Six-minute Walk Test Distance Research Articles

Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease.

Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease.

Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial Fibrillation Patients with Rheumatic Mitral Stenosis: A Preliminary Study

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking. Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Health Related Quality of Life (HRQoL) in patients with AF and RMS. Material and Methods: A prospective multicenter trial across tertiary hospitals in East Java assessed strict and lenient heart rate control's impact on the SMWT and HRQoL in AF and RMS patients. Sixty-one participants were randomized into strict and lenient groups over six months from March to August 2023. Medications were adjusted to achieve target heart rates, and HRQoL was assessed using SF-36 and SMWT at baseline and three months post-target heart rate attainment. Result: In our study, 29 patients were under strict heart rate control, and 32 were under lenient control. We found a decrease in HRQoL across all subscales, with significant differences observed in general health perception and physical function among those under strict control (p=0.002 and 0.03, respectively). However, no significant disparity was found in the SMWT distance difference between lenient and strict groups (p=0.529), nor in METs (p=0.326). Conclusion: In the study, lenient heart rate control demonstrates significant effects on the general health perception and physical function subscales compared to strict heart rate control. Keyword: Strict and lenient heart rate, HRQoL, Six-Minute Walk Test, Atrial Fibrillation, Rheumatic Mitral Stenosis.

IMPROVE-BMT: A Pilot Randomized Controlled Trial of Prehabilitation Exercise for Adult Hematopoietic Stem Cell Transplant Recipients.

Background: There is limited evidence on the effects of aerobic and resistance training exercise interventions to improve physical function and patient-reported outcomes prior to autologous and allogeneic hematopoietic stem cell transplant (HSCT). IMPROVE-BMT was a single-site, pilot randomized controlled trial investigating the feasibility, acceptability, and safety of a pragmatic resistance training exercise program prior to HSCT compared to usual HSCT care. Secondary aims included differences in physical function between the exercise group (EX) and usual care control group (UC). Methods: Outcome measurements were assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT, and +100 days post-HSCT. The exercise intervention was a home-based exercise program that incorporated resistance-band and bodyweight exercises. Results: Acceptability among participants was 83%; exercise adherence averaged at 92%; and there were zero exercise-related adverse or serious adverse events. The average pre-transplant exercise phase was 6.28 weeks (2.71-18.29 weeks). EX (n = 36) demonstrated larger increases in the six-minute walk test distance, short physical performance battery scores, and 30-s chair stands compared to UC (n = 38) and demonstrated significant within-group improvements for the six-minute walk test, the short physical performance battery, the 30-s chair stands, and the timed up-and-go test. Conclusions: IMPROVE-BMT demonstrates that pragmatic exercise is highly feasible for HSCT recipients and can potentially lead to enhanced recovery that may not be achievable in non-exercisers.

Outcomes of oncological intended thoracic surgery after lung transplantation.

Lung cancer following lung transplantation (LT) may require thoracic surgery (TS). There is an urgent need for data on surgical feasibility, clinical and surgical characteristics, as well as outcome data. We reviewed the medical records of LT patients who had undergone TS at the University Hospital Leipzig between the years 2000 and 2022. Data on medical and surgical history, pulmonary function test, arterial blood gas analysis, six-minute walking distance test, and surgical approach, perioperative management, anesthesiologic, and surgical procedures were analyzed. Among 248 LT patients, 13 patients (5.2%) developed lung cancer after 4.2 years on average and on 6 of them (46.2%), major TS procedure was performed for the resection of lung cancer. In one patient who underwent TS for a suspicious pulmonary nodule, it turned out to be a parenchymal scar. TS was carried out in 57.1% on the native lung and 42.9% on the transplant lung. Pneumonia and acute renal failure were predominantly observed postoperative complications. We found that the capacity of gas exchange either before or after TS was related to the degree of postoperative complications. The in-hospital survival was 71.4%. Incidence of lung cancer is increased after LT. Follow-up care allows early diagnosis with a comparably high share of operable tumor stage. Cancer as well as postoperative complications were more likely after single lung transplantation (SLT). Postoperative morbidity and mortality are higher in this scarce group of patients and hence, warrants a centered and experienced interdisciplinary approach.

Clinical Application of Cardiac Rehabilitation Program Based on Self-efficacy Theory in Patients with Acute Myocardial Infarction Undergoing Percutaneous Transluminal Coronary Intervention

Objective: This study aimed to evaluate the effectiveness of a cardiac rehabilitation program based on self-efficacy theory in patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary intervention (PCI). Methods: A retrospective analysis was conducted on the medical records of 417 patients with AMI who underwent PCI at our hospital from May 2020 to May 2022. Patients were categorized into a control group (210 patients following a cardiac rehabilitation program) and an observation group (207 patients following a cardiac rehabilitation scheme based on self-efficacy theory). Data on demographics, diseases, and 1-year follow-up information were collected from the participants. Comparisons between the groups were made in terms of left ventricular ejection fraction (LVEF), six-minute walk distance test (6MWD), hospitalization duration, the 36-item short-form health survey (SF-36) score, and the incidence of angina pectoris and AMI recurrence within one-year post-management. Results: Initially, the groups had no significant difference in LVEF and 6MWD (p > 0.05). However, after 1 and 3 months of management, the observation group exhibited higher LVEF and 6MWD than the control group (p < 0.001). The observation group had a significantly shorter hospitalization duration (p < 0.001) and higher SF-36 scores post-management (p < 0.001). Furthermore, the incidence of angina pectoris and AMI recurrence within a year post-management was lower in the observation group (p < 0.05). Conclusion: The cardiac rehabilitation program grounded in self-efficacy theory significantly improves cardiac function in patients with AMI, accelerates their post-PCI rehabilitation, improves quality of life, and reduces the recurrence of angina pectoris and AMI. This approach offers new directions for cardiac rehabilitation management of AMI.

Impact of interstitial lung disease on left ventricular myocardial function.

Interstitial lung disease (ILD) comprises a wide variety of pulmonary parenchymal disorders within which progressive fibrosing ILD (PF-ILD) constitutes a phenotypic subset. By use of speckle tracking-based strain analysis we aimed to evaluate the degree of left ventricular (LV) dysfunction in progressive vs. non-progressive fibrosing ILD (non-PF-ILD). A total of 99 ILD patients (mean age 63.7 ± 13.5 years, 37.4% female), composed of 50 PF-ILD and 49 non-PF-ILD patients, and 33 controls were prospectively enrolled and underwent conventional and speckle tracking echocardiography. Additional laboratory and pulmonary function testing, as well as six-minute walk test were performed. As compared to the non-PF-ILD cohort, PF-ILD patients exhibited a significantly impaired forced vital capacity (2.4 ± 1.0l vs. 3.1 ± 0.9l, p = 0.002), diffusion capacity for carbon monoxide (DLCO, 25.6 ± 16.3% predicted vs. 43.6 ± 16.67% predicted, p <0.001) and exercise capacity response as measured by the six-minute walk test distance (268.1 ± 178.2m vs. 432.6 ± 94.2m, p <0.001). Contrary to conventional echocardiographic LV parameters, both regional and global longitudinal LV strain measurements were significantly altered in ILD patients as compared to controls. No differences in LV strain were found between both patient groups. Significant correlations were observed between global longitudinal strain, on the one hand, and systemic inflammation markers, total lung capacity (TLC) and DLCO, on the other hand (high-sensitivity C-reactive protein: Pearson´s r = -0.30, p< 0.001; interleukin-6: Pearson´s r = -0.26, p = 0.007; TLC % predicted: Pearson´s r = 0.22, p = 0.02; DLCO % predicted: Pearson´s r = 0.21, p = 0.02). ILD is accompanied by LV dysfunction. LV functionality inversely correlates with the severity of the restrictive ventilatory defect and inflammation marker levels. These observations support the assumption of persistent low-grade systemic inflammation that may link systemic cardiovascular function to ILD status.

Six-minute walk test distance at time of hospital discharge is strongly and independently associated with all-cause mortality following cardiac surgery

We investigated the impact of distance covered in the six-minute walk test (6mWT) before being discharged from the hospital after cardiac surgery on the risk of all-cause mortality. Our study included 1127 patients who underwent cardiac surgery and then took part in a standardised physiotherapist-supervised inpatient rehabilitation programme during 2007–2017. The percentage of the predicted 6mWT distance, and the lower limit of normal distance was calculated based on individual patients’ age, sex, and body mass index. We used Cox regression with adjustment for confounders to determine multivariable-adjusted hazard ratios (HRs) for mortality. Over a median follow-up period of 6.4 (IQR: 3.5–9.2) years, 15% (n = 169) patients died. We observed a strong and independent inverse association between 6mWT distance and mortality, with every 10 m increase in distance associated to a 4% reduction in mortality (HR: 0.96, 95% CI 0.94–0.98, P < 0.001). Those in the top tertile for predicted 6mWT performance had a 49% reduced risk of mortality (HR: 0.51, 95% CI 0.33–0.79) compared to those in the bottom tertile. Patients who met or exceeded the minimum normal 6mWT distance had 36% lower mortality risk (HR: 0.64, 95% CI 0.45–0.92) compared to those who did not meet this benchmark. Subgroup analysis showed that combined CABG and valve surgery patients walked less in the 6mWT compared to those undergoing isolated CABG or valve surgeries, with a significant association between 6mWT and mortality observed in the isolated procedure groups only. In conclusion, the longer the distance covered in the 6mWT before leaving the hospital, the lower the risk of mortality.

Multidisciplinary-derived clinical score for accurate prediction of long-term mortality in fibrotic lung disease patients

BackgroundIdiopathic pulmonary fibrosis (IPF) stands out as one of the most aggressive forms of interstitial lung diseases (ILDs), currently without a definitive cure. Multidisciplinary discussion (MDD) is now considered a cornerstone in diagnosing and differentiating ILD subtypes. The Gender-Age-Physiology (GAP) score, developed to assess IPF prognosis based on sex, age, forced vital capacity, and diffusion capacity for carbon monoxide (DLCO), is limited in not considering dyspnea and functional impairment during the walking test. We proposed a MDD-based clinical score for mortality prediction among those patients.MethodsFrom December 2018 to December 2019, we enrolled ILD patients with IPF and non-IPF and followed-up them till December 2020. Based on DLCO, modified Medical Research Council (mMRC) Dyspnea Scale, and six-minute walking test (6MWT) distance, a functional score was developed for mortality prediction.ResultsWe enrolled 104 ILD patients, 12 (11.5%) died by the one-year follow-up. In receiver operating characteristic (ROC) curve analysis, DLCO (% predicted) was the most accurate variable predicting one-year mortality with an area under curve (AUC) of 0.88 (95% confidence interval [CI] = 0.80–0.94), followed by mMRC Dyspnea Score (AUC = 0.82 [95% CI = 0.73–0.89]), 6MWT distance (AUC = 0.80 [95% CI = 0.71–0.88]), and GAP score (AUC = 0.77 [95% CI = 0.67–0.84]). Only the GAP score (hazard ratio [HR] = 1.55, 95% CI = 1.03–2.34, p = 0.0.37) and functional score (HR = 3.45, 95% CI = 1.11–10.73, p = 0.032) were significantly associated with one-year mortality in multivariable analysis.ConclusionThe clinical score composite of DLCO, mMRC Dyspnea Scale, and 6MWT distance could provide an accurate prediction for long-term mortality in ILD patients, laying out a helpful tool for managing and following these patients.

Predicting Response to In-Hospital Pulmonary Rehabilitation in Individuals Recovering From Exacerbations of Chronic Obstructive Pulmonary Disease

BackgroundPredicting the response to pulmonary rehabilitation (PR) could be valuable in defining admission priorities. We aimed to investigate whether the response of individuals recovering from a COPD exacerbation (ECOPD) could be forecasted using machine learning approaches. MethodThis multicenter, retrospective study recorded data on anthropometrics, demographics, physiological characteristics, post-PR changes in six-minute walking distance test (6MWT), Medical Research Council scale for dyspnea (MRC), Barthel Index dyspnea (BId), COPD assessment test (CAT) and proportion of participants reaching the minimal clinically important difference (MCID). The ability of multivariate approaches (linear regression, quantile regression, regression trees, and conditional inference trees) in predicting changes in each outcome measure has been assessed. ResultsIndividuals with lower baseline 6MWT, as well as those with less severe airway obstruction or admitted from acute care hospitals, exhibited greater improvements in 6MWT, whereas older as well as more dyspnoeic individuals had a lower forecasted improvement. Individuals with more severe CAT and dyspnea, and lower 6MWT had a greater potential improvement in CAT. More dyspnoeic individuals were also more likely to show improvement in BId and MRC. The Mean Absolute Error estimates of change prediction were 44.70m, 3.22 points, 5.35 points, and 0.32 points for 6MWT, CAT, BId, and MRC respectively. Sensitivity and specificity in discriminating individuals reaching the MCID of outcomes ranged from 61.78% to 98.99% and from 14.00% to 71.20%, respectively. ConclusionWhile the assessed models were not entirely satisfactory, predictive equations derived from clinical practice data might help in forecasting the response to PR in individuals recovering from an ECOPD. Future larger studies will be essential to confirm the methodology, variables, and utility.

Association between six-minute walk distance and prognosis of atherosclerotic coronary heart disease post-cardiac rehabilitation.

Plaque accumulation in the coronary arteries is a major cause of coronary heart disease (CHD), a disease infamously known as a contributor for global death burden. Major adverse cardiac events (MACE) pose significant risks for CHD patients, highlighting the urgency of effective management and cardiac rehabilitation in CHD management. Studies have reported the role of the six-minute walk distance (6MWD) test in predicting outcomes for CHD patients; however, none have performed the investigation in Aceh setting. The aim of this study was to investigate the reliability of 6MWD as a prognostic factor for post-cardiac rehabilitation of patients with atherosclerotic CHD. A cross-sectional study was conducted in Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. MACE was determined through in-person interviews, and phone calls with 30 atherosclerotic CHD patients who completed cardiac rehabilitation between August 2018 and September 2020. The association between 6MWD and prognosis, assessed by MACE incidence, was calculated. The results revealed that 6MWD was strongly associated with MACE occurrence during post-cardiac rehabilitation (p=0.029; prevalence ratio 4.5). Furthermore, CHD patients achieving 6MWD of more than 300 meters exhibited a lower incidence of MACE (10.5%) than patients with 6MWD of less than 300 meters (45.5%). In conclusion, the present study sheds light on the importance of improving functional capacity in patients with atherosclerotic CHD post-cardiac rehabilitation due to its significant association with the prognosis.

Assessing Intense Physical Activity Among Smokers Via Using Smart Watch an Analytical Cross-Sectional Study

Background: Smoking is a well-known risk factor for various health conditions, particularly affecting cardiovascular and pulmonary systems. Despite extensive research, the impact of smoking on physical performance during intense activity remains inadequately explored. This study aims to bridge this knowledge gap by examining the effects of smoking on physical activity and cardiovascular responses. Objective: The primary goal of this study was to assess the impact of smoking on intense physical activity, specifically focusing on differences in heart rate (HR) responses and physical endurance between smokers and non-smokers. Methods: In this analytical cross-sectional study, 30 participants (15 smokers and 15 non-smokers) were recruited. The study employed the Six-Minute Walk Distance (6MWD) test, the Balke treadmill protocol, and the Ekblom-Bak test to evaluate physical performance. Heart rates were monitored using Garmin Vivismar4 smartwatches. Statistical analyses, including T-tests, were performed to compare the results between the two groups. Results: Smokers demonstrated a significantly lower distance covered in the 6MWD (0.22 ± 0.05 km) compared to non-smokers (0.26 ± 0.06 km). In the Balke treadmill and Ekblom-Bak tests, smokers showed a lower HR (94.8 ± 22.3 bpm and 94.6 ± 28.1 bpm, respectively) compared to non-smokers (143.2 ± 27.0 bpm and 139.9 ± 25.1 bpm). The findings suggest a compromised cardiovascular response and physical endurance in smokers. Conclusion: The study concludes that smoking adversely affects physical endurance and cardiovascular response during intense physical activity. These findings underscore the importance of considering smoking status in the assessment of physical fitness and highlight the need for further research on the long-term health implications of smoking.

Family Involvement and at-Home Physical Therapy on Duchenne Muscular Dystrophy: A Randomized Controlled Trial

BackgroundDuchenne muscular dystrophy (DMD) is a genetic condition that causes muscle weakness and begins in early childhood. To treat its complications, the rehabilitation program includes physical therapy, mainly on the musculoskeletal and the respiratory complications that appear on the evolution of the disease. This study aims to explore the effects of physical therapy with or without an at-home program on motor function among children with DMD. MethodsA randomized controlled trial was carried out for one year (one group with at-home and conventional physical therapy and another with conventional physical therapy). Motor function was measured using the Motor Function Measure (MFM) scale, the Vignos and Brooke scales, the Timed-up-and-Go test, and the six-minute walk distance test. ResultsTwenty-seven participants with DMD participated in this study. In the at-home and conventional physical therapy group, better motor function at the distal and global level was maintained, per the results of the MFM scale (P < 0.05). The rest of the variables did not achieve statistically significant changes. ConclusionsOur results suggest that complementing conventional treatment with at-home treatment in which the family is involved maintains better motor function, in participants with DMD.

Frailty in Older Patients with Transthyretin Cardiac Amyloidosis.

Background-Transthyretin cardiac amyloidosis (ATTR-CA) prevalence increases with age. The interplay between frailty and heart failure has been increasingly recognized. The objective of this study is to compare clinical, biological, and transthoracic echocardiography (TTE) characteristics of older ATTR-CA patients according to the G8 frailty screening tool. Methods-Patients over 75 years old with a confirmed diagnosis of ATTR-CA were included between January 2020 and April 2021. All patients underwent a routine blood test, TTE, and a functional assessment with a six-minute walking distance test (6MWD) or cardiopulmonary exercise testing (CPET), and the G8 score was calculated. Results-Fifty-two patients were included. Thirty-nine (75%) patients were frail and their mean NYHA stage was more severe (2.2 vs. 1.7; p = 0.004); 62% of them had a Gilmore stage of 2 or 3 (p = 0.05). Global left ventricular strain (GLS) was lower (-11.7% vs. -14.9%; p = 0.014) and the interventricular septum was thicker (18 ± 2 mm vs. 17 ± 2 mm; p = 0.033) in frail patients. There were no significant differences according to functional tests. Conclusion-The majority of older patients with ATTR-CA are frail according to the G8 score. They are more symptomatic and have an increased cardiac involvement and a poorer prognosis, requiring more personalized cardiac management.

Intravenous Iron for Heart Failure: Updated Systematic Review and Meta-Analysis.

While the administration of intravenous (IV) iron to those with heart failure has been implicated to be associated with a possible reduction in hospitalizations and improvement in symptoms, a recent large multicenter trial only showed modest benefits in reducing hospitalization, necessitating the updated systematic review. We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE database until January 9, 2023. Outcomes included total heart failure hospitalizations, first heart failure hospitalization, six-minute walk test (6MWT) distance, and incidence of infection. There were 13 studies with 3410 participants (1,790 with IV iron). Pooled analysis that reported the incidence of cardiovascular death showed that patients with IV iron did not have significantly lower odds of cardiovascular death or first heart failure hospitalization. In contrast, those who received IV iron had significantly lower total heart failure hospitalization (pooled odds ratio (OR) 0.63, 95% confidence interval (CI) 0.44-0.90, I2 59.0%, P = .017) and a composite of cardiovascular death and first heart failure hospitalization (pooled OR 0.55, 95% CI 0.47-0.64, I2 0%, P = .656). While the efficacy is modest, IV iron therapy could be associated with reduced hospitalization for heart failure without significant adverse events.

Elective Cardiac Procedure Patients Have Low Preoperative Cardiorespiratory Fitness.

Preoperative cardiorespiratory fitness may influence the recovery after cardiac procedure. The aim of this study was to investigate the cardiorespiratory fitness of patients scheduled for elective cardiac procedures, using a six-minute walk test, and compare the results with a population-based sample of Finnish adults. Patients (n=234) awaiting percutaneous coronary intervention or coronary angiography, coronary artery bypass grafting, aortic valve replacement or mitral valve surgery performed the six-minute walk test. VO2max was calculated based on the walk test. The patients were compared to a population-based sample of 60-69-year-old Finnish adults from the FinFit2017 study. The mean six-minute walk test distances (meters) and VO2max (ml/kg/min) of the patient groups were: 452±73 and 24.3±6.9 (coronary artery bypass grafting), 499±84 and 27.6±7.2 (aortic valve replacement), 496±85 and 27.4±7.3 (mitral valve surgery), and 519±90 and 27.3±6.9 (percutaneous coronary intervention or coronary angiography). The population-based sample had significantly greater walk test distance (623±81) and VO2max (31.7±6.1) than the four patient groups (all p-values<0.001). All patient groups had lower cardiorespiratory fitness than the reference population of 60-69-year-old Finnish adults. Particularly the coronary artery bypass grafting group had a low cardiorespiratory fitness, and therefore might be prone to complications and challenging rehabilitation after the operation.

Total iron binding capacity: an independent predictor of prognosis for pulmonary arterial hypertension in systemic lupus erythematosus

Objective To investigate the role of parameters of iron metabolism in systemic lupus erythematosus (SLE) patients with pulmonary arterial hypertension (PAH). Method This was a prospective observational study recruiting patients diagnosed with systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH). Patients with other factors that might lead to PAH were excluded from the study. All patients were assessed for PAH every 1–3 months and were followed up for 6 months. The primary outcome was considered improved if the grade of risk stratification declined at the endpoint; otherwise, it was considered unimproved. Results In total, 29 patients with SLE-PAH were included in this study. The mean of serum ferritin was higher than normal, and total iron binding capacity (TIBC) decreased in 48% of patients. Correlation analyses showed that serum iron (SI) was negatively correlated with World Health Organization functional class (WHO-FC) (r = −0.409, p = 0.028), and positively correlated with Six-Minute Walk Test distance (6MWD) (r = 0.427, p = 0.021) and tricuspid annular plane systolic excursion (TAPSE) (r = 0.388, p = 0.037). Primary outcomes improved in 12 patients at the endpoint, and univariate logistic regression analyses indicated that TIBC was associated with improved primary outcomes in patients with SLE-PAH (odds ratio 12.00, 95% confidence interval 1.90–75.72). Conclusion SI was negatively correlated with WHO-FC, and positively correlated with 6MWD and TAPSE. Furthermore, TIBC was associated with improved outcomes of patients with SLE-PAH, which could be an independent predictor of prognosis. Further research is needed to verify the findings.

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery.

The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0-25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6-15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2 O (4.6-16.6) cmH2 O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

The Six-Minute Walk Test Distance at Time of Hospital Discharge All-Cause Mortality Following Cardiac Surgery

To determine the association between the distance walked during the 6-minute walk test (6mWT) immediately prior to hospital discharge following cardiac surgery and the risk of all-cause mortality.

Myocardial Perfusion is Compromised in Patients with COPD and Associated with Reduced Functional Capacity

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the 3rd leading cause of death worldwide and carries with it significant cardiovascular mortality. Arterial stiffness is a known risk factor for cardiovascular disease that contributes to worsening myocardial blood flow and limits functional capacity, a marker of disease prognosis and quality of life in COPD. Myocardial perfusion is decided by a careful balance between myocardial blood flow and workload and has been strongly associated with cardiovascular mortality. Despite the convincing relationship between COPD and cardiovascular disease, to date, studies investigating myocardial perfusion and its relationship to functional capacity in COPD remains unexplored. Purpose: This study sought to test the hypothesis that myocardial perfusion is reduced in COPD and associated to functional capacity. Methods: Ten patients with COPD (GOLD Stage II-IV) with no overt signs of cardiovascular disease or diagnosis and 10 demographically matched, apparently healthy controls participated in this study completing a comprehensive analysis of vascular function and functional capacity. Carotid femoral applanation tonometry was used to assess myocardial perfusion (subendocardial viability ratio (SEVR)) and arterial stiffness (Pulse Wave Velocity (PWV)). Functional Capacity was measured via six-minute walk test distance (6MWT) with dyspnea being measured on a 0-10 scale. Results: Patients with COPD exhibited significantly ( p=0.041) reduced myocardial perfusion (SEVR: ΔCOPD=131±19% vs. ΔControl=153±28%) and increased arterial stiffness (PWV: ΔCOPD=8±1 m/s vs. ΔControl=6±1 m/s, p=0.013) when compared to matched controls. Functional Capacity was significantly ( p&lt;0.001) reduced in patients with COPD (6MWT Distance: ΔCOPD=274±87 m vs. ΔControl=476±99 m) while exhibiting significantly ( p=0.02) increased post exercise dyspnea (ΔCOPD=3.1±2.4 vs. ΔControl=0.8±1.2 a.u.). Myocardial perfusion was strongly associated to 6MWT distance ( p=0.038; r=0.693) and arterial stiffness was negatively associated with dyspnea ( p=0.015; r=-0.850). Conclusion: Our data supports that patient with COPD exhibit poor myocardial perfusion that is associated to worse functional capacity, key component of quality of life and mortality in this population. This preliminary data highlights the importance of cardiovascular screening in COPD as it emphasizes how myocardial perfusion impairments may predict prognosis in this population even when no diagnosis of cardiovascular disease is present. Future studies are warranted to investigate if impaired myocardial perfusion plays a causational role in decreasing functional capacity and its potential as a therapeutic target. Supported by American Heart Association (18CDA34110323 PRM &amp; PRE905812 KC/PRM). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Impact of muscular symptoms and/or pain on disease characteristics, disability, and quality of life in adult patients with hypophosphatasia: A cross-sectional analysis from the Global HPP Registry.

Hypophosphatasia (HPP) manifests in adults as fractures/pseudofractures, pain, muscle weakness, and other functional impairments. Better phenotypic disease characterization is needed to help recognize disability and treat patients with HPP. Baseline/pretreatment demographic, clinical characteristic, and patient-reported disability/health-related quality-of-life (HRQoL) data from adults (≥18 y) in the Global HPP Registry (NCT02306720) were stratified by presence of overt skeletal manifestations (skeletal group) versus muscular/pain manifestations without skeletal manifestations (muscular/pain group) and summarized descriptively. Disability was measured using the Health Assessment Questionnaire-Disability Index (HAQ-DI), and HRQoL using the 36-item Short Form Health Survey (SF-36v2). Of 468 adults, 300 were classified into the skeletal group and 73 into the muscular/pain group. The skeletal group had a higher median age at baseline (50.1 vs 44.4 y; P=0.047) but a lower median age at first HPP manifestation (12.3 vs 22.1 y; P=0.0473), with more signs and symptoms (median, 4 vs 3; P<0.0001) and involved body systems (median, 3 vs 2; P<0.0001) than the muscular/pain group. More patients in the skeletal group required any use of mobility aids (22.6% vs 3.5%, respectively; P=0.001). Six-Minute Walk test distances walked were similar between groups. SF-36v2 and HAQ-DI scores were similar between groups for physical component summary (n=238; mean [SD]: 40.2 [11.0] vs 43.6 [11.2]; P=0.056), mental component summary (n=238; mean [SD]: 43.6 [11.3] vs 43.8 [11.8]; P=0.902), and HAQ-DI (n=239; median [minimum, maximum]: 0.4 [0.0, 2.7] vs 0.3 [0.0, 2.1]; P=0.22). Adults with HPP experience similar QoL impairment regardless of skeletal involvement. https://clinicaltrials.gov/ct2/show/NCT02306720 and https://www.encepp.eu/encepp/viewResource.htm?id=47907, identifier NCT02306720; EUPAS13514.