Physical Function Research Articles

Work and disability benefit unraveled in chronic gastrointestinal patients

Abstract Background Persons with a chronic disease, such as chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disease, have a lower work participation (WP) than the healthy population. Instead, they might receive a disability benefit (DB). Positive Health (PH) is a newly developed, holistic view of health and comprises six dimensions: bodily functions, mental well-being, meaningfulness, quality of life, participation, and daily functioning. In this study we aim to determine whether the dimensions of PH relate to WP and DB in persons with GI-HPB. Methods GI-HPB patients attending the outpatient clinic of the Maastricht University Medical Center between 2019-2021 received validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L) and items regarding WP and DB. The relation between the six dimensions of PH, and WP and DB, were tested with univariate and multivariate statistics. Results 448 patients (Mage = 45 years; 69% female) were included. Univariate analysis revealed that, except for meaningfulness, all dimensions were significantly associated with WP (p≤.02) and DB (p≤.005). In multivariate analyses, lower age (p=.010), better general health (p=.044) and better physical functioning (p<.001) related to WP. Higher age (p=.002) and lower physical functioning (p=.011) related to DB. Conclusions Among GI-HPB patients, physical functioning related to both WP and DB. The chance of working was higher among younger patients and those with better general health while those with a higher age received DB more often. The PH concept was only partially relevant to work status and DB. Key messages • Within the dimensions of Positive health, work participation was associated with a lower age, a better general health and a better physical functioning. • Within the dimensions of Positive health, disability benefit was associated with higher age and lower physical functioning.

Associations between cardiac rehabilitation and clinical outcomes in patients with heart failure and cognitive frailty

Abstract Introduction Patients with heart failure (HF) often contend with various comorbidities, including cognitive impairment. Cognitive impairment has been increasingly recognised as cognitive frailty, which is reportedly associated with poor outcomes. On the other hand, cardiac rehabilitation (CR) for HF contributes to improved clinical outcomes. However, very few reports have examined whether CR is effective in patients with HF who have cognitive frailty. Purpose The present study aimed to investigate whether CR is associated with clinical outcomes in patients with HF, even in the presence of cognitive frailty. Methods This observational study analysed 1404 consecutive patients who admitted to a university hospital for the treatment of HF and received CR during hospitalisation. Patients who had dementia, did not perform the cognitive function evaluation, or died during hospitalisation were excluded from this study. All patients were encouraged to continue outpatient CR after hospital discharge. Cognitive function was assessed using the Mini-Cog© and a score ≤2 points was defined as the cognitive frailty. As physical function, quadriceps isometric strength (QIS) and 6-min walking distance (6MWD) were measured at the discharge and at the end of outpatient CR. The primary outcome was composite events, comprising all-cause death and re-admission due to HF. The secondary outcome was the change in physical function (ΔQIS and Δ6MWD) following outpatient CR. The association between participation in outpatient CR and composite events was assessed using the multivariate Cox proportional hazard models. We also compared the physical function changes between the presence or absence of cognitive frailty using analysis of covariance. Results The median age of the patients was 75 (interquartile range [IQR]: 66–81) years and 62.3% were males. Among them, 23.4% were identified as cognitive frailty. While 45.1% of overall population participated in outpatient CR, the cognitive frailty was relevant to a lower participation rate (P <0.001). Over a median follow-up period of 1.0 years (IQR: 0.3–2.4 years), a total of 544 composite events occurred. Participation in outpatient CR was associated with a reduced incidence of composite events in both the cognitive frailty and non-cognitive frailty, as well as in the overall patient population (Figure 1). Additionally, ΔQIS and Δ6MWD did not significantly differ between the cognitive frailty status (P = 0.655 and 0.573, respectively). Conclusions Participating in outpatient CR was linked to reduced rates of composite events and improved physical function in patients with HF, regardless of the presence or absence of cognitive frailty. Encouraging active participation in outpatient CR, even among patients with cognitive frailty, is essential as it is associated with favourable clinical outcomes.Survival analysisANCOVA

Proactive therapeutic drug monitoring of biologic drugs in patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis: systematic review and meta-analysis

ObjectiveTo address the efficacy and safety of proactive therapeutic drug monitoring of biologic drugs for patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, Central,...

Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial.

Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference -0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference -0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility.

Cut-off values for estimated cardiorespiratory fitness in terms of physical functioning among middle-aged to older adults.

Cardiorespiratory fitness is linked to various health outcomes. This study aimed to establish cut-off values for estimated cardiorespiratory fitness associated with poor physical functioning in middle-aged to older adults. A total of 2638 participants (1083 males), aged 40-69 years, performed a 6-min walking test (6MWT) to estimate cardiorespiratory fitness (VO<inf>2max)</inf> and completed a health-related questionnaire. Physical functioning was assessed using four outcomes: perceived health, perceived fitness, difficulties in 2-km walking, and difficulties in climbing several stairs. Receiver operator characteristics (ROC) curves were used to determine cut-off values for estimated VO<inf>2max</inf> and 6MWT distance linked to poor physical functioning based on the four outcomes. Analyses were done separately for males and females, and for 40- to 49-, 50- to 59-, and 60- to 69-year-old groups. Multinomial regression was used to analyze differences between fitness thirds in outcome variables. ROC analyses were significant for all outcomes (AUC 0.686-0.834, P<0.001). In the total group, cut-off values for estimated VO<inf>2max</inf> were 29.9-30.2 mL/kg/min, and for walking distance, 588.0-599.5 m. Cut-off values decreased with age, and mean differences between males and females were 3.3 mL/kg/min and 33 m. All cut-off values were within ±1.3 mL/kg/min of the lower fitness tertile. The odds ratios of having poor physical functioning in the middle and high fitness thirds were less than 0.50 compared to low fitness third. VO<inf>2max</inf> of 30 mL/kg/min and 600-m walking distance seemed reasonable cut-off values for poor physical functioning. Exceeding the currently proposed thresholds is a desirable goal to avoid consequences of insufficient fitness.

Disability in activities of daily living before hospitalisation and clinical outcomes following acute-phase rehabilitation in older individuals with cardiovascular disease

Abstract Background Older individuals with cardiovascular disease (CVD) frequently complicate disability in activities of daily living (ADLs), defined as needing assistance performing ADLs, which is at risk for further functional decline and higher mortality. Although acute-phase physical rehabilitation has been recently highlighted for its effectiveness on functional outcomes in older individuals with CVD, the effectiveness in those with pre-hospitalization ADLs disability is uncertain. Purpose To investigate the association between the ADLs disability before hospitalisation and outcomes after acute-phase rehabilitation, including physical function changes during hospitalisation and clinical events after hospital discharge in older individuals with CVD. Methods We studied 2792 individuals aged ≥65 admitted to a university hospital for CVD treatment and received inpatient physical rehabilitation tailored for each patient. The information on disability in ADLs before admission was obtained through interviews about difficulty performing basic ADLs, including feeding, bathing, toileting, dressing, and ambulating. The primary outcome was the Short Physical Performance Battery (SPPB), measured at the initiation of inpatient rehabilitation as a baseline and at hospital discharge to assess the changes in physical function during hospitalisation. We also investigated the five-year composite events of all-cause death and/or rehospitalisation due to heart failure after discharge. The repeated analysis of covariance adjusted for clinical characteristics was used to examine the change in SPPB between ADLs status. We also analysed the association between SPPB change after acute-phase rehabilitation and incidences of composite events in individuals with or without ADLs disability. Results Individuals with ADLs disability before hospitalisation were observed in 163 (5.8%) patients, who showed older age, higher prevalence of heart failure and comorbidities, and lower SPPB at baseline than those with ADLs independent. Conversely, SPPB was significantly higher at hospital discharge than at baseline, even in patients with pre-hospitalization ADLs disability and without interaction between the ADL status (P=0.091, Figure 1). The negative change in SPPB was observed only in 240 (8.6%), and its rate was higher in individuals with ADLs disability than those without (14.2% vs 7.8%, P=0.007). During the median follow-up of 2.6years, the composite events occurred in 760 patients (27.2%), and the combination of negative change in SPPB with ADLs disability was only associated with higher incidences of composite events against preserved SPPB with ADLs independent as reference (adjusted hazard ratio: 2.57, 95% confidence intervals: 1.11–5.97, Figure 2). Conclusions Acute-phase rehabilitation may contribute to better changes in physical function, which is associated with a lower risk of clinical events in older individuals with CVD and pre-hospitalisation ADLs disability.Figure 2

Quality of Life and Symptoms of Hospitalized Hematological Cancer Patients

Patients with hematological malignancies undergo intensive treatment and prolonged hospitalization, thus having a variety of physical and psychosocial symptoms and worse quality of life (QOL). This study aimed to assess the QOL and investigate the symptoms of hospitalized hematological cancer patients. A cross-sectional study was conducted in the hematology clinics and day units of two general hospitals of Heraklion, Crete. Adult patients with hematological malignancy and an adequate understanding of the Greek language participated. A demographic questionnaire, the European Organization for Research and Treatment for Cancer quality assessment questionnaire (EORTC QLQ-C30), and the MD Anderson Symptom Inventory (MDASI) were used. The sample consisted of 120 patients—42.5% were women, with a mean age of 65.6 years. The mean time from diagnosis was 33 months. The global health status of QoL had an average value of 47.1. The highest levels of QOL were found in the subscale of cognitive function (72.8) and the lowest in the role function (46.1). For the EORTC QLQ-C30 symptoms scale, the lowest score was found in nausea-vomiting (11.0) and the highest in fatigue (59.1). In the MDASI, in part I (core symptoms), higher levels but also medium intensities were reported at fatigue (78.3%, mean 3.5), drowsiness (65.0, mean 3.3), and distress (65.8%, mean 2.8). In part II, enjoyment of life (85.8%, mean 5.1) had the highest, and relation with other people (67.5%, mean 3.7) had the lowest scores. The increase in the severity of the core symptoms (part I) was related to females (rho = 0.193, p &lt;0.05) and comorbidities (rho = 0.220, p &lt; 0.05). It was also associated with a significant decrease in all functional domains and increased fatigue (rho = 0.571, p &lt; 0.05) in the EORTC QLQ-C30 questionnaire. The increased global health status was related to males (rho = −0.185, p &lt; 0.05) and physical functioning with younger age (rho = −0.331, p &lt; 0.05), higher education (rho = 0.239, p &lt; 0.05), fewer months from diagnosis (rho = −0.199, p &lt; 0.05), and low comorbidity (rho = −0.209, p &lt; 0.05). Finally, multiple linear regression analysis revealed that the total average symptom score of the MDASI was the most significant factor influencing the global health status of the EORTC QLQ-C30 (β = −4.91, p &lt; 0.001). The increased global health status of the EORTC QLQ C30 was not significantly related (p &gt; 0.05) to the social characteristics of the patients, such as education or employment, which requires further validation. The QoL of hematological cancer patients significantly decreases during treatments due to a considerable number of symptoms that must be taken into consideration for high-quality, individualized care.

A randomized controlled trial of an eight-week cardiac rehabilitation home verse hospital exercise programme for post coronary cardiac bypass patients

Abstract Background The prevalence and morbidity and mortality rates of coronary heart disease (CHD) continue to increase towards epidemic proportions in the Kingdom of Saudi Arabia (KSA). Despite the advances in Cardiac surgery, currently there are no established out-patient phase program of Cardiac Rehabilitation (CR) for CHD participants in KSA. Aim of the study To evaluate the effectiveness of a home-based CR (Home CR) program using individualized exercise (Physiotools-R) and out-patient phase of CR (Hospital CR) program compared to standard care of home instructions on physical function, physiological and psychological status, body composition and the quality of life of the CHD participants post Coronary Artery Bypass Graft (CABG) surgery. Methods 73 participants post-CABG surgery were randomly assigned to one of three groups: Hospital CR group (n=25), Home CR group (n=24) and Control group (n=24). Outcome measures include Incremental Shuttle Walk Test (ISWT), Metabolic Equivalent Tasks (METs), Psychosocial outcomes and body composition were recorded at baseline, eight weeks of CR intervention, and after four weeks of observation follow up. Intervention: Hospital CR program comprised of group based Aerobic Circuit Training, home based structured individualized exercise program. Each programme had 2 hours’ sessions, 3 times a week for 8 weeks, followed by four weeks of observation follow-up. The control group followed standard care comprised usual advice on post-operation precautions. Results Post intervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P &amp;lt; .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures Conclusion Home-based CR is as effective as hospital-based CR at improving exercise capacity in patients following CABG surgery. Home-based CR appears to be more effective at maintaining these improvements with no further input in the longer term.

Beneficial effect of honey from algae extract-fed bees on quality of life

Abstract Background Our team has been researching and developing special honeys from bees fed with syrups containing natural plant extracts for decades. Several pre-clinical studies have demonstrated that honey from bees fed with Chlorella algae extract contains a number of algal active ingredients with beneficial effects on the human body. Methods We conducted a prospective double-blind functional food study with 30 healthy volunteers with ethical approval. Based on strict inclusion and exclusion criteria, 30 gramms of honey has been eaten twice a day for 3 weeks under 150 ml of yoghurt. 15 people were fed honey from bees with special algae extract, while 15 concerned - as a control group - consumed acacia honey. Before and after the study, sleep quality was assessed by the SQS questionnaire, and quality of life by the SF-36, EORTC Q-C30 and EQ-5D tests. Results The specific algae extract contained honey improved the people’s sleep quality, their EQRTC parameters, their appetite, their digestion, and it also significantly reduced pain (p = 0.01), boosted the patients cognitive function, and reduced both constipation and diarrhoea. Significant differences in SF-36 parameters: pain decreased (12.9±1.6vs 6.6±1.1; p = 0.01), physical function (21.2±6.3vs 27.1±3.6; p = 0.01) and energy (11.2±2.7vs 13.9±1.4; p = 0.01) improved. No such changes occurred in control group. Conclusions Honey from bees fed with algae extract has a number of beneficial physiological effects on the human body, improving many parameters of quality of life. Key messages • The consumption of honey from bees fed with algae extract improves sleep, reduces pain, and has a positive effect on digestive and gastrointestinal symptoms. • Within public health, quality of life is an increasingly important issue and improving it with functional foods is an important area of research.

Baseline patient reported outcomes in patients with peripheral artery disease and type 2 diabetes from STRIDE: a phase 3, 52-week, randomised, double-blind, placebo-controlled trial

Abstract Introduction Lower extremity peripheral artery disease (PAD) is caused by atherosclerotic steno-occlusive arterial lesions in the lower extremities and can lead to intermittent claudication, severe functional impairment and reduced health-related quality of life (HRQoL). People living with type 2 diabetes (T2D) are at higher risk of developing PAD than those without T2D. The most common clinical manifestation of PAD, functional impairment, can be stratified based on severity using Fontaine classification (stages I-IV). There are a limited number of therapies approved for the management of PAD related functional impairment and no glucose-lowering medication has been shown to improve functional capacity in people with PAD and T2D. STRIDE is a phase 3 clinical trial investigating once-weekly subcutaneous (s.c.) semaglutide treatment in people with PAD (Fontaine IIa claudication) and T2D. Purpose To report the patient-reported outcomes (PROs) at baseline from STRIDE and elucidate the impact that PAD has on the functional capacity and HRQoL in this early-stage symptomatic PAD population with T2D. Methods STRIDE enrolled 792 participants with PAD (Fontaine IIa claudication) and T2D who were randomised to receive either 1 mg once-weekly s.c. semaglutide or placebo for 52 weeks. The primary outcome of STRIDE is the change in maximum walking distance at week 52 on a constant load treadmill. Baseline PRO assessments included two Patient Global Impression of Severity (PGI-S) questions and three patient-reported questionnaires: the six items version of the Vascular Quality of Life questionnaire (VascuQoL-6), the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Short Form 36 (SF-36). Results Baseline responses to both PGI-S questions showed that two thirds of patients reported a moderate-to-severe limitation in their ability to walk (64.9%) and reported that the impact of poor blood circulation in their legs on their HRQoL was also moderate-to-severe (62.5%) (Figure 1A and B). The baseline VascuQoL-6 median score was 15 (score range: 6-24, with a low score indicating more severe impact) and details of impact on the six domains are presented in Table 1. Baseline responses to the WIQ indicated that 20.1% of participants found the degree of difficulty to walk 200 meters either ‘much difficulty’ or were ‘unable to do so’ and 21.8% reported the same when climbing 2 flights of stairs. The secondary supportive outcome assessed in the SF-36 questionnaire was the domain physical functioning where a median baseline value of 38.09 was observed (score range: 19.03-57.60, with a low score indicating more impact). Conclusion Participants in STRIDE, characterized as having early-stage symptomatic PAD, have reported moderate-to-high impact on their physical functioning and HRQoL at baseline. These findings highlight the need for better therapies that improve the functional capacity and HRQoL in people with PAD and T2D.

Association of 5-times sit-to-stand test with muscle weakness and prognosis in older patients with cardiovascular disease

Abstract Background/Introduction In the elderly with cardiovascular disease (CVD), maintaining muscle strength and physical function is essential for preventing adverse outcomes like falls and hospitalizations. The decline in lower limb strength signals increased morbidity and mortality risks. The 5-times sit-to-stand test (5STS) is a practical method for assessing lower limb strength, yet its predictive value for muscle weakness and prognosis in older CVD patients is underexplored. Purpose This study aims to elucidate the 5STS's role in identifying muscle weakness and its impact on the prognosis of older patients with CVD, offering insights for targeted interventions. Methods We included 3585 patients aged ≥ 65 years with CVD (mean age, 75.8 ± 6.6 years, 64.5% male) who underwent assessment of the 5STS before discharge. Maximal quadriceps isometric strength (QIS) was evaluated as a marker of lower limb strength and expressed relative to body weight (% body weight: BW). The primary outcome was all-cause mortality. We used the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each sex to calculate the cut-off values of the 5STS for low QIS (male &amp;lt; 45%BW, female &amp;lt; 35%BW), which have been reported to be associated with prognosis. In addition, we performed Kaplan-Meier curves and Cox regression analyses in five groups defined by 5STS time quartile and 5STS inability to assess the prognostic significance of 5STS. Cox regression analysis was performed as a multivariate model including the following variables; age, sex, body mass index, acute coronary syndrome, heart failure, hypertension, diabetes, dyslipidemia, current smoker, prior myocardial infarction, prior heart failure, prior chronic obstructive pulmonary disease, prior dementia, albumin, hemoglobin, estimated glomerular filtration rate, C-reactive protein. Result Over a median follow-up of 2.23 years (interquartile range 0.87-4.52 years), 657 (18.3%) patients died. Kaplan-Meier analysis indicated that both slow 5STS performance and inability to execute the 5STS were significantly linked with poorer prognosis (log-rank p &amp;lt; 0.001, Figure 1). After comprehensive adjustment, the slowest quartile and inability to perform the 5STS were associated with significantly higher mortality rates compared to the fastest quartile (HR 1.34; 95% CI: 1.05-1.72; p = 0.021; HR: 2.28; 95% CI: 1.60-3.24; p &amp;lt; 0.001, Figure 2). The ROC AUC for 5STS in identifying low QIS was 0.75 (95% CI: 0.73-0.77) for males and 0.75 (95% CI: 0.72-0.77) for females, with cut-off times established at 9.71s for males and 9.48s for females. Conclusion The 5STS, assessable in diverse settings without specialized equipment and reflecting key clinical outcomes, could serve as a standard tool for evaluating lower limb function.

The effectiveness of various intensity interval training compared to continuous training in patients with heart failure: a systematic review and network meta-analysis

Abstract Background/Introduction Cardiac rehabilitation including exercise therapy is beneficial for improving exercise tolerance, physical function, quality of life (QOL), and life expectancy in patients with heart failure. High-intensity interval training (HIIT) is increasingly reported as a new training modality to improve exercise tolerance more effectively than conventional moderate-intensity continuous aerobic training (MCT). However, the optimal intensity of HIIT for achieving the greatest effects in patients with heart failure remain controversial. Purpose This systematic review and network meta-analysis aimed to examine the effectiveness of HIIT compared to MCT on exercise tolerance in patients with heart failure. Methods We searched for studies published up to 30 January 2024 in Embase, MEDLINE via Ovid SP, PubMed, and the Cochrane Library via Wiley Online Library with no limitations on data, language, or publication status. We included randomised controlled trials comparing the efficacy of HIIT and MCT on peak oxygen uptake (VO2), as a measure of exercise tolerance, aerobic threshold (AT) VO2, ventilatory equivalent of carbon dioxide (VE/VCO2) slope, and QOL. We categorized HIIT into three different intensities [&amp;gt; 80% heart rate max (HRM), 60-80% HRM, &amp;lt; 60% HRM] and compared the outcomes with those of MCT. Results We identified 15 randomised controlled trials with 557 patients from a total of 27,931 records. Our network meta-analysis revealed that the following results of peak VO2 from the comparisons among the three intensities of HIIT and MCT: &amp;gt; 80% HRM (10 studies, mean difference 1.27 ml/min/kg, 95% confidence interval -0.20 to 2.73), 60-80% HRM (3 studies, 1.47, -0.89 to 3.83), &amp;lt; 60% HRM (2 studies, 2.10, -1.22 to 5.43) (Fig. 1). Regarding AT VO2, HIIT at 60-80% HRM demonstrated significant improvements compared to MCT: &amp;gt; 80% HRM (8 studies, 0.18, -0.83 to 1.18), 60-80% HRM (2 studies, 2.50, 0.72 to 4.28), &amp;lt; 60% HRM (2 studies, 1.14, -0.93 to 3.20) (Fig. 2). Regarding VE/VCO2 slope, HIIT at 60-80% HRM also demonstrated significant improvements compared to MCT: &amp;gt; 80% HRM (7 studies, 0.29, -1.89 to 2.47), 60-80% HRM (2 studies, -3.26, -6.18 to -0.35), &amp;lt; 60% HRM (no study). The network meta-analysis did not reveal any significant differences in QOL between the various intensities of HIIT and MCT. Conclusions Our systematic review and network meta-analysis revealed that HIIT prescribed at a sub-maximal intensity, 60-80% heart rate max, is most effective in improving exercise tolerance. Higher intensity does not necessarily yield better outcomes, and future research on interval training should include detailed methodologies that account for the training intensity.Fig.1 Network meta-analysis on peak VO2Fig.2 Network meta-analysis on AT VO2

The utility of cardiac rehabilitation in improving endothelium-dependent vascular function in very elderly patients

Abstract Background Endothelial function is crucial for cardiovascular health and diseases. Cardiac rehabilitation has been reported to be useful in enhancing physical performance, quality of life, and endothelial function. The aging of patients with cardiovascular diseases is further progressing, and it is unclear whether cardiac rehabilitation improves physical function and endothelial function in very elderly patients with cardiovascular diseases. Purpose The purpose of this study is to investigate whether outpatient cardiac rehabilitation for individuals aged 80 and above improves physical function, quality of life (QOL), and vascular endothelial function. Methods Forty nine patients aged over 80 years with cardiovascular diseases participated in an outpatient cardiac rehabilitation program. Cardiac rehabilitation was conducted for 1 hour per session, 1-2 times per week for 3-4 months. Cardiopulmonary exercise testing (CPX) was conducted for the evaluation of physical function. QOL was assessed with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. The reactive hyperemia index (RHI) was measured using EndoPAT2000 in each patient to assess endothelial function. An RHI ≤ 1.67 was defined as endothelial dysfunction. Results The mean ± standard deviation of age was 84 ± 4 years, with 16 (33%) being male. Peak oxygen uptake improved significantly (from 14.1 ± 4.0 to 15.4 ± 3.9 mL/kg/min, P=0.002), as did short physical performance battery scores (from 10.1 ± 2.7 to 10.7 ± 2.0, P=0.004), mini-mental state examination scores (from 27.7 ± 2.2 to 28.2 ± 2.0, P=0.004), Japanese version of the Cardiovascular Health Study criteria (from 2.3 ± 1.3 to 1.5 ± 1.2, P&amp;lt;0.0001), and KCCQ scores (from 76.8 ± 18.4 to 81.4 ± 20.4, P=0.02) after the cardiac rehabilitation program. Endothelial function also improved (LogRHI 0.48 ± 0.39 to 0.57 ± 0.30, P=0.027), and the prevalence of endothelial dysfunction decreased from 54% to 36% after the cardiac rehabilitation program. Conclusion Even in the very elderly patients, outpatient cardiac rehabilitation is beneficial for improving physical function, quality of life, and endothelial function.

Health-related quality of life and prognosis in cardiac sarcoidosis

Abstract Background Cardiac sarcoidosis (CS) is characterized by inflammatory myocardial disease, often leading to conduction disturbances, ventricular tachycardias, and heart failure. While factors like initial symptoms, LVEF, and troponin levels are known prognostic indicators, the impact of CS on health-related quality of life (HRQoL) is not well-understood. Additionally, limited data exists on the predictive value of FDG-PET in CS. Purpose This study aimed to assess HRQoL in CS patients and investigate its prognostic relevance concerning cardiac events. Methods Patients diagnosed with CS completed the RAND-36 general health-related questionnaire, covering eight dimensions. Clinical data were obtained from the Finnish myocardial inflammatory diseases registry. Follow-up data on cardiac events, including life-threatening ventricular tachyarrhythmias (VT/VF), heart transplant, left ventricular assist device (LVAD) implantation, pericardial tamponade, or death, were collected over 36 months. Results Of the 240 CS patients surveyed, 179 (75%) were female, with a median age of 56 [IQR 48 – 64]. CS patients reported significantly lower RAND-36 scores across all dimensions compared to the general Finnish population. Over the 3-year follow-up, 38 (16%) patients experienced cardiac-related adverse events, including VT/VF (26 cases), deaths (8 cases), heart transplants (2 cases), LVAD implantation (1 case), and pericardial tamponade (1 case). We divided CS patients into those without adverse event (N=202) and with adverse events (N=38). Interestingly, in four dimensions of PF 70.0 [50.0-90.0] vs 60.0 [33.8-80.0], p=0.019, RP 50.0 [0.0-100.0] vs 0.00 [0-56.3], p=0.002, MH 76.0 [59.0-88.0] vs 66.0 [51.0-84.0], p=0.036, and SF 75.0 [50-100] vs 62.5 [37.5-78.1], p=0.037 were significantly lower scores in the event group. Univariate Cox regression analysis (Table 1) revealed that physical functioning (PF) and role-physical (RP) dimensions, along with certain clinical factors, such as younger age, higher NYHA classification, elevated proBNP levels, lower hemoglobin levels, and the main manifestation of the disease as ventricular tachyarrhythmia, independently predicted adverse cardiac events. In the multivariate analysis, lower role-physical scores and younger age remained independent prognostic factors for adverse cardiac events. Conclusions Patients with CS demonstrated lower HRQoL compared to the general Finnish population. This study enhances our understanding of prognosis in CS and underscores the predictive value of HRQoL in identifying future adverse cardiac events, highlighting its relevance in the clinical management of these patients.

Exercise interventions for Long COVID: a systematic review of randomised controlled trials

Abstract Background Long COVID is prevalent and costly. There is much debate around the effectiveness and tolerance of exercise among people with Long COVID due to the potential to exacerbate symptoms. Therefore, this systematic review aimed to examine the effectiveness and tolerance of exercise interventions among people with Long COVID as part of a wider project to inform updates to the Irish Health Service Executive’s Long COVID interim model of care. Methods Medline via EBSCOhost, Embase, and CENTRAL were systematically searched on 28 February 2023. Inclusion criteria were: (1) participants with Long COVID; (2) random assignment to either an exercise intervention or a comparison group; (3) a quantitative measure of at least one of 12 core Long COVID outcomes. Two reviewers independently extracted data and assessed study risk of bias using the Cochrane Risk of Bias tool. Results In total, 4,394 studies were identified, 569 full texts were screened, and eight studies were included. Follow up periods ranged from two to 28 weeks (mean=8.5 weeks). Sample sizes ranged from 39 to 119 (mean=56). All studies were in adults (mean age=49.9 years) and both sexes (mean female proportion=53.9%). Four studies were at low risk of bias, two unclear, and two high. The evidence suggests that exercise interventions led to short-term improvements in dyspnoea, fatigue, physical function and the physical domain of quality of life. Of the five studies that reported adverse events, rates were low and, when reported, mild. Of the seven studies that reported sufficient information, one of 252 participants who received exercise discontinued the intervention due to tolerance-related issues. Conclusions Available evidence suggests that exercise interventions may have short-term benefits and be tolerable among some people with Long COVID. However, the evidence base consists of a limited number of studies with small sample sizes and short follow-up periods. Key messages • There is much debate around the effectiveness and safety of exercise among people with Long COVID due to the potential to exacerbate symptoms. • The available evidence suggests that appropriate exercise interventions may have short-term benefits and be tolerable. However, there are notable limitations among the evidence.

Effectiveness of Ultrasound with Isometric Quadriceps Exercise and Retro walking in Osteoarthritis

Introduction: Knee osteoarthritis is a non-inflammatory, painful and degenerative joint disease; pathologic changes in osteoarthritis involve progressive hyaline joint cartilage loss with concomitant changes in subchondral bone and development of osteophyte. About symptomatic knee osteoarthritis affect 13% of women and 10% of men aged 60 years and older. Men have a lower prevalence of knee osteoarthritis than women. The tool used to measure pain intensity, physical functions in this study is WOMAC scale and to assess the range of motion by Universal goniometer. Aim : To Evaluate the Effectiveness of Ultrasound with Isometric quadriceps exercise and retro walking in osteoarthritis of knee. Method : A Total 30 both male and female participants between 45 to 65 years of age selected from RJS Group of institute of kopargaon , Kothari hospital kopargaon by using purposive sampling method according to the inclusion criteria. The total duration of the study is 3 weeks .total 30 participants allocated into two groups A and B 15 in each group. In group A were intervention Ultrasound with isometric quadriceps exercise and group B Ultrasound with retro walking were given for 3 weeks. Pre intervention and post intervention by WOMAC score and universal goniometer were taken analyzed compared using paired’ test. RESULT: As per statistical analysis both groups shown significant improvement but group B ( Ultrasound with Retro walking )was having most significant improvement as compare to group A ( Ultrasound with Isometric quadriceps exercises). CONCLUSION : This study concluded that Ultrasound with Retro walking was effective in participants with Osteoarthritis of knee .Hence there is reduction of pain, improving range of motion at knee joint and functional mobility, Activity of daily living in participants with osteoarthritis of knee.

Beyond the games: How sport-based social networks support illness self-management for organ transplant recipients

For people living with a long-term health condition, it is important to engage in illness self-management to maintain both physical and psychosocial functioning. Illness self-management is now understood as a collective process whereby social networks can make a significant contribution to outcomes. This study investigated the role of sport-based social networks for illness self-management for organ transplant recipients. Sixteen participants completed 3 interviews each in the 12-months after attending a Transplant Games event for the first time. Using a qualitative social network mapping method, it was found that despite it being a relatively short sporting event, participants found it easy to gain an immediate sense of closeness to other Transplant Games participants due to their shared illness experiences. Indeed, being able to discuss ongoing health concerns with their new Transplant Games network meant that participants could avoid causing unnecessary anxiety for their close family and friends. Furthermore, two selected participant narratives illuminate that new relationships gained from attending the Transplant Games network can remain available over a 12- month period but this does not necessarily disrupt one's existing support network. Overall, this study emphasises the value of sport-based social support for individuals with long-term health conditions and deepens our understanding of how social networks contribute to psychosocial functioning.

A systematic review of health outcomes of public transport use by older adults

Abstract Background and Aim Public transport use has been linked to several health benefits in the general population, and is crucial for older adults’ mobility, due to an age-related decline in mobility, and particularly the ability to use other transport modes. The objective of this systematic review is to determine what is known about the physical and mental health outcomes of public transport use by older adults and to identify remaining gaps in the literature. Methods Five electronic databases were searched in April 2023, with an update in January 2024: Pubmed, Scopus, Web of Science, Ageline and Transport Research International Documentation (TRID). Included were studies that were in English, contained a measure of public transport use as exposure, and any health outcome, including mental or physical health, physical or cognitive function, morbidity, or mortality, among people aged ≥ 60 years. Results Of a total of 2247 unique records that were screened, the full text of 20 was assessed for eligibility and 11 were identified as eligible. Citation search identified two additional studies, amounting to a total of 13 included studies. Significant health outcomes described in assessed studies were decreased obesity and depressive symptoms, and to a lesser extent increased gait speed and cognitive function. Conclusions Initial evidence suggests a positive impact of public transport use on obesity, depressive symptoms, gait and cognitive function, although available research was limited in context and methodology. Further research should focus on determining causality between public transport use and health, and be conducted in more diverse contexts. Transport and urban planners, as well as policymakers, should consider the implications of public transport on the health and independence of older adults. Key messages • Public transport use is linked to reduced obesity and depression among older adults. Links with other health outcomes were reported in several studies, but evidence is scarce. • Current research is limited in terms of quantity, scope, and design. Future research should be conducted in wider contexts, encompass a broader range of health outcomes, and address reverse causality.

Association between dietary supplements and frailty by sex: a cross-sectional study in South Korea

Abstract Background Evidence regarding the benefits of dietary supplements against frailty is lacking. Therefore, we aimed to examine the association between the use of dietary supplements and frailty. The analyses were stratified by sex to consider the sexual dimorphism in frailty. Methods This study used national, cross-sectional survey data from South Korea, namely the Korea National Health and Nutrition Examination Survey (KNHANES, 2018-2020). Adults aged 50 years were included. Data for up to four supplements were collected for each participant. A 46-item frailty index was constructed to assess frailty. All percentages (%) were weighted to represent the national population. The association between the use of dietary supplements and frailty was investigated using a linear regression analysis with socioeconomic/lifestyle factors and the amount of nutrient intake from diet included as covariates. Results Of the included 27,384 older adults, 57.28% were women. The proportion of supplement users was significantly higher in women (64.31% vs. 77.71%, p &amp;lt; 0.001). Any supplement use was negatively associated with frailty (B = -0.015, p &amp;lt; 0.001), and the association was more significant in women (Any supplement use * women: B = -0.012, p = 0.002). From the multivariable regression analysis stratified by sex, the use of red ginseng (men: B = -0.019, women: B = -0.015) and calcium (B = -0.027, women: B = -0.012) were negatively associated with frailty in both sexes while the statistical significance for vitamin C was found only in men (B = -0.020) (all p &amp;lt; 0.05). Conclusions Our findings demonstrated a significant negative association between the use of dietary supplements and frailty. The associations varied by type of supplements and by sex. The findings should be validated using prospective data. Key messages • Red ginseng and calcium supplements were negatively associated with frailty in both sexes. • We assessed frailty using frailty index which highlights the potential role of dietary supplements beyond the context of physical or musculoskeletal function.

Effect of Comprehensive Renal Rehabilitation in Hemodialysis: Systemic Review

Background: Renal rehabilitation is a multimodal, coordinated intervention aimed at improving a patient's physical, psychological, and social functioning. Additionally, a growing body of research indicates that exercise training improves left ventricular function, cardiac sympathetic and parasympathetic disharmony, as well as Vo2 max in hemodialysis patients. Purpose: To systematically summarize the randomized controlled studies and investigated the effect of comprehensive renal rehabilitation in hemodialysis. Data source: Four electronic data base (PubMed, Pedro, Cochrane and Google scholar) were searched from 2014 till 2024. Study selection: Two independent reviewers screened studies for eligibility first by title then by title then by abstract then finally full text. Data extraction: Fourteen studies met the inclusion criteria of this review, all of them were about comprehensive renal rehabilitation in hemodialysis studies quality was assessed using Pedro and the Cochrane risk of bias assessment tool. Data synthesis: Fourteen studies were included in the quality assessment, studies were of good quality while the rest were fair quality on the Pedro scale, studies state that. Results: Met-analysis showed that there was significant effect of comprehensive renal rehabilitation in hemodialysis in the outcome measurers (Fatigue level, Vo2 max, muscle strength, physical, mental function and blood pressure change). Conclusion: This analysis showed that there were effects of comprehensive renal rehabilitation in hemodialysis.