e.g. executive function). Several studies have found that combined cognitive tasks and muscle contractions can induce an earlier onset of fatigue and impair performance. However, it remains unclear if cognitive stress attenuates whole body dynamic exercise performance.PurposeTo determine if the addition of a cognitive task would limit maximal whole‐body exercise performance.Methods16 healthy Reserve Officer Training Corp cadets (19.6 ± 2 yrs, 5 Female) completed 3 graded exercise tests (GxT) separated by ≥ 24 hrs. The first GxT began at 3.5 mph, 0% grade increasing 2% every 2‐min until 16%, where speed increased by 0.5 mph every 2‐min until volitional fatigue. The next two GxTs (EFET, executive function exercise test) were identical to the first GxT while simultaneously completing an executive function test (Cedar Operator Workload Assessment Tool) on an iPad fixed to the treadmill. Heart rate (HR), respiration rate (RR), arterial blood saturation (SpO2) (Equivital Life monitoring system) and cerebral oxygenation (calculated tissue saturation index, TSI) using Near infrared spectroscopy was recorded throughout each test. Performance was determined by the number of stages completed. All data during the two EFET tests were averaged to form a singular response.ResultsData are mean ± SD, effect size calculated as Ω2. Concurrent executive function test and exercise did not significantly affect the number of stages completed when compared to the GxT (Stages completed, GxT= 8.6 ± 1.3, EFET= 8.5± 1.2, p= 0.2). However, 5 of 16 subjects completed fewer stages during EFET compared to GxT (Stages completed, GxT= 9.2± 1.3, EFET= 8.5± 1.1, p&lt;0.01) were labelled Non‐Resilient (NR). The other 11 subjects who completed the same or more stages during the EFET were labeled Resilient (R) (Stages completed, GxT= 8.4± 1.3, EFET= 8.5± 1.2, p= 0.10). The R group had similar TSI responses between trials (p= 0.3, Ω2 = 0.01) while the NR group had a greater decay in TSI at the highest intensities during EFET compared to GxT (p&lt;0.01, Ω2 = 0.11). Post hoc was unable to identify disparities at specific intensities (90% 61.9± 1.7 vs 63.7± 1.3 d=1.2 p&gt;0.05, 100% 59.9± 1.7 vs 62.1± 1.3 d= 1.4 p&gt;0.05, EFET vs. GxT, respectively). No difference in HR during EFET trials compared to GxT for NR (p=0.9, Ω2= 0.02) or R (p=0.5, Ω2 = 0.06) groups. No other variables differed between trials and groups.ConclusionConcurrent cognitive task does not impact graded exercise performance. However, our data suggests inter‐individual responses exist, where that some individuals maintain performance, while others cannot. The large effect size indicates NR were unable to sustain TSI during EFET. Therefore, maintenance of exercise performance with cognitive task seems to be related to one’s ability to preserve brain oxygenation during high intensity exercise.