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1.
Medicine (Baltimore) ; 99(23): e20625, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502040

RESUMEN

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common high-burden and highly disabling lung disease. The quality of life and exercise endurance of patients with COPD is often low because of atrophy of the respiratory and skeletal muscles. Although recommended by the global initiative for chronic obstructive lung disease guidelines, pulmonary rehabilitation (PR) has not been used widely because of its inherent limitations. Tuna-Hui-Chun-Gong (TNHCG) is a popular traditional exercise used to treat COPD in China. We aim to evaluate the safety and efficacy of TNHCG for PR of COPD. METHODS: The provided protocol is for a single-blind randomized controlled trial in which 120 COPD patients will be randomly and equally divided into the experimental or control group. The control group will be treated with standard COPD drugs while the experimental group will perform TNHCG exercises apart from standard drug treatment. The duration of treatment will be 24 weeks and a follow-up for 48 weeks. The primary outcome will be the 6-Minute Walk Test. The secondary outcomes will include the pulmonary function test, St George's respiratory questionnaire, COPD assessment test, modified medical research council dyspnea scale, Hospital Anxiety and Depression Scale, and exacerbation frequency. A safety assessment will also be performed during the trial. DISCUSSION: Our study will provide evidence to support TNHCG exercise as an additional measure for PR of COPD. TRIAL REGISTRATION: ChiCTR1900028332, Registered December 29, 2019. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Sichuan Traditional Chinese Medicine Regional Ethics Review Committee (No. 2019KL-050).


Asunto(s)
Tolerancia al Ejercicio , Ejercicio Físico , Medicina China Tradicional/métodos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego , Resultado del Tratamiento , Prueba de Paso
3.
J Rehabil Med ; 52(5): jrm00063, 2020 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-32449782

RESUMEN

OBJECTIVE: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission. DATA SOURCES: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched. STUDY SELECTION: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included. DATA EXTRACTION: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge. DATA SYNTHESIS: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15­45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450­473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31­47%), depression (33%, 95% CI 20­50%) and anxiety (30%, 95% CI 10­61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge. CONCLUSION: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.


Asunto(s)
Infecciones por Coronavirus/psicología , Coronavirus del Síndrome Respiratorio de Oriente Medio , Síndrome Respiratorio Agudo Grave/psicología , Adulto , Ansiedad/etiología , Betacoronavirus , Infecciones por Coronavirus/fisiopatología , Depresión/etiología , Prueba de Esfuerzo , Tolerancia al Ejercicio , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Pandemias , Alta del Paciente , Neumonía Viral , Pruebas de Función Respiratoria , Síndrome Respiratorio Agudo Grave/fisiopatología , Trastornos por Estrés Postraumático/etiología , Sobrevivientes
4.
Ther Adv Cardiovasc Dis ; 14: 1753944720924270, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32459138

RESUMEN

BACKGROUND: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. METHODS: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. RESULTS: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients' engagement and adherence as well as resource constraints. CONCLUSION: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.


Asunto(s)
Terapia por Ejercicio , Claudicación Intermitente/terapia , Enfermedad Arterial Periférica/terapia , Actitud del Personal de Salud , Terapia por Ejercicio/efectos adversos , Tolerancia al Ejercicio , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Recuperación de la Función , Resultado del Tratamiento
5.
Einstein (Sao Paulo) ; 18: eAO5268, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32428066

RESUMEN

Objective To evaluate the effect of an interdisciplinary intervention with a motivational approach on exercise capacity and usual physical activity levels in overweight and obese adolescents. Methods This is a randomized, controlled clinical trial with single blinding of subjects. Adolescents aged 15 to 18 years with overweight and obesity (body mass index ≥ 85 percentile) were included. The adolescents were randomized into two groups: interdisciplinary intervention or control - traditional approach aiming at lifestyle modifications. The initial evaluations were carried out, including the cardiopulmonary exercise test and the physical activity level measurement by using the International Physical Activity Questionnaire and a pedometer. The evaluations were performed in two moments: time zero (time of inclusion in the study) and after 3 months (end of intervention). There were 12 sessions with weekly meetings. Results A total of 37 participants were included, 19 in the Intervention Group. There were no significant differences in the baseline demographic, anthropometric and physical activity characteristics between groups, with mean age of 17.3±1.0 years in the Control Group, and 16.8±0.9 years in the Intervention Group (p=0.14). The motivational intervention did not cause significant differences (p>0.05) in the comparison of the variables of exercise capacity and usual physical activity (questionnaire and pedometer) between groups. Conclusion The intervention with a motivational approach did not alter exercise capacity and levels of usual physical activity in overweight and obese adolescents. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.


Asunto(s)
Tolerancia al Ejercicio/fisiología , Ejercicio Físico/psicología , Motivación/fisiología , Entrevista Motivacional/métodos , Sobrepeso/psicología , Adolescente , Índice de Masa Corporal , Prueba de Esfuerzo/psicología , Femenino , Humanos , Estilo de Vida , Masculino , Obesidad/psicología , Obesidad/terapia , Método Simple Ciego , Encuestas y Cuestionarios
6.
Medicine (Baltimore) ; 99(17): e19874, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332655

RESUMEN

INTRODUCTION: Heart transplantation (HT) is known to be the final therapy for patients with advanced heart failure; however, the exercise capacity of these patients remains under the aged-predicted value after HT. Many studies have described the effectiveness and safety of cardiac rehabilitation (CR) in HT recipients. Nevertheless, long-term follow-up data of HT recipients undergoing CR are insufficient, and there is a lack of evidence on the long-term effects of CR. In this case report, we present the long-term benefits of CR in an HT recipient, including serial follow-up clinical data over 1 year. PATIENT CONCERNS: A 48-year-old female patient underwent HT because of advanced dilated cardiomyopathy. DIAGNOSIS: Cardiopulmonary exercise test showed reduced exercise capacity and pulmonary function. The grip power and quadriceps muscle strength were also decreased after HT. INTERVENTIONS: The patient underwent a phase I CR program for 3 months, followed by a phase III CR program for 7 months. In the beginning, moderate-intensity continuous training was conducted. Thereafter, high-intensity interval training was implemented after a period of adjustment for interval training. OUTCOMES: The exercise capacity, 6-min walk distance, muscle strength, and vital capacity were improved after CR. CONCLUSION: CR in HT recipients may improve muscle strength and pulmonary function as well as exercise capacity, without serious cardiovascular complications. Phase III CR may help maintain exercise capacity in these patients.


Asunto(s)
Cuidados Posteriores/métodos , Rehabilitación Cardiaca/normas , Trasplante de Corazón/rehabilitación , Resultado del Tratamiento , Rehabilitación Cardiaca/métodos , Rehabilitación Cardiaca/tendencias , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/fisiopatología , Cardiomiopatía Dilatada/cirugía , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio , Femenino , Trasplante de Corazón/psicología , Trasplante de Corazón/normas , Humanos , Persona de Mediana Edad
7.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-32124586

RESUMEN

Iron deficiency (ID) is recognized as an important comorbidity in patients undergoing cardiac surgery; however, it still remains under-diagnosed and under-treated in clinical practice. This study aims at comparing efficacy and the effects on exercise capacity of intravenous ferric carboxymaltose (FCM) versus ferric gluconate (FG) in patients with ID anemia (IDA) resulting from cardiac surgery. We retrospectively analyzed data from our records of in-hospital patients with IDA after cardiac surgery undergoing cardiac rehabilitation. Group I was treated with FG, group II with FCM. Efficacy measures included changes (baseline vs discharge) in hemoglobin (Hb) and in distance traveled at six-minutes walking test (6MWT). Data from 74 in-patients (mean age 67.5±10.4 years, 43% women) were analyzed. At discharge, patients treated with FCM showed higher levels of Hb (11.1±1.2g/dl vs 10.2±1.1 g/dl; p=0.001), greater distance traveled at 6MWT (279.2±108.8 meters vs 236.3±72.7 meters; p=0.048), and lower in-hospital rehabilitation length of stay (20.3±7 vs 25.3±11.7 days; p=0.043) as compared to FG group. At multivariate analysis, the most powerful predictors of Hb increase >1 g/dl at discharge were transferrin levels (p=0.019) and treatment with FCM (p<0.001). FCM replacement therapy and iron serum levels were the most powerful predictors of 6MWT distance improvement (>100 meters) at discharge (p=0.13 and p=0.003, respectively). In patients with IDA following cardiac surgery, intravenous FCM is effective in restoring Hb levels and in improving exercise capacity after cardiac surgery.


Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Tolerancia al Ejercicio , Compuestos Férricos/uso terapéutico , Hematínicos/uso terapéutico , Maltosa/análogos & derivados , Anciano , Anemia Ferropénica/etiología , Femenino , Humanos , Infusiones Intravenosas , Masculino , Maltosa/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
8.
Bratisl Lek Listy ; 121(3): 206-210, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32115978

RESUMEN

OBJECTIVES: The aim of the present study was to evaluate the relationship between exercise capacity and n/lymphocyte ratio (NLR) in patients enrolled in a cardiopulmonary rehabilitation program. BACKGROUND: NLR has recently been used as a potential marker to determine inflammation in cardiac and non-cardiac diseases. METHODS: In this retrospective study, an exercise test and six-minute walking test (6MWT) were carried out in 23 patients with coronary artery disease and 28 patients with pulmonary disease before cardiopulmonary rehabilitation program, and routine hemogram test results were evaluated. RESULTS: The result of 6MWT test distance was 333.43 ± 86.58 m in the cardiac rehabilitation group and 348.46 ± 81.37 m in the pulmonary rehabilitation group. There was a negative correlation between 6MWT and NLR in the cardiac rehabilitation group (p < 0.05). As NLR increased, the MET value and duration of exercise decreased in the pulmonary rehabilitation group (p < 0.05). CONCLUSION: NLR could be used as a predictor to evaluate the exercise capacity in patients to be enrolled in cardiopulmonary rehabilitation program (Tab. 3, Ref. 30) Keywords: exercise capacity, neutrophil/lymphocyte ratio, rehabilitation.


Asunto(s)
Rehabilitación Cardiaca , Tolerancia al Ejercicio , Linfocitos , Neutrófilos , Humanos , Estudios Retrospectivos , Caminata
10.
Open Heart ; 7(1): e001144, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32180986

RESUMEN

Objective: Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) managed medically has a poor prognosis. Balloon pulmonary angioplasty (BPA) offers a new treatment for inoperable patients. The national BPA service for the UK opened in October 2015 and we now describe the treatment of our initial patient cohort. Methods: Thirty consecutive, inoperable, anatomically suitable, symptomatic patients on stable medical therapy for CTEPH were identified and offered BPA. They initially underwent baseline investigations including Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) quality of life (QoL) questionnaire, cardiopulmonary exercise test, 6 min walk distance (6MWD), transthoracic echocardiography, N-terminal probrain natriuretic peptide (NT pro-BNP) and right heart catheterisation. Serial BPA sessions were then performed and after completion, the treatment effect was gauged by comparing the same investigations at 3 months follow-up. Results: A median of 3 (IQR 1-6) BPA sessions per patient resulted in a significant improvement in functional status (WHO functional class ≥3: 24 vs 4, p<0.0001) and QoL (CAMPHOR symptom score: 8.7±5.4 vs 5.6±6.1, p=0.0005) with reductions in pulmonary pressures (mean pulmonary artery pressure: 44.7±11.0 vs 34.4±8.3 mm Hg, p<0.0001) and resistance (pulmonary vascular resistance: 663±281 vs 436±196 dyn.s.cm-5, p<0.0001). Exercise capacity improved (minute ventilation/carbon dioxide production: 55.3±12.2 vs 45.0±7.8, p=0.03 and 6MWD: 366±107 vs 440±94 m, p<0.0001) and there was reduction in right ventricular (RV) stretch (NT pro-BNP: 442 (IQR 168-1607) vs 202 (IQR 105-447) pg/mL, p<0.0001) and dimensions (mid RV diameter: 4.4±1.0 vs 3.8±0.7 cm, p=0.002). There were no deaths or life-threatening complications and the mild-moderate per-procedure complication rate was 10.5%. Conclusions: BPA is safe and improves the functional status, QoL, pulmonary haemodynamics and RV dimensions of patients with inoperable CTEPH.


Asunto(s)
Angioplastia de Balón , Presión Arterial , Hipertensión Pulmonar/terapia , Arteria Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Resistencia Vascular , Anciano , Angioplastia de Balón/efectos adversos , Enfermedad Crónica , Tolerancia al Ejercicio , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Reino Unido , Función Ventricular Derecha , Remodelación Ventricular
11.
High Blood Press Cardiovasc Prev ; 27(3): 225-230, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32219669

RESUMEN

INTRODUCTION: Cardiac rehabilitation (CR) improves the functional capacity and the prognosis of patients with coronary artery disease. AIM: Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-min Walk Test-6MWT) and the improvement in left ventricular ejection fraction (LVEF) after CR. METHODS: We collected data from 249 patients (age 66.79 ± 11.06 years; males 81.52%) with a recent history of Acute Coronary Syndrome that performed CR. The functional improvement after CR was expressed as the Δ between distance covered at the final versus the initial 6-min Walking Test (6-MWT), while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR. RESULTS: Patients were divided accordingly to their pre-rehab LVEF (≥ 55% vs < 55%). With superimposable age and baseline 6MWT distance covered (434.58 vs 405.12 m, p = 0.08), the latter group presented higher Δ meter values at 6MWT (167.93 vs 193.97 m, p = 0.018). However, no statistically significant positive correlation between Δ meters and Δ LVEF was found. Moreover, linear regression analyses found that nor baseline LVEF nor Δ LVEF were significant determinants of Δ meters when considering the whole group, with age, basal 6MWT and peak CK-MB as additional covariates in the model. CONCLUSION: Although it could be expected that an increase in LVEF is related to the functional improvement after CR, no significant correlation was found in our population.


Asunto(s)
Síndrome Coronario Agudo/rehabilitación , Atención Ambulatoria , Rehabilitación Cardiaca/métodos , Terapia por Ejercicio , Tolerancia al Ejercicio , Volumen Sistólico , Función Ventricular Izquierda , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Anciano , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Prueba de Paso
13.
Pneumologie ; 74(2): 88-102, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-32050280

RESUMEN

Cardiorespiratory fitness has been established as an independent overall predictor of morbidity and mortality. However, patients' symptoms or stated levels of exercise intolerance correlate only poorly with resting functional and imaging tests. Cardiopulmonary exercise testing (CPET) is the gold standard for the integrative assessment of the cardiocirculatory, pulmonary and metabolic response to exercise and can help identify the source of exercise limitation, monitor disease progression, evaluate treatment responsiveness and inform about prognosis. Though CPET offers more valuable and pertinent information with slightly more expenditure of time compared to other methods even at submaximal exercise levels, it remains underutilized for various reasons such as costs, reimbursement and expertise. CPET can be seen as a complex, but not necessarily difficult tool. The objective of this review was to provide a description of the underlying principles of physiology, and an easy-to-follow guidance to indications, methodology, and interpretative strategies of CPET.


Asunto(s)
Capacidad Cardiovascular , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/normas , Guías de Práctica Clínica como Asunto , Ejercicio Físico , Tolerancia al Ejercicio , Humanos , Consumo de Oxígeno
14.
Am Heart J ; 222: 183-190, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32105984

RESUMEN

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a significant cause of morbidity and mortality worldwide. Exercise intolerance is the main symptom of HFpEF and is associated with a poor quality of life and increased mortality. Currently, there are no approved medications for the treatment of HFpEF. Praliciguat (IW-1973), a novel soluble guanylate cyclase stimulator that may help restore deficient nitric oxide-soluble guanylate cyclase-cyclic guanosine 3',5'-monophosphate signaling, is being investigated for the treatment of patients with HFpEF. METHODS: CAPACITY HFpEF is a phase 2, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial designed to evaluate the safety and efficacy of praliciguat over 12 weeks in approximately 184 patients with HFpEF. Eligible patients must have evidence supporting clinical HFpEF and at least 2 of the following 4 conditions associated with NO deficiency: diabetes/prediabetes, hypertension, obesity, and age >70 years. The primary efficacy end point is the change from baseline in peak VO2 by cardiopulmonary exercise test (CPET). Secondary end points include the change from baseline in 6-minute walk test distance and the change in ventilatory efficiency on CPET, as well as number of CPET responders. Other exploratory end points include changes in echocardiographic parameters, New York Heart Association functional classification, cardiac events, blood and urine biomarkers pathophysiologically relevant to heart failure, and patient-reported outcomes including Kansas City Cardiomyopathy Questionnaire. CONCLUSIONS: The CAPACITY HFpEF trial will provide data on short-term safety and efficacy of praliciguat on peak exercise capacity, as well as multiple secondary end points of submaximal functional capacity, patient-reported outcomes, and biomarkers.


Asunto(s)
Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/tratamiento farmacológico , Pirazoles/administración & dosificación , Pirimidinas/administración & dosificación , Volumen Sistólico/fisiología , Administración Oral , Anciano , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Ecocardiografía , Femenino , Estudios de Seguimiento , Agonistas de la Guanilato Ciclasa C/administración & dosificación , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda/fisiología
15.
Phys Ther ; 100(3): 438-446, 2020 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-32043129

RESUMEN

BACKGROUND: Survivors of breast cancer commonly report functional limitations, including cancer-related fatigue (CRF) and decreased aerobic capacity. One key gap is addressing the 3 energy systems (aerobic, anaerobic lactic, and alactic), requiring assessment to establish a baseline exercise intensity and duration. OBJECTIVE: This study examined the feasibility of energy system-based assessment, also providing descriptive values for assessment performance in this population. DESIGN: This was a cross-sectional study. METHODS: Seventy-two posttreatment survivors of breast cancer were recruited. Following a baseline musculoskeletal assessment, women attempted 3 energy system assessments: submaximal aerobic (multistage treadmill), anaerobic alactic (30-second sit-to-stand [30-STS]), and anaerobic lactic (adapted burpees). Heart rate (HR) and rating of perceived exertion (RPE) were recorded. Secondary outcomes included body composition, CRF, and upper- and lower-limb functionality. RESULTS: Seventy of 72 participants performed the 30-STS and 30 completed the adapted burpees task. HR and RPE specific to each task were correlated, reflecting increased intensity. Women reported low-moderate levels of CRF scores (3% [2.1]) and moderate-high functionality levels (upper-limb: 65.8% [23.3]; lower-limb: 63.7% [34.7]). LIMITATIONS: All survivors of breast cancer had relatively low levels of CRF and moderate functioning. Additionally, on average, participants were classified as "overweight" based on BMI. CONCLUSION: This study is the first to our knowledge to demonstrate feasibility of energy system assessment in survivors of breast cancer. Using a combination of HR and RPE, as well as baseline assessment of each energy system, clinicians may improve ability to prescribe personalized exercise and give patients greater ability to self-monitor intensity and progress.


Asunto(s)
Umbral Anaerobio/fisiología , Neoplasias de la Mama/fisiopatología , Supervivientes de Cáncer , Ejercicio Físico/fisiología , Rendimiento Físico Funcional , Adulto , Anciano , Composición Corporal , Neoplasias de la Mama/terapia , Estudios Transversales , Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio , Extremidades/fisiopatología , Estudios de Factibilidad , Femenino , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Fatiga Muscular/fisiología , Esfuerzo Físico , Sedestación , Posición de Pie
16.
Am J Med Sci ; 359(3): 140-146, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32089156

RESUMEN

BACKGROUND: Although anticoagulation therapy can reduce the risk for pulmonary embolism (PE) recurrence, symptoms such as exertional dyspnea or pain can persist for several months to years. Therefore, we aimed to assess the improvement of ventilatory efficiency and exercise capacity during cardiopulmonary exercise test in PE patients after short duration of anticoagulant therapy. MATERIALS AND METHODS: Pulmonary function testing, arterial blood gas analysis and cardiopulmonary exercise test were performed in 30 PE patients after anticoagulant therapy of 4 weeks (early phase) and after 6 months (late phase). In addition, another 30 healthy volunteers underwent the same tests. RESULTS: Percentage of forced vital capacity (FVC %pred) improvement was evident in the PE group (P < 0.01) after 6 months of treatment. Peak Load, peak Load %pred, peak oxygen uptake (V∘O2), peak V∘O2%pred increased significantly after treatment for 6 months (P < 0.01), while lowest minute ventilation in relation to carbon dioxide production (V∘E / V∘CO2) and lowest V∘E / V∘CO2 %pred decreased significantly (P = 0.001). In PE group, the increment of peak V∘O2 %pred from 4 weeks to 6 months correlated with the decrease of lowest V∘E / V∘CO2 %pred (r = 0.639, P < 0.001) but not the increment of FVC %pred (r = 0.058, P = 0.769). CONCLUSIONS: Exercise capacity improved significantly and there was a gradual improvement in ventilatory efficiency after 6 months of anticoagulation therapy.


Asunto(s)
Anticoagulantes/uso terapéutico , Tolerancia al Ejercicio , Embolia Pulmonar/tratamiento farmacológico , Ventilación Pulmonar , Anciano , Análisis de los Gases de la Sangre , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria
17.
Braz J Med Biol Res ; 53(3): e9391, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32077467

RESUMEN

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.


Asunto(s)
Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Ventilación Voluntaria Máxima/fisiología , Consumo de Oxígeno/fisiología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Recuperación de la Función/fisiología , Anciano , Humanos , Cinética , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología
18.
Arch Cardiovasc Dis ; 113(3): 168-175, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32067947

RESUMEN

BACKGROUND: Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair. OBJECTIVES: To evaluate the feasibility of an early exercise training programme after aortic valve repair. METHODS: Consecutive patients were prospectively included in 13 postoperative centres. Patients underwent an exercise training programme for approximately 3-5 weeks. Transthoracic echocardiography and a cardiopulmonary exercise test were performed before and after the exercise training programme. RESULTS: Fifty patients (mean±standard deviation [SD] age: 50±13 years) were included a mean of 13.6±12.0 days after aortic valve repair. The preoperative degree of aortic insufficiency was moderate to severe in 35 patients (70%) and the aortic valve was bicuspid in 24 patients (48%). Valve-sparing root replacement and isolated aortic valve repair (including 10% supracoronary aorta replacement) were performed in 64% and 36% of patients, respectively. We found no aortic insufficiency occurrence or worsening and no adverse clinical events after the exercise training programme. Mean left ventricular ejection fraction increased significantly (from 54%±8% to 57%±9%; P=0.0007). Mean peak oxygen consumption and first ventilatory threshold increased from 17.0±5.3 to 22.5±7.8mL/kg/min (32% increase) and from 12.0±3.9 to 14.3±5.2mL/kg/min (19% increase), respectively (both P<0.05). CONCLUSION: Exercise training early after aortic valve repair is safe and seems to significantly improve exercise capacity.


Asunto(s)
Válvula Aórtica/cirugía , Anuloplastia de la Válvula Cardíaca , Terapia por Ejercicio , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Adulto , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Anuloplastia de la Válvula Cardíaca/efectos adversos , Anuloplastia de la Válvula Cardíaca/instrumentación , Terapia por Ejercicio/efectos adversos , Tolerancia al Ejercicio , Estudios de Factibilidad , Femenino , Francia , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Sistema de Registros , Factores de Riesgo , Volumen Sistólico , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda
19.
J Sports Sci ; 38(4): 430-469, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31889469

RESUMEN

High-intensity-interval-training (HIIT) has been suggested to have beneficial effects in multiple populations across individual systematic reviews, although there is a lack of clarity in the totality of the evidence whether HIIT is effective and safe across different populations and outcomes. The aim of this meta-review was to establish the benefits, safety and adherence of HIIT interventions across all populations from systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with/without meta-analyses) of randomised & non-randomised trials that compared HIIT to a control. Thirty-three systematic reviews (including 25 meta-analyses) were retrieved encompassing healthy subjects and people with physical health complications. Evidence suggested HIIT improved cardiorespiratory fitness, anthropometric measures, blood glucose and glycaemic control, arterial compliance and vascular function, cardiac function, heart rate, some inflammatory markers, exercise capacity and muscle mass, versus non-active controls. Compared to active controls, HIIT improved cardiorespiratory fitness, some inflammatory markers and muscle structure. Improvements in anxiety and depression were seen compared to pre-training. Additionally, no acute injuries were reported, and mean adherence rates surpassed 80% in most systematic reviews. Thus, HIIT is associated with multiple benefits. Further large-scale high-quality studies are needed to reaffirm and expand these findings.Abbreviations: ACSM: American College of Sports Medicine; BMI: Body Mass Index; BNP: Brain Natriuretic Peptide; BP: Blood Pressure; CAD: Coronary Artery Disease; CHD: Coronary Heart Disease; COPD: Chronic Obstructive Pulmonary Disease; CRP: c- reactive Protein; CVD: Cardiovascular Disease; DBP: Diastolic Blood Pressure; ES: Effect Size; FAS: Reduced Fatty Acid Synthase; FATP-1: Reduced Fatty Acid Transport Protein 1; FMD: Flow Mediated Dilation; Hs-CRP: High-sensitivity c- reactive Protein; HDL: High Density Lipoprotein; HIIT: High-Intensity Interval Training; HOMA: Homoeostatic Model Assessment; HR: Heart Rate; HTx: Heart Transplant Recipients; IL-6: Interleukin-6; LDL: Low Density Lipoprotein; LV: Left Ventricular; LVEF: Left Ventricular Ejection Fraction; MD: Mean Difference; MetS: Metabolic Syndrome; MPO: Myeloperoxidase; MICT: Moderate-Intensity Continuous Training; NO: Nitric Oxide; NRCT: Non-Randomised Controlled Trial; PA: Physical Activity; PAI-1: Plasminogen-activator-inhibitor-1; QoL: Quality of Life; RCT: Randomised Controlled Trial; RoB: Risk of Bias; RPP: Rate Pressure Product; RT: Resistance Training; SBP: Systolic Blood Pressure; SD: Standardised Difference; SMD: Standardised Mean Difference; TAU: Treatment-As-Usual; T2DM: Type 2 Diabetes Mellitus; TC: Total Cholesterol; TG: Triglycerides; TNF-alfa: Tumour Necrosis Factor alpha; UMD: Unstandardised Mean Difference; WC: Waist Circumference; WHR: Waist-to-Hip Ratio; WMD: Weighted Mean DifferenceKey points: HIIT may improve cardiorespiratory fitness, cardiovascular function, anthropometric variables, exercise capacity, muscular structure and function, and anxiety and depression severity in healthy individuals and those with physical health disorders.Additionally, HIIT appears to be safe and does not seem to be associated with acute injuries or serious cardiovascular events.


Asunto(s)
Capacidad Cardiovascular , Entrenamiento de Intervalos de Alta Intensidad/psicología , Salud Mental , Calidad de Vida , Antropometría , Ansiedad/prevención & control , Biomarcadores/sangre , Depresión/prevención & control , Tolerancia al Ejercicio , Humanos , Inflamación/sangre , Músculo Esquelético/anatomía & histología , Músculo Esquelético/fisiología
20.
Adv Exp Med Biol ; 1232: 215-221, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893413

RESUMEN

Patients with hematological malignancy might already have decreased muscle oxygen saturation at rest and exercise capacity before undergoing hematopoietic stem cell transplantation (HSCT). However, to date, no studies have investigated the relationship between exercise capacity and muscle oxygen saturation at rest in these patients. Therefore, purpose of this study was to investigate the relationship between exercise capacity and muscle oxygen-hemoglobin (O2Hb) saturation (SmO2) at rest and patients' hemoglobin level before undergoing HSCT. METHODS: This study included 60 men with hematologic disease who underwent allo-HSCT. Patients performed a 6-minute walk test (6MWT) to determine exercise capacity, and muscle O2Hb saturation at rest was evaluatabed using near-infrared spectroscopy (BOM-L1TRW, Omegawave Inc., Japan); hemoglobin levels in hematological malignancy patients before undergoing HSCT were also evaluated. RESULTS: There was a significant correlation between the 6MWT and muscle O2Hb saturation at rest in hematological malignancy patients (p < 0.05). Additionally, the 6MWT was significantly correlated to the hemoglobin level (p < 0.05). Furthermore, muscle O2Hb saturation at rest was significantly related to hemoglobin level (p < 0.05). CONCLUSION: In patients with hematological malignancy, a relationship exists between exercise capacity, muscle O2Hb saturation, and hemoglobin level before they undergo HSCT. Therefore, rehabilitation staff, nurses, and physicians should recognize these relationships in patients who undergo allo-HSCT. Moreover, physiotherapists may need to promote muscle oxidative metabolism through exercise to increase exercise capacity in these patients.


Asunto(s)
Tolerancia al Ejercicio , Trasplante de Células Madre Hematopoyéticas , Hemoglobinas , Músculo Esquelético , Adolescente , Adulto , Hemoglobinas/metabolismo , Humanos , Japón , Masculino , Persona de Mediana Edad , Músculo Esquelético/metabolismo , Adulto Joven
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