Incremental Shuttle Walk Test Research Articles

Sex differences and determinants of anxiety symptoms in patients with COPD initiating pulmonary rehabilitation

BackgroundAnxiety is common in patients with chronic obstructive pulmonary disease (COPD). However, there is little evidence available regarding gender differences, and severity of dyspnea in relation to anxiety in patients with COPD. AimsWe examined gender differences and the association of dyspnea with anxiety in a cohort of patients with COPD prior to entering a pulmonary rehabilitation (PR) program. MethodWe analyzed data from a prospective cohort of COPD patients who attended PR from 2013 to 2019 in Lytham, Lancashire, UK. Patients were aged 40 years or older with a post-bronchodilation forced expiratory volume in 1 s (FEV1) less than 80 % of the predicted normal value and FEV1/FVC (forced vital capacity) ratio less than 0.7. We assessed quality of life (QoL) using the Saint George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT). ResultsNine hundred ninety-three patients with COPD (mean age = 71 years, FEV1/FVC = 58 % predicted, 51 % male) entered the PR program. Of these, 348 (35 %) had anxiety symptoms (AIR ≥8); of these 165 (47 %) were male and 183 (53 %) female, (χ2 = 3.33, p = 0.06). On logistic multivariate analysis, the following variables were independently associated with elevated anxiety: younger age (p < 0.001), female sex (p = 0.03), higher SGRQ-total score (p < 0.001) and high FEV1/FVC (p < 0.002). Dyspnea was associated with anxiety r = 0.25, p < 0.001. ConclusionOver a third of COPD patients had clinically relevant anxiety symptoms with a higher prevalence in women than men. Anxiety was associated with younger age, female gender, and impaired QoL. Early recognition and treatment of anxiety in patients with COPD is worthy of consideration for those attending PR, especially women.

What are the determinants of change in walking fitness in patients with a history of depression following cardiac rehabilitation?

This study aims to investigate the demographic, clinical and service level factors determining change in walking fitness in cardiac rehabilitation (CR) patients with a history of depression following the CR programme. National Audit of Cardiac Rehabilitation (NACR) clinical data were used to identify 1476 patients with a history of depression who had their pre and post incremental shuttle walk test (ISWT) recorded between 1st Jan 2016 and 31st Jan 2020. A multiple linear regression was conducted to examine the determinants of change in walking fitness (m) following CR. Mean age was 61 (SD 10.45) and mean ISWT distance at baseline and outcome were 352.06m (SD 169.48) and 463.43m (SD 197.65), respectively. Multivariate analysis revealed that change in walking distance reduced by 1.6m for each year increase in age at baseline (P < 0.001). Females and unemployed patients had less improvement in walking fitness (23.1m and 21.5m, respectively). Having a body mass index >30 was associated with lower improvement (24.2m, p < 0.001), while physically active patients had 14.6m higher change. Higher baseline ISWT quintiles were associated with less improvement, and increased waiting time to start CR was associated with reduced change in walking fitness following CR. Older age, female gender, unemployment, higher baseline BMI, longer waiting time, and lower physical activity were associated with reduced walking fitness improvement in patients with a history of depression. Targeted intervention and prompt access to CR can optimize outcomes.

The useful lean tissue and appendicular skeletal muscle mass indices related to physical performance in patients undergoing hemodialysis

BACKGROUND: Low muscle quantity commonly seen in patients undergoing hemodialysis (HD) is the key contributor of declined physical performance and increases the risk of morbidity and mortality. However, how to normalize muscle mass for operational criteria in this population remains unknown. OBJECTIVE: To identify the clinically useful whole body lean tissue mass (LTM) and appendicular skeletal muscle mass (ASM) indices pertinent to physical performance in patients undertaking HD. METHODS: Whole body LTM in 38 and ASM in 22 patients undergoing HD were measured by body composition monitor (BCM) and dual-energy X-ray absorptiometry (DXA), respectively. Physical performance was assessed by handgrip strength, the incremental shuttle walk test, sit-to-stand tests, gait speed, Short Physical Performance Battery and Duke Activity Status Index. Besides crude LTM and ASM, the other muscle indices were utilized normalizing for height, height squared, weight, body mass index (BMI), fat mass and body fat%. RESULTS: Regardless of BCM or DXA being used, the relationships between different muscle mass indices and physical function were not consistent. While the most useful LTM index which was strongly associated with physical function involved adjustment for height, the strongest (and most useful) ASM index was normalization for BMI. CONCLUSION: The superiority of adjustment for BMI or height (height2) recommended by international sarcopenia consensus is also suitable for patients undergoing HD. Patients’ BMI or fat mass should be considered in estimating prevalence of sarcopenia and evaluating relationship between muscle mass and physical performance.

Hemodynamic, ventilatory and gas exchange responses to exercise using a cycle ergometer and the incremental shuttle walk test in pregnant women

BackgroundCardiovascular disease, including hypertension, in pregnant women is a leading cause of morbidity and mortality globally. The development of reference intervals for cardiovascular responses using exercising testing to measure oxygen utilisation (V̇O2) with cardiopulmonary exercise testing (CPET), and distances walked using the incremental shuttle walk test (ISWT), may be promising methods to assess and stratify pregnant women regarding their risk of adverse pregnancy outcomes, to encourage exercise during pregnancy, and to improve exercise prescriptions during pregnancy. We aimed to determine the reference intervals for V̇O2 at rest, anaerobic threshold (AT) and submaximal exercise using CPET, and the reference interval for the ISWT, to develop a correlation equitation that predicts submaximal V̇O2 from the distance walked in the ISWT, and to explore the relationship between hemoglobin (Hb) and ferritin concentration and V̇O2 at AT in women in second trimester. MethodsAfter prospective IRB approval (HREC 15/23) and clinical trials registration (ANZCTR ACTRN12615000964516), and informed written consent, we conducted CPET and the ISWT according to international guidelines in a university associated tertiary referral obstetric and adult medicine hospital, in healthy pregnant women in second trimester (14 to 27 gestational weeks). Hemoglobin and ferritin concentrations were recorded from pathology results in the participants’ medical records at the time of exercise testing. Adverse events were recorded. Results90 participants undertook CPET, 28 of which also completed the ISWT. The mean ± SD age and body mass index (BMI) were 32 ± 3.2 years, and 25 ± 2.7 kg/m2. Median (IQR) gestation was 23 (22,24) weeks. One in four women were 24 weeks or greater gestation. The reference intervals for V̇O2 at rest, AT and submaximal exercise were 2.9 to 5.3, 8.1 to 20.7 and 14.1 to 30.5 mL/kg/min respectively. The reference interval for the ISWT was 218 to 1058 meters.metres. The correlation equation to predict submaximal V̇O2 from the distance walked in the ISWT was submaximal V̇O2 (mL/kg/min) = 0.012*distance walked in ISWT (m) + 14.7 (95% CI slope 0.005 to 0.070, Pearson r = 0.5426 95% CI 0.2126 to 0.7615, P=0.0029). Hemoglobin concentration was positively correlated with V̇O2 at AT (AT V̇O2 (mL/kg/min) = 0.08*Hb (g/L) + 4.9 (95% CI slope 0.0791 to 0.143, Pearson r = 0.2538 95% CI 0.049 to 0.438, P=0.016). There was no linear association between ferritin and submaximal V̇O2 (Pearson r = 0.431 P=0.697). There were no maternal or fetal complications. ConclusionsCPET and ISWT are safe and feasible in women in second trimester including those at or beyond 24 weeks gestation. We have established the reference interval for V̇O2 at rest, AT and submaximal exercise by CPET, the reference interval for the distance walked for the ISWT, and a correlation equation to predict submaximal V̇O2 for use in clinical practice and research. Hemoglobin rather than ferritin is likely correlated with exercise capacity in pregnancy suggesting vigilance to correct lower hemoglobin levels may positively impact maternal health. Clinical trials registryThe study was prospectively registered with the Australian and New Zealand Clinical Date of registration – 15/9/2015; Date of initial participant enrolment - 4/11/2015; Clinical trial identification number; ACTRN12615000964516; URL of the registration site - https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369216 Prior presentation and published abstract“Oxygen utilization and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women.” Obstetric Anaesthetists Association Meeting Edinburgh May 2023 Traer E, Ismail H, Leeton L, Bernhard R, Dennis AT. Oxygen utilisation and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women. International Journal of Obstetric Anesthesia 2023;54: Supplement 1. Article 103659 O7 Traer E, Ismail H, Leeton L, Bernhard R, Dennis AT. “Oxygen utilization and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women.” Poster presentation, iPOETTS abstract competition. Evidence Based Perioperative Medicine EPBOM World Congress of Perioperative Medicine, July 2023, London, U.K.

Effect of Adding a Program of Contextualized, Personalized, Remote Physical Activity Support to Conventional Cardiac Rehabilitation.

The objective of this investigation was to conduct a randomized controlled trial to evaluate whether KiActiv Heart alongside usual care (UC) promotes positive physical activity (PA) change versus UC alone. Patients in cardiac rehabilitation (n = 130) undertook an 8-wk intervention with follow-up at wk 8. Both groups attended UC and wore a PA monitor during the intervention. The intervention group accessed the digital service and received weekly one-to-one remote mentor sessions. The primary outcome was change in PA to achieve the Association of Certified Physiotherapists in Cardiac Rehabilitation (ACPICR) recommendations. The secondary outcome was cardiorespiratory fitness (CRF) change, measured using incremental shuttle walk test (ISWT). The probability of meeting ACPICR "Daily Activity" recommendation was statistically significantly greater in the intervention group versus control at wk 8 ( P < .05). No statistically significant differences between groups were found for mean ISWT change (intervention 89 ± 116 m; control 44 ± 124 m). Participation in KiActiv Heart alongside UC was associated with statistically significant improvement in probability of meeting ACPICR recommendation and non-statistically significant but potentially clinically important increases in CRF versus UC alone. This builds on existing evidence for effectiveness.

Efficacy and safety of a music-therapy facilitated pulmonary telerehabilitation program in COPD patients: the COPDMELODY study protocol.

Despite considerable evidence for the benefit in chronic obstructive pulmonary disease (COPD), the implementation of pulmonary rehabilitation (PR) is insufficient. However, music therapy may help address this gap due to its unique benefits. Therefore, we aimed to develop a music-therapy facilitated pulmonary telerehabilitation program based on rhythm-guided walking, singing, and objective telemonitoring. A supervised, parallel-group, single-blinded, randomized controlled clinical trial will be conducted, including 75 patients with COPD anticipated to be randomized in a 1:1:1 ratio into three groups. The intervention groups will receive a 12-week remotely monitored rehabilitation program, while the usual care group will not receive any rehabilitation interventions. Of the two intervention groups, the multi-module music therapy group will contain rhythm-guided walking and singing training, while the rhythm-guided walking group will only include music tempo-guided walking. The primary outcome is the distance of the incremental shuttle walking test. Secondary outcomes include respiratory muscle function, spirometry, lower extremity function, symptoms, quality of life, anxiety and depression levels, physical activity level, training adherence, and safety measurements. The results of this study can contribute to develop and evaluate a home-based music-facilitated rehabilitation program, which has the potential to act as a supplement and/or substitute (according to the needs) for traditional center-based PR in patients with stable COPD. Clinical trial registration: https://classic.clinicaltrials.gov/, NCT05832814.

Using reference equations to standardise incremental shuttle walk test performance in children and young people with chronic conditions and facilitate the evaluation of exercise capacity and disease severity

AimsThe aim was to evaluate whether standardised exercise performance during the incremental shuttle walk test (ISWT) can be used to assess disease severity in children and young people (CYP) with...

Effectiveness and cost-effectiveness of a web-based cardiac rehabilitation programme for people with chronic stable angina: protocol for the ACTIVATE (Angina Controlled Trial Investigating the Value of the ‘Activate your heart’ Therapeutic E-intervention) randomised controlled trial

IntroductionChronic stable angina is common and disabling. Cardiac rehabilitation is routinely offered to people following myocardial infarction or revascularisation procedures and has the potential to help people with chronic stable...

Is an 8-Week Regimen of Nordic Walking Training Sufficient to Benefit Cognitive Performance in Healthy Older Adults? A Pilot Study.

Nordic walking requires the association of walking and coordination of limbs while orienteering in a natural environment. It has been shown to improve functional capacities more than normal walking. However, its cognitive benefits are less clear. The main hypothesis was that this training improves visuospatial capacities and inhibition functions. A total of 14 healthy older adults were included. The training was performed in three sessions of 75 min a week for 8 weeks. Pre-, intermediate, and post-tests were carried out. Cognitive functions including global cognition (MoCA), executive functions (Color-Word Stroop test), speed of information processing, switching capacities (Trail Making Test A and B), and visuospatial capacities (Rey Complex Figure Copy Task) were assessed. Motor functions including balance control (Unipedal Balance Test), functional mobility (Timed Up and Go), hamstring flexibility (Chair Sit and Reach test), and motor coordination (Four-Square Stepping Test) were evaluated. Physical function, including lower limb strength (Timed Sit-To-Stand) and cardiovascular capacities (Incremental Shuttle Walking Test), was measured. Cardiovascular capacity, strength of lower limbs, and motor coordination were positively affected by training. With respect to cognition, training improved visuospatial capacities, while switching capacities, information processing speed, and executive functions did not improve. A possible explanation is that they needed a longer program duration to show benefits. However, analyses of responders suggested that NW positively affected cognitive functioning in a subset of participants. Eight weeks of NW training produced physical, motor, and cognitive improvements. A longer training duration could be necessary to extend the benefits to executive functions in all participants.

Measurement properties of the incremental step test for people with chronic obstructive pulmonary disease: a cross-sectional study

ObjectivesThe new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk...

Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis.

This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases. Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George's Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer. The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R2 = 0.67, AR2 = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05). Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.

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.

Predictors of reduced incremental shuttle walk test performance in patients with long post-COVID-19.

One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = -7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

Validiation of EPInfant scale in children: Estimation and production paradigms, using VO2 as reference criteria

to determine the criterion validity of the EPInfant scale in children in the estimation and production paradigm considering oxygen consumption (VO2) as the reference standard. Twenty healthy boys, aged 9.8 ± 1.5 years, were selected. They all performed an incremental shuttle walking test (ISWT) followed by a perceptual regulated-exercise test (PRET). VO2 and heart rate (HR) were recorded during both exercise tests. Average VO2 and HR values were considered as a perceptual reproduction test (PRT). EPInfant's validity in estimating the exercise intensity was evaluated by regression analysis between VO2, HR, and PE during ISWT and PRET. All regression analysis models showed a robust positive relationship between PE and benchmarks (r2 > 0.90). The intraclass correlation coefficient for VO2 and HR was 0.89 (0.70 to 0.96) and 0.64 (0.08 to 0.86), respectively. Low mean discordance for VO2 and HR was observed in the Bland-Altman analysis. The EPInfant scale presented adequate criterion validity for estimating and regulating running exercise intensity in boys between 8 and 12 years.

Randomised control trial of a novel digital system to provide contextualised data feedback to augment physical activity behaviour change in a free-living environment as part of cardiac rehabilitation

Abstract Background Physical activity (PA) is a core component of cardiac rehabilitation (CR) and is crucial for enhancing cardiovascular (CV) fitness[1]. In the UK, CR programmes involve 1-2 hours of face-to-face contact per week over 6-8 weeks, implying that 98-99% of the intervention period is currently unmonitored and not optimised for potential positive lifestyle interventions. Consequently, CR staff are blind to PA that occurs outside of the clinical setting, which could be of too low or high intensity and/or duration, according to the Association of Certified Physiotherapists in Cardiac Rehabilitation (ACPICR) guidelines[2]. A previous pilot study showed a novel digital system to be feasible, acceptable and effective for CR patients[3], making it a promising intervention to assess in a randomised control trial (RCT). Purpose To conduct a RCT to examine whether contextualised data feedback delivered using a novel digital service, in conjunction with usual care (UC) promotes positive PA behavioural change, with direct comparison to UC alone. Methods This prospective, parallel group, open-label, RCT enrolled 130 patients eligible for CR and consisted of an 8-week intervention period with follow-up at 8-weeks. The intervention group received the novel digital CR service plus UC, with the control group receiving UC alone. The primary outcome was changes in PA to achieve the ACPICR guidelines. Both groups wore a PA monitor to collect minute-level energy expenditure data that underwent processing using a patented method to extract the specific PA metrics required for analysis. The secondary outcome was changes in CV fitness between pre and post assessments, measured using Incremental Shuttle Walk Test (ISWT). Results Patient characteristics are shown in Table 1. Adherence to data collection was good, with an average of 37 complete days (≥768 minutes per day) of PA data per person. Fifty-six intervention group patients and 49 control group patients were analysed for the primary outcome. A significant difference (p&amp;lt;0.025) in the probability of achieving the ACPICR ‘Daily Activity’ guideline was found between groups, with the intervention group more likely to achieve the guideline at week-8 versus control. Despite Covid-19 challenges, pre and post ISWT measurements were obtained for 33 intervention group patients and 37 control group patients. No significant differences between groups were found. However, the average improvement seen in the intervention group, +89 metres (m), exceeded the minimum clinically important difference for the ISWT (+70 m), and was more than double that seen in the control group, +44 m. Conclusion This RCT builds on previous evidence supporting the use of the novel digital service in CR[3]. Engagement with, and completion of, the digital CR service was excellent. Participation was associated with statistically significant improved PA in relation to ACPICR guidelines and clinically important increases in CV fitness versus UC alone.Table 1

Performance-based outcome measures for physical capacity and functional ability among patients with pulmonary embolism

Abstract Introduction Pulmonary embolism (PE) is a serious health condition with up to 50 % of patients experiencing persisting symptoms with shortness of breath, pain, reduced physical performance and psychological distress, also known as post-PE syndrome. This condition has received increasing attention, including recommendations of assessing physical capacity to identify patients who may benefit from rehabilitation interventions to increase functional ability and health. However, as the PE population is heterogeneous compared to other cardiac patient groups, outcome measures for assessing physical capacity traditionally used in cardiac rehabilitation may not be reliable. This scoping review aims to map the performance-based outcome measures (PBOM) used in research literature to measure physical capacity in a PE population, to map the nature of the research and investigate the psychometric properties of the identified instruments in a PE population. Methods The methodology of the review process was guided by the Joanna Briggs Institute (JBI) framework for scoping reviews and reporting followed the PRISMA guidelines. Results The search identified a total of 4585 potentially relevant studies of which 234 studies met the inclusion criteria. A substantial part of studies (190 studies) was on a CTEPH population (chronic thromboembolic pulmonary hypertension), a condition developed by just 1-2% of patients with PE. The majority of included research articles originated from Europe (51%) and Asia (36%). Ten different PBOMs were identified for measuring physical capacity in a PE/CTEPH population, with 6MWT and CPET as the far most commonly used and the Bruce protocol/Modified Bruce protocol and Incremental Shuttle Walk test (ISWT) as third and fourth. No studies were identified reporting on psychometric properties of the 10 PBOMs in a PE / CTEPH population. Conclusions No studies were identified reporting on validity or reliability of any of the 10 identified PBOMs in a PE/CTEPH population. Thus, there is a need for conducting studies that establish the reliability, validity and responsiveness of PBOMs in a PE population, to enable identification of at-risk patients and to monitor effects of treatment and rehabilitation interventions.

Five-Repetition Sit-to-Stand Test: Responsiveness and Minimal Important Difference in Idiopathic Pulmonary Fibrosis.

Rationale: Standing from a sitting position is an important activity of daily living. The five-repetition sit-to-stand test (5STS) is a simple physical performance test that measures the fastest time taken to stand five times from a chair with arms folded. It can be measured in most healthcare settings and at home, where traditional field walking tests may not be possible. The 5STS has been validated in community-dwelling older adults and people with chronic obstructive pulmonary disease, but data in idiopathic pulmonary fibrosis (IPF) are limited.Objectives: The aims of this cohort study were to establish the construct validity, responsiveness to pulmonary rehabilitation (PR), and minimal important difference (MID) of the 5STS in IPF.Methods: In 149 people with IPF, we compared the 5STS with measures of lung function, exercise capacity, quadriceps strength, breathlessness, and health-related quality of life. Responsiveness and effect sizes were determined by measuring the 5STS before and after PR. The MID was estimated using anchor- and distribution-based methods.Results: The 5STS correlated significantly with incremental shuttle walk test (ISW) (r = -0.55), isometric quadriceps maximum voluntary contraction (QMVC) (r = -0.45), Medical Research Council dyspnea scale score (r = 0.40), Chronic Respiratory Questionnaire-Total (r = -0.21), and King's Brief Interstitial Lung Disease Questionnaire-Total (r = -0.21) but not forced vital capacity percentage predicted or quadriceps one-repetition maximum (1RM). There was a significant but very weak correlation between change in 5STS and changes in Medical Research Council (r = 0.18), ISW (r = -0.21), and Chronic Respiratory Questionnaire-Total (r = -0.26) but no significant correlation with change in 1RM (r = -0.12) or QMVC (r = -0.18). 5STS time improved with PR (median [25th percentile, 75th percentile] change, -1.97 [-3.47, -0.62] s; P < 0.001). The effect size for the 5STS was 0.66 and higher than quadriceps 1RM, QMVC, and ISW. The mean (range) MID estimate was -1.93 (-1.85 to -2.10) seconds.Conclusions: In people with IPF, the 5STS is a valid physical performance measure that is responsive to exercise-based interventions and suitable for use in most healthcare settings.

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary-analysis.

Protein-energy wasting is commonly observed in patients undergoing hemodialysis, leading to reduced muscle mass and, in severe cases, sarcopenia, which significantly impacts the patients' quality of life and clinical outcomes. Exercise interventions are frequently employed to address muscle loss in these patients. However, the relationship between exercise capacity and skeletal muscle mass in this context remains uncertain. In this study, researchers conducted a series of body composition analysis and exercise capacity test to explore the relationship between exercise capacity and skeletal muscle mass. This study recruited 32 patients undergoing hemodialysis and analyzed their demographic and clinical parameters. To assess aerobic exercise capacity, the incremental shuttle walking test (ISWT) was conducted, while the handgrip strength test was used to evaluate muscle strength. The patients' body compositions were assessed using the Fresenius Body Composition Monitor, and the appendicular skeletal muscle was scanned using a GE Healthcare Lunar iDXA scanner. Three sequential linear models were employed to model the relationship between ISWT and skeletal muscle mass. Model 1 regressed ISWT against gender and age; Model 2 added handgrip strength, fat tissue index, and Davies comorbidity scores as additional predictors; and Model 3 further included the appendicular skeletal muscle index (appendicular skeletal muscle/height). After controlling for age and gender (Model 1: R2 = 0.373), and subsequently including handgrip strength, fat tissue index, and Davies comorbidity score effects (Model 2: R2 = 0.581), the impact of appendicular skeletal muscle on ISWT was found to be non-significant (Model 3: R2 = 0.600). There was no significant correlation observed between exercise capacity and skeletal muscle mass in patients undergoing hemodialysis, indicating the factors influencing exercise capacity in this patient population are complex and that increasing skeletal muscle mass may not necessarily involve solely addressing the improvement of exercise capacity.

Preoperative pulmonary rehabilitation in medical inoperable patients with early stage non-small cell lung cancer and postoperative results

Aims: The impact of postoperative complications after surgery for lung cancer is substantial, with the increasing age of patients and the presence of comorbidities. Impairment in exercise capacity is a potential modifiable risk factor for postoperative complications. This study aimed to assess the contribution of preoperative pulmonary rehabilitation (PR) for increasing operability conditions in non-small cell lung cancer (NSCLC) for patients with limited pulmonary functions and postoperative results.&#x0D; Methods: The patients with NSCLC who had preoperative pulmonary rehabilitation and underwent surgical resection in our clinics between 2010-2019 were evaluated retrospectively. The patients enrolled in a comprehensive, multidisciplinary, supervised outpatient 10-day duration PR program preoperatively, consisting of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, and nutritional support. Exercise capacity and VO2 peak were evaluated by using an incremental shuttle walk test (ISWT).&#x0D; Results: Eighteen patients who underwent surgery due to NSCLC and had a pre-operative pulmonary rehabilitation program were evaluated. All the cases were male; the mean age was 66.2 (53-77) years. The squamous cell/adenocarcinoma ratio was 2.6 (13:5), and the mean tumor size was 4.6 (8-18) cm. The postoperative hospital stay was 12.7 (4-42) days, and they were followed up for an average of 30.2 (2-83) months. &#x0D; Conclusion: Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD, increasing their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention for risk modification and to decrease surgical morbidity and mortality. The results of our study also revealed the importance of preoperative pulmonary rehabilitation in centers where lung cancer surgery was performed.

Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years.

The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. This cross-sectional study recruited community-dwelling healthy subjects aged 21-80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg's dyspnoea score and Borg's rate of perceived exertion (RPE). 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0-850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0-450.0) (aged 60-80) to 480.0 m (IQR:438.0-650.0) (aged 40-59) to 780.0 m (IQR:670.0-960.0) (aged 21-39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) -6.31(Age, years) -3.61(Weight, kilograms) +2.54(HR change, beats per minute); R2 = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21-80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.