Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
1.
Aust Crit Care ; 34(3): 217-225, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33039302

RESUMO

BACKGROUND: Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to their severity of illness along with the care required to maintain the position and integrity of the ECMO cannula. Many patients on ECMO receive passive exercises, and rehabilitation is often delayed owing to medical instability, with a high proportion of patients demonstrating severe muscle weakness. The physiological effects of an intensive rehabilitation program started early after ECMO commencement remain unknown. OBJECTIVES: The primary objective of this study was to describe the respiratory and haemodynamic effects of early intensive rehabilitation compared with standard care physiotherapy over a 7-d period in patients requiring ECMO. METHODS: This was a physiological substudy of a multicentre randomised controlled trial conducted in one tertiary referral hospital. Consecutive adult patients undergoing ECMO were recruited. Respiratory and haemodynamic parameters, along with ECMO settings, were recorded 30 min before and after each session and continuously during the session. In addition, the minimum and maximum values for these parameters were recorded outside of the rehabilitation or standard care sessions for each 24-h period over the 7 d. The number of minutes of exercise per session was recorded. RESULTS: Fifteen patients (mean age = 51.5 ± standard deviation of 14.3 y, 80% men) received ECMO. There was no difference between the groups for any of the respiratory, haemodynamic, or ECMO parameters. The minimum and maximum values for each parameter were recorded outside of the rehabilitation or standard care sessions. The intensive rehabilitation group (n = 7) spent more time exercising per session than the standard care group (n = 8) (mean = 28.7 versus 4.2 min, p < 0.0001). Three patients (43%) in the intensive rehabilitation group versus none in the standard care group mobilised out of bed during ECMO. CONCLUSIONS: In summary, early intensive rehabilitation of patients on ECMO had minimal effect on physiological parameters.


Assuntos
COVID-19 , Oxigenação por Membrana Extracorpórea , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
2.
Physiotherapy ; 105(1): 114-119, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30340838

RESUMO

OBJECTIVES: To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD. DESIGN: Prospective prevalence study; PT study in CLD subgroup. SETTING: Tertiary metropolitan public hospital. PARTICIPANTS: Women with cystic fibrosis (CF, n=38), chronic obstructive pulmonary disease (COPD, n=27) and 69 healthy women without CLD. PT study - 10 women with CLD. INTERVENTIONS: Five continence PT sessions over 3 months. MAIN OUTCOME MEASURES: Prevalence and impact of incontinence (questionnaire), number of leakage episodes (7-day accident diary), pelvic floor muscle function (ultrasound imaging) and quality of life (King's Health Questionnaire). RESULTS: The majority of women in all three groups reported episodes of incontinence (CF 71%; COPD 70%; healthy women 55%). Compared to age-matched healthy controls, women with CF reported more episodes of incontinence (P=0.006) and more commonly reported stress incontinence (P=0.001). A logistic regression model revealed that women with CLD were twice as likely to develop incontinence than healthy women (P=0.05). Women with COPD reported significantly more 'bother' with incontinence than age-matched women with incontinence. There was a significant reduction in incontinence episodes following treatment, which was maintained after three months. CONCLUSIONS: The presence of CLD is an independent predictor of incontinence in women. In older women this is associated with more distress than in age-matched peers without CLD. Larger treatment studies are indicated for women with CLD and incontinence.


Assuntos
Fibrose Cística/epidemiologia , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/reabilitação , Adulto , Fatores Etários , Idoso , Fibrose Cística/psicologia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Incontinência Urinária/psicologia
3.
Physiotherapy ; 103(1): 53-58, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27036613

RESUMO

OBJECTIVES: To identify urinary incontinence and its impact on men with stable chronic obstructive pulmonary disease (COPD) and men without lung disease. DESIGN: Prospective questionnaire study. SETTING: Outpatients attending a public metropolitan hospital. PARTICIPANTS: Men with COPD (n=49) and age-matched men without lung disease (n=36). INTERVENTIONS: Validated questionnaires to identify the prevalence and impact of urinary incontinence. MAIN OUTCOME MEASURES: Prevalence of urinary incontinence and relationship with disease-specific factors, and relationship of urinary incontinence with anxiety and depression. RESULTS: The prevalence of urinary incontinence was higher in men with COPD (n=19/49) compared with men without lung disease (n=6/36; P=0.027). In men with COPD, symptoms of urgency were more prevalent in men with urinary incontinence (P=0.005), but this was not evident in men without lung disease (P=0.101). Only men with COPD reported symptoms of urgency associated with dyspnoea, and this did not vary between men with and without urinary incontinence (P=0.138). In men with COPD, forced expiratory volume in 1 second (FEV1) was lower in those with urinary incontinence compared with those without urinary incontinence {mean 38 [standard deviation (SD) 14] % predicted vs 61 (SD 24) % predicted; P=0.002}. The impact of urinary incontinence did not differ between the two groups (P=0.333). CONCLUSIONS: Incontinence is more prevalent in men with COPD than in men without lung disease. The prevalence of urinary incontinence increases with greater disease severity, as reflected by lower FEV1. Screening for urinary incontinence should be considered in men with COPD and compromised lung function.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Depressão/epidemiologia , Dispneia/epidemiologia , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Incontinência Urinária/psicologia
4.
Intern Med J ; 46(6): 663-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27257148

RESUMO

Idiopathic pulmonary fibrosis is a progressive interstitial lung disease of unknown aetiology with a dismal median survival of 3 years. Patients typically develop progressive dyspnoea and increasing exercise limitation. With a rising incidence and prevalence, an unpredictable disease course and limited treatment options, it is rapidly becoming an important public health concern. To date, lung transplantation has been the sole viable hope for treatment for those who qualify. However, the landscape of idiopathic pulmonary fibrosis management is changing, with the recent emergence of novel pharmacotherapy shown to have a favourable influence on the natural history of this disease.


Assuntos
Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/epidemiologia , Fibrose Pulmonar Idiopática/cirurgia , Transplante de Pulmão , Austrália/epidemiologia , Gerenciamento Clínico , Tratamento Farmacológico , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Incidência , Fatores de Risco , Tomografia Computadorizada por Raios X
5.
Int J STD AIDS ; 26(2): 133-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24700199

RESUMO

Obesity is a risk factor for osteoarthritis. Antiretroviral therapy (ART)-treated HIV-infected patients are frequently affected by overweight and obesity, and may be at increased risk of osteoarthritis. BMI however is a measure which does not discriminate adipose from non-adipose body mass, or fat distribution, which may have different effects. This study aimed to examine relationships between body composition and knee cartilage volume, as assessed by magnetic resonance imaging in HIV infection. 35 ART-treated HIV-infected men aged 51.7 years (mean) 7.9 (SD) and 18 healthy men aged 49.5 years (mean) 6.4 (SD) participated. Cartilage volume was measured on magnetic resonance imaging of the dominant knee using validated methods. Body composition was measured using dual x-ray absorptiometry. HIV-infected participants had less total body and gynoid fat (kg) (p = 0.04 and p = 0.007, respectively) and more percent android fat mass and percent trunk fat mass (p = 0.001 and p < 0.001, respectively) than controls. In HIV-infected participants there was an inverse association between total body fat mass and average tibial cartilage volume (R = -8.01, 95% CI -15.66, -0.36). Also, in HIV-infected participants there was an inverse association between android fat mass and average cartilage volume (R = -90.91, 95% CI -158.66, -23.16). This preliminary study found that both total body and android fat mass were inversely related to average knee cartilage volume in ambulant, ART-treated HIV-infected adults. These findings are features of early knee osteoarthritis and this may be of future significance in HIV.


Assuntos
Composição Corporal , Cartilagem Articular/patologia , Articulação do Joelho/patologia , Obesidade/complicações , Osteoartrite do Joelho/patologia , Absorciometria de Fóton , Tecido Adiposo , Índice de Massa Corporal , Estudos de Casos e Controles , Humanos , Articulação do Joelho/anatomia & histologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Fatores de Risco
6.
Respir Med ; 108(9): 1303-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25087836

RESUMO

BACKGROUND: The 6-min walk distance (6MWD) and incremental shuttle walk distance (ISWD) are clinically meaningful measures of exercise capacity in people with non-cystic fibrosis (CF) bronchiectasis, but the change in walking distance which constitutes clinical benefit is undefined. This study aimed to determine the minimal important difference for the 6MWD and ISWD in non-CF bronchiectasis. METHODS: Thirty-seven participants with mean FEV1 70% predicted completed both field walking tests before and after an 8-week exercise program. The minimal important difference was calculated using a distribution-based and anchor-based method, with the global rating of change scale used. RESULTS: The mean change in 6MWD in participants who reported themselves to be unchanged was 10 m, compared to 36 m (small change) and 45 m (substantial change) (p = 0.01). For the ISWD, the mean change in participants who reported themselves to be unchanged was 33 m, compared to 54 m (small change) and 73 m (substantial change) (p = 0.04). The anchor-based method defined the minimal important difference for 6MWD as 24.5 m (AUC 0.76, 95% CI 0.61-0.91) and for ISWD as 35 m (AUC 0.88, 95% CI 0.73-0.99), based on participant's global rating of change. The distribution-based method indicated a value of 22.3 m for the 6MWD and 37 m for the ISWD. There was excellent agreement between the two methods for the 6MWD (kappa = 0.91) and the ISWD (kappa = 0.92). CONCLUSIONS: Small changes in 6MWD and ISWD may represent clinically important benefits in people with non-CF bronchiectasis. These data are likely to assist in the interpretation of change in exercise capacity following intervention.


Assuntos
Bronquiectasia/reabilitação , Teste de Esforço/métodos , Terapia por Exercício/métodos , Caminhada , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/etiologia , Bronquiectasia/fisiopatologia , Fibrose Cística/complicações , Tolerância ao Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Capacidade Vital/fisiologia
8.
Clin Transplant ; 28(2): 252-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24372876

RESUMO

INTRODUCTION: Exercise rehabilitation is a key element of care following lung transplantation; however, little is known about the patients' experience of rehabilitation, or whether it meets the needs of this complex patient group. This qualitative study explored patients' expectations of a supervised exercise rehabilitation program following lung transplantation. METHODS: Participants undertook two semi-structured interviews, one before and one after the rehabilitation program. Interviews were digitally recorded, and themes were developed using line-by-line iterative thematic analysis and grounded theory. RESULTS: Eighteen adults (11 females) with mean age of 52 participated in a mean of 26 sessions of exercise training. Themes were (i) desire for normalcy including resuming family roles and performing everyday activities; (ii) the importance of rehabilitation as the mechanism for how this transformation occurred; (iii) the benefits of exercising in a group setting; and (iv) the limitations on rehabilitation that were imposed by comorbidities, either existing pre-transplant or occurring as a postoperative sequelae. CONCLUSION: Post-transplant exercise rehabilitation was perceived as a highly valuable tool that assisted recipients to return to "normal life." Group exercise was motivational, offered peer support, and therefore was advantageous to assist patients to achieve their desired physical performance level following transplantation.


Assuntos
Terapia por Exercício , Pneumopatias/reabilitação , Transplante de Pulmão , Pacientes/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pneumopatias/psicologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Motivação , Satisfação do Paciente , Prognóstico , Pesquisa Qualitativa , Adulto Jovem
9.
Chron Respir Dis ; 8(1): 21-30, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21339371

RESUMO

There is limited information about the benefits of pulmonary rehabilitation (PR) in patients with bronchiectasis. This study aimed to evaluate the effects of an out-patient PR program in patients with a primary diagnosis of bronchiectasis and to compare them with a matched COPD group who completed the same PR program. A retrospective review was conducted of patients with bronchiectasis or COPD who completed 6 to 8 weeks of PR at two tertiary institutions. The outcome measures were the 6-minute walk distance (6MWD) and Chronic Respiratory Disease Questionnaire (CRQ). Ninety-five patients with bronchiectasis completed the PR (48 male; FEV(1) 63 [24] % predicted; age 67 [10] years). Significant improvements in 6MWD (mean change 53.4 m, 95% CI 45.0 to 61.7) and CRQ total score (mean change 14.0 units, 95% CI 11.3 to 16.7) were observed immediately following PR. In patients with complete follow-up (n = 37), these improvements remained significantly higher than baseline at 12 months (20.5 m, 95% CI 1.4 to 39.5 for 6MWD; 12.1 points, 95% CI 5.7 to 18.4 for CRQ total score). The time trend and changes in the 6MWD and CRQ scores were not significantly different between the bronchiectasis and the COPD groups (all p > 0.05). This study supports the inclusion of patients with bronchiectasis in existing PR programs. Further prospective RCTs are warranted to substantiate these findings.


Assuntos
Bronquiectasia/reabilitação , Terapia por Exercício , Tolerância ao Exercício/fisiologia , Caminhada/fisiologia , Idoso , Análise de Variância , Teste de Esforço , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários
10.
Respiration ; 81(2): 124-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20357426

RESUMO

BACKGROUND: Prescription of an appropriate exercise training intensity is critical to optimise the outcomes of pulmonary rehabilitation; however, prescribing cycle ergometry training is challenging if peak work is unknown. Recently two studies reported regression equations which allow estimation of peak cycle work rate from the 6-minute walk distance (6MWD) in chronic obstructive pulmonary disease (COPD). OBJECTIVES: To compare estimates of peak work and target training work rate (60% peak) obtained from these equations. METHODS: Sixty-four (38 male) subjects, mean ± SD age 70 ± 8 years and FEV(1) 49 ± 18% predicted with COPD performed the 6-minute walk test according to a standardised protocol. Estimates of peak work were obtained using the published equations and agreement was examined using Bland and Altman plots. RESULTS: Mean 6MWD was 376 ± 86 m compared to 464 ± 110 m and 501 ± 83 m in samples used to derive the equations. There was substantial variation in estimates of peak work between equations (range 1-75 Watts difference) with a coefficient of variation of 35%. Differences were greater in men than in women (p < 0.001). The Luxton equation predicted higher peak work than the Hill equation in younger subjects and at work rates over 50 Watts. Estimated training work rate differed by more than 20 Watts in 18 subjects (28%). CONCLUSIONS: This comparison of reference equations for predicting peak cycle work rate from 6MWD indicates substantial variation between methods that differs systematically across the range of work rates. Further research is required to validate the equations and assess their utility for exercise prescription in pulmonary rehabilitation.


Assuntos
Teste de Esforço , Exercício Físico/fisiologia , Esforço Físico , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
HIV Clin Trials ; 11(5): 270-82, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21126957

RESUMO

PURPOSE: to determine the effects of exercise on metabolic and morphological outcomes among people with HIV using a systematic search strategy of randomized, controlled trials (RCTs). METHODS: two independent reviewers assessed studies using a predetermined protocol. RESULTS: nine RCTs (469 participants, 41% females) of moderate quality were included. Compared to nonexercising controls, aerobic exercise (AE) resulted in decreased body mass index (weighted mean difference [WMD] -1.31; 95% CI, -2.59, -0.03; n=186), triceps skinfold thickness of subcutaneous fat (WMD -1.83 mm; 95% CI,-2.36, -1.30; n=144), total body fat (%) (standardised mean difference [SMD],-0.37; 95% CI, -0.74, -0.01; n=118), waist circumference (SMD -0.74 mm, 95% CI, -1.08, -0.39; n=142), and waist:hip ratio (SMD -0.94; 95% CI, -1.30, -0.58; n=142). Progressive resistive exercise (PRE) resulted in increased body weight (5.09 kg; 95% CI, 2.13, 8.05; n=46) and arm and thigh girth (SMD 1.08 cm; 95% CI, 0.35, 1.82; n=46). Few studies examined blood lipids, glucose, and bone density. CONCLUSIONS: few RCTs exist and their quality varies. AE decreases adiposity and may improve certain lipid subsets. PRE increases body weight and limb girth. No additional effects of combining AE and PRE are evident. Larger, higher quality trials are needed to understand the effects of exercise on metabolic outcomes (eg, lipids, glucose, bone density) relevant to persons with chronic, treated HIV.


Assuntos
Exercício Físico/fisiologia , Infecções por HIV/metabolismo , Infecções por HIV/reabilitação , HIV , Adulto , Glicemia/metabolismo , Peso Corporal/fisiologia , Colesterol/sangue , Feminino , Infecções por HIV/sangue , Infecções por HIV/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Dobras Cutâneas , Tomografia Computadorizada por Raios X , Triglicerídeos/sangue , Circunferência da Cintura/fisiologia , Relação Cintura-Quadril
12.
Anaesth Intensive Care ; 37(6): 953-60, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20014602

RESUMO

In the critical care setting it may be difficult to determine an accurate reading of oxygen saturation from digital sensors as a result of poor peripheral perfusion. Limited evidence suggests that forehead sensors may be more accurate in these patients. We prospectively compared the accuracy of a forehead reflectance sensor (Max-Fast) with a conventional digital sensor in patients with acute respiratory distress syndrome during a high positive end-expiratory pressure (PEEP) recruitment manoeuvre (stepwise recruitment manoeuvre). Sixteen patients with early acute respiratory distress syndrome were enrolled to evaluate the blood oxygen saturation during a stepwise recruitment manoeuvre. PEEP was increased from baseline (range 10 to 18) to 40 cmH2O, then decreased to an optimal level determined by individual titration. Forehead and digital oxygen saturation and arterial blood gases were measured simultaneously before, during and after the stepwise recruitment manoeuvre at five time points. Seventy-three samples were included for analysis from 16 patients. The SaO2 values ranged from 73 to 99.6%. The forehead sensor provided measurements that deviated more from arterial measures than the finger sensor (mean absolute deviations 3.4%, 1.1% respectively, P=0.02). The greater variability in forehead measures taken at maximum PEEP was reflected in the unusually large precision estimates of 4.24% associated with these measures. No absolute differences from arterial measures taken at any other time points were significantly different. The finger sensor is as accurate as the forehead sensor in detecting changes in arterial oxygen saturation in adults with acute respiratory distress syndrome and it may be better at levels of high PEEP such as during recruitment manoeuvres.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Feminino , Dedos , Testa , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório/sangue , Adulto Jovem
13.
Intern Med J ; 39(8): 495-501, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19732197

RESUMO

Measurement of exercise capacity is an integral element in assessment of patients with cardiopulmonary disease. The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. A distance less than 350 m is associated with increased mortality in chronic obstructive pulmonary disease, chronic heart failure and pulmonary arterial hypertension. Desaturation during a 6MWT is an important prognostic indicator for patients with interstitial lung disease. The 6MWT is sensitive to commonly used therapies in chronic obstructive pulmonary disease such as pulmonary rehabilitation, oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. However, it appears less reliable to detect changes in clinical status associated with medical therapies for heart failure. A change in walking distance of more than 50 m is clinically significant in most disease states. When interpreting the results of a 6MWT, consideration should be given to choice of predictive values and the methods by which the test was carried out.


Assuntos
Teste de Esforço/métodos , Teste de Esforço/normas , Cardiopatias/fisiopatologia , Pneumopatias/fisiopatologia , Caminhada/fisiologia , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Humanos , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Tempo
15.
Spinal Cord ; 47(10): 763-8, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19365395

RESUMO

STUDY DESIGN: Prospective, observational study. OBJECTIVES: To determine the proportion of patients with non-traumatic spinal cord injury (NTSCI) who regain the ability to walk and to describe walking outcomes with reference to three commonly used clinical measures of walking capacity. SETTING: Spinal Rehabilitation Unit specializing in NTSCI, Melbourne, Australia. METHODS: Demographic, clinical and mobility data collected from a consecutive cohort of patients admitted to the spinal rehabilitation unit between March 2006 and December 2007. Main outcome measures were the Timed Up And Go (TUG), the 10-m walk test (10 mWT) and the 6-min walk test (6MWT). Logistic regression analysis was conducted to explore predictors of walking ability after NTSCI. RESULTS: Of 62 patients, 30 (48%) regained some capacity to walk during inpatient rehabilitation. Initial ASIA grade was the strongest predictor of walking. Twenty-seven patients regained the ability to perform functional tests (TUG, 10 mWT and 6MWT) of walking at approximately 2 months after injury. Their performance at discharge remained low compared with normal scores but were similar to those measured in some studies of subjects with traumatic spinal cord injury (TSCI). CONCLUSION: Three simple clinical tests of walking suggest that half of all NTSCI patients are able to walk at discharge from inpatient rehabilitation. Their gait speed, however, remained impaired and not compatible with safe and efficient community walking.


Assuntos
Tolerância ao Exercício/fisiologia , Transtornos Neurológicos da Marcha/reabilitação , Paralisia/reabilitação , Recuperação de Função Fisiológica/fisiologia , Doenças da Medula Espinal/reabilitação , Caminhada/fisiologia , Atividades Cotidianas , Idoso , Estudos de Coortes , Avaliação da Deficiência , Teste de Esforço , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paralisia/fisiopatologia , Aptidão Física/fisiologia , Modalidades de Fisioterapia , Estudos Prospectivos , Índice de Gravidade de Doença , Doenças da Medula Espinal/fisiopatologia , Resultado do Tratamento
16.
Transplant Proc ; 41(1): 292-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19249538

RESUMO

Pulmonary rehabilitation (PR) following lung transplantation (LT) is regarded as part of best practice management; however, the optimal duration and composition of PR programs for LT patients is unknown. This study aimed to describe changes in functional outcomes of LT patients who participated in our standard outpatient post-LT PR program. A prospective, repeated measures design was used. Functional exercise capacity (6-minute walk distance [6MWD]), lung function (forced expiratory volume in 1 second [FEV(1)], forced vital capacity [FVC]) and quality of life (Short Form 34 [SF-36]) were assessed at 1, 2, and 3 months following LT. All subjects attended a 1-hour outpatient group exercise training class 3 days per week until 12 weeks post-LT and education sessions facilitated by the multidisciplinary team. Patients with postoperative complications (mechanical ventilation, major myopathy) were excluded. Data were analyzed using descriptive statistics and analysis of variance with repeated measures. Thirty-six subjects (50% men), 81% bilateral LT, mean age 46 +/- 14 years were included. Significant improvements were demonstrated in 6MWD (451 +/- 126 m to 543 +/- 107 m, P < .001), FEV(1) (71% +/- 18% to 81% +/- 4%, P < .0001), FVC (69% +/- 14% to 81% +/- 18%, P < .0001), and all SF36 domains (P < .05). Large improvements were seen in the first month of rehabilitation, with smaller but clinically significant improvements continuing in the second month. Further prospective, longitudinal studies are required to determine whether a longer period of pulmonary rehabilitation would result in additional improvements.


Assuntos
Terapia por Exercício , Transplante de Pulmão/reabilitação , Qualidade de Vida , Adulto , Volume Expiratório Forçado , Nível de Saúde , Humanos , Transplante de Pulmão/fisiologia , Transplante de Pulmão/psicologia , Saúde Mental , Pessoa de Meia-Idade , Testes de Função Respiratória , Comportamento Social , Espirometria , Capacidade Vital
18.
Respir Med ; 103(5): 780-5, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19070473

RESUMO

BACKGROUND: The 6-Minute Walk Test (6MWT) is a widely used measurement of functional exercise capacity in chronic lung disease. While exercise intolerance has been identified in patients with bronchiectasis, the clinical determinants of the 6MWT in this population have not been examined. The aim of this study was to 1) establish the relationship between the 6-Minute Walk Distance (6MWD), disease severity and Health-Related Quality of Life (HRQOL) and 2) identify predictors of exercise tolerance in adults with bronchiectasis. METHODS: The 6MWT was performed in 27 patients with bronchiectasis (mean [SD] FEV(1) 73.9% predicted [23.4]). Disease severity was assessed using spirometry and HRCT scoring while HRQOL was evaluated using the St George's Respiratory Questionnaire (SGRQ) and the Short-Form 36 (SF-36). The relationships were evaluated using correlation and multiple regression. RESULTS: The 6MWD correlated positively with FVC (r=0.52, p<0.01), generations of bronchopulmonary divisions (r(s)=0.38, p<0.05) and SF-36 physical summary (r=0.71, p<0.001) while a negative correlation was observed between all domains of the SGRQ (all correlations r>0.5, p<0.001). Multiple regression analysis indicated that the SGRQ activity, symptom scores and generations of bronchial divisions involved were identified as independent predictors of the 6MWD, explaining 76% of the variance. CONCLUSIONS: Measures of HRQOL demonstrated a stronger association with the 6MWD compared to physiological measures of disease severity in patients with predominantly mild to moderate bronchiectasis.


Assuntos
Bronquiectasia/fisiopatologia , Tolerância ao Exercício/fisiologia , Nível de Saúde , Qualidade de Vida , Caminhada/fisiologia , Adulto , Idoso , Teste de Esforço/métodos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Espirometria , Inquéritos e Questionários , Capacidade Vital
19.
Int J STD AIDS ; 19(8): 514-8, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18663035

RESUMO

Regular physical activity is recommended for patients with human immunodeficiency virus (HIV) to help manage their disease. However, to date, little is known about levels of uptake of this advice. This study describes daily physical activity in HIV antibody-positive patients attending a public hospital infectious diseases clinic, compares them with those of patients attending the clinic for general infectious diseases and investigates compliance with the recommendations of the Centres for Disease Control and Prevention and American College of Sports Medicine physical activity guidelines. During April 2006, 261 patients completed the International Physical Activity Questionnaire short form. One hundred and ninety-one reported being HIV antibody-positive. Results showed that 1:4 HIV antibody-positive and 1:3 HIV antibody-negative respondents failed to meet the recommended guidelines. These findings are of concern, given the evidence-based benefits of regular physical activity. Further work is needed to identify barriers to participation and interventions that can improve uptake.


Assuntos
Exercício Físico , Infecções por HIV , Atividade Motora , Inquéritos e Questionários , Adolescente , Adulto , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Centers for Disease Control and Prevention, U.S. , Exercício Físico/fisiologia , Feminino , Fidelidade a Diretrizes , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Sociedades , Medicina Esportiva , Estados Unidos , Vitória
20.
Thorax ; 63(6): 549-54, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18245143

RESUMO

BACKGROUND: Interstitial lung disease (ILD) is characterised by exertional dyspnoea, exercise limitation and reduced quality of life. The role of exercise training in this diverse patient group is unclear. The aims of this study were to establish the safety of exercise training in ILD; its effects on exercise capacity, dyspnoea and quality of life; and whether patients with idiopathic pulmonary fibrosis (IPF) had similar responses to those with other types of ILD. METHODS: 57 subjects with ILD (34 IPF) were randomised to receive 8 weeks of supervised exercise training or weekly telephone support. The 6 min walk distance (6MWD), incremental exercise test, modified Medical Research Council (MRC) dyspnoea score and Chronic Respiratory Disease Questionnaire (CRDQ) were performed at baseline, following intervention and at 6 months. RESULTS: 80% of subjects completed the exercise programme and no adverse events were recorded. The 6MWD increased following training (mean difference to control 35 m, 95% CI 6 to 64 m). A significant reduction in MRC score was observed (0.7 points, 95% CI 0.1 to 1.3) along with improvements in dyspnoea (p = 0.04) and fatigue (p<0.01) on the CRDQ. There was no change in peak oxygen uptake; however, exercise training reduced heart rate at maximum isoworkload (p = 0.01). There were no significant differences in response between those with and without IPF. After 6 months there were no differences between the training and control group for any outcome variable. CONCLUSIONS: Exercise training improves exercise capacity and symptoms in patients with ILD, but these benefits are not sustained 6 months following intervention.


Assuntos
Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Doenças Pulmonares Intersticiais/reabilitação , Adolescente , Adulto , Idoso , Dispneia/etiologia , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Apoio Social , Telemedicina/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...