Walking Distance In Patients Research Articles

Sotatercept: The First FDA-Approved Activin A Receptor IIA Inhibitor Used in the Management of Pulmonary Arterial Hypertension.

This report illustrates the Food and Drug Administration (FDA) approval of first-in-its-class activin A receptor IIA inhibitor, sotatercept (Winrevair™), for the treatment of pulmonary arterial hypertension (PAH). Sotatercept is used to increase exercise capacity, improve WHO functional class, and decrease the risk of clinical worsening events in adults with PAH. One phase 2 trial, one phase 3 trial, and an ongoing open-label extension study is described in detail within the current text. Sotatercept significantly improved the 6-min walk distance in patients with PAH after 24 weeks with a mean change increase of 40.1 meters in the experimental group versus 1.4 meters decrease in the placebo group. Epistaxis, telangiectasia, increased hemoglobin, hematocrit, red blood cell levels, and dizziness were adverse events more frequently observed in the sotatercept group than in the placebo group. Sotatercept has shown significant benefits in the reduction of pulmonary vascular resistance and N-terminal pro b-type natriuretic peptide in patients with PAH. However, more studies are needed to evaluate the reduction in mortality. Limitations in practice include high cost and unknown long-term effects.

Estimation of minimal clinically important difference for 6-minute walking distance in patients with acute stroke using anchor-based methods and credibility instruments.

Stroke impairs a patient's ability to walk. In patients with acute stroke, a 6-min walking distance (6MWD) is recommended to assess walking function. Minimal clinically important difference (MCID) is used to determine the effectiveness of rehabilitation; however, the MCID for 6MWD has not been adequately validated. This study aimed to estimate the MCID of 6MWD, a measure of walking endurance, in patients with acute stroke using anchor-based methods. Based on the change in 6MWD from baseline to the follow-up measurement 2weeks later, the MCID was estimated using anchor-based methods (receiver operator operating characteristic curves, predictive and adjustment models) with a patient- and therapist-rated global rating of change scale (p-GRC, t-GRC) as external anchors. The accuracy of "meaningful change" was estimated from the area under the curve. Using MCID's credibility instruments, the credibility of each anchor was evaluated. Using the credibility instrument, high credibility was defined as satisfying 3/5 of the Core criteria and 6/9 of all criteria. The analysis included 58 patients. The MCID for each anchor was 78.7-100.0m for p-GRC, and 95.2-99.5m for t-GRC. The p-GRC demonstrated excellent accuracy (area under the curve >0.8). With p-GRC as anchors, over 50% of patients showed improvement. The p-GRC satisfied the core criterion of 3/5 and all criteria of 6/9 on the reliability instrument. The t-GRC demonstrated low reliability and satisfied the core criterion of 2/5 and all criteria of 3/9. Since the percentage of improved groups exceeded 50%, the adjusted model was useful in the anchor-based method. Therapists may not accurately capture patient fatigue and subjective symptoms, potentially affecting the correlation between the 6MWD change score and the t-GRC and, consequently, the reliability instrument. The p-GRC showed high accuracy and reliability; therefore, the MCID was estimated to be 78.7m.

Effect of Arm-Ergometry Versus Treadmill Supervised Exercise on Cardiorespiratory Fitness and Walking Distances in Patients With Peripheral Artery Disease: The ARMEX Randomized Clinical Trial.

To compare arm-ergometry and treadmill supervised exercise training on cardiorespiratory fitness and walking distances in patients with peripheral artery disease (PAD). ARMEX was a single-center, single-blinded, parallel group, non-inferiority trial enrolling symptomatic patients with PAD. Patients were randomized (1:1 ratio) to a 12-wk arm-ergometry (AEx) or standard treadmill (TEx) supervised exercise training protocol. The powered primary end point was the change in peak oxygen uptake (VO 2 ) at 12 wk, measured on a treadmill cardiopulmonary exercise test (CPX). Secondary outcomes included changes in VO 2 at the first ventilatory threshold (VT-1), ventilatory efficiency (ratio of minute ventilation [VE] to carbon dioxide production [VCO 2 ], VE/VCO 2 ), walking distances by CPX and 6-min walking test (6MWT), and self-reported walking limitations. Fifty-six patients (66±8yr; 88% male) were randomized (AEx, n =28; TEx, n =28). At 12 wk, VO 2peak change was not significantly different between groups (0.75 mL/kg/min; 95% CI, -0.94 to 2.44; P =.378), despite a significant increase only in AEx. VO 2 at VT-1 improved in both groups without between-group differences, and VE/VCO 2 slope improved more in AEx. The TEx attained greater improvements in walking distance by CPX (121.08 m; 95% CI, 24.49-217.66; P =.015) and 6MWT (25.08 m; 95% CI, 5.87-44.29; P =.012) and self-perceived walking distance. Arm-ergometry was noninferior to standard treadmill training for VO 2peak , and treadmill training was associated with greater improvements in walking distance. Our data support the use of treadmill as a first-line choice in patients with PAD to enhance walking capacity, but arm-ergometry could be an option in selected patients.

Impact of Real-Time Assessment of Pulse Oximetry on the 6-Min Walk Distance in Patients With Chronic Respiratory Disease.

Continuous monitoring of pulse oximetry (SpO2 ) is recommended during the 6-min walk test (6MWT) to ensure that the lowest SpO2 is recorded. In this case, severe exercise-induced desaturation (EID; SpO2 < 80%) triggers walking interruption by the examiner. Our main objective was to assess the impact of this approach on 6MWT distance in patients with chronic respiratory diseases and, second, to evaluate the safety of the test without interruption due to severe EID. 6MWTs with continuous monitoring of SpO2 were prospectively performed in subjects with chronic respiratory disease. The participants were randomly allocated to walk with or without SpO2 real-time assessment. SpO2 visualization during the test execution was available only in the first group, and walking interruption was requested by the examiner if SpO2 < 80%. One hundred forty-five participants were included in each group (68.6% females, 62 [52-69] y old) without differences in demographic and resting lung function parameters between them. The main respiratory conditions were COPD (n = 101), asthma (n = 73), pulmonary hypertension (n = 47), and interstitial lung disease (n = 39). The walked distance was similar comparing groups (349.5 ± 117.5 m vs 351.2 ± 105.4 m). Twenty-five subjects presented with severe EID in the group with real-time SpO2 assessment, and 20 subjects had severe EID in the group without real-time assessment respectively (overall prevalence of 15.5%). The 23 participants who had their test interrupted by the examiner due to severe EID in the first group (2 subjects stopped by themselves due to excessive symptoms) walked a shorter distance compared to the 11 subjects with severe EID without test interruption in the second group (9 subjects stopped by themselves due to excessive symptoms): 240.6 ± 100.2 m versus 345.9 ± 73.4 m. No exercise-related serious adverse events were observed. Interruption driven by severe EID reduced the walked distance during the 6MWT. No serious adverse event, in turn, was observed in subjects with severe desaturation without real-time SpO2 assessment.

Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary.

Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary.

Responsiveness and minimal clinically important difference of the 6-minute walk distance in patients undergoing colorectal cancer surgery.

This study aimed to clarify the responsiveness and minimal clinically important difference (MCID) of the 6-minute walk distance (6MWD) from before and 1 week after surgery in patients with colorectal cancer (CRC). This retrospective cohort study enrolled 97 patients with primary CRC scheduled for surgery. An anchor-based approach estimated the MCID of the 6MWD, with postoperative physical recovery and EuroQol 5-dimension 5L questionnaire assessments serving as anchors. Effect size (ES) and standardized response mean (SRM) of the 6MWD were calculated to evaluate responsiveness, and the receiver operating characteristic (ROC) curve was used to estimate the MCID of the 6MWD. Of the 97 patients, 72 were included in the analysis. The absolute value of ES and SRM of the 6MWD were 0.69 and 0.91, respectively. The ROC curve indicated that the optimal cut-off values for estimating the MCID of the 6MWD were -60 m (area under the curve [AUC] = 0.753 [95% CI: 0.640-0.866]) and -75 m (AUC = 0.870 [95% CI: 0.779-0.961]) at each anchor. From before to 1 week after surgery, the responsiveness of the 6MWD was favorable, and the MCID of the 6MWD was -75 to -60 m in patients with CRC.

Effects of acute whole-body and lower limb heating on hemodynamic responses to walking in patients with peripheral artery disease

Background: The exercise pressor reflex is exaggerated in patients with peripheral artery disease (PAD). There has been speculation regarding cardiovascular benefits of heating therapy for patients with PAD. The impact of acute leg heating and whole-body heating on hemodynamic responses during walking remains incompletely understood. The purpose of this study was to evaluate the effects of acute whole-body and lower leg heating on hemodynamic responses to walking in both patients with PAD and healthy control subjects. Hypothesis: We hypothesized that both acute whole-body and lower leg heating would attenuate the pressor response to walking in patients with PAD. Methods: 10 PAD patients (68 ± 7 yrs; Male/Female, N = 7/3) and 8 age-matched healthy control subjects (64 ± 5 yrs, Male/Female, N = 5/3) participated in this study. The treadmill walking test followed the Gardner protocol, involving a constant speed of 2 mph with a 2%-grade increment every 2 minutes. The study encompassed 3 trials/visits: 1) non-heating (control), 2) post leg heating, and 3) post whole-body heating. The order of these visits was randomized. During the leg heating visit, the subjects' lower limbs (below the knees) were immersed in warm water (40-42℃) for 30 minutes. Whole-body heating was administered by outfitting the subjects in a tube-lined heating suit until their internal temperature increased by 0.3℃ (~ 45 min). Hemodynamic responses were assessed by comparing the average systolic blood pressure (SBP) and heart rate (HR) during the last 3 stages of treadmill walking with baseline values. Results: Resting SBP and HR did not exhibit significant differences between groups (all P &gt; 0.05). During the control visit, the increase in SBP due to treadmill walking was significantly (P = 0.04) higher in patients with PAD than in healthy subjects. No group differences were observed in the increase in HR by treadmill walking. The responses in SBP and HR to treadmill walking, following leg heating, were comparable to those observed in the control visit for both groups (all P &gt; 0.05). Compared to the control visit, whole-body heating significantly attenuated the SBP (ΔSBP%, 32.9 ± 13.5 vs. 21.3 ± 9.5 %, P = 0.02) and HR responses (ΔHR%, 61.6 ± 24.3 vs. 42.7 ± 15.6 %, P = 0.03) to treadmill walking in PAD. However, in healthy subjects after whole-body heating, these responses were not different from the control visit (both P &gt; 0.05). Neither whole-body nor leg heating had any impact on the walking distance in patients with PAD. Discussion and Conclusion: Acute whole-body heating significantly attenuated the pressor response to walking in patients with PAD, while lower leg heating exhibited no such impact. These findings suggest potential benefits of acute whole-body heating for patients with PAD. We speculate that the comprehensive systemic adjustments by whole-body heat exposure play a pivotal role in improving the exaggerated pressor response to exercise in PAD. Conversely, local lower leg heating, as observed in our study, seems insuffcient to change the hemodynamic response to exercise in patients with PAD. This study was supported by NIH R01 HL141198 and R01 HL144781. This is the full abstract presented at the American Physiology Summit 2024 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.

Associations of hypertension with clinical and instrumental characteristics in the ukrainian cohort of patients hospitalized for COVID-19

long COVID-19 syndrome causes sustained limitations in activity and work capacity in a significant proportion of convalescents, the risk of which is higher among patients who required hospitalization. Phenotyping of COVID-19 survivors based on the most common comorbidities’ role in shaping the risks of the acute phase endpoints and development of post-covid syndrome can be used to improve the efficacy of predicting the course of the disease. To study the associations of hypertension (HT) with the clinical features of acute COVID-19 in hospitalized patients, severity of residual functional disorders and pulmonary affection by the time of discharge. Material and methods. 221 hospitalized patients with COVID-19 (age 53,4 ± 13,6 years, 53% female) were examined 1-2 days before discharge. The study protocol included interview and analysis of medical documentation to retrospectively extract the anamnestic data and clinical features of the acute phase; lung ultrasound, reactive hyperemia test of the brachial artery, and a 6-minute walk test. Results. The most frequently identified comorbidities in the study cohort were HT, obesity, and type 2 diabetes, which were present in 40%, 38%, and 10% of participants, respectively. Hypertensive patients were older (57,8 ± 11,8 vs 50,7 ± 13,9 years, р &lt; 0,001), had higher BMI (31,7 ± 5,3 vs 31,7 ± 5,3 кг/м2, р &lt; 0,001), higher prevalence of obesity (59% vs 25%, p &lt; 0,001) and type 2 diabetes (21% vs 2%, p &lt; 0,001) compared to normotensive participants, but were characterized by comparable laboratory indices, parameters of pulmonary parenchyma affection (by CT scan and lung ultrasound), endothelial function, SpO2 levels during the acute phase of the disease and by the time of discharge, as well as age- and anthropometric parameters-adjusted 6-minute walk distance (67,4 ± 10,5 % vs 69,5 ± 13,6 %, p &gt; 0,05). Hypertensive patients hospitalized for COVID-19 were characterized by older age, higher prevalence of obesity and type 2 diabetes compared to normotensive participants but did not differ in their laboratory profile (including markers of systemic inflammation, prothrombotic activation, renal function, and liver damage), levels of pulmonary affection by CT and lung ultrasound, and endothelium-dependent vasodilatation in a reactive hyperemia test of the brachial artery. The observed decrease in the 6-minute walk distance in patients with HT was explained by differences in age and anthropometric parameters.

Effects of dapagliflozin and empagliflozin on 6-min walk distance in heart failure with preserved and reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials involving 2624 patients.

Dapagliflozin and empagliflozin are antidiabetic medications. They are the first two sodium-glucose cotransporter-2 inhibitors (SGLT2i) to receive the US Food and Drug Administration approval to manage heart failure. Emerging new trials have examined changes in the 6-min walk distance as a clinically significant response to dapagliflozin and empagliflozin in patients with heart failure with reduced ejection fraction (HFpEF) and heart failure with preserved ejection fraction (HFrEF). This meta-analysis aims to evaluate the effects of dapagliflozin and empagliflozin on the 6-min walk distance in patients with HFpEF and HFrEF. To our knowledge, no such meta-analysis has been published. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify eligible studies reported up to December 16, 2023. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). A p-value ≤ 0.05 is considered as statistically significant. The meta-analysis included a total of 8 studies with 2624 patients. Overall, the results showed insignificant differences in the 6-min walk between the SGLT2i and placebo (MD 24, 95% CI -0.30 to 18.78, p = 0.06). Results became significant after resolving the heterogeneity (MD 6.72, 95% CI 0.13 to 13.31, p = 0.05). Notably, the results of each drug separately were insignificant. More robust observations occurred in the HFpEF group (MD 10.73, 95% CI 1.08 to 20.39, p = 0.03). Compared to placebo, patients on dapagliflozin reported significant improvement in the Kansas City Cardiomyopathy Questionnaire Clinical Summary (KCCQ-CS) and Overall Summary (KCCQ-OS) with values of MD 5.18 (95% CI 2.80 to 7.57, p < 0.0001) and MD 4.06 (95% CI 1.66 to 6.46, p = 0.0009), respectively. The dapagliflozin group and patients with HFpEF had reported a significant reduction in their weight compared with the control group (MD -0.59 CI -1.09 to -0.08, p = 0.02) and (MD -0.80 CI -1.47 to -0.13, p = 0.02), respectively. No significant side effects were observed for dapagliflozin or empagliflozin. Patients with HFpEF experienced benefits from SGLT2i administration, as evidenced by improved 6-min walk distances and weight reduction. Dapagliflozin demonstrated clinical and overall improvements in KCCQ scores and was more effective in reducing weight than the placebo. Both Dapagliflozin and Empagliflozin were well-tolerated and exhibited favorable safety profiles. Future studies could benefit from a larger patient population, a longer follow-up period, and a broader range of SGLT2i.

Estimating maximum work rate during cardiopulmonary exercise testing from the six-minute walk distance in patients with heart failure

BackgroundExercise is recommended for patients with chronic heart failure (CHF) and its intensity is usually set as a percentage of the maximal work rate (MWR) during cardiopulmonary exercise testing (CPX) or a symptom-limited incremental test (SLIT). As these tests are not always available in cardiac rehabilitation due to logistic/cost constraints, we aimed to develop a predictive model to estimate MWR at CPX (estMWR@CPX) in CHF patients using anthropometric and clinical measures and the 6-min walk test (6 MWT), the most widely used exercise field test. MethodsThis is a multicentre cross-sectional retrospective study in a cardiac rehabilitation setting. Six hundred patients with HF in New York Heart Association (NYHA) functional class I-III underwent both CPX and 6 MWT and, through multivariable linear regression analysis, we defined several predictive models to define estMWR@CPX. ResultsThe best model included 6 MWT, sex, age, weight, NYHA class, left ventricular ejection fraction (LVEF), smoking status and chronic obstructive pulmonary disease COPD (adjusted R2 = 0.55; 95% LoA −39 to 33 W). When LVEF was excluded as a predictor, the resulting model performed only slightly worse (adjusted R2 = 0.54; 95% LoA −42 to 34 W). Only in 34% of cases was the percentage difference between estMWR@CPX and real MWR@CPX <10% in absolute value. EstMWR@CPX tended to overestimate low values and underestimate high values of true MWR@CPX. ConclusionsOur results showed a lack of accuracy in the predictive model evaluated; therefore, for an accurate prescription of cycle-ergometer exercise training, it is necessary to assess MWR by CPX or SLIT.

Physiotherapy versus alternative medicine for pain and quality of life in patients with lumbar spinal stenosis: a systematic review with meta-analysis

IntroductionLumbar spinal stenosis (LSS) is a prevailing condition widely affecting mobility. However, many non-invasive treatments have been proposed for LSS. Physiotherapy is reported as more commonly used with very little evidence reporting the efficacy of alternative medicine. For clinicians, there was a need to find a better mode of treatment. The purpose of this paper is to compare the effectiveness of physiotherapy interventions and alternative medicine for leg pain, back pain, and walking distance in patients with LSS.MethodsData sources: PubMed, Web of Science, and Scopus databases were searched for papers published in the previous 5 years (2016–2020). The systematic review and meta-analysis were conducted from September 2021 to December 2021 at the Musculoskeletal Research Lab of Maharishi Markandeshwaer Institute of Physiotherapy &amp; Rehabilitation. Study selection and outcomes: randomised controlled trials (RCT), randomised clinical trials, randomised cross-over trials, quasi-RCTs, and non-RCTs were included if they evaluated the effects of physiotherapy or alternative medicine on pain and walking distance in patients with LSS. The Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), Self-paced walk test (SPWT), and treadmill walking were used as outcome measures. All the authors independently screened and extracted data from the 8 studies retrieved through the search using a pilot-tested performa. The quality of studies was assessed using the PEDro scale and the Cochrane risk of bias criteria.ResultsMeta-analysis was performed using a fixed-effects model that showed (1) Physiotherapy was more effective than the control in improving leg pain. The Standardised mean difference (SMD) (95% CI) in the NRS score for leg pain was found to be 1.12 (0.83, 1.40); (2) Physiotherapy was more effective than the control in improving back pain. The SMD (95% CI) in the NRS score for back pain was 0.29 (−0.18, 0.76); (3) Physiotherapy was more effective than the control in improving walking distance. The SMD (95% CI) for walking distance was found to be 144.59 m (133.16 m, 159.02 m).ConclusionsThe results of the present study indicate that physiotherapy has higher significant results than alternative medicine in patients with lumbar spinal stenosis.

Effect of Dapagliflozin Versus Placebo on Symptoms and 6-Minute Walk Distance in Patients With Heart Failure: The DETERMINE Randomized Clinical Trials.

Sodium-glucose cotransporter 2 inhibitors reduce the risk of worsening heart failure (HF) and cardiovascular death in patients with HF irrespective of left ventricular ejection fraction. It is important to determine whether therapies for HF improve symptoms and functional capacity. The DETERMINE (Dapagliflozin Effect on Exercise Capacity Using a 6-Minute Walk Test in Patients With Heart Failure) double-blind, placebo-controlled, multicenter trials assessed the efficacy of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on the Total Symptom Score (TSS) and Physical Limitation Scale (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ) and 6-minute walk distance (6MWD) in 313 patients with HF with reduced ejection fraction (DETERMINE-Reduced) and in 504 patients with HF with preserved ejection fraction (DETERMINE-Preserved) with New York Heart Association class II or III symptoms and elevated natriuretic peptide levels. The primary outcomes were changes in the KCCQ-TSS, KCCQ-PLS, and 6MWD after 16 weeks of treatment. Among the 313 randomized patients with HF with reduced ejection fraction, the median placebo-corrected difference in KCCQ-TSS from baseline at 16 weeks was 4.2 (95% CI, 1.0, 8.2; P=0.022) in favor of dapagliflozin. The median placebo-corrected difference in KCCQ-PLS was 4.2 (95% CI, 0.0, 8.3; P=0.058). The median placebo-corrected difference in 6MWD from baseline at 16 weeks was 3.2 meters (95% CI, -6.5, 13.0; P=0.69). In the 504 patients with HF with preserved ejection fraction, the median placebo-corrected 16-week difference in KCCQ-TSS and KCCQ-PLS was 3.2 (95% CI, 0.4, 6.0; P=0.079) and 3.1 (-0.1, 5.4; P=0.23), respectively. The median 16-week difference in 6MWD was 1.6 meters (95% CI, -5.9, 9.0; P=0.67). In an exploratory post hoc analysis of both trials combined (DETERMINE-Pooled), the median placebo-corrected difference from baseline at 16 weeks was 3.7 (1.5, 5.9; P=0.005) for KCCQ-TSS, 4.0 (0.3, 4.9; P=0.036) for KCCQ-PLS, and 2.5 meters (-3.5, 8.4; P=0.50) for 6MWD. Dapagliflozin improved the KCCQ-TSS in patients with HF with reduced ejection fraction but did not improve KCCQ-PLS or 6MWD. Dapagliflozin did not improve these outcomes in patients with HF with preserved ejection fraction. In a post hoc analysis including all patients across the full spectrum of ejection fraction, there was a beneficial effect of dapagliflozin on KCCQ-TSS and KCCQ-PLS but not 6MWD. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03877237 and NCT03877224.

Neuromuscular Electrical Stimulation for Intermittent Claudication (NESIC): multicentre, randomized controlled trial.

This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication. The primary outcome was change in absolute walking distance, measured by a standardized treadmill test at 3 months. Secondary outcomes included intermittent claudication (IC) distance, adherence, quality of life, and haemodynamic changes. Of 200 participants randomized, 160 were included in the primary analysis (intention to treat, Tobit regression model). The square root of absolute walking distance was analysed (due to a right-skewed distribution) and, although adjunctive NMES improved it at 3 months, no statistically significant effect was observed. SET as local standard care seemed to improve distance compared to best medical therapy at 3 months (3.29 units; 95 per cent c.i., 1.77 to 4.82; P < 0.001). Adjunctive NMES improved distance in mild claudication (2.88 units; 95 per cent c.i., 0.51 to 5.25; P = 0.02) compared to local standard care at 3 months. No serious adverse events relating to the device were reported. Supervised exercise therapy is effective and NMES may provide further benefit in mild IC.This trial was supported by a grant from the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health and Care Research partnership. Trial registration: ISRCTN18242823.

Changes in pain scores and walking distance after transforaminal epidural steroid injection in patients with lumbar foraminal spinal stenosis.

Transforaminal epidural steroid injections (TFESI) are widely used in patients with lumbar foraminal spinal stenosis. Previous studies have evaluated the effects of TFESI on lumbar foraminal spinal stenosis using only pain scores. However, no study has evaluated the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis. This study aimed to assess the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis stratified according to disease severity. This retrospective study reviewed the medical records of patients who received TFESI for lumbar foraminal spinal stenosis. A total of 128 patients were divided into the moderate and severe groups based on the extent of fat obliteration and the presence of nerve root compression. A significant decrease in the numeric rating scale (NRS) scores was observed in the moderate and severe groups compared with the corresponding baseline values 4 weeks after TFESI; however, the NRS pain scores were lower in the moderate group than those in the severe group. In addition, the proportion of patients who experienced pain reduction (≥50%) was higher in the moderate group than that in the severe group. The moderate and severe groups showed a significant increase in walking distance compared with the baseline values 4 weeks after the treatment. However, the walking distance values did not differ significantly between the moderate and severe groups. Furthermore, the degree of satisfaction was higher in the moderate group than that in the severe group. Lumbar TFESI may reduce pain scores and increase walking distance in patients with moderate or severe lumbar foraminal spinal stenosis. Patients with moderate foraminal stenosis had better pain relief outcomes than those with severe foraminal stenosis.

A Double Blind, Placebo Controlled, Randomised Trial of Extracorporeal Shockwave Therapy as a Novel Treatment For Intermittent Claudication

Objective: Peripheral occlusive arterial disease affects 202 million people worldwide, with intermittent claudication as its most prevalent manifestation. The recommended management for non-life limiting intermittent claudication is conservative and includes best medical therapy in the form of antiplatelet and statin therapy, smoking cessation, and supervised exercise. However, provision of supervised exercise programmes and uptake among intermittent claudication patients is very poor. Extracorporeal shockwave therapy (ESWT) technology has been adapted from renal lithotripsy to a variety of musculoskeletal uses and in vitro and in vivo data has shown improved perfusion of the myocardium and hind leg in the setting of arterial ischaemia. Pilot data has demonstrated that ESWT is effective for improving walking distances in patients with intermittent claudication.1 This study aims to consider its effectiveness for improving quality of life in patients with intermittent claudication.

Prognostic implications of six-minute walking distance in patients with heart failure with preserved ejection fraction

BackgroundThe incremental prognostic value of the six-minute walking test over conventional risk factors has not been evaluated in an adequate number of patients with heart failure with preserved ejection fraction (HFpEF). Therefore, we aimed to examine its prognostic significance using data from the FRAGILE-HF study. Methods and resultsA total of 513 older patients who were hospitalized for worsening heart failure were examined. Patients were classified according to the tertiles of six-minute walking distance (6MWD): T1 (<166 m), T2 (166–285 m), and T3 (≥285 m). During the 2-year follow-up period after discharge, 90 all-cause deaths occurred. Kaplan–Meier curves showed that the T1 group had significantly higher event rates than the other groups (log-rank p = 0.007). Cox proportional hazard analysis revealed that the T1 group was independently associated with lower survival, even after adjusting for conventional risk factors (T3: hazard ratio 1.79, 95% confidence interval 1.02–3.14, p = 0.042). The addition of the 6MWD to the conventional prognostic model showed a statistically significant incremental prognostic value (net reclassification improvement 0.27, 95% confidence interval 0.04–0.49; p = 0.019). ConclusionsThe 6MWD is associated with survival in patients with HFpEF and has an incremental prognostic value over conventional well-validated risk factors.

Moderate dose of dietary nitrate improves skeletal muscle microvascular function in patients with peripheral artery disease.

Peripheral artery disease (PAD) is an atherosclerotic disease characterized by compromised lower-extremity blood flow that impairs walking ability. We showed that a moderate dose of dietary nitrate in the form of beetroot juice (BRJ, 0.11mmol/kg) can improve macrovascular function and maximal walking distance in patients with PAD. However, its impacts on the microcirculation and autonomic nervous system have not been examined. Therefore, we investigated the impacts of this dose of dietary nitrate on skeletal muscle microvascular function and autonomic nervous system function and further related these measurements to 6-min walking distance, pain-free walking distance, and exercise recovery in patients with PAD. Patients with PAD (n=10) ingested either BRJ or placebo in a randomized crossover design. Heart rate variability, skeletal muscle microvascular function, and 6-min walking distance were performed pre- and post-BRJ and placebo. There were significant group×time interactions (P<0.05) for skeletal muscle microvascular function, 6-min walking distance, and exercise recovery, but no changes (P>0.05) in heart rate variability or pain-free walking distance were noted. The BRJ group demonstrated improved skeletal muscle microvascular function (∆ 22.1±7.5%·min-1), longer 6-min walking distance (Δ 37.5±9.1m), and faster recovery post-exercise (Δ -15.3±4.2s). Furthermore, changes in skeletal muscle microvascular function were positively associated with changes in 6-min walking distance (r=0.5) and pain-free walking distance (r=0.6). These results suggest that a moderate dose of dietary nitrate may support microvascular function, which is related to improvements in walking distance and claudication in patients with PAD.

Retraction: Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial

Retraction: Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial

Minimal Clinically Important Difference of the 6-Minute Walk Distance in Patients Undergoing Lumbar Spinal Canal Stenosis Surgery: 12 Months Follow-Up.

Retrospective review of prospectively collected data. We evaluated the responsiveness of the 6-minute walk distance (6MWD) and determined the threshold of the minimal clinically important difference (MCID) in patients who underwent lumbar spinal stenosis (LSS) surgery. Little evidence exists on the MCID of 6MWD after LSS surgery. The 6MWD is an objective gait assessment that can be measured quickly. In total, 126 patients (74 men; average age, 72.2 ± 6.5yr) were included and assessed preoperatively and at 12 months postoperatively. We used the Oswestry Disability Index (ODI), as an anchor to calculate the MCID for the 6MWD and measured internal and external responsiveness of the 6MWD. The external responsiveness was assessed in 2 ways: (1) One based on the anchoring questionnaire and (2) another based on the scale distribution. The anchor-based approach was evaluated using the Spearman rank correlation coefficient and receiver-operating characteristic curve. The distribution-based approach was evaluated using the minimal detectable change. The ODI scores and 6MWD for each anchor significantly improved postoperatively. The change in the 6MWD was significantly correlated with change in the ODI (6mo, r = -0.45; 12mo, r = -0.49). The receiver-operating characteristic analysis demonstrated good discriminative properties for the 6MWD using the ODI anchor (6mo, 0.72; 12mo, 0.78). The cutoff values for 6MWD were 102.3 and 57.5 at 6 and 12 months, respectively. In the distribution-based approach, the minimal detectable change for the 6MWD was 95.7m. We validated both the internal and external responsiveness of the 6MWD using the ODI and estimated the MCID in the 6MWD for patients undergoing LSS surgery. However, there was lower validity for the MCID among those participants with the high walking ability and low disability at baseline.

Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

INTRODUÇÃO: A claudicação neurogênica (NC) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar menor ou igual a 12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.