Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease.

AIM: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. METHODS: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St George's Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed. RESULTS: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV(1), FVC, FVC%, FEV(1)/FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St George's Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. CONCLUSIONS: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study.

BACKGROUND AND AIMS: To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD). METHODS: Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg's Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed. RESULTS: BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p ≤ 0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05). CONCLUSIONS: According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.

Prolonged activity of knee extensors and dorsal flexors is associated with adaptations in gait in diabetes and diabetic polyneuropathy.

BACKGROUND: People with diabetes or diabetic polyneuropathy often experience limitations in mobility and gait. These limitations are believed to be related to disturbed muscle function and sensory information. In previous studies on diabetic gait, results were confounded by a lower, preferred walking speed in people with diabetes or diabetic polyneuropathy. This study aimed to identify gait-velocity independent effects of diabetes and diabetic polyneuropathy on lower extremity kinematics and muscle activation patterns. METHODS: Eight people with diabetic polyneuropathy, 10 diabetic controls without polyneuropathy and ten healthy, age-matched controls walked at their preferred velocity and a standard velocity of 1.4 ms(-1). Muscle activation patterns of gluteus maximus, biceps femoris, rectus femoris, vastus medialis, gastrocnemius medialis, soleus, and tibialis anterior, and spatiotemporal and joint angles characteristics were analysed. FINDINGS: Independent of walking speed, muscle activation differed between groups. In diabetic polyneuropathy participants activation of ankle-joint dorsal flexors was prolonged by 5-10% of the stride cycle. Activity of monoarticular knee-joint extensors lasted about 10% longer in both diabetic groups compared to healthy elderly. Initiation of muscle activity did not differ between groups. If gait velocity was controlled, spatiotemporal characteristics were similar between groups. INTERPRETATION: The study showed that independent of the preferred lower gait velocity, people with diabetes or diabetic polyneuropathy adjust the timing of muscle activity. Contrarily, the concurrent changes in spatiotemporal characteristics occurred to be the result of changed velocity only. The delayed cessation of muscle activity suggested a reduced rate of force development underlying the adjusted timing of muscle activation.

Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis.

OBJECTIVE: The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF). DESIGN: A prospective study. PATIENTS: Seventeen patients diagnosed with IPF. METHODS: A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated. RESULTS: A significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p < 0.05) severities, and an increase in the 6MWD (p = 0.04) and general health related quality of life scores (health perception, physical role, and emotional status subscores) were found after the program (p < 0.05). CONCLUSION: Home-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.

The effect of in-patient chest physiotherapy in lung cancer patients.

GOALS OF WORK: The aim of our study was to investigate the effect of the in-patient chest physiotherapy (ICP) in patients with lung cancer. PATIENTS AND METHODS: Eighteen patients with stage IIIA, IIIB, or IV lung cancer (3 females and 15 males) were included. The demographic characteristics and the clinical history of the patients were recorded. Pain (visual analog scale), pulmonary function (pulmonary function test), functional capacity (6-min walking test, Karnofsky performance status (KPS) scale), and health-related quality of life (Nottingham Health Profile (NHP)) parameters were evaluated. The ICP program, including breathing control, breathing exercises, relaxation training, upper and lower extremity exercises, mobilization, and transcutaneous nerve stimulation, was designed to meet each patient's individual needs. MAIN RESULTS: After the exercise program, there was a significant decrease in the severity of the dyspnea, fatigue, and pain symptoms (p < 0.05), improvement in the physical mobility, pain, energy, emotional status and sleep subcategories of the NHP (p < or = 0.05), and increase in the 6-min walking distance (75 +/- 15.95 m, p = 0.003). However, pulmonary function test results and KPS scores did not show statistically significant changes (p > 0.05). CONCLUSIONS: ICP programs may be beneficial to lung cancer patients by reducing respiratory symptoms, pain, and improving health-related quality of life and exercise capacity. For this reason, the results of this study suggest that ICP programs, which are prepared by taking the individual requirements of lung cancer patients, should be placed in the treatment of the lung cancer.