Evolution of Muscular Oxygenation during a Walking Test in Preterm Children.

OBJECTIVE: To explore measures of peripheral muscular oxygenation, coupled to gait characteristics, between preterm and full-term children during a 6-minute walking test (6MWT). STUDY DESIGN: Prepubescent children performed a 6MWT. During the test, changes in muscular oxyhemoglobin, deoxyhemoglobin, and total hemoglobin were measured with Near-infrared spectroscopy technology, positioned on subjects' calves. Gait variables were monitored with the OptoGait system. RESULTS: Forty-five children (33 full-term children and 12 preterm children, mean age, 4.9 ± 0.7 and 4.6 ± 0.9 years, respectively) participated in this study. Statistical analysis highlighted a decreased walking performance for preterm children, with significantly lower walking distance (P < .05) than children born full-term (405.1 ± 91.8 m vs 461.0 ± 73.3 m respectively; -9%). A concomitant increase of oxygen extraction (over the time course of Variation of desoxyhemoglobin) was observed from the third minute of the test (P < .05). No statistically significant difference was found for other near-infrared spectroscopy measures. Finally, the analysis of gait variables highlighted a group effect for walking speed (P < .05) and stride length (P < .01). CONCLUSIONS: Premature children showed decreased walking performance and greater change in peripheral muscular oxygen extraction, associated with slower walking speed and stride length. This may point to a muscular maladjustment and reduced functional capacities for children born preterm. These phenomena could be responsible for greater muscular fatigue.

Prospective validation of the endurance shuttle walking test in the context of bronchodilation in COPD.

This study focused on repeatability data and minimal important difference (MID) estimates of the endurance shuttle walking test (ESWT). 255 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s 54.7±13.2% predicted) completed four ESWTs at different times during the 8-week study: two under baseline conditions with tiotropium (1 week apart), one after a single dose and one after 4 weeks of either fluticasone propionate/salmeterol combination or placebo in addition to tiotropium. 97 patients performed all the tests with a portable metabolic system. Reproducibility of test performance and cardiorespiratory response was investigated with the data obtained on the first two ESWTs. The mean differences between the first two ESWT performances (-6.7±72.2 s and -7.3±113.1 m for endurance time and walking distance, respectively) were not statistically significant. The between-test end-exercise and isotime values for each cardiorespiratory parameter were not significantly different from each other. With the exception of arterial oxygen saturation by pulse oximetry, the repeatability of cardiorespiratory adaptations to ESWT was also confirmed with strong Pearson and intraclass correlation coefficients. Finally, changes of 56-61 s and 70-82 m in endurance time and distance walked, respectively, were perceived by patients. This study provides methodological information supporting the reliability of the ESWT and suggests MID estimates for this test.

Cerebral oxygenation during hyperoxia-induced increase in exercise tolerance for untrained men.

This study aimed to investigate the involvement of cerebral oxygenation in limitation of maximal exercise. We hypothesized that O2 supplementation improves physical performance in relation to its effect on cerebral oxygenation during exercise. Eight untrained men (age 27 ± 6 years; VO2 max 45 ± 8 ml min(-1) kg(-1)) performed two randomized exhaustive ramp exercises on a cycle ergometer (1 W/3 s) under normoxia and hyperoxia (FIO2 = 0.3). Cerebral (ΔCOx) and muscular (ΔMOx) oxygenation responses to exercise were monitored using near-infrared spectroscopy. Power outputs corresponding to maximal exercise intensity, to threshold of ΔCOx decline (ThCOx) and to the respiratory compensation point (RCP) were determined. Power output (W max = 302 ± 20 vs. 319 ± 28 W) and arterial O2 saturation estimated by pulse oximetry (SpO2 = 95.7 ± 0.9 vs. 97.0 ± 0.5 %) at maximal exercise were increased by hyperoxia (P < 0.05). However, the ΔMOx response during exercise was not significantly modified with hyperoxia. RCP (259 ± 17 vs. 281 ± 25 W) and ThCOx (259 ± 23 vs. 288 ± 30 W) were, however, improved (P < 0.05) with hyperoxia and the ThCOx shift was related to the W max improvement with hyperoxia (r = 0.71, P < 0.05). The relationship between the change in cerebral oxygenation response to exercise and the performance improvement with hyperoxia supports that cerebral oxygenation is limiting the exercise performance in healthy young subjects.

Occupational Therapy for Improving Occupational Performance in COPD Patients: A Scoping Review.

Background. Chronic obstructive pulmonary disease (COPD) is a multisystemic chronic condition which may induce significant consequences in daily life activities. Preserving activities of daily living in COPD is therefore a common treatment goal among people living with COPD, which leaves ample opportunity for occupational therapy interventions to comprise part of their rehabilitation. However, the question of how exactly occupational therapists can and do contribute to pulmonary rehabilitation remains underexplored. Purpose. To reveal the contribution of occupational therapy intervention in the pulmonary rehabilitation on improving the occupational performance of patients with COPD. Method. A scoping review was performed by selecting articles focusing on occupational therapy in pulmonary rehabilitation for patients with COPD. A total of four databases were surveyed for article selection. Findings. Among nine studies selected, seven studies reported a significant improvement in the occupational performance of patients with occupational therapy. However, two studies did not observe differences between the groups regarding occupational performance. Implications. Occupational therapy in pulmonary rehabilitation seems to contribute to the improvement of occupational performances of patients with COPD. Nevertheless, research focused on this field needs to be further developed to support the positive impact of occupational therapy in COPD management.

Effect of Individualized Coaching at Home on Quality of Life in Subacute Stroke Patients.

Background: Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods: This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results: The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively (p = 0.02). Discussion: Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.

The effect of a home-based coaching program on heart rate variability in subacute stroke patients: a randomized controlled trial.

Autonomic imbalance in stroke is characterized by increased sympathetic activity and reduced vagal nerve activity. Physical activity could be a strategy to counteract autonomic control impairments after a stroke. The aim of the study was to evaluate the effect on heart rate variability of a 6-month coaching program in a home setting in subacute stroke patients. Eighty-four stroke patients participated in the study. They were randomly assigned to the experimental group or the control group. The intervention was a coaching program, consisting of physical activity, home visits and a weekly phone call. Patients were evaluated after hospital discharge (T0) and at the end of the 6-month period (T1). Heart rate variability measures were recorded in the supine and orthostatic positions. Time and frequency domain values were treated using Kubios. Distance on 6 minutes walking test (6MWT), Barthel and motricity index and modified functional ambulation categories were evaluated. No effects were found on time and frequency domain values in the supine and orthostatic positions in either group. Walking distance on 6MWT increased significantly between T0 and T1 in experimental group (377 ± 141-448 ± 140 m; P < 0.02) with no effects in control group (373.6 ± 150.6-394.6 ± 176.4 m). No other functional effects were found. A coaching program in a home setting had no effect on heart rate variability, probably due to time of recovery and exercise intensity. Future research is needed to understand the lack of changes in heart rate variability by physical activity in subacute stroke patients.

Time to exhaustion and time spent at a high percentage of VO2max in severe intensity domain in children and adults.

The aim of the study was to compare time spent at a high percentage of VO2max (>90% of VO2max) (ts90%), time to achieve 90% of VO2max (ta90%), and time to exhaustion (TTE) for exercise in the severe intensity domain in children and adults. Fifteen prepubertal boys (10.3 ± 0.9 years) and 15 men (23.5 ± 3.6 years) performed a maximal graded exercise to determine VO2max, maximal aerobic power (MAP) and power at ventilatory threshold (PVTh). Then, they performed 4 constant load exercises in a random order at PVTh plus 50 and 75% of the difference between MAP and PVTh (PΔ50 and PΔ75) and 100 and 110% of MAP (P100 and P110). VO2max was continuously monitored. The P110 test was used to determine maximal accumulated oxygen deficit (MAOD). No significant difference was found in ta90% between children and adults. ts90% and TTE were not significantly different between children and adults for the exercises at PΔ50 and PΔ75. However, ts90% and TTE during P100 (p < 0.05 and p < 0.01, respectively) and P110 (p < 0.001) exercises were significantly shorter in children. Children had a significantly lower MAOD than adults (34.3 ± 9.4 ml · kg vs. 53.6 ± 11.1 ml · kg). A positive relationship (p < 0.05) was obtained between MAOD and TTE values during the P100 test in children. This study showed that only for intensities at, or higher than MAP, lower ts90% in children was linked to a reduced TTE, compared to adults. Shorter TTE in children can partly be explained by a lower anaerobic capacity (MAOD). These results give precious information about exercise intensity ranges that could be used in children's training sessions. Moreover, they highlight the implication of both aerobic and anaerobic processes in endurance performances in both populations.

Effect of individualized coaching at home on walking capacity in subacute stroke patients: A randomized controlled trial (Ticaa'dom).

BACKGROUND: The gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients. METHODS: Stroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age≥18 years, first ischemic or hemorrhagic stroke, and stroke within<6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (T0), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1. RESULTS: Eighty-three participants (age: 61y [IQR=22]; time post-stroke: 2.4 month [IQR=1.7]; Barthel index: 100[IQR=5]) were included in the study: (EG, n=41; CG, n=42). The difference between the two groups was not significant at T1(418m [IQR=165] for the EG and 389m [IQR=188] for the CG; P=0.168) and at T2(425m [IQR=121] for the EG vs. 382m [IQR=219] for the CG; P=0.208). CONCLUSION: Our study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. http://ClinicalTrials.gov (NCT01822938).

An original field evaluation test for chronic obstructive pulmonary disease population: the six-minute stepper test.

PURPOSE: The aim of this study was to evaluate a new field test, the six-minute stepper test (6-MST), by studying its reproducibility, sensitivity and validity. METHODS: After a familiarization test, 16 patients with chronic obstructive pulmonary disease (COPD) and 15 healthy subjects performed two six-minute stepper tests per day over three evaluation days. Ten of the 16 patients with COPD also performed a six-minute walking test (6-MWT) with an analysis of gas exchange to compare the metabolic requirements of the two tests. Dyspnoea Borg values were evaluated with Borg's CR-10 scale. RESULTS: The mean (SD) scores for the COPD group for the first and second six-minute stepper tests were 382.49 (106.01) and 412.45 (118.39) strokes/6 minutes, respectively. Crossed comparison between the first or the second six-minute stepper tests of each evaluation day revealed no significant difference, indicating the reproducibility of the test. The sensitivity was demonstrated by a significantly higher performance in the healthy group (P < 0.001), demonstrating the ability of the test to detect two groups with different fitness levels. Finally, mean dyspnoea Borg values (SD) were significantly lower (P < 0.05) during the six-minute stepper test than during 6-MWT (2.5 (1.5) versus 3.1 (1.2)). CONCLUSIONS: This study demonstrated that the six-minute stepper test is a reproducible, sensitive, secure, well-tolerated and feasible test for patients with COPD. The reproducibility and sensitivity of the six-minute stepper test suggests that this test could be used in the evaluation of exercise tolerance in patients with COPD.

Correspondences between continuous and intermittent exercises intensities in healthy prepubescent children.

The aim of this article is to determine correspondences between three levels of continuous and intermittent exercise (CE and IE, respectively) in terms of steady-state oxygen uptake (VO(2SS)) and heart rate (HR) in children. Fourteen healthy children performed seven exercises on a treadmill: one graded test for the determination of maximal aerobic speed (MAS), three CE at 60, 70 and 80% of MAS (CE60, CE70 and CE80) and three IE (alternating 15 s of exercise intercepted with 15 s of passive recovery) at 90, 100 and 110% of MAS (IE90, IE100 and IE110). Mean VO(2SS) and mean HR were determined for both continuous and intermittent exercises. For comparison, three associations were designed: CE60 versus IE90, CE70 versus IE100 and CE80 versus IE110. No VO(2SS) difference was observed for CE60 versus IE90 and CE70 versus IE100 whereas a significant difference (P < 0.01) was found for CE80 versus IE110 (1.36 +/- 0.45 vs. 1.19 +/- 0.38 L min(-1), respectively). Significant linear regressions were found for the three CE versus IE associations for VO(2SS) (0.60 < r (2) < 0.99, P < 0.05). For the three associations, mean HR presented no significant difference. Only one significant relation was found for CE80 versus IE110 association (r(2) = 0.49, P < 0.05). Correspondences between CE and IE intensities are possible in terms of VO(2SS) whatever the level of exercise; even if for high intensities, VO(2SS) was higher during CE. These results demonstrated that it is possible to diversify the exercise modality while conserving exercise individualization.

Predicting the rate of oxygen consumption during the 3-minute constant-rate stair stepping and shuttle tests in people with chronic obstructive pulmonary disease.

BACKGROUND: The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V'O2) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V'O2 of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V'O2 of these tests. METHODS: This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha <0.05) of V'O2 to construct COPD-specific metabolic equations. The mean squared error (MSE) of the COPD-specific and ACSM equations was calculated and compared. Bland-Altman analyses evaluated level of agreement between measured and predicted V'O2 using each equation; limits of agreement (LoA) and patterns of bias were compared. RESULTS: Stepping rate/shuttle speed and body mass were identified as significant predictors of V'O2. The MSE of the COPD-specific equations was 0.05 L·min-1 for both tests. Mean difference between measured and predicted V'O2 was 0.00 L·min-1 (95% LoA -0.46, 0.46) and 0.00 L·min-1 (95% LoA -0.44, 0.44) for the 3-min CRSST and 3-min CSST, respectively. For the ACSM metabolic equations, the MSE was 0.10 L·min-1 and 0.18 L·min-1 for the 3-min CRSST and 3-min CSST, respectively. The ACSM metabolic equations underestimated V'O2 of the 3-min CRSST by -0.18 L·min-1 (95% LoA -0.68, 0.32), and overestimated V'O2 of the 3-min CSST by 0.35 L·min-1 (95% LoA -0.14, 0.84). CONCLUSIONS: This study presents metabolic equations to predict V'O2 of the 3-min CRSST and 3-min CSST for people with COPD that are more accurate than the ACSM metabolic equations.

Intensity level and on-court role of wheelchair rugby players during competition.

BACKGROUND: This study aims at quantifying the level of physical activity of wheelchair rugby players during matches in order to compare defensives players (DP) and offensives players (OP) profiles. Our hypothesis is that OP would present a higher energy expenditure and intensity level values during matches than DP, due to specific actions according to the on-court role. METHODS: Fifty-two players, including 24 DP and 28 OP (mean age of 34±9 years), from eight French teams involved in the national elite championship and in the French national cup, participated. The seven wheelchair rugby players' classes were differentiated from 0.5 points (most severe deficiencies) to 3.5 points (less severe deficiencies). DP and OP were regrouped from 0.5 to 1.5 points and from 2 to 3.5 points, respectively. Energy expenditure (in kcal), intensity level (in metabolic equivalent of task) and physical activity time (in minutes) of wheelchair rugby players during competition were evaluated. RESULTS: Statistical analysis between DP and OP showed a significant difference in vigorous activity time with a higher vigorous activity time for OP than DP; P<0.007), associated with higher mean intensity level for OP vs. DP (4.3±1.0 METs vs. 3.8±0.9 METs respectively; P=0.049). No significant differences between DP and OP were found for active energy expenditure (385±158 kcal vs. 446±199 kcal, for DP and OP respectively) during matches. CONCLUSIONS: This study highlighted significantly different wheelchair rugby player profiles between competing DP and OP for the time spent in high intensity and intensity level. Offensive players were more explosive during a match than DP; therefore, training should be adapted accordingly to their roles.

Effort Assessment of Stroke Patients in Physiotherapy Session by Accelerometry and Perceived Exertion Score: Preliminary Study.

OBJECTIVE: To determine whether post-stroke patient's perceived exertion correlates with effort intensity score as measured by a wearable sensor and to assess whether estimates of perceived exertion are correlated to the cerebral hemisphere involved in the stroke. METHODS: We evaluated the effort intensity score during physiotherapy sessions using a wearable sensor and subjects assessed their perceived exertion using the modified Borg CR10 Scale. RESULTS: Fifty-seven subacute stroke patients participated in the study. The correlation between perceived exertion rating and measured effort intensity was insignificant-mean (r=-0.04, p=0.78) and peak (r=-0.05, p=0.70). However, there was a significant difference (p<0.02) in the perceived exertion ratings depending on the cerebral hemisphere where the stroke occurred. Patients with left-hand side lesions rated their perceived exertion as 4.5 (min-max, 0.5-8), whereas patients with right-hand side lesions rated their perceived exertion as 5.0 (2-8). CONCLUSION: While there was an insignificant correlation between perceived exertion and effort intensity measured by a wearable sensor, a consistent variations in perceived exertion estimates according to the side of the cerebral lesion was identified and established.

Exercise-based games interventions at home in individuals with a neurological disease: A systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to summarize the current best evidence for the effectiveness, feasibility, user compliance and safety of exercise-based games (EBGs), including virtual reality and interactive video game interventions, for the rehabilitation of individuals with neurological disorders at home. MATERIAL AND METHODS: We identified randomized controlled trials (RCT) evaluating the effects of EBGs in neurological patients in home settings by searching 3 electronic databases (MEDLINE, SCOPUS, CENTRAL Library) from inception to March 2018. All data pertaining to participants, interventions, outcomes, supervision and cost-effectiveness were independently extracted by 2 reviewers. Risk of bias was independently assessed by 2 reviewers. RESULTS: Reports of 11 RCT studies with heterogeneous populations (i.e., stroke, Parkinson disease and multiple sclerosis) were included in the review. The treatment of experimental groups included EBGs (i.e., commercially available games such as Nintendo Wii or Dance Dance Revolution or custom-designed devices), and control groups received a controlled (i.e., conventional therapy) or uncontrolled (i.e., usual care) intervention. Across studies, EBGs at home tended to have limited effects on upper and lower limbs. We demonstrated an increased risk of participants dropping out of the program or discontinuing training in experimental groups (n=51 participants) as compared with controls (n=23 participants). Few adverse events (2 of 6 studies), such as minor musculoskeletal pain, were reported in balance training. CONCLUSIONS: This systematic review reveals that EBGs seem a relevant alternative for rehabilitation at home because the effectiveness of these interventions was at least equivalent to conventional therapy or usual care. We give recommendations for the development of new EBG therapies.

Home-based physical activity incentive and education program in subacute phase of stroke recovery (Ticaa'dom): study protocol for a randomized controlled trial.

BACKGROUND: Stroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa'dom) on functional capacity in subacute stroke patients. METHODS: This study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state. DISCUSSION: The results of this trial will demonstrate the value of implementing the Ticaa'dom program during the subacute phase of stroke recovery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01822938 . Registered on 25 March 2013.

Exercise training at the crossover point improves bodily and cardiorespiratory data but not quality of life in women with metabolic syndrome.

BACKGROUND: This study investigated the effects of an exercise program at the intensity corresponding to the crossover point of substrate utilization (COP) on anthropometric measures, health-related quality of life (HRQoL) and cardiorespiratory fitness (i.e., peak oxygen uptake [V̇O2peak] and peak power output [Ppeak]) in women with metabolic syndrome (MetS). METHODS: Nineteen obese and post-menopausal women with MetS (age: 54.8±8.1 years, body mass: 89.0±12.2 kg, Body Mass Index: 34.5±4.0 kg/m2) followed a 12-week program consisting of three 45-minute sessions per week of cycle ergometer exercise. The imposed exercise intensity corresponded to COP. Before and after the program, HRQoL, V̇O2peak and Ppeak were measured and then compared. RESULTS: Body mass (89.0±12.2 vs. 86.2±11.0 kg), Body Mass Index (34.5±4.0 vs. 33.4±3.6 kg/m2), waist (106±10 vs. 100±9 cm) and hip (117±11 vs. 114±11 cm) circumferences, waist-to-hip ratio (0.91±0.07 vs. 0.88±0.07), fat mass (43.3±4.6 vs. 41.9±4.6%), fat-free mass (56.7±4.6 vs. 58.2±4.6%), V̇O2peak (16.6±3.4 vs. 18.1±4.1 mL/min/kg) and Ppeak (102±22 vs. 125±27 W) were significantly improved after the exercise program (P<0.05), but HRQoL showed no significant improvement on any subscale (i.e., physical functioning: performance limitation for physical activities including bathing and dressing, role physical: problems with work or other daily activities, bodily pain, general health, vitality, social functioning, role emotional and mental health; P>0.05). CONCLUSIONS: Although a 12-week exercise program at COP improved anthropometric measures and cardiorespiratory fitness in women with MetS, self-perceived HRQoL did not significantly improve. This finding may be linked to a significant but still insufficient reduction in body mass, probably because COP is too weak exercise intensity to induce important energy expenditure.

Three-minute constant rate step test for detecting exertional dyspnea relief after bronchodilation in COPD.

BACKGROUND: The aim of this study was to evaluate the responsiveness of the 3-minute constant rate step test (3-MST) to detect the relief of exertional dyspnea (respiratory discomfort) after acute bronchodilation in COPD patients. PATIENTS AND METHODS: A total of 40 patients with moderate-to-severe COPD (mean forced expiratory volume in 1 second: 45.7 (±14.7), % predicted) performed four 3-MSTs at randomly assigned stepping rates of 14, 16, 20 and 24 steps/min after inhalation of nebulized ipratropium bromide (500 µg)/salbutamol (2.5 mg) and saline placebo, which were randomized to order. Patients rated their intensity of perceived dyspnea at the end of each 3-MST using Borg 0-10 category ratio scale. RESULTS: A total of 37 (92.5%), 36 (90%), 34 (85%) and 27 (67.5%) patients completed all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions, respectively. Compared with placebo, ipratropium bromide/salbutamol significantly decreased dyspnea at the end of the third minute of exercise at 14 steps/min (by 0.6±1.0 Borg 0-10 scale units, P<0.01) and 16 steps/min (by 0.7±1.3 Borg 0-10 scale units, P<0.01); however, no statically significant differences were observed between treatments at 20 and 24 steps/min (both P>0.05). CONCLUSION: The 3-MST, when performed at 14 and 16 steps/min, was responsive to detect the relief of exertional dyspnea after acute bronchodilation in patients with moderate-to-severe COPD.

Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit.

BACKGROUND: The current literature contains little information about the level of physical activity of hospitalized patients who have had a stroke. Improving knowledge in the area could help optimize rehabilitation. OBJECTIVES: To determine the level of physical activity of hospitalized patients who have had a stroke to discover if they achieved the recommended 30 minutes of physical activity per day (equivalent to 142 kcal) during sessions of 10 consecutive minutes. SETTING: Physical and Rehabilitation Medicine Unit of the Jean Rebeyrol Hospital, Limoges, France. PARTICIPANTS: All patients (N = 88) who had sustained a stroke within the previous 6 months were included over a period of 7 months. MAIN OUTCOME MEASURES: The duration of physical activity and related energy expenditure were estimated using a SenseWear armband (BodyMedia [Jawbone]). Subjects wore the sensor on the nonparetic arm for 2 consecutive days from 9 am to 4:30 pm, corresponding to the period spent daily on rehabilitation. The Fisher simple correlation test and Mann-Whitney nonparametric test were performed. RESULTS: A total of 88 patients aged 66 ± 17 years with a mean poststroke period of 43 ± 34 days and a mean Barthel Index of 61 ± 25/100 were enrolled in the study. Between 9 am and 4:30 pm, patients took part in an average of 23 ± 30 minutes of physical activity (equivalent to 91 ± 122 kcal). Correlations were found between physical activity time in the hospital and physical activity before the stroke occurred (r = 0.345, P < .0001), the Barthel Index (r = 0.284, P = .0002), body mass index (r = -0.440, P < .0001), and time to hospital release (r = -0.183, P = .0194). CONCLUSION: It was found that 62% of patients did not achieve the recommended amount of physical activity. Sessions dedicated to physical activity could motivate patients who have had a stroke and help them meet recommendations before leaving the rehabilitation unit.

Comparison Between 30-15 Intermittent Fitness Test and Multistage Field Test on Physiological Responses in Wheelchair Basketball Players.

The intermittent nature of wheelchair court sports suggests using a similar protocol to assess repeated shuttles and recovery abilities. This study aimed to compare performances, physiological responses and perceived rating exertion obtained from the continuous multistage field test (MFT) and the 30-15 intermittent field test (30-15IFT). Eighteen trained wheelchair basketball players (WBP) (WBP: 32.0 ± 5.7 y, IWBF classification: 2.9 ± 1.1 points) performed both incremental field tests in randomized order. Time to exhaustion, maximal rolling velocity (MRV), VO2peak and the peak values of minute ventilation (V Epeak), respiratory frequency (RF) and heart rate (HRpeak) were measured throughout both tests; peak and net blood lactate (Δ[Lact(-)] = peak-rest values) and perceived rating exertion (RPE) values at the end of each exercise. No significant difference in VO2peak, VEpeak, and RF was found between both tests. 30-15IFT was shorter (12.4 ± 2.4 vs. 14.9 ± 5.1 min, P < 0.05) but induced higher values of MRV and Δ[Lact(-)] compared to MFT (14.2 ± 1.8 vs. 11.1 ± 1.9 km·h(-1) and 8.3 ± 4.2 vs. 6.9 ± 3.3 mmol·L(-1), P < 0.05). However, HRpeak and RPE values were higher during MFT than 30-15IFT(172.8 ± 14.0 vs. 166.8 ± 13.8 bpm and 15.3 ± 3.8 vs.13.8 ± 3.5, respectively, P < 0.05). The intermittent shuttles intercepted with rest period occurred during the 30-15IFT could explain a greater anaerobic solicitation. The higher HR and overall RPE values measured at the end of MFT could be explained by its longer duration and a continuous load stress compared to 30-15IFT. In conclusion, 30-15IFT has some advantages over MFT for assess in addition physical fitness and technical performance in WBP.

Effects of modified multistage field test on performance and physiological responses in wheelchair basketball players.

A bioenergetical analysis of manoeuvrability and agility performance for wheelchair players is inexistent. It was aimed at comparing the physiological responses and performance obtained from the octagon multistage field test (MFT) and the modified condition in "8 form" (MFT-8). Sixteen trained wheelchair basketball players performed both tests in randomized condition. The levels performed (end-test score), peak values of oxygen uptake (VO2peak), minute ventilation (VEpeak), heart rate (HRpeak), peak and relative blood lactate (Δ[Lact(-)] = peak--rest values), and the perceived rating exertion (RPE) were measured. MFT-8 induced higher VO2peak and VEpeak values compared to MFT (VO2peak: 2.5 ± 0.6 versus 2.3 ± 0.6 L · min(-1) and VEpeak: 96.3 ± 29.1 versus 86.6 ± 23.4 L · min(-1); P < 0.05) with no difference in other parameters. Significant relations between VEpeak and end-test score were correlated for both field tests (P < 0.05). At exhaustion, MFT attained incompletely VO2peak and VEpeak. Among experienced wheelchair players, MFT-8 had no effect on test performance but generates higher physiological responses than MFT. It could be explained by demands of wheelchair skills occurring in 8 form during the modified condition.