Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction.

We investigated physiological responses and exercise capacity in sedentary young smokers during sub-maximal and maximal test and its impact on dyspnea and exercise intolerance. Fifty sedentary male smokers and non-smokers (age: 24 ± 1 years., weight: 71 ± 9 kg, height: 177.3 ± 4.8 cm, body mass index: 22.6 ± 2.5 kg/m2) underwent two visits with pulmonary function tests, breathing pattern, and inspiratory capacity measurement at rest and during sub-maximal and maximal exercise. Smokers show reduced exercise capacity during six minutes walk test (6-MWT) with decreased walked distance (p < 0.001) and inspiratory capacity (p < 0.05). During cardiopulmonary exercise test (CPET), smokers had higher minute ventilation VE for a given submaximal intensity (p < 0.05) and lower minute ventilation at maximal exercise (p < 0.001). End expiratory lung volume was significantly lower in sedentary smokers at rest (p < 0.05), at ventilatory threshold during exercise (p < 0.05), but not during peak exercise. End inspiratory lung volume was significantly lower in smokers at rest (p < 0.05) and ventilatory threshold (p < 0.05). Cigarette smoking alters lung function during submaximal and maximal exercise. This alteration is manifested by the development of dynamic hyperinflation contributing to exercise capacity limitation.

What is the interest of the electroencephalogram in the syndromic diagnosis?

INTRODUCTION: The identification of the epileptic syndrome is a challenge particularly in childhood epilepsies. In fact, the diagnosis may need several years to be fulfilled. OBSERVATION: Our patient presented at the age of 3 years 6 months atypical absence. His electroencephalogram (EEG) showed generalized spikes and waves andpolyspikes and waves. At age 6, he has developed other types of seizures: slow fall of the head, shoulders jerks,slow fall to the side and loss of consciousness. All these phenomena were organized in a fortuitous and variable association from one period to another over 2 years. Meanwhile, the child developed cognitive impairment. EEG showed fast rhythms in sleep and waking. It was only at the age of 8years, whenthe child developedtonic seizures,that we made the diagnosis of Lennox-Gastaut syndrome. CONCLUSION: In the absence of Specific Markers, syndromic diagnosis in epilepsy remains Electro- clinical.

A reappraisal of small- and large-fiber damage in carpal tunnel syndrome: New insights into the value of the EMLA test for improving diagnostic sensitivity.

OBJECTIVES: To reappraise the respective involvement of small- and large-fiber damage in carpal tunnel syndrome (CTS) and to determine the diagnostic sensitivity of autonomic tests compared to conventional nerve conduction study (NCS). METHODS: Thirty-two manual workers complaining of at least unilateral CTS were enrolled. They underwent clinical interview and completed the symptom severity scale of the Boston CTS Questionnaire (sssBCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). In addition, transcarpal NCS was performed to investigate large sensory and motor fibers of the median nerve, while small autonomic fibers were assessed by recording sympathetic skin reflexes (SSR) at the palm and by grading skin wrinkling in response to eutectic mixture of local anesthetic (EMLA) cream application at the pulp of the index finger. For each neurophysiological variable, sensitivity and specificity values for the diagnosis of CTS were calculated and clinical correlations were studied. RESULTS: Among 64 hands examined, 36 were clinically symptomatic, while 22 were clinically asymptomatic and served as controls. Among all the neurophysiological variables studied, only the values of transcarpal sensory nerve conduction velocity and the EMLA test grade were found to be more altered in clinically symptomatic hands, with also a trend towards prolonged distal motor latency. Overall, for the diagnosis of clinically symptomatic CTS, NCS, SSR, and the EMLA test had a sensitivity of 66.7%, 22.2%, and 69.4%, respectively, and a specificity of 72.7%, 90.9%, and 50%, respectively. Combining NCS and the EMLA test led to a sensitivity of 88.9% and a specificity of 45.4%. The sssBCTQ (r=-0.34, P=0.009) and the total NPSI score (r=-0.41, P=0.001) correlated to a more altered EMLA test grade, but not to any NCS or SSR variables. In symptomatic hands, burning sensation was associated with more severe small-fiber lesion, while other pain and sensory symptoms were rather found to be reduced in case of large-fiber damage, evidenced by NCS alteration. CONCLUSIONS: This study confirms the discrepancy between conventional NCS results and clinical presentation of CTS, but still suggests a major involvement of Aß fibers in the positive sensory symptoms of CTS, excepting burning sensation. On the other hand, the EMLA test was found to correlate with clinical data and to be able to improve sensitivity of neurophysiological investigation in diagnosing CTS.

The effect of a motor skills training program in the improvement of practiced and non-practiced tasks performance in children with developmental coordination disorder (DCD).

The purpose of the present study was to examine the effect of a group-based task oriented skills training program on motor and physical ability for children with DCD. It was also investigated if there was an effect on fine motor and handwriting tasks that were not specifically practiced during the training program. Forty-one children aged 6-10years took part in this study. Children were assigned to three groups: an experimental training group consisting of 14 children with DCD, a control non-training group consisted of 13 children with DCD and a control non-training group consisting of 14 typically developed children. The measurements included were, the Movement Assessment Battery for Children (MABC), the Modified Agility Test (MAT), the Triple Hop Distance (THD), the 5 Jump-test (5JT) and the Handwriting Performance Test. All measures were administered pre and post an 8-week training program. The results showed that 10 children of the DCD training-group improved their performance in MABC test, attaining a score above the 15th percentile after their participation in the training program. DCD training-group showed a significant improvement on all cluster scores (manual dexterity (t (13)=5.3, p<.001), ball skills (t (13)=2.73, p<.05) and balance (t (13)=5.13, p<.001). Significant performance improvements were also found in MAT, THD, 5JT (t (13)=-4.55; p<.01), handwriting quality (t (12)=-2.73; p<.05) and speed (t (12)=-4.2; p<.01) after the training program. In conclusion, improvement in both practiced and non-practiced skills, in the training program, may reflect improvement in motor skill but also transfer to other skills.

The effects of 8 weeks of motor skill training on cardiorespiratory fitness and endurance performance in children with developmental coordination disorder.

Interventions based on everyday motor skills have been developed to be effective in children with developmental coordination disorder (DCD). The purpose of the present study was to examine the effects of motor skill training on exercise tolerance and cardiorespiratory fitness in children with DCD. Children were assigned to 3 groups: an experimental training group comprising 14 children with DCD, a control nontraining group comprising 13 children with DCD, and a control nontraining group comprising 14 typically developed children. All participants were tested twice with an interval of 8-weeks on a cardiopulmonary exercise test, pulmonary function testing, and a 6-min walk test. After the training program the maximal power output was significantly increased for DCD group at anaerobic threshold (p < 0.05) and at peak level (maximal oxygen uptake, p < 0.001). Improvement in power output was more pronounced at the anaerobic threshold (t (13) = -5.21, p < 0.001) than at the maximal intensity (maximal oxygen uptake, t (13) = -3.08, p < 0.01) in the DCD training group. Children with DCD that participated in the training program improved their walking distance (t (13) = -9.08, p < 0.001), had a higher maximum heart rate (t (13) = -3.41, p < 0.01), and reduced perceived exertion (t (13) = 2.75, p < 0.05). The DCD nontraining group and the typically developed group did not change on any of the measures. In conclusion, training delayed reaching the anaerobic threshold and improved aerobic endurance and exercise tolerance in children with DCD.

Comparative Study of Bronchial Hyperresponsiveness Between Football and Judo Groups in Prepubertal Boys.

BACKGROUND: Exercise induced bronchospasm (EIB) commonly occurs during exercise. The comparative effects of different sports on airway responsiveness among prepubertal boys remain to be determined. OBJECTIVES: To assess differences in post exercise spirometry between footballers, judokas and a control group in prepubertal boys. PATIENTS AND METHODS: A total of ninety six prepubertal boys were studied. Bronchial hyper responsiveness (BHR) to exercise challenge test was defined by a diagnosis of baseline spirometry, followed by an incremental exercise test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity exercise. A 10% or greater post-challenge fall in forced expiratory volume in FEV1 is used as a diagnostic criterion. RESULTS: There was no significant difference in baseline spirometry between all groups (P > 0.05). The post exercise spirometry test revealed the presence of EIB in 16 of 32 (50%) footballers against 9 out of 32 (28.12%) in both judokas and control subjects at 5 min after the exercise. Also, there was a significantly higher decrease (P < 0.05) in mean FEV1 at 5 minuts in footballers (-9.60 ± 6.18) compared to judokas (-5.41 ± 5.85). CONCLUSIONS: The footballers have more BHR than judokas, especially at 5min after the exercise. This may be due to prolonged hyperventilation, atopy and increased exposure to inhaled allergens and pollutants during training and competition.

Assessment of physical fitness and exercise tolerance in children with developmental coordination disorder.

Children with developmental coordination disorder (DCD) have been shown to be less physically fit when compared to their typically developing peers. The purpose of the present study was to examine the relationships among body composition, physical fitness and exercise tolerance in children with and without DCD. Thirty-seven children between the ages of 7 and 9 years participated in this study. Participants were classified according to results obtained on the Movement Assessment Battery for Children (MABC) and were divided in 2 groups: 19 children with DCD and 18 children without DCD. All children performed the following physical fitness tests: The five-jump test (5JT), the triple-hop distance (THD) and the modified agility test (MAT). Walking distance was assessed using the 6-min walking test (6MWT). Children with DCD showed higher scores than children without DCD in all MABC subscale scores, as well as in the total score (p<0.001). Participants with DCD were found to perform significantly worse on the MAT (p<0.001), the THD (p<0.001) and 5JT (p<0.05). Moreover, children with DCD had poorer performance on the 6MWT than children without DCD (p<0.01). Our results found significant correlations among body mass index (BMI), THD (r=0.553, p<0.05), 5JT (r=0.480, p<0.05) and 6MWT (r=0.544, p<0.05) only in DCD group. A significant correlation between MAT and 5JT (r=-0.493, p<0.05) was found. Similarly, THD and 5JT (r=0.611, p<0.01) was found to be correlated in children with DCD. We also found relationships among 6MWT and MAT (r=-0.522, p<0.05) and the 6MWT and 5JT (r=0.472, p<0.05) in DCD group. In addition, we found gender specific patterns in the relationship between exercise tolerance, explosive strength, power, DCD, and BMI. In conclusion, the present study revealed that BMI was indicative of poorer explosive strength, power and exercise tolerance in children with DCD compared to children without DCD probably due to a limited coordination on motor control.

Assessment of cardiorespiratory and neuromotor fitness in children with developmental coordination disorder.

The decreased participation in physical activity by children with probable developmental coordination disorder (pDCD) has raised concerns about their aerobic fitness and lung function levels. The purpose of the present study was to examine assessment of cardiorespiratory and neuromotor fitness, using laboratory-based tests during an incremental treadmill protocol in healthy children with and without pDCD. Twenty sex children ages 6-9 years took part in this study. Motor coordination was assessed using the Movement Assessment Battery for Children (MABC). All participants performed a cardiopulmonary exercise test (CPET) on a cycle ergometer. Pulmonary function was assessed by spirometric measurements (forced vital capacity: FVC, forced expiratory volume in 1s: FEV1) and walking distance (6MWD) was assessed using the 6-min walking test. The children with pDCD had lower VO2max than children without pDCD (p < 0.01). Moreover, FVC and FEV1 were significantly higher in children without pDCD than in children with the disorder (p < 0.05, p < 0.01 respectively). Likewise, children with pDCD had poorer performance on the 6MWD than children without pDCD (p < 0.01). A significant correlation between the absolute value for FEV1 and 6MWD (r = 0.637, p < 0.05) in pDCD group was observed. We found a significant correlation between VO2max and MABC score (r = -0.612, p < .001) and between VO2max and 6MWD (r = 0.502, p < .001) for all children. Moreover, a significant correlation between VO2max and FEV1 (r = 0.668, p < .05) was found in children with pDCD. Overall, the reduced aerobic capacity of DCD was associated with decreased of lung function, as well as an alteration of peripheral muscle responses.

Comparative study of aerobic performance between football and judo groups in prepubertal boys.

PURPOSE: The aim of this study was to compare the impact of the practice of football and judo on lung function and aerobic performance of prepubertal boys. METHODS: A total of ninety six prepubertal boys were studied. They assessed a measure of body composition using the skin folds method. They performed lung plethysmography at rest, followed by an incremental exercise test. RESULTS: There was no significant difference in baseline spirometry between all groups (P>0.05). The maximal oxygen uptake [VO2max] and the VO2 at the ventilatory threshold [VT] were similar between all groups (P>0.05). The maximal minute ventilation [VEmax] of judokas was significantly higher than footballers (P<0.01) and similar at the [VT]. The Heart rate [HR] at [VT] of footballers and judokas was similar and significantly higher than control group (P<0.01). VO2max was significantly related to LM and negatively associated with FM. At the [VT] there was a significant relationship between P[VT] and LM and mainly with VE to VO2 [VT], P[VT] and HR[VT] in all groups. CONCLUSION: Training in football and judo does not affect lung volumes and capacities, VO2max and VO2 at the [VT].

[The six minute walk test: which predictive values to apply for Tunisian subjects aged between 40 and 80 years?]. / Le test de marche de six minutes: quelles valeurs predictives a appliquer pour les sujets ages entre 40 et 80 ans de la population Tunisienne?

AIM: To establish predictive values for the six minutes walk test (6MWT) specific to subjects old more than 40 years from Tunisian population and to compare them with the other pre-established reference equations. METHODS: 155 voluntary Tunisian subjects, including 75 women, from 40 to 80 years old, sedentaries, no smokers, and without acute or chronic pathologies carried 2 TM6m in a hospital corridor on a way of 30 meters length according to the American Thoracic Society recommendations. Covered distance, heart rate and level of dyspnea were given during each 6MWT. RESULTS: The covered distance was better at the second 6MWT and was significantly different from the predicted values from pre-established equations. Age, sex, weight and size contributed in a multiple linear regression model to explain 60% of the variance of the covered distance and to establish the following regression equation: calculated distance (m) = 299.8 - (4.34 * ageyears) + (342.6 * heightm) - (1.46 * weightkg) + (62.5 * sex) with sex=1 for men and 0 for women and the lower Limit of the normal = calculated distance--124.5 m CONCLUSION: The use of the regression equation established in this study would be adapted to the subjects between 40 and 80 years old and pertaining to the Tunisian population, and its use must be limited to these criteria.

[Comparison of four techniques for the measurement of lung volumes and airway resistances by plethysmography]. / Comparaison de quatre techniques de mesure pléthysmographique des résistances des voies aériennes et des volumes pulmonaires.

OBJECTIVE: To search influence of measurement technique of thoracic gas volume(Vgt) and airway resistance(Raw) by plethysmography on results. MATERIALS AND METHODS: 20 healthy subjects, aged 22.75 + 0.40 years were studied. Vgt and Raw were measured by series of gentle panting manoeuvres (GPM) or calm respiration (CR) before and after closure of a shutter valve. So, four methods were compared : method 1 (M1) CR before ahd after, method 2 (M2): CR before and GPM after, method 3 (M3) GPM before and CR after, and method 4 (M4): GPM before and after the closure of the shutter valve. Five tests were maked with each method. RESULTS: There is no significant inter-tests variability with each method. Raw(cm H2O/L/s) measured by M1 and M2 were so elevated if compared to M3 and M4 (M1 : 2.65 + 0.102; M2: 2.47 + 0.171; M3: 1.21 + 0.080; M4: 1.30 + 0.102 ; p < 0.05). There is also a significant variability intermethods in Vgt I): (M1: 3.53 + 0.188; M2 : 3.60 + 0.203; M3 : 3.91 + 0.262; M4: 3.84 + 0.247; p < 0.05). CONCLUSION: The plethysmography measurement method must be considered in the interpretation of Vgt and Raw values.

Exhaled nitric oxide level during and after heavy exercise in athletes with exercise-induced hypoxaemia.

Endogenous nitric oxide (NO) is an important mediator of vasodilatation, bronchodilatation and lung inflammation. We hypothesised that the exhaled NO level may be modified in some endurance-trained athletes during and after intense exercise. Nine athletes with exercise-induced hypoxaemia (EIH), 12 athletes without EIH and 10 untrained subjects exercised for 15 min at 90% maximal oxygen consumption (VO(2)max). Exhaled NO was measured during exercise, and after 1 h and 22 h of recovery. Exhaled NO concentration ( C(NO)) decreased significantly during exercise in all subjects and returned to basal values after 1 h of recovery with no further modification. Exhaled NO output (V(NO)) rose significantly during exercise, rapidly dropped down following exercise and was similar to resting values after 1 h and 22 h of recovery. The results also showed that C(NO) and V(NO) were significantly lower in the athletes with EIH in comparison with the untrained subjects (V(NO) was 5.32 +/- 0.77 nmol/min versus 3.61 +/- 0.72 nmol/min at rest, 18.52 +/- 1.50 nmol/min versus 15.00 +/- 2.06 nmol/min during heavy exercise, and 5.52 +/- 1.04 nmol/min versus 3.79 +/- 0.76 nmol/min after 22 h recovery, in untrained subjects and EIH athletes, respectively). These findings do not confirm the hypothesis of pulmonary inflammation associated with EIH. However, potential NO epithelial down-regulation may occur and contribute to the development of gas exchange abnormality in some endurance-trained athletes.