Lower Functional Exercise Capacity Research Articles

Post-COVID-19 condition: systemic inflammation and low functional exercise capacity.

Post-COVID-19 condition (PCC) is characterised by a plethora of symptoms, with fatigue appearing as the most frequently reported. The alterations that drive both the persistent and post-acute disease newly acquired symptoms are not yet fully described. Given the lack of robust knowledge regarding the mechanisms of PCC we have examined the impact of inflammation in PCC, by evaluating serum cytokine profile and its potential involvement in inducing the different symptoms reported. In this cross-sectional study, we recruited 227 participants who were hospitalised with acute COVID-19 in 2020 and came back for a follow-up assessment 6-12 months after hospital discharge. The participants were enrolled in two symptomatic groups: Self-Reported Symptoms group (SR, n = 96), who did not present major organ lesions, yet reported several debilitating symptoms such as fatigue, muscle weakness, and persistent loss of sense of smell and taste; and the Self-Reported Symptoms and decreased Pulmonary Function group (SRPF, n = 54), composed by individuals with the same symptoms described by SR, plus diagnosed pulmonary lesions. A Control group (n = 77), with participants with minor complaints following acute COVID-19, was also included in the study. Serum cytokine levels, symptom questionnaires, physical performance tests and general clinical data were obtained in the follow-up assessment. SRPF presented lower IL-4 concentration compared with Control (q = 0.0018) and with SR (q = 0.030), and lower IFN-α2 serum content compared with Control (q = 0.007). In addition, SRPF presented higher MIP-1β serum concentration compared with SR (q = 0.029). SR presented lower CCL11 (q = 0.012 and q = 0.001, respectively) and MCP-1 levels (q = 0.052 for both) compared with Control and SRPF. SRPF presented lower G-CSF compared to Control (q = 0.014). Female participants in SR showed lower handgrip strength in relation to SRPF (q = 0.0082). Male participants in SR and SRPF needed more time to complete the timed up-and-go test, as compared with men in the Control group (q = 0.0302 and q = 0.0078, respectively). Our results indicate that different PCC symptom profiles are accompanied by distinct inflammatory markers in the circulation. Of particular concern are the lower muscle function findings, with likely long-lasting consequences for health and quality of life, found for both PCC phenotypes.

Impaired functional exercise capacity and greater cardiovascular response to the 6-min walk test in congenital generalized lipodystrophy

BackgroundCongenital Generalized Lipodystrophy (CGL) is an ultra-rare disease characterized by metabolic disorders. However, the evaluation of functional exercise capacity, cardiovascular (CV) response to exercise, and peripheral arterial disease (PAD) in CGL is scarce. Here we evaluated the performance and CV response to exercise and their association with PAD in CGL compared to healthy individuals.MethodsTwelve CGL and 12 healthy subjects matched for age and gender were included. Functional exercise capacity, CV response, and PAD were measured using the six-minute walk test (6MWT) and ankle-brachial index (ABI), respectively.ResultsAt baseline, CGL subjects showed reduced predicted walked distance (6MWD) (p = 0.009) and increased heart rate (HR), systolic (SBP), and diastolic (DBP) pressures compared to healthy subjects (p < 0.05). Most CGL subjects presented normal ABI values (1.0 ≤ ABI ≤ 1.4). Only 25% (n = 3) had ABI ≤ 0.9. CGL subjects did not present changes in ABI and blood pressure 12 months after metreleptin (MLP) replacement, but they walked a greater 6MWD than baseline (p = 0.04). Further, 6MWD and right ABI measurements were positively correlated in CGL subjects (p = 0.03). Right ABI negatively correlated with glucose, triglycerides, and VLDL-c (p < 0.05).ConclusionsWe observed that CGL subjects had lower functional exercise capacity and higher cardiovascular effort for similar performance of 6MWT, suggesting that strategies for decreasing exercise effort in this population should be essential. Furthermore, better physical performance was associated with high ABI in CGL. Additional studies are needed to clarify leptin's role in preserving functional exercise capacity in CGL.

Follow-up of functional exercise capacity in patients with COVID-19: It is improved by telerehabilitation

BackgroundThe impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic. MethodPatients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program. ResultsAt discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program. ConclusionsPatients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.

Associations of Perioperative, Donor, and Recipient Factors with Functional Exercise Capacity after Orthotopic Heart Transplantation

<h3>Purpose</h3> Low functional exercise capacity (FEC) is directly associated with reduced quality of life and poor prognosis after orthotopic heart transplant (OHT). Due to inconsistencies in the literature, the purpose of this study is to investigate several proposed independent risk factors for poor FEC post-OHT. <h3>Methods</h3> Thirty OHT recipients (22 males; <3 months post-OHT) performed a graded cardiopulmonary exercise test on an upright cycle ergometer or a treadmill dependent on fall risk in an outpatient cardiac rehab setting. FEC was dichotomized into high (≥14 ml/kg/min, or ≥12 ml/kg/min if on beta blockers) and low (<14 ml/kg/min, or <12 ml/kg/min if on beta blockers). Univariable and multivariable regression were used to study associations with FEC. Variable selection was facilitated using lasso and backwards selection. <h3>Results</h3> 15 patients exhibited high FEC. Characteristics were similar between groups, with the high FEC group having higher cardiac index (CI) and cardiac output (CO), longer ischemic time (IT), less chance of falling (all <i>p</i><0.04), higher anaerobic threshold (AT) and metabolic equivalents (both <i>p</i><.01) (Table 1). Each 30-min increase in IT was associated with a 40% [95% CI: 1.04, 2.09] increase in the odds of testing with high FEC, which remained significant following adjustment for AT and CI. Univariable linear association of IT with FEC was not significant. However, IT was an important factor in multivariable analysis with CPET duration, exertion, hemodynamics and test modality. Each 30-min increase in IT was associated with a 0.31 [95% CI: 0.04, 0.57] increase in FEC with all other variables constant. <h3>Conclusion</h3> Lower cardiac output and index as well as higher fall risk were associated with low FEC. Shorter IT was paradoxically associated with low FEC. Higher FEC despite longer IT suggest centers may be willing to travel further for donor hearts, although other perioperative factors may contribute to poor FEC.

Importance of "muscle" and "intestine" training before major HPB surgery: A review.

Major hepato-pancreato-biliary (HPB) surgery is one of the most invasive abdominal surgeries. Through the experiences of several clinical trials, including those involving patients undergoing major HPB surgery, we have recognized the importance of "muscle" and "intestine" training before surgery. This review article summarizes the results of our clinical trials, specifically focusing on the importance of "muscle" and "intestine". The patients with low skeletal muscle mass or those with low functional exercise capacity showed a significantly worse postoperative course and poor long-term survival after surgery for HPB malignancy. The introduction of prehabilitation (preoperative physical and nutritional support) improved nutritional status and functional exercise capacity, even in patients with malignancy. Daily physical activity was correlated with nutritional status before surgery. These results indicated the usefulness of prehabilitation. The intestinal microenvironment, which is extrapolated from the fecal concentrations of short-chain fatty acids (SCFAs), showed a significant association with the incidence of surgery-induced bacterial translocation and postoperative infectious complications (POICs). The use of perioperative synbiotics not only increased the fecal levels of SCFAs but also prevented the incidence of POICs. A recent study also indicated that there are correlations between muscle mass and the intestinal microenvironment. Further investigation is required to determine the best "muscle" and "intestine" training protocol to improve the outcomes of major HPB surgeries.

Mortality Predictive Factors in Subjects With COPD After a Pulmonary Rehabilitation Program: A 3-Year Study.

COPD is a high-mortality disease and projected to become the third leading cause of death worldwide by 2030. Our aim was to evaluate predictors of 3-y mortality and factors associated with early (1 y) and late (second and third year) mortality in subjects with severe COPD who completed a pulmonary rehabilitation program. A historical cohort study was performed with subjects with COPD who were admitted to a day-hospital for chronic respiratory failure for a pulmonary rehabilitation program, from January 2008 to December 2010. The population was characterized based on sociodemographic factors, body mass index, smoking habits, lung function tests, respiratory failure, comorbidities, bacterial colonization, Modified Medical Research Council dyspnea index, 6-min walk test, mechanical ventilation, noninvasive ventilation, long-term oxygen therapy, hospital admissions, and mortality. From 183 patients who completed a pulmonary rehabilitation program, 93 had COPD. Our cohort had 78 male and 15 female subjects. The mean age ± SD was 68.6 ± 8.9 y, ranging from 43 to 85 y. After the pulmonary rehabilitation program, there were fewer, although not statistically significantly different hospital admissions (2.1 vs 1.7, P = .17). Three years after the pulmonary rehabilitation program, 34 subjects died (36.6%). Hypercapnic respiratory failure (P = .02), noninvasive ventilation (P = .002), lung cancer (P = .001), shorter 6-min walk distance (P = .03), and higher number of previous hospital admissions (P < .001) were associated with a higher mortality rate. There is a high mortality rate in late-stage patients with COPD. The most relevant factors associated with mortality were lung cancer, respiratory failure and noninvasive ventilation, severe exacerbations with hospitalization, and lower functional exercise capacity.

Densidade mineral óssea de idosas independentes com diferentes perfis físico-funcionais e polimorfismos do gene do receptor da vitamina D

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n1p20 The aim of the study was to compare BMD among physically independent elderly women with different physical-functional profiles and vitamin D receptor gene (VDR) polymorphisms, as well as to analyze the effect of the interaction between these last two aspects on BMD. Overall, 165 elderly women had BMD assessed by bone densitometry. Handgrip and lower limb strength and functional exercise capacity (6MWT) were also assessed. VDR polymorphisms (TaqI, BsmI, ApaI and FokI) were analyzed by polymerase chain reaction. For analyses, elderly women were categorized according to their performance on physical-functional tests into low performance (LP; &lt;25th percentile), normal performance (NP; 25th percentile ≤ NP ≤ 75thpercentile) and high performance (HP;&gt; 75th percentile). Regarding functional exercise capacity, LP group showed lower BMD compared to HP and NP groups (p=0,003). With respect to handgrip strength, there was a trend for LP group to have lower bone mineral density compared to NP group (p=0.08). No differences were observed in femur and lumbar BMD in comparisons among the different VDR genotypes (0.07≤p≤0.94); among different groups regarding lower limb strength (p=0.49) and in the interaction analysis among variables (0.17≤p≤0.77). It was concluded that physically independent elderly women with low functional exercise capacity have lower bone mineral density than those classified as normal and high performance. However, apparently, there is no effect of the interaction between VDR gene polymorphisms and physical and functional factors on BMD.

Directly measured physical activity as a predictor of hospitalizations in patients with chronic obstructive pulmonary disease

Patients with clinically stable chronic obstructive pulmonary disease (COPD) are physically inactive, and this inactivity appears to be an independent predictor of hospitalizations. To explore this relationship further, we compared physical activity of COPD patients assessed in 2008 to subsequent hospitalizations and mortality. Sixty adults with a history of cigarette smoking, a diagnosis of COPD, a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <0.70, and no recent exacerbation were studied. Physical activity was measured using a triaxial accelerometerworn on the waist for seven consecutive days and the vector magnitude units (VMUs) that are the sum of movements in three planes over each minute were recorded. Those patients with mean VMU<170 (the median) were considered to be less physically active, and those with a 6-minute walk distance (6MWD) test of <350 m were considered to have lower functional exercise capacity. These two variables, along with age, gender, and a history of exacerbations in the preceding 12 months, FEV1, body mass index, and supplemental oxygen requirement, were related to subsequent all-cause and respiratory-related hospitalizations that occurred over the ensuing 53±2 months. The mean age was 68±11 years, 50% were male, and the FEV1 was 53±19%. All-cause and respiratory-related hospitalizations occurred in 58 and 35%, respectively. A 6MWD<350 m and VMU<170 each significantly predicted subsequent all-cause and respiratory-related hospitalizations in univariate Cox proportional hazards analyses after controlling for previous exacerbations. Both 6MWD<350 m and VMU<170 counts remained in a multivariate model predicting respiratory-related hospitalization. These results indicate that both directly measured physical activity and functional exercise capacity are important predictors of hospitalization in COPD.

Pain and physical performance in people with COPD

Patients with Chronic Obstructive Pulmonary Disease (COPD) have been shown to experience significant pain that interferes with their daily activities and quality of life. The purpose of this study was to examine if pain is associated with functional exercise capacity (assessed with the six-minute walk test, 6MWT), physical activity (assessed by accelerometry), and muscle performance (maximal knee extensor torque) in people with COPD. Twenty-six people with moderate to severe COPD completed the McGill Pain Questionnaire (MPQ), the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), and a form to list medications and comorbidities. After spirometric testing, participants performed the 6MWT. Physical activity was monitored for two days using a tri-axial accelerometer (DynaPort MiniMod). At least 3 days after the 6MWT, maximal and fatiguing concentric contractions of knee extensors were assessed. Pain severity was negatively correlated with the 6MWT (p<0.05), and quality of life (p<0.05), whereas it was positively correlated with body mass index (BMI) (p<0.001), and the number of comorbidities (p<0.001). Subjects with severe pain showed lower standing and activity times (p<0.01), lower 6MWT (p<0.05), higher BMI (p<0.001), a higher number of comorbidities (p<0.001) and lower quality of life (p<0.01) compared to subjects with minimal or no pain. Pain in patients with COPD is associated with low functional exercise capacity, reduced physical activity, and high BMI. Pain can adversely affect physical activity and quality of life in patients with COPD. Early evaluation of pain needs to be considered in the assessment and treatment plan for people with COPD.

Physical Health Status Measures Predict All-Cause Mortality in Patients With Heart Failure

Physical health status measures have been shown to predict death in heart failure (HF); however, few studies found significant associations after adjustment for confounders, and most were not representative of all HF patients. HF patients from southeastern MN were prospectively enrolled between 10/2007 and 12/2010, completed a 12-item Short Form Health Survey (SF-12) and a 6-minute walk, and were followed through 2011 for death from any cause. Scores ≤ 25 on the SF-12 physical component indicated low self-reported physical functioning, and the first question of the SF-12 measured self-rated general health. Low functional exercise capacity was defined as ≤ 300 m walked during a 6-minute walk. Over a mean follow-up of 2.3 years, 86 deaths occurred among the 352 participants. A 1.6-fold (95% confidence interval, 1.0-2.7) and 1.8-fold (95% confidence interval, 1.1-2.9) increased risk of death was observed among patients with low self-reported physical functioning and low functional exercise capacity, respectively. Poor self-rated general health corresponded to a 2.7-fold (95% confidence interval, 1.5-4.9) increased risk of death compared with good to excellent general health. All measures equally discriminated between who would die and who would survive (C-statistics: 0.729, 0.750, and 0.740 for self-reported physical functioning, self-rated general health, and functional exercise capacity, respectively). Three physical health status measures, captured by the SF-12 and a 6-minute walk, equally predict death among community HF patients. Therefore, the first question of the SF-12, which is the least burdensome to administer, may be sufficient to identify HF patients at greatest risk of death.

Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation

Improvements in health status following pulmonary rehabilitation (PR) diminish with time. Acute exacerbations of COPD (AECOPDs) negatively impact adherence after PR and likely accelerate this diminution of benefit. This study was designed to characterize the pre-AECOPD status of patients with moderate or severe COPD who had completed PR, and then to measure the impact of AECOPDs on health-related quality of life (HRQL) and functional exercise capacity. Sixty subjects who completed PR were enrolled in a 6-month observational study and were followed up until an AECOPD occurred. In the event of an AECOPD, primary outcome measures, the 6-min walk test (6MWT) and the chronic respiratory disease questionnaire (CRDQ), were repeated 2 weeks after the onset of symptoms. Between-group and repeated-measures analyses were performed. The mean (+/- SD) age of the 53 subjects (49% female) completing the study was 68 +/- 9 years. Baseline airflow obstruction was moderate in 35 subjects (66%) and severe in 18 subjects (34%). Thirty-four subjects experienced a moderate or severe AECOPD. The mean distance walked on the baseline 6MWT in those subjects who experienced AECOPDs was 350 +/- 95 m, compared to 416 +/- 95 m walked in those subjects who did not (difference, 66 m; p < 0.02). The presence of an AECOPD was associated with significant reductions in 6MWT distance walked (difference, 59.3 +/- 80 m; p < 0.01) and in the CRDQ domains of fatigue (difference, 1 +/- 1.3; p < 0.01), emotion (difference, 0.6 +/- 0.95; p < 0.01), and mastery (difference, 0.5 +/- 1.4; p < 0.05). Patients with lower functional exercise capacity are more likely to experience AECOPDs following PR. AECOPDs are associated with significant and clinically meaningful reductions in functional exercise capacity and HRQL.