A role for cardiopulmonary exercise testing in detecting physiological changes underlying health status in Idiopathic pulmonary fibrosis: a feasibility study.

INTRODUCTION: There is limited data available on the use of CPET as a predictive tool for disease outcomes in the setting of IPF. We investigated the feasibility of undertaking CPET and the relationship between CPET and quality of life measurements in a well-defined population of mild and moderate IPF patients. METHODS: A prospective, single-centre observational study. RESULTS: Thirty-two IPF patients (mild n = 23, moderate n = 9) participated in the study, n = 13 mild patients attended for repeat CPET testing at 12 months. At baseline, total K-BILD scores and total IPF-PROM scores significantly correlated with 6MWT distance, but not with baseline FVC % predicted, TLco % predicted, baseline or minimum SpO2. VO2 peak/kg at AT positively correlated with total scores, breathlessness/activity and chest domains of the K-BILD questionnaire (p < 0.05). VO2 peak significantly correlated with total IPF PROM scores and wellbeing domains (p < 0.05), with a trend towards statistical significance for total IPF-PROM and VO2 peak/kg at anaerobic threshold (p = 0.06). There was a statistically significant reduction in FVC% predicted at 12 months follow up, although the mean absolute decline was < 10% (p < 0.05). During this period VO2 peak significantly reduced (21.6 ml/kg/min ± 2.9 vs 19.1 ± 2.8; p = 0.017), with corresponding reductions in total K-BILD and breathlessness/activity domains that exceeded the MCID for responsiveness. Lower baseline VO2 peak/kg at anaerobic threshold correlated with greater declines in total K-BILD scores (r = - 0.62, 0.024) at 12 months. Whilst baseline FVC% predicted or TLco % predicted did not predict change in health status, CONCLUSION: We have shown that it is feasible to undertake CPET in patients with mild to moderate IPF. CPET measures of VO2 peak correlated with both baseline and change in K-BILD measurements at 1 year, despite relatively stable standard lung function (declines of < 10% in FVC), suggesting its potential sensitivity to detect physiological changes underlying health status.

Post-stroke fatigue: how it relates to motor fatigability and other modifiable factors in people with chronic stroke.

Post-stroke fatigue (PSF) is a common symptom associated with disability and decreased quality of life. Distinction can be made between perceived fatigue and fatigability. The first aim of this study was to evaluate the prevalence of perceived fatigue and fatigability amongst patients with chronic stroke and to explore how these two parameters relate. The second aim was to study the relationship between modifiable factors (sleep disorders, anxiety, depression and activities of daily living) and fatigue in this population. Sixty-two patients with chronic stroke (> 6 months) were included. Perceived fatigue was evaluated using the Fatigue Severity Scale (FSS). Motor fatigability was assessed with the percent change in meters walked from first to last minute of the 6-min Walk Test and an isometric muscular fatigability test. Subjects also completed self-report questionnaires assessing anxiety and depression (Hospital Anxiety and Depression Scale-HADS), sleep quality (Pittsburgh Sleep Quality Index-PSQI) and activity limitations (ACTIVLIM-stroke). Seventy-one percent of participants presented PSF. There was no correlation between the FSS and motor fatigability. FSS significantly correlated with HADS-Anxiety (ρ = 0.53, P < 0.001), HADS-depression (ρ = 0.63, P < 0.001), PSQI (ρ = 0.51, P < 0.001) and ACTIVLIM (ρ = - 0.30, P < 0.05). A linear regression model showed that the HADS-Depression, the PSQI and the ACTIVLIM explained 46% of the variance of the FSS. A high proportion of chronic stroke patients presents PSF, with no relation between their fatigue and fatigability. Perceived fatigue is associated with potentially modifiable factors: anxious and depressive symptoms, poor sleep quality and activity limitations. Registered at ClinicalTrials.gov (NCT04277234) (21/02/2019).

Predictive factors over time of health-related quality of life in COPD patients.

BACKGROUND: Health-related quality of life (HRQoL) should be seen as a tool that provides an overall view of the general clinical condition of a COPD patient. The aims of this study were to identify variables associated with HRQoL and whether they continue to have an influence in the medium term, during follow-up. METHODS: Overall, 543 patients with COPD were included in this prospective observational longitudinal study. At all four visits during a 5-year follow-up, the patients completed the Saint George's Respiratory Questionnaire (SGRQ), pulmonary function tests, the 6-min walk test (6MWT), and a physical activity (PA) questionnaire, among others measurements. Data on hospitalization for COPD exacerbations and comorbidities were retrieved from the personal electronic clinical record of each patient at every visit. RESULTS: The best fit to the data of the cohort was obtained with a beta-binomial distribution. The following variables were related over time to SGRQ components: age, inhaled medication, smoking habit, forced expiratory volume in one second, handgrip strength, 6MWT distance, body mass index, residual volume, diffusing capacity of the lung for carbon monoxide, PA (depending on level, 13 to 35% better HRQoL, in activity and impacts components), and hospitalizations (5 to 45% poorer HRQoL, depending on the component). CONCLUSIONS: Among COPD patients, HRQoL was associated with the same variables throughout the study period (5-year follow-up), and the variables with the strongest influence were PA and hospitalizations.

Responsiveness and minimal clinically important difference of SGRQ-I and K-BILD in idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) specific version of St. George's Respiratory Questionnaire (SGRQ-I) and King's Brief Interstitial Lung Disease questionnaire (K-BILD) are validated health-related quality of life (HRQL) instruments, but no or limited data exist on their responsiveness and minimal clinically important difference (MCID). The objectives of this study were to assess responsiveness of SGRQ-I and K-BILD and determine MCID separately for deterioration and improvement in a large, prospective cohort of patients with IPF in a real-world setting. METHODS: Consecutive patients with IPF were recruited. SGRQ-I, K-BILD, SGRQ, Shortness of Breath Questionnaire, pulmonary function tests and 6-min walk test measurements were obtained at baseline and at six and 12 months; at six and 12 months, patients also completed Global Rating of Change Scales. Responsiveness was assessed using correlation coefficients and linear regression. Cox regression was used for mortality analyses. MCID was estimated using receiver operating characteristic curves with separate analyses for improvement and deterioration. RESULTS: A total of 150 IPF patients were included and 124 completed the 12-month follow-up. Based on all HRQL anchors and most physiological anchors, responsiveness analyses supported the evidence pointing towards SGRQ-I and K-BILD as responsive instruments. Multivariate analyses showed an association between SGRQ-I and mortality (HR: 1.18, 95% CI: 1.02 to 1.36, p = 0.03) and a trend was found for K-BILD (HR: 0.82, 95% CI: 0.64 to 1.05, p = 0.12). MCID was estimated for all domains of SGRQ-I and K-BILD. MCID for improvement differed from deterioration for both SGRQ-I Total (3.9 and 4.9) and K-BILD Total (4.7 and 2.7). CONCLUSIONS: SGRQ-I and K-BILD were responsive to change concerning both HRQL and most physiological anchors. MCID was determined separately for improvement and deterioration, resulting in different estimates; especially a smaller estimate for deterioration compared to improvement in K-BILD. TRIAL REGISTRATION: Clinicaltrials.gov, no. NCT02818712. Registered 30 June 2016.

The Two Minute Walk Test Overground and on a Self-Paced Treadmill Detects Dual Task Deficits in Individuals With Parkinson's Disease.

The aim of this project was to 1) evaluate the potential of the Two Minute Walk Test (2MWT) to detect declines in gait velocity under dual task conditions, and 2) compare gait velocity overground and on a self-paced treadmill in Parkinson's disease (PD). Twenty-three individuals with PD completed the 2MWT under single and dual task (serial 7s) conditions overground and on a self-paced treadmill. There was a significant decrease in gait velocity from single to dual task conditions overground (1.32±.22 m/sec to 1.10±.25 m/sec, p <.001) and on the self-paced treadmill (1.24±.21 m/sec to 1.05±.25 m/sec, p <.001). Overground and treadmill velocities were not statistically different from each other; however, differences approached or exceeded the minimal clinical important difference. The 2MWT coupled with a cognitive task provides an effective model of identifying dual task declines in individuals with PD. Further studies comparing overground and self-paced treadmill velocity is warranted in PD.

Efeito do exercício físico nas funções cognitivas e motoras de idosos com doença de Alzheimer: uma revisão / Effect of physical exercise on the cognitive and motor functions of the older people with Alzheimer's disease: a review

OBJETIVO: Analisar o efeito do exercício físico nos aspectos cognitivos e motores de idosos com doença de Alzheimer. MÉ- TODOS: Foi realizada busca nas seguintes bases de dados: Pub- Med, MEDLINE, LILACS, Periódico CAPES e Web of Science ™, no período de 2011 a 2016. Foram utilizadas as seguintes palavras-chave: "physical exercise", "exercise", "training", "motor intervention", "aged", "older", "elderly", "Alzheimer's dementia", "Alzheimer's disease", "Alzheimer", "Cognition", "cognitive performance", "motor" e "motor performance". RESULTADOS: Além da busca em base de dados, foi realizada busca manual nas listas de referências dos artigos selecionados. Foram encontrados três estudos que preencheram todos os critérios de inclusão adotados neste trabalho. Todos demonstraram melhoras tanto no desempenho cognitivo quanto motor de idosos com doença de Alzheimer submetidos a exercícios físicos. CONCLUSÃO: Observou-se melhora e/ou manutenção das funções cognitivas e motoras em todos os estudos. Apesar disso, não houve consenso sobre o tipo de exercício, sua intensidade e a duração adequada para idosos com doença de Alzheimer. (AU)

OBJECTIVE: To analyze the effect of physical exercise on the cognitive and motor aspects of older people with Alzheimer's disease. METHODS: The following databases were searched: Pubmed, Medline, Lilacs, CAPES Journal, and Web of Science from 2011 to 2016. The following keywords were used: "Physical exercise", "exercise", "training "" Motor intervention "," Aged "," older "," elderly","Alzheimer's dementia","Alzheimer's disease","Alzheimer", "Cognition", "cognitive performance", "Motor". RESULTS: In addition to database search, a manual search was performed in the reference lists of the selected articles. Three studies were found that fulfilled all the inclusion criteria adopted in this study. All of them demonstrated improvements in both the cognitive and motor performance of older people with Alzheimer's disease undergoing physical exercises. CONCLUSION: Improvement and/or maintenance of cognitive and motor functions was observed in all studies. Despite this, there was no consensus on the type of exercise, its intensity and adequate duration for elderly people with Alzheimer's disease. (AU)

Functional electrical stimulation improves quality of life by reducing intermittent claudication.

OBJECTIVE: To determine if Functional Electrical Stimulation (FES) would improve ischemic pain, walking distance, and quality of life of patients with intermittent claudication. DESIGN: Single blind, randomized block, two factorial design. PATIENTS: Patients diagnosed with Peripheral Artery Disease (PAD) and intermittent claudication (IC). Ankle Brachial Index ranged 0.4-0.9 on at least one leg. Patients were randomly assigned to experimental (FES+Walk, N=13) or control (WALK, N=14) groups. INTERVENTION: Experimental group patients received FES to the dorsiflexor and plantarflexor muscles while walking for 1h/day, six days/week for eight weeks. Control group patients received similar intervention without FES. A Follow-up period of both groups lasted eight weeks. OUTCOME MEASURES: Outcome measures were taken at baseline (T0), after intervention (T1), and after follow-up (T2). Primary measures included Perceived Pain Intensity (PPI), Six minute walk (6MW), and Peripheral Arterial Disease Quality of Life (PADQOL). Secondary measures included Intermittent Claudication Questionnaire (ICQ) and Timed Up and Go (TUG). RESULTS: Group by time interactions in PPI were significant (P<0.001) with differences of 27.9 points at T1 and 36.9 points at T2 favoring the FES+Walk group. Groups difference in Symptoms and Limitations in Physical Function of the PADQOL reached significance (T1=8.9, and T2=8.3 improvements; P=0.007). ICQ was significant (T1=9.3 and T2=13.1 improvements; P=0.003). Improvement in 6MW and TUG tests were similar between groups. CONCLUSIONS AND RELEVANCE: Walking with FES markedly reduced ischemic pain and enhanced QOL compared to just walking. FES while walking may offer an effective treatment option for the elderly with PAD and Intermittent Claudication. TRIAL REGISTRATION: NIH-NIA 1R21AG048001 https://projectreporter.nih.gov/project_info_description.cfm?aid=8748641&icde=30695377&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC. https://clinicaltrials.gov/ct2/show/NCT02384980?term=David+Embrey&rank=1.

Affective responses in mountain hiking-A randomized crossover trial focusing on differences between indoor and outdoor activity.

INTRODUCTION: Affective responses during physical activity (PA) are important for engagement in PA programs and for adherence to a physically active lifestyle. Little is known about the affective responses to PA bouts lasting longer than 45 minutes. Therefore, the aims of the present study were to analyse acute effects on affective responses of a three-hour outdoor PA intervention (mountain hiking) compared to a sedentary control situation and to an indoor treadmill condition. METHODS: Using a randomized crossover design, 42 healthy participants were randomly exposed to three different conditions: outdoor mountain hiking, indoor treadmill walking, and sedentary control situation (approximately three hours each). Measures included the Feeling Scale, Felt Arousal Scale and a Mood Survey Scale. Repeated measures ANOVAs were used to analyse differences between the conditions. RESULTS: Compared to the control situation, the participants showed a significant increase in affective valence (d = 1.21, p < .001), activation (d = 0.81, p = .004), elation (d = 1.07, p < .001), and calmness (d = 0.84, p = .004), and a significant decrease in fatigue (d = -1.19, p < .001) and anxiety (d = -.79, p < .001) after mountain hiking. Outdoor mountain hiking showed significantly greater positive effects on affective valence, activation, and fatigue compared to indoor treadmill walking. DISCUSSION: The results indicate that a three-hour PA intervention (mountain hiking) elicits higher positive and lower negative affective responses compared to a sedentary control situation and to an indoor PA condition. Outdoor mountain hiking can be recommended by health professionals as a form of PA with the potential to positively influence affective responses. TRIAL REGISTRATION: ClinicalTrials.gov NCT02853760. https://clinicaltrials.gov/. Date of registration: 08/02/2016 (retrospectively registered). Date of enrolment of the first participant to the trial: 05/01/2014.

Risk factors for cognitive decline associated with gait speed in community-dwelling elderly Koreans with MMSE scores of 30.

BACKGROUND AND AIM: We aimed to investigate the association between lower gait speed and cognitive decline over a 3-year period in community-dwelling older people with mini-mental state examination (MMSE) scores of 30 at baseline. METHODS: The study was based on data from 10,003 Koreans aged 60 years or older who completed the National Elderly Survey in both 2008 and 2011. Among them 620 subjects achieved MMSE scores of 30 in 2008. Over a 3-year period, preservation of MMSE score 28 or more was defined as preserved cognition and decrease of three or more points as cognitive decline. A 4-m gait speed was measured at baseline. Data on sociodemographic factors (age, number of schooling years, and household composition), alcohol drinking, current smokers, Korean version of Short form Geriatric Depression Scale score, and self-reported comorbid conditions, were collected. RESULTS: Of 620 (weighted 884) respondents included in the analysis, 208 (52.3 %) of 398 males (weighted 567) and 152 (68.5 %) of 222 females (weighted 317) suffered cognitive decline over the 3-year period. After adjustment, lower gait speed was associated with cognitive decline in males (OR 2.29; 95 % CI 1.07-4.89, P = 0.032). Educational level was a significant risk factor for both men and women (OR 0.86; 95 % CI 0.79-0.93 in males, OR 0.75; 95 % CI 0.65-0.87 in females). Males diagnosed with hypertension (OR 0.44; 95 % CI 0.22-0.88) or male smokers (OR 0.38; 95 % CI 0.19-0.75) were significantly less likely to have cognitive decline. There was no significant association between cognitive decline and gait speed in females. CONCLUSIONS: Higher 4-m gait speed is associated with preservation of cognitive function over time in men, but not in women.

Between-day test-retest reliability of gait variability in older individuals improves with a familiarization trial.

Gait variability is an important measure in clinical settings to diagnose older individuals with fall risk. This study examines whether a familiarization trial improves test-retest reliability of gait variability. Twenty-two older participants walked twice at 1 day and twice 7 days later. The standard deviations of stride length, swing time, stance time, stride time and minimum foot clearance were calculated. The test-retest reliability of (1) between-day comparison of the first trials and (2) between-day comparison of the second trials of all gait variability measures was quantified with the intraclass-correlation coefficient (ICC), the smallest detectable differences (SDD) and the bias and the limits of agreement (LoA). The between-day comparison of the second trials per day showed higher ICC values, lower LoA values and lower SDD values in all analyzed parameters. Our data suggest that the reliability of gait variability in an older population can be considerably improved just with the aid of one familiarization trial.