Improvement In Functional Capacity Research Articles

Effects of home-based telerehabilitation-assisted inspiratory muscle training in patients with idiopathic pulmonary fibrosis: A randomized controlled trial.

There are few studies that have used inspiratory muscle training (IMT) as an intervention for patients with isolated idiopathic pulmonary fibrosis (IPF). This study aimed to investigate and interpret the effects of home-based telerehabilitation-assisted IMT in patients with IPF. Twenty-eight participants with IPF took part in the study. Lung function tests, functional exercise capacity by 6-min walk distance (6MWD), dyspnoea perception by modified medical research council dyspnoea scale (mMRC), and inspiratory muscle strength by maximal inspiratory pressure (MIP) were assessed. IMT was performed twice a day, 7 days/week, for 8 weeks. The intervention group (n = 14) performed IMT at 50% of their baseline MIP while the control group (n = 14) performed IMT without applied resistance. Loading intensity was progressed by keeping the load at 4-6 on a modified Borg scale for the highest tolerable perceived respiratory effort for each patient. Dyspnoea based on mMRC score (p < 0.001, η2 effect size = 0.48) significantly decreased within the intervention group compared with the control group. There were significant increases in the intervention group compared to the control group based on 6MWD (p < 0.001, η2 effect size = 0.43), MIP (p = 0.006, η2 effect size = 0.25) and MIP % predicted (p = 0.008, η2 effect size = 0.25). The findings of this study suggest that an 8-week home-based telerehabilitation-assisted IMT intervention produced improvements in inspiratory muscle strength, leading to improvements in functional exercise capacity and dyspnoea.

Changes in COPD-related anxiety symptoms during pulmonary rehabilitation: a prospective quantitative and qualitative study.

Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPD-related anxiety symptoms over the course of a PR program. Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPD-related anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach. A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception. COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program.

Hybrid Training System Consisting of Synchronized Neuromuscular Electrical Stimulation for Voluntary Exercise Using an Articular Motion Sensor.

Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength, preventing muscle atrophy, and decreasing pain. Recently, NMES has become a substitute for exercise therapy for metabolism improvement and functional capacity improvement. However, NMES has several disadvantages. First, slow-twitch muscle contractions are insufficient because the recruitment pattern of NMES does not obey Henneman's size principle. Second, when using surface electrodes, it is difficult to contract deep skeletal muscles at the application site. Third, electrical stimulation causes discomfort. Therefore, we devised a simultaneous combination of NMES and voluntary muscle contractions to overcome the weak points of NMES. A hybrid training system (HTS) that resists the motion of a volitionally contracting agonist muscle with force generated by its electrically stimulated antagonist was developed as a technique to combine the application of NMES and volitional contractions. This motion sensor makes it possible to simultaneously combine voluntary movements with NMES. Our HTS synchronizes with voluntary movements, enhancing safety and reducing discomfort. This HTS enhances the exercise effect of even simple exercise. So far, our HTS has been reported to be effective for muscle strength enhancement, prevention of muscle atrophy, improvement of physical function, pain relief, enhancement of physical fitness, and improvement of metabolic function. HTS are expected to be useful methods in environments where sufficient exercise load is not available or for individuals with low exercise tolerance.

Effect of cardiac rehabilitation on heart rate recovery in patients with coronary artery disease

Background/Aim: It is well-established that individuals with coronary artery disease (CAD) often exhibit autonomic dysfunction and a reduction in vagal function is associated with increased mortality and morbidity. Vagally mediated heart rate recovery (HRR) can be assessed by analyzing the post-exercise heart rate (HR) decay. It is hypothesized that effective exercise-based cardiac rehabilitation (CR) can enhance post-exercise parasympathetic function. This study aims to evaluate the impact of CR on HRR and other cardiac parameters in CAD patients. Methods: This retrospective cohort study was conducted at a single center. It included patients with CAD who were referred to the CR unit and completed either 30 or 60 sessions. These patients were free from angina or angina-equivalent symptoms at the time of enrollment and were receiving guideline-directed medical therapy for ischemic heart disease. A customized CR program was implemented for each patient. To calculate HRR, the maximum HR during the exercise test and HR values at 1, 2, and 3 minutes after exercise cessation were recorded. The differences between the maximum HR and the HR values at the end of the 1st, 2nd, and 3rd minutes after exercise were designated as HRR1, HRR2, and HRR3, respectively. Results: This study enrolled 104 patients with CAD. Following CR, there was a significant improvement in functional capacity, as assessed by the 6-minute walk test (from 367.83 [56.58] to 381.61 [53.76], P=0.001), and endurance, as measured by the Cycle Ergometer Test Maximum Watts (from 63.22 [22.29] to 77.38 [19.87], P&lt;0.001). CR also led to a noteworthy increase in HRR1, HRR2, and HRR3 (P=0.036, P=0.015, P=0.002, respectively). Conclusion: In our study, both the functional capacity and endurance of CAD patients improved significantly after CR sessions. Additionally, HRR showed a substantial increase following CR, suggesting that exercise-based CR can enhance post-exercise parasympathetic function. HRR may serve as a potential prognostic marker for predicting outcomes in CR.

Effect of three different exercise trainings on functional capacity in early stage severe burn patients: A randomized controlled trial.

This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients. A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients. Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05). Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

Impact of sodium-glucose cotransporter-2 inhibitor use on peak VO2 in advanced heart failure patients.

Advanced heart failure (HF) is an epidemic that affects multiple organ systems with high morbidity and mortality rates despite optimal medical therapy (OMT) and remains the leading cause of hospitalizations in type 2 diabetes-related cardiovascular disease. The addition of sodium-glucose co-transporter inhibitors (SGLT2i) in treating these patients has seen improved mortality and hospital admission rates. As such, we felt it was important to investigate whether the use of SGLT2i improved functional capacity in patients with HF when compared to OMT by evaluating maximum oxygen consumption (peak VO2) using cardiopulmonary exercise testing (CPET). We found 94 heart failure patients between August 2020 and August 2021 who underwent CPET before and after treatment at Mayo Clinic in Florida. 50 patients received OMT and 44 received OMT and SGLT2i therapy. CPET results before and after were compared for each group. The baseline ejection fraction was not significantly different between groups, with the OMT group at 38% and the SGLT2i group at 33%, p = 0.10. OMT patients were found to have a significantly lower hemoglobin A1c of 5.7 (5.4-6.1) compared to those with SGLT2i therapy of 6.4 (5.8-7.1), p = 0.01. The baseline peak VO2 was 17.3 ml/kg/min (13.3-21.6) in the OMT group and 17.3 ml/kg/min (14.4-18.9) in the SGLT2i group, p = 0.18, not significantly different. The interesting finding is that the follow-up peak VO2 at one year for the OMT group was 17 ml/kg/min (13.3-21.6), which was not significantly different from the SGLT2i group peak VO2 of 17 ml/kg/min (14.6-19.6), p = 0.19. Our study is the first to compare before and after peak VO2 values of the OMT+SGLT2i group to the patient's own baseline and we found no significant improvement. Our single-center data shows no improvement in functional capacity after the addition of SGLT2i therapy to OMT in patients with advanced heart failure. Improved hospitalization and symptoms may be attributed to other numerous effects of SGLT2i such as volume management.

Meta-analysis of [18F]FDG-PET/CT in pulmonary sarcoidosis.

18F-Fluorodeoxyglucose (FDG) PET/CT is emerging as a tool in the diagnosis and evaluation of pulmonary sarcoidosis, however, there is limited consensus regarding its diagnostic performance and prognostic value. A meta-analysis was conducted with PubMed, Science Direct, MEDLINE, Scopus, and CENTRAL databases searched up to and including September 2023. 1355 studies were screened, with seventeen (n = 708 patients) suitable based on their assessment of the diagnostic performance or prognostic value of FDG-PET/CT. Study quality was assessed using the QUADAS-2 tool. Forest plots of pooled sensitivity and specificity were generated to assess diagnostic performance. Pooled changes in SUVmax were correlated with changes in pulmonary function tests (PFT). FDG-PET/CT in diagnosing suspected pulmonary sarcoidosis (six studies, n = 400) had a pooled sensitivity of 0.971 (95%CI 0.909-1.000, p = < 0.001) and specificity of 0.873 (95%CI 0.845-0.920)(one study, n = 169). Eleven studies for prognostic analysis (n = 308) indicated a pooled reduction in pulmonary SUVmax of 4.538 (95%CI 5.653-3.453, p = < 0.001) post-treatment. PFTs displayed improvement post-treatment with a percentage increase in predicted forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO) of 7.346% (95%CI 2.257-12.436, p = 0.005) and 3.464% (95%CI -0.205-7.132, p = 0.064), respectively. Reduction in SUVmax correlated significantly with FVC (r = 0.644, p < 0.001) and DLCO (r = 0.582, p < 0.001) improvement. In cases of suspected pulmonary sarcoidosis, FDG-PET/CT demonstrated good diagnostic performance and correlated with functional health scores. FDG-PET/CT may help to guide immunosuppression in cases of complex sarcoidosis or where treatment rationalisation is needed. FDG-PET/CT has demonstrated a high diagnostic performance in the evaluation of suspected pulmonary sarcoidosis with radiologically assessed disease activity correlating strongly with clinically derived pulmonary function tests. In diagnosing pulmonary sarcoidosis, FDG-PET/CT had a sensitivity and specificity of 0.971 and 0.873, respectively. Disease activity, as determined by SUVmax, reduced following treatment in all the included studies. Reduction in SUVmax correlated with an improvement in functional vital capacity, Diffusion Capacity of the Lungs for Carbon Monoxide, and subjective health scoring systems.

Cardiopulmonary exercise testing in transthyretin amyloid cardiomyopathy patients: a long-term follow-up study.

Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) experience reduced functional capacity. We evaluated changes in functional capacity over extensive follow-up using cardiopulmonary exercise testing (CPX). ATTR-CM patients underwent CPX and blood testing at baseline, first [V1, 8 (6-10) months] and second follow-up (V2) at 35 (26-41) months after start of disease-specific therapy. We included 34 ATTR-CM patients, aged 77 (±6) years (88.2% men). CPX showed two patterns with functional capacity improvement at V1 and deterioration at V2. Peak work capacity ( P = 0.005) and peak oxygen consumption (VO 2 , P = 0.012) increased at V1 compared with baseline and decreased at V2. The ventilation to carbon dioxide relationship slope (VE/VCO 2 ) increased at V2 compared with baseline and V1 ( P = 0.044). A cut-off for peak VO 2 at 14 ml/kg·min showed more events (composite of death and heart failure hospitalization): less than 14 vs. greater than 14 ml/kg·min ( P = 0.013). Cut-offs for VE/VCO 2 slope at 40 showed more events greater than 40 vs. less than 40 ( P = 0.009). ATTR-CM patients showed an improvement and deterioration in the short-term and long-term follow-up, respectively, with a better prognosis for those with peak VO 2 above 14 ml/kg·min and for a VE/VCO 2 slope below 40.

Neuromodulation in Management of Patients with Failed Back Surgery Syndrome. An Outcome Assessment Study

Abstract Background Failed back surgery syndrome (FBSS) is a constellation of conditions that describes persistent or recurring low back pain following spine surgeries with a reported point prevalence in the general adult population of 37% and a lifetime prevalence of between 60% and 85%. It always has a significant impact on patients’ quality of life. Neuromodulation such as spinal cord stimulation has been showing significant effect and improvement in pain scores and functional capacity of the FBSS patients with a reflected effect on their daily activities and quality of life. Aim and Objectives Our aim in this study is to assess the change in pain scores, quality of life and opioid medications intake as an outcome of neuromodulation procedures performed to patients diagnosed with failed back surgery syndrome, and to detect the post procedure complications. Subjects and Methods This is a mixed prospective-retrospective study conducted at Ain Shams University (ASU) hospital and Oregon Health and Science University (OHSU) hospital during the period from September 2019 till December 2022. Patients who are 18 years old or older diagnosed with FBSS for more than 6 months and treated with spinal cord stimulation with successful trials during this time frame were included in the study. Results 34 patients were included in this study who had successful SCS trials and underwent a permanent implantation of SCS devices with post procedure follow up period of 12 months. Patients showed median pain numerical rating scale (NRS) of 7/10 at baseline with median NRS of 4/10 through the follow up period, also, there was a significant improvement of functional capacity using metabolic equivalent assessment with 74% of patients became moderate capacity compared to 32% at baseline. Quality of life assessed by activity measure of post-acute care (AM-PAC) showed significant improvement from mean of 16.87 ± 2.74 at baseline to mean of 19.97 ± 2.93 through follow up. Also there was a significant reduction of opioid medication usage. Post procedure complications was of low percentage with the most commonly detected were battery dysfunction in 7 patients and pocket pain in 6 patients. Reoperation was needed in 13 patients with 4 needed just revision and 9 patients required a complete removal of the device. Conclusion Failed back surgery syndrome is a widely described chronic pain condition which has a negative impact on the patients’ quality of life and daily activities with an evidenced effect on chronic use and abuse of opioid analgesic medications. We presented in our study that SCS could be offered as an effective modality of treatment with a statistically significant reduction in pain scores and a significant improvement in functional capacity and quality of life. Also, it has a recognizable but not statistically significant reduction in opioid analgesic medications and a very low percentage of procedure related complications.

The Role of SGLT2 Inhibitors in Managing Heart Failure with Reduced Ejection Fraction

Introduction: Heart failure with reduced ejection fraction (HFrEF) remains a significant clinical challenge despite advances in therapy. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as promising adjuncts in HFrEF management, with evidence from clinical trials suggesting improved outcomes. This study aims to evaluate the effectiveness and safety of SGLT2 inhibitors in HFrEF. Methodology: A prospective, single-center observational study was conducted at Hayatabad Medical Complex, Peshawar, from June 2023 to March 2024. Forty-eight patients with HFrEF were enrolled, and baseline demographic, clinical, and laboratory data were collected. Patients received standard therapy alongside SGLT2 inhibitors. Follow-up assessments were performed over 10 months to evaluate changes in left ventricular ejection fraction (LVEF), symptoms, functional capacity, and adverse events. Results: Following SGLT2 inhibitor therapy, a significant increase in LVEF (mean increase of 5.2 percentage points) was observed, accompanied by reductions in heart failure symptoms and improvements in functional capacity. Heart failure hospitalization rates decreased by 50%, with a favorable safety profile observed. Conclusion: This study demonstrates the effectiveness and safety of SGLT2 inhibitors in managing HFrEF. The findings support their integration into clinical practice guidelines and emphasize the need for personalized, multidisciplinary approaches to optimize outcomes in HFrEF patients.

The Role of Exercise: Physical Fitness Changes Caused by Hypocaloric Diet and Exercise in Men Who Are Overweight

Objective There is evidence showing the effect of hypocaloric diet and increasing physical activity on weight loss. However, the effect of these factors on body composition and functional capacity remains unclear. Also, it is not clear which type of exercise (aerobic, resistance) has effective health benefits for men who are overweight. The aim of this study is to investigate whether a 12-week combined exercise or walking intervention combined with a hypocaloric diet provides improvements in body composition and functional capacity of men who are overweight compared to those who do not exercise. Methods 60 healthy adult men who are overweight were randomized and divided into 3 groups: 1: Hypocaloric Diet + Combined Exercise; 2: Hypocaloric Diet + Walking; 3: Hypocaloric Diet. The exercise groups were trained for 12 wk, 3 days a week and 60 min (60 min\\3 days\\12 wk). Body composition was determined with Bioelectrical Impedance Analysis (BIA) device, strength parameters with MicroFet 2, functional capacity with 6-min walking test. Results Improvement was observed in all groups at the end of 12 wk. The greatest improvement was in the combined exercise group. While the values of the combined exercise group increased in Skeletal Muscle Mass, there was a decline in the walking and non-exercising group. Basal Metabolism was maintained in combined exercise, but a decrease occurred in the non-exercising group. Muscle force increased in combined exercise; however, it was maintained in the legs in the walking group. Cardiorespiratory fitness was at best level in walking group, but there was no difference between combined exercise. Conclusions As a result, a hypocaloric diet without an exercise prescription is sufficient to lose weight in the short term (12 wk) at a certain level. But exercise is more important for body composition, weight management and functional capacity. Long-term and in-depth studies should be conducted to interpret the results better.

Effects of closed kinetic chain exercises on balance and gait in people with multiple sclerosis: A randomized controlled trial

IntroductionBalance and gait impairments are among the most common consequences of multiple sclerosis (MS). A closed kinetic chain enhances balance and gait abilities in people with multiple sclerosis (PwMS). This study aims to compare the effectiveness of an integrated Telko and conventional physical therapy (CPT) intervention versus CPT alone on gait and balance in PwMS. MethodsTwenty-six PwMS were enrolled in the trial, and they were randomized to either the combined Telko and CPT experimental group (n = 13) or the CPT alone control group (n = 13). All participants underwent 15-min sessions of CPT three times a week for four weeks. Additionally, participants in the experimental group received a 15-min Telko training session after each CPT session. Outcome measures consisted of the Berg Balance Scale (BBS), the 6-Minute Walk Test (6MWT), and the Timed Up and Go (TUG) assessment. ResultsTwenty-four PwMS completed the study. The PwMS in the combined Telko and CPT experimental group exhibited significant improvements in balance, functional capacity, gait speed, and mobility following the intervention (P < 0.05). In the CPT group, PwMS also experienced significant improvements in functional capacity (P < 0.05). The between-group analysis revealed no significant differences among the outcome measures (P > 0.05). ConclusionsThe combined Telko and CPT intervention did not demonstrate superiority over CPT alone in improving balance and gait in PwMS. Further experimental studies are necessary to fully understand the effects of a closed kinetic chain for lower extremities on the balance and gait of individuals with PwMS.

Predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization

Predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization

The effect of bachmann bundle pacing on diastolic function in patients with non-obstructive HCM

Abstract Background and Objective Patients with non-obstructive HCM (nHCM) have advanced diastolic dysfunction and atrial remodeling, leading to increased heart failure hospitalisations. The objective of this study was to evaluate the role of Bachmann bundle pacing (BBP) in diastolic filling compared to right atrial appendage pacing (RAAP). Methods Forty patients with symptomatic nHCM and normal LV function were prospectively enrolled from January 2021 to June 2023. Inclusion criteria included electrocardiographic evidence of inter-atrial delay, E/e’ &amp;gt; 15, and an indication for ICD implantation. BBP was attempted in twenty patients, others underwent RAAP. A Biotronik Selectra 3D 40-S sheath was used for BBP in patients in whom initial lead implantation was unsuccessful. BBP was defined based on P-wave morphology and fluoroscopic lead position. The RV lead was implanted in the RV apex in all patients and the AV delay was optimized based on diastolic filling period and E/e’. Devices were programmed in DDD mode. During follow up, diastolic function, functional capacity, atrial fibrillation, and heart failure hospitalisations were assessed in both groups. Results Among the forty patients (age 48.2+7.8 yrs, males 75%, ESC-SCD Risk 4.3+0.6%), the baseline P wave duration, E/A, E/e’ were 138.4+16.4 ms, 2.5+0.5, and 17.5+2.4, respectively. Six patients (15%) had a history of paroxysmal AF (3 each in BBP and RAAP groups). Of the 16 patients (80%) who underwent successful BBP, the Selectra 3D 40-S sheath was used in 8 patients (Figure 1, Panel A). During BBP, a bachmann bundle potential was recorded in 7 of 16 patients (43.8%) (Figure 1, Panel C). The pacing threshold (1.5+0.5@0.4ms vs. 0.9+0.3@0.4ms, p=0.026) was higher and the atrial sensing (1.8+0.4 vs. 3.3+0.6, p=0.002) was lower in the BBP group compared to the RAAP group at 4 weeks and 6 months of follow up. There was an acute rise in threshold (2.1@0.4 ms) in 1 BBP patient at 4 weeks of follow up. Patients in the BBP group had a reduction in P wave duration compared to the patients in the RAAP group (-22.5 + 5.4 vs. +5.6 + 3.2 ms, p&amp;lt;0.001). During follow up (11.4 + 3.4 months), there was a significant improvement in diastolic function (E/e’), functional capacity (NYHA Class) and reduction in NT-proBNP in the BBB group compared to the RAAP group (Figure 1). The percentage of atrial pacing was similar in both groups (BBP 73.2 + 7.8 vs. RAAP 78.5 + 9.1 %, p=0.219). The risk of atrial fibrillation/tachycardia (12.5% vs. 35.0%, p=0.022) and heart failure hospitalisations (6.3% vs. 20%, p=0.042) was lower in the BBP group compared with RAAP during follow up. Conclusions BBP is safe and effective in improving diastolic function, functional capacity and heart failure hospitalizations in patients with nHCM.BBP Pacing using Selectra 3D 40-S SheathChange in E/e', NYHA, and NT-pro BNP

Redefining Iron Deficiency in Patients With Chronic Heart Failure.

A serum ferritin level <15 to 20 μg/L historically identified patients who had absent bone marrow iron stores, but serum ferritin levels are distorted by the systemic inflammatory states seen in patients with chronic kidney disease or heart failure. As a result, nearly 25 years ago, the diagnostic ferritin threshold was increased 5- to 20-fold in patients with chronic kidney disease (ie, iron deficiency was identified if the serum ferritin level was <100 μg/L, regardless of transferrin saturation [TSAT], or 100 to 299 μg/L if TSAT was <20%). This guidance was motivated not by the findings of studies of total body or tissue iron depletion, but by a desire to encourage the use of iron supplements to potentiate the response to erythropoiesis-stimulating agents in patients with renal anemia. However, in patients with heart failure, this definition does not reliably identify patients with an absolute or functional iron-deficiency state, and it includes individuals with TSATs (≥20%) and serum ferritin levels in the normal range (20-100 mg/L) who are not iron deficient, have an excellent prognosis, and do not respond favorably to iron therapy. Furthermore, serum ferritin levels may be distorted by the use of both neprilysin and sodium-glucose cotransporter 2 inhibitors, both of which may act to mobilize endogenous iron stores. The most evidence-based and trial-tested definition of iron deficiency is the presence of hypoferremia, as reflected by as a TSAT <20%. These hypoferremic patients are generally iron deficient on bone marrow examination, and after intravenous iron therapy, they exhibit an improvement in exercise tolerance and functional capacity (when meaningfully impaired) and show the most marked reduction (ie, 20%-30%) in the risk of cardiovascular death or total heart failure hospitalizations. Therefore, we propose that the current ferritin-driven definition of iron deficiency in heart failure should be abandoned and that a definition based on hypoferremia (TSAT <20%) should be adopted.

HIGH-INTENSITY INTERVAL TRAINING DOES NOT AFFECT THE EXPRESSION OF ENDOTHELIAL GENES IN SPONTANEOUSLY HYPERTENSIVE RAT

Objective: Hypertension and the aging process result in changes to the endothelial-related muscular system that may negatively impact exercise capacity. Research has shown that high-intensity interval training(HIIT) may be beneficial for individuals with hypertension.However, there are currently no studies that compare the effects of this type of exercise on endothelial markers in the skeletal muscles of aging rats.In order to examine the effects of HIIT on muscular microcirculation markers in hypertension, we assessed the genes encoding proteins related to vasomotor function (NOS3 and ET-1) and angiogenesis (VEGF and PIK3R2) in the soleus and diaphragm muscles of old spontaneously hypertensive rats. To corroborate our results, we analyzed the expression of these genes in samples from individuals who participated in HIIT for 6 weeks (GSE 109657). Design and method: Male 12-month-old spontaneously hypertensive rats were randomly assigned to either a sedentary group (n=10) or a high-intensity interval training (HIIT) group (n=10). The HIIT group underwent training on a rodent treadmill for 50 minutes per day, five times per week, for a period of eight weeks. Systolic blood pressure (SBP), functional capacity, and expression of endothelial gene-encoding proteins associated with NOS3, ET-1, VEGF, and PIK3R2 were analyzed. We retrieved a transcriptomic dataset (GSE109657) of human muscle biopsies collected from the vastus lateralis pre- and post-HIIT (a total of 22 samples, 11 pre-HIIT and 11 post-HIIT) for differential expression analysis. The relative expressions of NOS3, PIK3R2, VEGF were displayed through a heatmap using the MORPHEUS tool. In this dataset, ET-1 expression was not detected thus, we only represented the ET-2 transcriptional variant in the heatmap Results: Our findings indicated that that 8-week of HIIT led to a statistically significant reduction in SBP (p=0.001) and improvement in functional capacity (p&lt;0.001) without affecting the expression of NOS3, PIK3R2, VEGF, or ET-1 in the soleus and diaphragm muscles. Additionally, our reanalysis of vastus lateralis muscle biopsy revealed no differences in the genes of interest, corroborating our results. Conclusions: These findings suggest that 8-week of HIIT may promote decreased arterial pressure and enhanced physical condition without interfering with the expression of mRNA-encoding vasomotor and angiogenic factors in different skeletal muscles.

Long‐term pneumatic stenting with positive expiratory pressure therapy for severe expiratory central airway collapse

AbstractExpiratory central airway collapse (ECAC) comprising excessive central airway collapse (EDAC) and tracheobronchomalacia. Treatment is challenging for severe cases that are not candidates for surgical management. We report a case of severe ECAC successfully managed with continuous positive airway pressure (CPAP) therapy. A 75‐year‐old female patient status post right pneumonectomy, presented with chronic cough. Dynamic bronchoscopy evaluation showed severe EDAC which improved with intraprocedural noninvasive positive pressure (NIPPV) therapy. Due to patients' comorbidities, she was not a candidate to surgical tracheobronchoplasty. Therefore, we attempted pneumatic stenting with long‐term CPAP therapy resulting in improvement of symptoms and functional capacity. The long‐term efficacy of pneumatic stenting has not been clearly established yet. Literature review of management of ECAC with NIPPV consist primarily of case reports and there is only one clinical trial being conducted to assess the efficacy of CPAP therapy in ECAC. While NIPPV arises as a sufficient alternative for management of severe ECAC, larger scale studies are needed to prove the real efficacy of NIPPV in this setting.

Effects of dual-task resistance exercise on cognition, mood, depression, functional fitness, and activities of daily living in older adults with cognitive impairment: a single-blinded, randomized controlled trial

BackgroundRegular exercise is emphasized for the improvement of functional capacity and independence of older adults. This study aimed to compare the effects of a dual-task resistance exercise program and resistance exercise on cognition, mood, depression, physical function, and activities of daily living (ADL) in older adults with cognitive impairment.MethodsA total of 44 older adults participated in the study. Participants were randomly allocated to an experimental group (n = 22) performing a dual-task resistance exercise program for cognitive function improvement and a control group (n = 22) performing a resistance exercise program. Both groups performed the exercise for 40 min per session, three times a week, for 6 weeks (18 sessions). Cognition, mood, depression, functional fitness, and ADL were quantified before and after the intervention using the Mini-Mental State Examination (MMSE), profile of mood states (POMS), geriatric depression scale (GDS), senior fitness test (SFT), and Korean version of ADL, respectively.ResultsThere was a significant time and group interaction on the MMSE (p = 0.044). There were no significant time and group interactions in the POMS, GDS, SFT, or ADL. Cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after dual-task resistance exercise, and cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after resistance exercise.ConclusionsDual-task resistance exercise is more effective than resistance exercise in improving cognitive function in older adults with cognitive impairment. Both dual-task resistance exercise and resistance exercise improves mood, depression, functional fitness, and ADL after the intervention. We propose using dual-task resistance exercises for cognitive and physical health management in the older adults with cognitive impairment.Trial registrationThis study was registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) (Registration ID, KCT0005389; Registration date, 09/09/2020).

Improvement Functional Capacity In Adult After Percutaneous ASD Closure

This case report describes a 24-year-old woman with a secundum atrial septal defect (ASD) who underwent successful percutaneous ASD closure with significant improvement in symptoms and functional capacity. The patient presented with easy fatigue and shortness of breath on exertion for 10 years. Echocardiography revealed a large secundum ASD with moderate to severe tricuspid regurgitation, mild mitral regurgitation, mild pulmonary regurgitation, and dilatation of the right atrium and ventricle. Right heart catheterization confirmed a large left-to-right shunt and pulmonary hypertension. The patient underwent ASD closure with a Figulla Flex II device, resulting in immediate improvement of hemodynamics. Follow-up at 3 and 6 months demonstrated decreased right ventricular size, improved left ventricular function, and increased exercise caapacity. This case highlights the benefits of ASD closure in improving symptoms and cardiac function, even in patients with longstanding right ventricular dilation.

Effectiveness of exercise-based cardiac rehabilitation for patients with left ventricular assist device: A systematic review and meta-analysis.

Exercise-based cardiac rehabilitation (EBCR) improves functional capacity in heart failure (HF). However, data on the effect of EBCR in patients with advanced HF and left ventricular assist devices (LVADs) are limited. This meta-analysis aimed to evaluate the impact of EBCR on the functional ability of LVAD patients by comparing the corresponding outcome indicators between the EBCR and ST groups. PubMed, Embase, Clinical Trials, and Cochrane Library databases were searched for studies assessing and comparing the effects of EBCR and standard therapy (ST) in patients following LVAD implantation. Using pre-defined criteria, appropriate studies were identified and selected. Data from selected studies were extracted in a standardized fashion, and a meta-analysis was performed using a fixed-effects model. The protocol was registered on INPLASY (202340073). In total, 12 trials involving 477 patients were identified. The mean age of the participants was 52.9 years, and 78.6% were male. The initiation of EBCR varied from LVAD implantation during the index hospitalization to 11months post-LVAD implantation. The median rehabilitation period ranged from 2weeks to 18months. EBCR was associated with improved peak oxygen uptake (VO2) in all trials. Quantitative analysis was performed in six randomized studies involving 214 patients (EBCR: n = 130, ST: n = 84). EBCR was associated with a significantly high peak VO2 (weighted mean difference [WMD] = 1.64mL/kg/min; 95% confidence interval [CI], 0.20-3.08; p = .03). Similarly, 6-min walk distance (6MWD) showed significantly greater improvement in the EBCR group than in the ST group (WMD = 34.54m; 95% CI, 12.47-56.42; p = .002) in 266 patients (EBCR, n = 140; ST, n = 126). Heterogeneity was low among the included trials. None of the included studies reported serious adverse events related to EBCR, indicating the safety of EBCR after LVAD implantation. This study demonstrated that EBCR following LVAD implantation is associated with greater improvement in functional capacity compared with ST as reflected by the improved peak VO2 and 6MWD values. Considering the small number of patients in this analysis, further research on the clinical impact of EBCR in LVAD patients is warranted.