Improvement In Functional Capacity Research Articles

Improvement of Functional Capacity and Quality of Life by Cardiac Rehabilitation: Case Series

Cardiac rehabilitation (CR) is a long-term program involving prescribed exercise, education, and counseling to mitigate the physiological and psychological impacts of cardiac disease. Despite evidence supporting its effectiveness in reducing mortality rates, CR remains underutilized, particularly among patients with heart failure. This research aims to highlight the importance of CR in improving the quality of life and functional capacity for post-cardiac surgery and heart failure patients. The study involved a series of case illustrations, including patients undergoing aortic valve replacement, coronary artery bypass graft surgery, and congenital heart disease repair. Each patient completed a Phase II rehabilitation program consisting of 12 exercise sessions, with functional capacity measured using the six-minute walk test (6MWT). The results indicated significant improvements in both functional capacity and quality of life, including reductions in depression levels. The findings suggest that CR is highly beneficial in enhancing patients' overall recovery and quality of life, particularly when integrated into standard postoperative care. Given these results, healthcare systems should promote broader access to CR programs to maximize patient outcomes. Additionally, future research should explore long-term benefits and develop personalized CR programs to cater to diverse patient needs.

Effect of Masking Secondary to the COVID-19 Pandemic on Functional Capacity Improvement in Cardiac Rehabilitation.

Given the difficulty to perform exercise training wearing a mask, we examined differences in functional capacity improvement between masking during the coronavirus disease 2019 (COVID-19) pandemic and non-masking prior to the pandemic for patients undergoing cardiac rehabilitation (CR). Records of 660 patients who underwent and completed≥18 sessions of CR in 2018 (n=318, non-masking) and in 2022 (n=342, masking) at an academic health system were analyzed. The primary outcome was post-CR change in functional capacity in metabolic equivalents (MET) measured by exercise stress test. Sessions of CR participation and changes in depression, anxiety, and quality of life scores were secondary outcomes. We used multivariable linear regression to adjust for differences in baseline CR outcome measures, demographics, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk, and comorbid conditions. Baseline age (64.6±0.46yr), sex (28% female), and racial distribution (85% white) were similar between the masking and non-masking groups. Non-masking patients were more likely to be classified in the AACVPR high risk category and had lower anxiety scores at baseline compared to masking patients. After CR, both groups had similar and significant improvements in depression, anxiety, and quality of life scores, but the improvement in functional capacity was lower in the masking group (-0.62±0.12MET, P <.001) compared to the non-masking group. Results remained significant after multivariable adjustment. Cardiac rehabilitation patients requiring masking during the COVID-19 pandemic had less improvement in functional capacity than patients who did not wear masks during CR prior to the pandemic. Interventions to mitigate the potential side effects of masking for CR patients may require further exploration.

Mavacamten for Obstructive Hypertrophic Cardiomyopathy: Rationale for Clinically Guided Dose Titration to Optimize Individual Response.

Mavacamten is the first and only cardiac myosin inhibitor approved in 5 continents for the treatment of adults with symptomatic New York Heart Association class II and III obstructive hypertrophic cardiomyopathy. An evidence-based rationale was used to develop individualized mavacamten dosing, guided by commonly used clinical parameters. Echocardiography is recommended as part of routine clinical assessment of patients with hypertrophic cardiomyopathy, and left ventricular (LV) outflow tract gradient and LV ejection fraction are parameters that can be readily assessed and monitored by echocardiography. Therefore, an echocardiography-based, clinically guided dose-titration strategy was developed to optimize patient benefit from mavacamten for the treatment of symptomatic obstructive hypertrophic cardiomyopathy while minimizing the risk of LV ejection fraction reduction. Results from clinical trials paired with extensive modeling and simulation analyses support a dose-titration and monitoring strategy based on serial echocardiographic measures of Valsalva LV outflow tract gradient and LV ejection fraction. This dosing approach allows for the identification of the lowest individualized mavacamten dose and exposure required to provide improvements in LV outflow tract obstruction, functional capacity, and symptoms. Mavacamten is primarily metabolized by CYP2C19 (cytochrome P450 2C19), and CYP2C19 metabolizer phenotype has an effect on mavacamten exposure. Therefore, this approach has also been demonstrated to provide a favorable safety profile irrespective of patients' CYP2C19 metabolizer status. The dose-titration strategy includes additional considerations for the potential onset of systolic dysfunction in the context of intercurrent illness, and for the potential of drug-drug interactions with inhibitors and substrates of cytochrome P450 enzymes. This posology is reflected in the mavacamten US prescribing information.

Importance of Cardiac Rehabilitation in Post-myocardial Infarction

The benefits of cardiac rehabilitation have been demonstrated for several years by various studies showing a 25-35% reduction in mortality, fewer complications and improved physical capabilities and quality of life. In this article, we describe the beneficial effect of cardiac rehabilitation on post-myocardial infarction patients with coronary artery disease. Patient aged 60, chronic smoker, diabetic, hypertensive and dyslipidemic. Admitted for management of a post-infarction complicated by 35% left ventricular (LV) dysfunction related to a right coronary occlusion dilated by a stent. The patient was recruited 3 weeks after hospitalization for a cardiac rehabilitation program after an initial clinical and paraclinical evaluation. The final evaluation showed a marked improvement in cardiorespiratory and functional capacity, with improvements in VO2 (Oxygen uptake) peak, the first ventilator threshold VT1, maximum heart beat and VE (minute ventilation)/VCO2 (carbon dioxide output) ratio. We also noted an improvement in cardiovascular risk factors with goal attainment, quality of life based on the HAD (Hospital Anxiety and Depression scale) questionnaire, and adherence to treatment. Cardiac rehabilitation is aimed at all dilated, operated or medically treated coronary patients. It requires a comprehensive, multidisciplinary approach, and helps to improve exercise performance, quality of life and psychological profile, as well as contributing to better socio-professional reintegration.

Left Ventricular Deformation and Myocardial Work Parameters in Patients with Hereditary Transthyretin Amyloidosis Treated with Patisiran: A Single-Center Study.

Background: In recent years, many advances have been made in the treatment of hereditary transthyretin amyloidosis (ATTRv). Patisiran is a small-interfering RNA used to treat ATTRv with only polyneuropathy or polyneuropathy and cardiomyopathy. The aim of our study was to assess the effect of patisiran on cardiac function in ATTRv patients using speckle tracking echocardiography (STE) analysis. Methods: A single-center prospective study was performed enrolling 21 patients with ATTRv (11 M-52% of the population; 10 F-48% of the population; median age 66 ± 8.4 years old). A total of 7 patients had cardiac amyloidosis and polyneuropathy, and 14 patients had only polyneuropathy without cardiac involvement. Cardiological evaluation including electrocardiograms, echocardiography with STE, and assessment of myocardial work parameters was performed in all patients before starting patisiran and after 9-18 months. Functional capacity was assessed using the 6 min walk test; quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Results: We did not find a significant difference in gender prevalence of ATTR amyloidosis in all of the population (p-value 0.79), but we found that cardiac amyloidosis significantly predominated in the male sex compared to patients with only neuropathy. In all patients, we found a slight improvement in functional capacity and quality of life. We did not find significant changes in left ventricular ejection fraction (LVEF), but we found a significant improvement in left ventricular global longitudinal strain (GLS), global work waste (GWW), and global work efficiency (GWE), especially in patients with cardiac amyloidosis; E/e' average and left atrial stiffness also improved significantly in patients with cardiac amyloidosis. Conclusions: Our study confirms a positive effect of patisiran on cardiac function, particularly the absence of signs of subclinical deterioration as detected by very sensitive STE parameters such as GLS, MW, and atrial stiffness during follow up in patients treated with patisiran.

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.