Significant Differences In 6MWT Research Articles

Home-based prehabilitation with exercise to improve postoperative recovery for older adults with frailty having cancer surgery: the PREHAB randomised clinical trial

BackgroundFrailty is a state of vulnerability as a result of decreased reserves. Prehabilitation may increase reserve and improve postoperative outcomes. Our objective was to determine if home-based prehabilitation improves postoperative functional recovery in older adults with frailty having cancer surgery. MethodsThis double blind randomised trial enrolled people ≥60 yr having elective cancer surgery and ≥3 weeks from enrolment to surgery as eligible. Participation in a remotely supported, home-based exercise prehabilitation program plus nutritional guidance was compared with standard care plus written advice on age-appropriate activity and nutrition. The primary outcome was 6-min walk test (6MWT) distance at the first postoperative clinic visit. Secondary outcomes included physical performance, quality of life, disability, length of stay, non-home discharge, and 30-day readmission. ResultsOf 543 patients assessed, 254 were eligible and 204 (80%) were randomised (102 per arm); 182 (94 intervention and 88 control) had surgery and were analysed. Mean age was 74 yr and 57% were female. Mean duration of participation was 5 weeks, mean adherence was 61% (range 0%–100%). We found no significant difference in 6MWT at follow-up (+14 m, 95% confidence interval −26–55 m, P=0.486), or for secondary outcomes. Analyses using a prespecified adherence definition of ≥80% supported improvements in 6MWT distance, complication count, and disability. ConclusionsA home-based prehabilitation program did not significantly improve postoperative recovery or other outcomes in older adults with frailty having cancer surgery. Program adherence may be a key mediator of prehabilitation efficacy. Clinical trial registrationNCT 02934230.

Effects of a Structured Pulmonary Rehabilitation Program in COVID-19 Pneumonia Patients

Objective: To evaluate the functional outcome and psychological function among post-COVID-19 patients who joined a structured outpatient Pulmonary Rehabilitation (PR) program.Methods. This is a retrospective study conducted at the Rehabilitation Department, Hospital Serdang from January until August 2021. Individuals with a diagnosis of COVID-19 infection category 3, 4 and 5 underwent 4 weeks of PR program as outpatients. Outcome measures include 6 Minute Walk Test (6MWT), Duke Activity Status Index (DASI), and Grip Strength (GS) of the dominant hand. Data from pre- and post-program were analysed using Wilcoxon Signed Ranks Test. Depression, Anxiety, Stress Scale (DASS-21 item) pre- and post-program were analysed using the likelihood ratio test.Results. A total of 20 patients completed the program, with the majority of them had COVID-19 category 5 (47.6%), being male (66.7%) and with a median age of 47 ± 11.9. There was a significant difference in 6MWT, DASI (both p < 0.001) and GS of the dominant hand (p < 0.05). Mean difference of the 6MWT pre- and post-program was 73 meters. There was an improvement in the severity level of DASS-21 items.Conclusion. This study demonstrated that the PR program is beneficial to improve functional outcomes for COVID-19 survivors. With regards to the psychological assessment, there was an improvement in the level of depression, anxiety and stress severity.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S43

Impact of Thera-Pep and Forced Expiratory Technique in Chronic Bronchitis Patients

Aim: To study the impact of Thera-Pep and Forced Expiratory Technique in Chronic Bronchitis patients. Objectives: To find the effect of Thera-pep device in mobilizing secretion. To find the effect of forced expiratory technique in mobilizing secretion and To compare the effect of Thera-pep and forced expiratory technique in chronic bronchitis patients. Materials and Method: 54 patients were included according to inclusion and exclusion criteria, were randomized by chit method into two groups. Group A (Forced Expiratory technique with coughing) and Group B (Thera-PEP device with coughing) - with 27 patients in each group. All the patients were assessed with Six Minute Walk Test (6MWT) and Peak Expiratory Flow Rate (PEFR). The treatment was given for twice a day for 6 days a week for 2 weeks. After 2 weeks, effect of interventions were assessed by 6MWT and PEFR. Results: There was no significant difference in 6MWT and PEFR score in comparison of both experimental and conventional intervention. The inter group values of 6MWT and PEFR showed significant improvement in chronic bronchitis patients. The intra group values of 6MWT and PEFR showed no significant improvement in comparison of the techniques in chronic bronchitis patients. Conclusion: Both the techniques are effective on removal and mobilizing of secretion individually in chronic bronchitis patients. However, the techniques when compared with each other were equally effective and there was no significant difference between each other.

P3678Pulmonary artery ablation during open mitral valve surgery for pulmonary artery hypertension: a prospective randomized study

Abstract Purpose Recent investigations of pulmonary artery (PA) ablation into the treatment of idiopathic pulmonary artery hypertension (PAH) have suggested improvement of functional capacity, and hemodynamics. We investigated the impact of PA ablation in patients with PAH due to left heart disease (Dana Point, 2008) scheduled for open-heart mitral valve surgery. Methods Fifty patients aged 52±10 with mitral valve disease complicated severe PAH (mean PAP >40mm Hg) were randomly assigned to mitral valve surgery with or without PA ablation procedure. Eligible criteria: positive reactive test with nitric oxide inhalation (decrease of mean PAP more than 10 mm Hg without decrease of cardiac output). There were no between group differences in preoperative characteristics. Surgical procedure After bypass is establishedthe fibrous fold of pericardiumand the ligamentum arteriosum are dissected out, and the branches of the right and left pulmonary artery are mobilized well out into the hilum of the lungs bilaterally. PA ablation was performed epicardially at the bifurcation of the main PA, and 10 mm distal to the right and left PA's using AtriCure Isolator®multifunctional pen. Serial assessment of echocardiography, right heart catheterization (catheter Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital stay. The primary endpoints were the change of meanpulmonary artery pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality, freedom from PADN-related complication: PA perforation, PA dissection, and PA thrombosis (MDCT assessment). Results There were no early deaths. No procedure-related complications were observed. On first day after surgery patients from ablation group showed significant reduction of mean PAP (from 50.6±5.3to 34.6±9.9 mm Hg, p<0.001), and significant improvement of 6MWT at discharge (from 229±34 m to 475±21 m, p<0.001). On first day after surgery patients from control group also showed significant reduction of mean PAP (from 51.3±6.3to 47.2±8.5 mm Hg, p=0.011), and significant improvement of 6MWT at discharge (from 249±32 m to 335±18 m, p<0.001). Nevertheless, there was significant between group difference in mean PAP on first day after surgery (34.6±9.9 mm Hg, vs 47.2±8.5 mm Hg, p=0.005). Moreover there was significant differences in 6MWT at discharge (475±21 m vs 335±18 m, p=0.002) with benefit to ablation group. Epicardial pulmonary artery ablation Conclusions We report for the first time the effect and superiority of PA ablation on functional capacity and hemodynamics in patients with mitral valve disease complicated PAH. Epicardial PA ablation for the treatment PAH can be effectively and safely performed during open heart surgery. Acknowledgement/Funding None

Exercise and Cognitive Training as a Strategy to Improve Neurocognitive Outcomes in Heart Failure: A Pilot Study

Mild cognitive impairment, especially memory loss, is prevalent in patients with heart failure (HF) and contributes to poor clinical outcomes and higher mortality. This study evaluated a combined aerobic exercise and cognitive training (EX/CT) program on memory, executive function, attention, processing speed and reaction time compared to exercise only or a usual care attention control (UCAC) stretching and flexibility program. Participants completed a standardized neurocognitive battery at baseline, 3 months, and 6 months along with demographic, clinical, and functional capacity (6-minute walk test). A linear mixed model analysis was used with comorbidity as a covariate. Sixty-nine participants were enrolled, the mean age was 61 ± 10 years, 54% were women, 55% were African American, and the mean left ventricular ejection fraction percentage was 35 ± 15. A significant group by time interaction for verbal memory was found at 3 months (F [2, 53] = 4.3, p = 0.018) but was not sustained at 6 months in the EX/CT group. Processing speed/attention differed across treatment groups between baseline and 6 months, but improvement occurred among UCAC participants. There were also significant group differences in the 6MWT distance occurring at 3 months (F [2, 52] = 3.5, p = 0.036); however, significant improvement was observed within the EX/CT group only. There were no significant differences in 6MWT in the other groups at 3 or 6 months. An EX/CT intervention was associated with improved memory in persons with HF and warrants further investigation in a larger trial. The relationship between functional capacity and cognitive function also needs further study.

Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study.

The aim of the study was to investigate the immediate effects of a thin, easily customizable insole on pain and walking ability in patients with rheumatoid arthritis (RA) who have forefoot pain, and to determine whether the insoles were in use 1year afterwards. An experimental, assessor-blinded design was applied to compare the immediate effects when walking with or without insoles in random order. After 1year, a structured telephone interview was conducted. Twenty-one subjects with RA and foot pain in at least one forefoot when walking and in response to the Gänslen test were recruited consecutively from the outpatient clinic and the inpatient ward at a hospital for people with rheumatic disease. Each subject was given a 4-mm thin individually customized insole of a malleable plastic material (CI-Core®) with synthetic textile material on the upper side. The 6-min walk test (6MWT) was used to assess the ability to walk, and a 10-cm visual analogue scale to measure the intensity of foot pain induced by walking with and without the insole. A standardized questionnaire with five items was used to determine the use of, and degree of satisfaction with, insoles after 1year. The median (interquartile range) foot pain intensity was 19 (15) with and 36 (27) without insoles (p<0.001; effect size=0.6). No statistically significant differences in 6MWT were found between the presence or absence of insoles (p=0.07). After 1year, 90% of the participants were still using the insoles. The use of thin, easily customizable insoles resulted in immediate clinically relevant relief in walking-induced forefoot pain. Most of the patients were still using the insoles after 1year.

Gas exchange responses during 6-min walk test in patients with pulmonary arterial hypertension.

The 6-min walk test (6MWT) is the most widely utilized method of assessing exercise capacity in pulmonary arterial hypertension (PAH). Cardiopulmonary exercise testing has the advantage of providing additional physiological information over 6MWT. The goals of our study were to describe the addition of gas exchange measurements to 6MWT and to determine how these parameters were related to the severity of PAH in three major subgroups of PAH (idiopathic (IPAH), connective tissue disease-related (CTPAH) and congenital heart disease-related (CHPAH)). Seventy-six PAH patients (IPAH, n = 28; CTPAH, n = 24; CHPAH, n = 24) completed the 6MWT with simultaneous gas exchange measurements. The 6-min walk distance (6MWD), oxygen uptake ( V ˙ O2 ), carbon dioxide production ( V ˙ CO2 ), oxygen saturation, minute ventilation to carbon dioxide output ( V ˙ E / V ˙ CO2 ) and end-tidal partial pressure for carbon dioxide (PET CO2 ) were compared between subgroups, different functional classes (FCs) and pharmacotherapy. Whilst no significant difference in 6MWT was observed, absolute V ˙ O2 and V ˙ CO2 were higher for IPAH (P < 0.05). Differences were removed when V ˙ O2 and V ˙ CO2 were expressed relative to body mass (i.e. mL/kg/min). CHPAH had the most significant desaturation during 6MWT (CPAH: 73 ± 15%; CTPAH: 90 ± 8%, IPAH: 92 ± 8%, P < 0.01). There was no difference in V ˙ E / V ˙ CO2 and PET CO2 between groups; however, New York Health Association (NYHA) FC II performed better than FC III subjects in 6MWT with lower V ˙ E / V ˙ CO2 and higher end-exercise PET CO2 . Similarly, individuals on more advanced pharmacotherapy (triple therapy vs monotherapy) had poorer gas exchange during exercise. Whilst 6MWT and gas exchange did not differentiate between PAH groups, individuals with more severe disease and on more advanced pharmacotherapy had poorer gas exchange during exercise.

심부전 환자의 신체활동과 규칙적 운동에 대한 측정의 일관성 및 운동역량과 삶의 질과의 관련성

Purpose: In order to examine whether daily physical activity (DPA) can be considered the same as a regular exercise (RE) in patients with Heart Failure (HF), we examined the relationship between RE and DPA, and we explored the relationship of RE and DPA with exercise capacity and quality of life (QOL) in patients with HF. Methods: This cross-sectional, correlational study utilized pretest data (N = 136) of a long-term intervention study. Data of the parent study were collected from May 1st to September 26th, 2013. Measures included questions about regular exercise, International Physical Activity Questionnaire, a 6-Minute Walk Test (6MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The data were analyzed using descriptive analysis, Chi-square test, and ANOVA using the SPSS 21.0 program. Results: There were inconsistencies in measures between RE and DPA. About 42.0% of the participants engaging in health enhancing physical activity did not consider themselves to be regular exercisers. Depending on the levels of RE and DPA, significant differences in 6MWT and QOL were observed. Conclusion: RE is more likely to be related to the health status of patients with HF. Deliberate assessment and cautious interpretation of DPA in patients with HF is needed.

Macrolide Therapy in Adults and Children with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and Meta-Analysis

BackgroundA systematic review and meta-analysis was conducted to evaluate the efficacy and safety of macrolide therapy in adults and children with bronchiectasis.MethodsWe searched the PUBMED, EMBASE, CENTRAL databases to identify relevant studies. Two reviewers evaluated the studies and extracted data independently. The primary outcome was the number of bronchiectasis exacerbations. Secondary outcomes included exacerbation-related admissions, quality of life (QoL), spirometry, 6-minute walk test (6MWT) and adverse events.ResultsNine eligible trials with 559 participants were included. Six were conducted on adults, and the remaining on children. Macrolide therapy significantly reduced the number of patients experiencing one or more exacerbation in adults [risk ratio (RR) = 0.59; 95% CI, 0.40 to 0.86; P = 0.006; I2 = 65%] and children [RR = 0.86; 95% CI, 0.75–0.99; P = 0.04; I2 = 0%], but not the number of patients with admissions for exacerbation. Macrolide therapy was also associated with reduced frequency of exacerbations in adults (RR = 0.42; 95% CI, 0.29 to 0.61; P<0.001; I2 = 64%) and children (RR = 0.50; 95% CI, 0.35 to 0.71; P<0.001). Pooled analyses suggested that spirometry, including FEV1 and FVC, were significantly improved in adults but not in children. Macrolide therapy improved the QoL (WMD, −6.56; 95% CI, −11.99 to −1.12; P = 0.02; I2 = 86%) but no significant difference in 6MWT (WMD, 4.15; 95% CI, −11.83 to 20.13; P = 0.61; I2 = 31%) and the overall adverse events (RR, 0.96; 95% CI, 0.82 to 1.13; P = 0.66; I2 = 0%) in adults. However, reports of diarrhea and abdominal discomforts were higher with macrolide therapy.ConclusionsMacrolide maintenance therapy, both in adults and children, was effective and safe in reducing bronchiectasis exacerbations, but not the admissions for exacerbations. In addition, macrolide administration in adults was associated with improvement in QoL and spirometry, but not 6WMT. Future studies are warranted to verify the optimal populations and clarify its potential effects on antimicrobial resistance.

Treatment Outcomes in Pulmonary Arterial Hypertension (PHA) Associated with Systemic Sclerosis (Sscl.) in Matched Groups Using Either Bosentan or Sildenafil Monotherapy

Purpose The purpose of the study was to compare treatment outcomes in patients diagnosed with Pulmonary Arterial Hypertension (PAH) in association with Sscl. using Bosentan or Sildenafil monotherapy. Methods and Materials The Newcastle database was searched to identify all patients with (PAH) in association with Sscl. who had been treated at the Northern Pulmonary Vascular Service with either Bosentan or Sildenafil as monotherapy. The outcomes of two groups matched for age, haemodynamics, six minute walk (6MWD) and functional class at baseline who were treated with either Sildenafil or Bosentan monotherapy were compared at 3 and 6 months on therapy. Patients were selected who had no exercise limitation due to joint or muscle disease. Primary outcome measures were 6MWD and Camphor quality of life scores. Results A total of 25 patients were identified,12 treated with Sildenafil and 13 with Bosentan. In the Sildenafil group there was no significant differences in either Camphor or 6MWT at 0-3 or 0-6mths. Camphor scores, symptoms 0-3mths p= 0.33 0-6mths p=0.89, activites 0-3mths p-=0.94 0-6mths p=0.18, quality of life (QOL) 0-3mths p= 0.91, 0-6mths p=0.73. At baseline 6MWT mean (SD) 238(102) 3mths 252(126) 6mths 288(104) 0-3mths p=0.52, 0-6mths p=0.25. The Bosentan group showed a significant difference in 6MWT,baseline mean (SD) 233(126) 3mths 276(137) 6mths 264(104) 0-3mths p=0.01, 0-6mths p=0.02, however there were no significant differences in Camphor scores. Symptoms 0-3mths p=0.17, 0-6mths p=0.45, activities 0-3mths p=0.28, 0-6mths 0.08, QOL 0-3mths p=0.57, 0-6mths 0.34. Conclusions There was a significant improvement in 6MWD at 3 and 6 months seen in treatment with Bosentan but not Sildenafil. There were no improvements seen in Camphor scores in either group.

A MODIFIED REGIMEN OF EXTRACORPOREAL CARDIAC SHOCK WAVE THERAPY (CSWT) FOR TREATMENT OF CORONARY ARTERY DISEASE

ObjectivesOur purpose was to evaluate the clinical outcomes of a new cardiac shock wave therapy (CSWT) treatment regimen with a shorter duration.MethodsA total of 55 patients with severe coronary artery...

Tiotropium and exercise training in COPD patients: Effects on dyspnea and exercise tolerance

Exercise training improves exercise tolerance in chronic obstructive pulmonary disease (COPD). Tiotropium 18 microg once daily induces sustained bronchodilation throughout the day and reduces hyperinflation, one of the pathophysiological factors contributing to exertional dyspnea in COPD patients. To determine whether tiotropium enhances the effects of exercise training in patients with COPD. Multicenter, 25 week randomized, double-blind, placebo-controlled, parallel-group study. Twelve Italian Pulmonary Units practicing pulmonary rehabilitation. Two hundred thirty four COPD patients (196 males; mean age: 67.4 +/- 7.6; forced expiratory volume at 1 second (FEV1): 41.4 +/- 13.0% predicted) were randomised to tiotropium 18 microg or placebo inhalation capsules taken once daily. Both groups underwent a 8 week pulmonary rehabilitation program (PR) consisting of 3 exercise training session per week. Baseline, at the end of PR and after 12 weeks, patients completed pulmonary function testing, six minute walking test (6MWT), the Baseline and Transition Dyspnea Index (BDI and TDI), and the St. George's Respiratory Questionnaire (SGRQ). Relative to placebo, tiotropium had larger trough and post-study drug FEV1 responses on all test days. At the end of and 12 weeks following PR, patients on tiotropium showed no statistically significant differences in 6MWT compared to patients on placebo. Compared to the period immediately prior to PR, the mean improvement in 6MWT was only 29.7 meters (7.1%) for the combined cohort. Mean TDI focal scores at the end of PR were 3.60 for tiotropium and 2.25 for placebo (p < 0.01). At 12 weeks after PR, TDI focal scores were 2.71 for tiotropium and 2.11 for placebo (p = 0.16). Reduction in all four SGRQ component scores, indicating an improvement in health-related quality of life, was observed for the tiotropium group over the duration of the study compared to placebo but the differences were not statistically significant. During the study period, there were fewer exacerbations and exacerbation days in the tiotropium group. Although significant improvements were observed with perceived dyspnea, compared to placebo, the addition of tiotropium to pulmonary rehabilitation did not improve the 6MWT.