Physical Activity In Patients Research Articles

The Investigation of Machine Learning and Deep Learning Classification of Internet of Things (IoT) Enabled Medical Devices

The present cross-sectional, quantitative study investigates the classification capabilities of ML and DL in processing data from IoT-enabled medical devices: heart rate variability (HRV), blood pressure, blood glucose levels, and physical activity in patients with diabetes and cardiovascular diseases. Eight patients from AIIMS, New Delhi participated in this study. In the current investigation, two types of measurements are taken into consideration: cardiovascular measures and diabetes management metrics, which include BMI, blood pressure, blood glucose, physical activity, and HRV. The outcomes showed a positive association with blood glucose level and age (0.55), negative correlation between blood glucose and physical activity (-0.68), which had significant significance towards exercising importance in diabetes management. Blood glucose correlated moderately favorably with BMI with 0.45, while age and BMI correlated at 0.32. These results show how ML and DL techniques can improve the interpretation of complex health parameters from IoT-enabled devices to better manage patients and develop specific healthcare plans in chronic diseases.

Continuous heart monitoring to evaluate treatment effects in pulmonary hypertension

Abstract Background The treatment of pulmonary hypertension (PH) has improved rapidly in recent years, and there is increasing evidence to support the role of early intervention. However, studies demonstrate that timely intervention is often still lagging which affects clinical outcomes in patients with PH. Purpose To assess treatment effects after escalation of specific PH treatments using continuous heart monitoring via a Reveal LINQ loop recorder. Methods The patients change in heart rate variability (HRV), heart rate (HR), and physical activity were assessed before and after treatment escalation. Treatment escalation was defined as an additional PAH drug, pulmonary endarterectomy (PEA), percutaneous balloon angioplasty (PBA), or bilateral lung transplantation (BLTX). Results In this prospective study, 41 patients (27 with PAH and 14 with chronic thromboembolic pulmonary hypertension) were enrolled. Among them, 15 patients (36.6%) underwent PH treatment escalation. Prior to escalation, patients were monitored for a median of 100 (range: 68–100) days and after therapy escalation for a median duration of 165 (range: 89–308) days. In the escalation group, a significant increase in HRV (Figure), physical activity indexed by daytime HR was observed, while a significant decrease was seen in nighttime HR assessed at baseline and after treatment escalation. These changes were found both in the PAH and CTEPH group. In parallel a significant improvement in WHO functional class, 6-minute walking distance, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) was observed. Conclusions This is the first study to demonstrate a direct association between specific PH therapies and changes in HRV, HR nighttime and physical activity in patients with PAH and CTEPH. Continuous monitoring allows for an early intervention with supplementary treatment for PH. This is especially relevant considering the increasing availability of wearables that allow for a convenient measurement of relevant prognostic parameters in PH.

The mSQUASH is a feasible and valid measurement tool to uniformly assess daily physical activity in patients with rheumatic diseases

BackgroundThe modified Short QUestionnaire to ASsess Health-enhancing physical activity (mSQUASH) was originally developed and validated in Dutch patients with axial spondyloarthritis (axSpA). To support world-wide distribution, applicability and comparability of...

A Remote Behaviorally Designed Intervention to Promote Physical Activity in Patients With Knee Osteoarthritis: Results of a Pilot Randomized Clinical Trial.

We evaluated a behaviorally designed intervention utilizing gamification and social support to improve physical activity and reduce symptoms in patients with osteoarthritis of the knee (KOA). Veterans with KOA, aged 40-80 years, were enrolled in this randomized controlled trial. Participants received a Fitbit and completed a 2- to 4-week baseline period. A Web-based platform administered biweekly surveys after randomization and tracked physical activity. Participants selected a daily step goal that was 33%, 40%, or 50% above their baseline. The intervention arm received game playing aspects and a social support partner to advance weekly step performance while the control arm only received weekly updates. The primary outcome was the change in steps per day averaged over 2-week intervals. We used mixed effects regression, adjusting for baseline step count. Secondary outcomes assessed the change in KOOS (Knee Injury and Osteoarthritis Outcome Score) over 32 weeks. Thirty-one participants were included in the final analysis. Most participants were male (90.3%), Black (70.96%), had a mean (SD) age of 60 (13) years, and body mass index of 33.7 (5.9) kg/m2. Participants that received the intervention walked a total of 1119 (95% confidence interval: -562, 2799) more steps per day (p = 0.19). The effect was greatest in the first 6 months (1491 [-272, 3254], p = 0.10). Compared with controls, those that received the intervention had improvement over time in total KOOS (mean 2-week change +0.62 [0.031, 1.20] vs -0.38 [-1.04, 0.28], p = 0.02) and several subscales. This intervention demonstrated promise for promoting greater physical activity and improving symptoms in patients with KOA.

Comparison of exercise capacity and physical activity in patients with hyperthyroidism and controls

BackgroundHyperthyroidism impairs muscle mitochondrial metabolism and destroys many body systems. However, information is limited on how much physical and physiological outcomes are impaired in patients with newly diagnosed hyperthyroidism (NDH) and euthyroid. The comparison of pulmonary function, functional exercise capacity, respiratory muscle strength and endurance, physical activity levels (PAL), dyspnea, and quality of life (QoL) in patients and healthy controls was aimed. MethodSixteen patients with hyperthyroidism (evaluated twice at new diagnosis and euthyroid state) and healthy controls were compared. Pulmonary function was evaluated with a spirometer, functional exercise capacity with a 6-min walking test (6-MWT), respiratory muscle strength with a mouth pressure device and endurance with threshold loading test, PAL with metabolic holter, dyspnea with Modified Medical Research Council (MMRC) scale, and QoL with Quality of Life in Thyroid Patients Scale (ThyPRO). ResultsSix-MWT distance and respiratory muscle endurance significantly decreased, and MMRC dyspnea scale and ThyPRO scores were higher in patients with NDH and euthyroid compared to controls (p < 0.05). In addition, maximum inspiratory pressure and maximum expiratory pressure significantly decreased in patients with NDH compared to controls, and PAL was less active according to the number of steps in euthyroid patients (p < 0.05). The pulmonary function test was similar in both groups (p > 0.05). ConclusionExercise capacity, respiratory muscle strength and endurance, PAL, dyspnea, and QoL were affected in patients. Patients with hyperthyroidism should be evaluated at the onset of diagnosis, followed up, and referred to cardiopulmonary rehabilitation programs at the earliest. ClinicalTrials number: NCT04825964.

Is Kinesiophobia Associated With Quality of Life, Level of Physical Activity, and Function in Older Adults With Knee Osteoarthritis?

Beyond knee pain itself, the fear of movement, also known as kinesiophobia, recently has been proposed as a potential factor contributing to disability and functional limitation in patients with knee osteoarthritis (OA). Nevertheless, the available evidence on the association of kinesiophobia with patient-reported outcome measures (PROMs) in knee OA remains limited. Among patients with nonoperatively treated knee OA, we asked: (1) Is kinesiophobia associated with decreased quality of life (QoL), functional outcomes, and physical activity? (2) What are the patient disease and psychosocial demographic factors associated with kinesiophobia? This was a multicenter, cross-sectional study of 406 general orthopaedic patients from two urban, referral-based tertiary hospitals in Singapore under a single healthcare group who received nonoperative treatment for knee OA. Between July 2020 and January 2022, a total of 1541 patients were treated for knee OA nonoperatively. Based on that, 60% (923) of patients were rejected due to refusal to participate in the study, 3% (52) of patients were enrolled but did not show up for their appointments for data collection, and a further 10% (160) had incomplete data sets, leaving 26% (406) for this study's analysis. The mean age of patients was 64 ± 8 years, 69% were women, and 81% were Chinese. The level of kinesiophobia in patients was measured using the Brief Fear of Movement scale, a validated 6-item questionnaire ranging from a score of 6 to 24 to measure kinesiophobia in OA, with higher scores representing higher levels of kinesiophobia. In terms of PROMs, the QoL and functional level of patients were measured using the QoL and activities of daily living (ADL) components of the widely validated 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12). The KOOS-12 is a questionnaire consisting of 12 items encompassing three domains (QoL, ADL, and pain), with each item ranging from 0 to 4 and higher scores representing worse outcomes. The University of California, Los Angeles (UCLA) Activity Scale was used to measure the level of physical activity in patients. The UCLA score is a descriptive 10-level activity scale ranging from a score of 1 to 10, with higher scores representing greater physical activity levels. A directed acyclic graph, which is a relationship map used to depict and visualize the confounders between the studied variables, was used to identify the confounders between kinesiophobia and PROMs (QoL, function, and physical activity). An ordinal regression model was used to explore: (1) the association between kinesiophobia (as measured using the Brief Fear of Movement scale) and PROMs (as measured using KOOS QoL, KOOS ADL, and the UCLA Activity Scale), adjusting for key confounders such as age, gender, pain, side of arthritis, OA duration/severity, and psychosocial factors (for example, depression, anxiety, and education levels), and (2) the association between kinesiophobia (Brief Fear of Movement scale) and various patient disease and psychosocial demographic factors. After accounting for confounders, greater kinesiophobia (higher Brief Fear of Movement scores) was associated with lower QoL (KOOS QoL score adjusted IQR OR 0.69 [95% confidence interval (CI) 0.53 to 0.90]; p = 0.007) and lower physical activity (UCLA score adjusted IQR OR 0.68 [95% CI 0.52 to 0.90]; p = 0.007); however, there was no association between kinesiophobia and function (KOOS ADL score adjusted IQR OR 0.90 [95% CI 0.70 to 1.17]; p = 0.45). After adjusting for age, gender, OA duration, pain, and BMI, higher levels of anxiety (Patient Health Questionnaire 2 [PHQ-2] anxiety score adjusted OR 2.49 [95% CI 1.36 to 4.58]; p = 0.003) and depression (PHQ-2 depression score adjusted OR 3.38 [95% CI 1.73 to 6.62]; p < 0.001) were associated with higher levels of kinesiophobia. Education level, OA disease severity, side of arthritis (unilateral versus bilateral), and history of previous injury or surgery on the knee were not associated with kinesiophobia. Clinicians should assess for kinesiophobia and other psychological comorbidities such as depression and anxiety at the point of initial evaluation and subsequent follow-up of knee OA with simple validated tools like the Brief Fear of Movement scale (kinesiophobia) in the clinic. This allows for clinicians to identify high-risk individuals and offer evidence-based treatment such as cognitive behavioral therapies with a multidisciplinary team, including a physical therapist and psychologist, to manage these psychological comorbidities and improve outcomes in patients with knee OA. While kinesiophobia was found to be associated with poorer QoL and physical activity, future studies including larger observational cohort studies should be conducted to determine causal and prognostic relationships between kinesiophobia and outcomes in knee OA. Level III, prognostic study.

Exercise-Induced Proteomic Profile Changes in Patients with Advanced Heart Failure.

The pathophysiological background of the processes activated by physical activity in patients with heart failure (HF) is not fully understood. Proteomic studies can help to preliminarily identify new protein markers for unknown or poorly defined physiological processes. We aimed to analyse the changes in the plasma proteomic profile of HF patients after a cardiopulmonary exercise test (CPET) to define pathways involved in the response to exercise. The study prospectively enrolled 20 male patients with advanced HF (aged 53.3 ± 8.3 years). Blood samples were taken from the patients before and immediately after the CPET to obtain plasma proteomic profiles. Two-sample t-tests (paired or non-paired) were performed with and without false discovery rate (FDR) correction for multiple testing. Enrichment analysis was performed to associate biological processes and pathways with the study results. A total of 968 plasma proteins were identified, of which 722 underwent further statistical analysis. Of these, 236 proteins showed differential expression when comparing all plasma samples collected before and after CPT (p < 0.05), and for 86 of these the difference remained statistically significant after FDR correction. Proteins whose expression changed after exercise are mostly involved in immune response and inflammatory processes, coagulation, cell adhesion, regulation of cellular response to stimulus and regulation of programmed cell death. There were no differences in resting proteomics according to HF etiology (ischemic vs. non-ischemic). Changes in the proteomic profile revealed a complexity of exercise-induced processes in patients with HF, suggesting that few major physiological pathways are involved. Further studies focusing on specific pathways are needed.

Physical Activity before and After Bariatric Surgery.

Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.

Nutritional Support and Physical Activity Intervention Programs with a Person-Centred Approach in People with Chronic Obstructive Pulmonary Disease: a Scoping Review.

The knowledge is sparse in the literature on intervention programs using nutritional support and physical activity for patients with chronic obstructive pulmonary disease within a person-centred approach. We aimed to explore and map the existing evidence on intervention programs with a person-centred approach, focusing on nutritional support and physical activity for people with COPD. A scoping review was conducted using Arksey & O'Malley's methodological framework. A search in the databases CINAHL and PubMed, and a grey literature search, was conducted in June 2022 and updated in June 2023. We identified studies published between 2012 and 2023. The PRISMA checklist for scoping reviews, supported by The PAGER framework was used for reporting the method. A total of 15 studies were included. The primary interventions comprised behavior of change or self-management, addressing needs assessment, motivation, personal goals, education, and physical activity. Health-related quality of life and hospital stay displayed no clinically significant variances. However, eight studies demonstrated differences in physical function and activity levels. Nutritional outcomes were addressed in one study, and three studies involved relatives. This scoping review addresses a knowledge gap in nutritional support interventions with a person-centred approach. It indicates that there is a need to increase nutritional support and consider the patient's physical and social environmental resources within Behavior of change or Self-management intervention programs for patients with COPD. The review found no clinical effect on health-related quality of life, although there were some effects on physical activity. The results highlight how the interdisciplinary team can include the patients' resources when structuring the management of COPD by applying a person-centred approach.

Nutrition intake and physical activity in patients with chronic wounds

Nutrition intake and physical activity in patients with chronic wounds

Adherence to long-term telemonitoring-supported physical activity in patients with chronic heart failure

Chronic heart failure (CHF) is one of the most common diseases with a prevalence of 1–2% in adults, disproportionately affecting the elderly. Despite consistent drug therapy, physical activity (PA) is an integral part of current guidelines. Yet adherence to regular PA and exercise interventions is poor and potential predictors and barriers to PA remain elusive. We examined the effects of a telemonitoring-based exercise intervention in 699 CHF patients in a prospective, randomized-controlled (1:1), multicenter trial. The study was registered in the German Clinical Trials Register under DRKS00019022 on 28.05.2020. For both, the exercise and control group, self-reported PA (MET*h/week) increased and sedentary behavior declined during the 12-month intervention period. In the exercise group, daily step count as analyzed via activity trackers remained stable (pre: 6459 [4016] steps/day, post: 6532 [3858] steps/day; p = 0.621). The average number of completed exercise instruction videos provided via an online application was 1.50 [1.44] videos/week at the beginning and gradually decreased to 1.00 [1.50] videos/week; p < 0.001). Multivariate regression model revealed that exercise-related PA (MET*h/week) and exercise capacity (Wmax) at baseline, CHF severity, atrial fibrillation and age predicted changes in self-reported exercise-related PA (R2 = 0.396). Furthermore, the BMI and the average number of completed videos per week at baseline were associated with the change in completed videos over the course of the study (R2 = 0.251). Our results show the influence of certain baseline characteristics as barriers and predictors of PA progression. Therefore, exercise programs should pay attention to patients’ individual conditions to set achievable goals, and eventually affect the adherence and sustainability of exercise-focused interventions.

Ulcerative colitis: definition, epidemiology, pathogenesis, clinic, diagnosis, follow-up. Lecture. Part I

Inflammatory bowel diseases (IBD) are currently one of the most difficult problems in modern global internal medicine in general and in gastroenterology in particular. The diseases demonstrate a relapsing, progressive nature, significant decrease in the quality of life, physical activity of patients, complications from other organs and systems of the human body, a decrease or even loss of working capacity, difficulties in socialization and creating a family. An insufficiently predicted course of the disease, acute or chronic intestinal complications can lead to surgical interventions. According to the severity of the course, the frequency of disability, complications, including those, that require surgical intervention; in terms of the economic costs of the health care system, IBDs are ahead of a number of other widespread diseases of digestive organs. The variety of clinical, anatomical (in particular, localization and extend of damage to the Gut), endoscopic signs of the disease in combination with different degrees of severity and activity of the disease, the presence of local and systemic extraintestinal manifestations determine difficulties in early establishing the diagnosis, in differential diagnosis and in choosing an effective and safe therapy, which is prescribed for the purpose of not only achieving, but also further maintaining a stable remission of the disease.In the vast majority of patients, the disease is characterized by a chronic relapsing course and requires long­­term, constant, often life­­long drug treatment with the use of drugs from various pharmacological groups, including combination therapy. An active search for predictably effective drugs for the treatment for IBD continues at the present time. According to the new International Classification of Diseases, 11th revision (2022), three diseases are included in the IBD group: ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis, i.e. a disease in which it is impossible to clearly determine whether it is UC or CD of the colon. In modern medicine, there is a tendency towards greater clarity and conciseness in the formulation of diagnoses, examination algorithms and treatment regimens. Inflammatory bowel disease remains diseases with many unknowns, both in terms of establishing a clear diagnosis and in terms of prognosis and predictability of the consequences of drug therapy.

Stair-Climbing Training with Interferential Electrotherapy Improves Knee Muscle Strength, Dynamic Postural Stability, Pain Score, and Physical Activity in Patients with Knee Osteoarthritis.

Background/Objective: This study aimed to compare the functional outcomes, such as knee muscle strength, dynamic postural stability, pain scores, and physical activity, in patients with knee osteoarthritis (OA) on stair climbing training with and without interferential electrotherapy (IFE) for 12 weeks. Methods: A total of 40 knee OA patients with Kellgren-Lawrence (K-L) grade ≤ 2 were enrolled (20 stair-climbing training with IFE vs. 20 stair-climbing training without IFE). The knee quadriceps and hamstring muscle strengths were measured using an isokinetic device. The dynamic postural stability was assessed using postural stabilometry. The pain score was evaluated using the visual analog scale (VAS). Physical activity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The WOMAC score was significantly different (p < 0.019) between stair-climbing training with and without IFE in patients with knee OA, while knee muscle strength, dynamic postural stability, or pain score were not (all p > 0.05). Conclusion: Stair-climbing training with IFE was more beneficial for physical activity recovery than stair-climbing training without IFE. Therefore, clinicians and therapists should be aware that stair climbing, which can be practiced in daily life for the management of patients with knee OA, and the addition of IFE may improve physical activity.

Effect of Behavior-change Interventions on Daily Physical Activity in Patients with Intermittent Claudication: The OPTIMA Systematic Review with Meta-Analysis.

The study aimed to synthesize evidence of daily physical activity (PA) following Behavior-change technique (BCT)-based interventions compared to any control in individuals with peripheral arterial disease/intermittent claudication (PAD/IC); and examine the relationship between BCTs and daily PA. Systematic search of 11 databases from inception to 30/11/2022 was conducted, plus weekly email alerts of new literature until 31/8/2023. Studies comparing BCT-based interventions with any control were included. Primary analysis involved a pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane-RoB-2 and ROBINS-I tools. Certainty of evidence was evaluated with the GRADE system. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Outcome measures were short-term (<6 months) change in daily PA, and maintenance of the daily PA (6 months or longer) reported as standardized mean differences (SMDs) with 95% confidence intervals (95%CIs). Forty-one studies (4,339 patients; 26 RCTs/3,357 patients; 15 non-RCTs/982 patients; study mean age 60.3 to 73.8, 29.5% female) were included. Eleven RCTs (15 comparisons, 952 participants) suggested that BCT-based interventions increased daily PA in the short term compared to non-SET [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ∼473 steps/day] with high certainty. Evidence of maintenance of daily PA (≥6 months) is unclear [increase of 0.12 SMD (95%CI: -0.04 to 0.29); ∼288 steps/day; 6RCTs, 8 comparisons, 899 participants], with moderate certainty. For daily PA, compared to SET it was inconclusive both for < 6months change [-0.13 SMD, 95%CI: -0.43 to 0.16); 3RCTs, 269 participants; low certainty] and ≥6months [-0.04 SMD, 95%CI: -0.55 to 0.47); 1 RCT, 89 participants; very low certainty]. It was unclear whether the number of BCTs or any BCT domain were independently related to an increase in PA. BCT-based interventions improve short-term daily PA in people with PAD/IC compared to non-SET controls. Evidence for maintenance of the improved PA at 6 months or longer and comparison with SET is uncertain. BCT-based interventions are effective choices for enhancing daily PA in PAD/IC.

A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study.

The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)-integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. In total, 3 themes were identified from provider interviews: (1) providers' knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting.

Factors associated with physical activity in patients with upper gastrointestinal cancer during outpatient chemotherapy: A cross-sectional study

ObjectiveThis study aimed to clarify the physical activity level of patients with upper gastrointestinal cancer during outpatient chemotherapy and the factors associated with decreased physical activity levels after drug administration. MethodsIn this cross-sectional study, activity intensity and steps were measured using an accelerometer in 39 patients with upper gastrointestinal cancer for 1 week before and after drug administration. Furthermore, the participants responded to a questionnaire on their lifestyles. ResultsNo significant differences in steps and activity intensity were found before and after drug administration, and many participants had low activity levels. Logistic regression analysis showed that the Geriatric 8 scores and domestic roles were positively associated with higher activity levels after drug administration, whereas total bedtime showed a negative association. A predictive score for low activity was calculated from the three associated factors, and receiver operating characteristic analysis was conducted, resulting in an area under the curve of 0.90. ConclusionsPhysical activity may be low in patients with upper gastrointestinal cancer during outpatient chemotherapy. To maintain and promote physical activity, the results suggest the need to predict those who become less active after treatment and to support them by focusing on their domestic roles and total bedtime while considering their general condition. Our newly proposed predictive score can objectively identify patients with lower physical activity, regardless of the nurse's experience and ability, and improve patients' support during chemotherapy, even in the limited time available as outpatients.

Comparison of water- vs. land-based exercise for improving functional capacity and quality of life in patients living with and beyond breast cancer (the AQUA-FiT study): a randomized controlled trial.

Patients living with and beyond breast cancer frequently exhibit several side effects that can impact quality of life and physical functioning way beyond diagnosis and cancer therapies. Traditional on-land exercise has shown to be effective in reducing several symptoms of BC but little is known about the role of water-based exercise in improving physical and psychological well-being. To compare land- vs. water-based exercise training for BC survivors to improve Health-Related Quality of Life (HRQoL), cancer-related fatigue (CRF), physical functioning, body composition and physical activity in patients with BC. A randomised, parallel group (1:1) controlled trial was conducted between 2020 and 2022. Patients were randomly allocated to complete a similar exercise training twice weekly during 12 weeks either on land (LG) using traditional gym equipment or in a swimming pool (WG) using body-weight exercises and water-suitable accessories. Both groups were supervised and monitored by an experienced physiotherapist. Main outcome was HRQoL (EORTC QLQ C30 and B23 module) and CRF measured with the Piper Scale. Secondary variables included functional capacity with the 6 Minutes Walking Test (6MWT), upper and lower body strength (handgrip strength and 30″ Sit-to-Stand (STS) test), body composition and objectively measured physical activity. 28 patients were assessed and randomised during the study period. One patient did not receive the allocated intervention due to skin issues and one patient was dropped out during the intervention. A significant effect of time was found for both symptom severity (F(2,52) = 6.46, p = 0.003) and overall functioning (F1.67,43.45 = 5.215, p =0 .013) but no interaction was found between group and time. No effects were reported for CRF. Similar findings were reported for functional capacity (time effect F1.231,32.019 = 16.818, p < 0.001) and lower body strength (time effect F2,52 = 15.120, p < 0.001) as well as fat mass (time effect F2,52 = 4.38, p = 0.017). Notably, a significant time per group interaction was reported for physical activity (F2,52 = 6.349, p =0.003) with patients in the WG significantly improving PA levels over time while patients in the LG exhibited a marked decreased. Exercise training either in water or on land can decrease symptom severity and improve functionality and body composition. Water-based training seems more effecting than land-based exercise to improve physical activity patterns over time.

Особенности вегетативной регуляции ритма сердца у пациентов с гипертонической болезнью после ишемического инсульта

INTRODUCTION. A decrease in heart rate variability indicates a violation of the autonomic control of cardiac activity, which is one of the reasons for the poor prognosis in this category of patients. Until now, the problem of the effectiveness and safety of correction of high blood pressure during the acute period of ischemic stroke remains a subject of debate. AIM. To determine clinical, autonomic and hemodynamic changes at rest and during an active orthostatic test to assess the functional state and adaptive capabilities of the cardiovascular system and identify risk factors for the unfavorable course of arterial hypertension in patients with hypertension in the acute period of ischemic stroke. MATERIAL AND METHODS. 78 patients with hypertension who were treated in a therapeutic hospital were examined. The first group consisted of 40 people with hypertension complicated by ischemic stroke, the second group included 38 people with uncomplicated hypertension. The patient's condition was assessed using the NIHSS scale and the Rankin scale. data from electrocardiography, duplex scanning of blood vessels, computed tomography of the brain, transthoracic ECHO-CG, portable monitor VNS-Micro and Poly-Spectrum SM from Neurosoft. The study of heart rate variability was carried out in patients with stroke upon admission, on days 5-10 and before discharge from the hospital (days 15-21). With the Revermead mobility index, more than 7 patients underwent an active orthostatic test with parallel ECG recording, measurement of blood pressure and heart rate at rest and when moving to a vertical position. RESULTS AND DISCUSSION. Patients with insufficient recovery of neurological functions on days 5-7 of stroke demonstrate the development of hypotension during an orthostatic test. An active orthostatic test on days 15-21 of stroke is successfully performed by patients with increased tone of the sympathetic nervous system. Patients with good recovery of neurological functions at discharge have normal autonomic reactivity and an adequate response of the sympathetic division of the autonomic nervous system to standing. CONCLUSION. Young men with hypertension should be closely monitored by physicians and receive primary stroke prevention. To increase tolerance to physical activity in patients who did not complete an active orthotest on days 5-7 of a stroke, daily passive verticalization is necessary. KEYWORDS: ischemic stroke, active orthotest, heart rate variability, hypertension, verticalization

154 Avoidance of Physical Activity Among Patients with Chronic Obstructive Pulmonary Disease (COPD): An Observational Study

Abstract Purpose While physical activity is recognized as an essential component in COPD treatment, patients with COPD often exhibit lower levels of physical activity compared with their lung-healthy peers. The primary objective of our study was to describe the proportion of patients with COPD who report avoidance behavior related to physical activity. Methods A questionnaire-based, observational study was conducted among patients with COPD, scheduled to attend a pulmonary rehabilitation program. Participants completed the COPD Anxiety Questionnaire (CAF-R) and functional tests were conducted prior to participation of the rehabilitation program. Results We included 48 participants (24 males, mean: age 70±7.8 years, body mass index 25±5.0, MRC dyspnoea scale 2.5±0.9, One-Minute-Sit-To-Stand-Test 19 ±6.0 repetitions). Findings revealed that 60% (95% CI [46%-0,74%]) reported avoidance of physical exertion, 44% (95% CI [24%-52%]) avoid activities causing breathlessness, and 35% (95% CI [22%-48%]) try avoid any form of physical activity. Conclusions Our findings show that a large proportion of patients with COPD exhibit avoidance behavior concerning physical activity. While the underlying reasons are likely multifaceted, apprehension towards breathlessness emerges as a potential contributing factor. The results underscore the importance of investigating avoidance behavior in people with COPD to better understand how to promote physical activity within this population. Future interventions designed to increase physical activity in patients with COPD should include identification of the extent of avoidance behavior and implementation of strategies to manage the behavior, such as exposing individuals to physical activity within a secure environment. Support/funding This study received financial support from the Karen Elise Jensen Foundation and the Eva Merethe Falck Crones Foundation.

The Effect of Dapagliflozin on Accelerometer-Based Measures of Physical Activity in Patients with Heart Failure: An Analysis of the DETERMINE Trials.

Background: Wearable accelerometers can quantify the frequency and intensity of physical activity during everyday life and may provide complementary data to established functional outcome measures on the effect of heart failure therapies on functional limitations. Methods: In a voluntary substudy of the DETERMINE (Dapagliflozin EffecT on ExeRcise capacity using a 6-MINutE walk test in patients with HF) trials, patients wore a waist-worn tri-axial accelerometer for as long as possible (ideally for 24 hours/day for 7 days) at 3 points during the trial; between the screening visit and randomization (baseline data), and during weeks 8 and 14-16. Accelerometer outcomes included the change from baseline to week 16 in the total number of steps, time spent in light-to-vigorous physical activity (LVPA), time spent in moderate-to-vigorous physical activity (MVPA), movement intensity during walking, number of vector magnitude units (VMUs)' and total activity counts. Results: Adequate baseline and week 16 accelerometer data were available for 211 of 817 (26%) randomized patients (defined as ≥10 hours of wear-time for ≥3 days). Dapagliflozin had a favorable effect on the mean change from baseline at 16 weeks in the number of steps (between-group difference 778 [95%CI 240, 1315]), time spent in MVPA (0.16 hours [95%CI 0.03, 0.29]) and in the mean VMUs (25 counts per minute [95%CI 0.1, 49]). There were no between-group differences in the other accelerometer outcomes of interest. Conclusions: In this exploratory analysis of the DETERMINE trials, dapagliflozin had a beneficial effect on selected accelerometer-based measures of physical activity in patients with HF across the entire left ventricular ejection fraction spectrum, yet did not improve 6MWD, as previously reported. These data suggest that accelerometer-based measurements of everyday activity may provide complementary information to 6MWD and identify beneficial effects of treatment not detected by 6MWD. Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03877237 and NCT03877224.