Exergaming as an Additional Tool in Rehabilitation of Young Patients with Rheumatoid Arthritis: A Pilot Randomized Controlled Trial.

Objective: To assess the effectiveness of home videogame-based exercise (exergaming) as an additional rehabilitative tool in young patients with rheumatoid arthritis (RA). Materials and Methods: After a baseline (T0) evaluation, 40 RA inpatients (18-35 years of age) underwent both a 4-week-lasting traditional rehabilitation program and a training by Nintendo® Wii-Fit™ videogame system. At discharge (T1), subjects were randomly assigned (1:1) to two groups: Group A (experimental group), including subjects who continued Wii-Fit training at home for additional 8 weeks, and Group B (control group), including subjects maintaining their habitual activity during the 8-week follow-up (T2). Measures of disease activity, quality of life, and fatigue were evaluated at each time point. Results: From T0 to T1, a significant improvement in most evaluated outcomes was reported in both study groups. At T2 assessment, only Group A patients experienced a significant improvement of quality of life and fatigue, with a 13.4% reduction in Global Health (GH) values, only a slight increase (4.2%) in Health Assessment Questionnaire (HAQ) score, and a 19.1% Functional Assessment of Chronic Illness Therapy (FACIT) improvement as compared with T1. In contrast, Group B patients reported a 65.8% increase in GH values, a 33% increase in HAQ score, and a 53.4% reduction in FACIT values from T1 to T2. The extended videogame-based home training was an independent predictor of Δ%GH (ß = 0.851; P < 0.001), Δ%HAQ (ß = 0.542; P < 0.001), and Δ%FACIT (ß = -0.505; P < 0.001). Conclusions: Home exergaming may be an effective additional rehabilitative tool in RA, since it allows to maintain the benefits of traditional multidisciplinary rehabilitation.

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis.

OBJECTIVE: To assess the prevalence of diffuse idiopathic skeletal hyperostosis and its relationship with vascular risk factors among patients with congestive heart failure. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 584 consecutive patients admitted to a Rehabilitative Cardiology Unit. METHODS: Chi-square Automatic Interaction Detector (CHAID) decision tree analysis was used to build a predictive model. RESULTS: The mean age (standard deviation) of the study population was 68.1 years (standard deviation 12.3), and 77.7% of the subjects were men. The overall prevalence of diffuse idiopathic skeletal hyperostosis in the cohort was 49.8%. Logistic regression analysis showed that age was a predictor of diffuse idiopathic skeletal hyperostosis (odds ratio: 1.034; 95% confidence interval 1.021-1.047, p < 0.001), with increasing odds ratios for increasing age tertiles. The CHAID prediction model identified 2 age "buckets": < 69 and ≥ 69 years. Patients ≥ 69 years had a diffuse idiopathic skeletal hyperostosis prevalence of 60.1%, compared with 39.2% among those < 69 years. Notably, body mass index was a predictor of diffuse idiopathic skeletal hyperostosis in this younger subset of patients (p = 0.028), with 2 body mass index "buckets", ≤ 23.3 and > 23.3 kg/m2, the latter showing more than twice the prevalence of diffuse idiopathic skeletal hyperostosis (43.2% vs 20%). CONCLUSION: Diffuse idiopathic skeletal hyperostosis is extremely frequent among patients with congestive heart failure, with age and body mass index being the strongest predictors.

Left ventricular hypertrophy as protective factor after bypass grafting.

Left ventricular hypertrophy (LVH) is a well established cardiovascular risk factor, accounting for an increase in cardiovascular morbid-mortality, although how much the magnitude and the kind of LVH could affect cardiovascular outcomes is in large part unknown. We speculate that mild LVH in absence of left ventricular (LV) chamber dilation, could play a protective role towards functional capacity, clinical outcome, cardiovascular and total morbi-mortality in conditions in which LV systolic function is generally reduced. Accordingly to many epidemiological observations, the availability of extra-quote of systolic function could lead to a significative improvement in the final outcome of some kinds of heart patients, as those undergoing bypass-grafting, where the stress for heart and cardiovascular system is always high. We suppose that the functional reserve available for patients with LVH could make the difference with respect to other patients undergoing myocardial revascularization. Similarly, the availability of a contractile reserve warranted by LVH could ensure a little gain in the outcome for patients after other major cardiovascular events (such as myocardial infarction or other heart surgery as surgical valve replacement). However, our hypothesis only involves mild LVH without LV chamber dilation, that is the initial stage of "non-dilated concentric" LVH and "non-dilated eccentric" LVH according to the new four-tiered classification of LVH based on relative wall thickness and LV dilation. Support for our hypothesis derives from the well-known protective role of systolic function that is a major factor in almost all cardiovascular diseases, where LV ejection fraction (LVEF) has shown to significantly improve quality of life, as well as morbidity and mortality. The knowledge that mild LVH in absence of LV chamber dilation is not as harmful in such conditions as believed at present could make avoidable some drugs prescription in some stages of the disease. Furthermore, it may allow a better evaluation of the risk profile of patients with LVH undergoing some cardiovascular major events like bypass grafting, myocardial infarction or surgical heart valve replacement.

Hypermagnesemia predicts mortality in elderly with congestive heart disease: relationship with laxative and antacid use.

The aim of this study was to evaluate the role of magnesium levels on 3-year survival in the elderly with congestive heart failure (CHF) admitted to the Rehabilitative Cardiology Unit of S. Maugeri Foundation Scientific Institute of Telese/Campoli. All elderly patients > or = 65 years old with a diagnosis of CHF underwent clinical and instrumental examination, and their demographics, co-morbidity, and in-hospital and 3-year mortality rates were recorded. Hypomagnesemia was found in 4.8%, normomagnesemia in 67.5%, and hypermagnesemia in 27.8% of subjects. The hypomagnesemic group was excluded for numerical exiguity; the analysis was performed on a total of 199 elderly patients. Hypermagnesemia was found in 29.1% and normomagnesemia in 70.9%. At the univariate analysis no differences were found in hypermagnesemia in respect to normomagnesemia group, except for slightly higher levels of creatininemia (1.35 +/- 0.61 vs. 1.13 +/- 0.55 mg/dL, respectively; p < 0.02), greater disability (lost ADL, 2.69 +/- 1.57 vs. 2.15 +/- 1.56, respectively; p < 0.05), more mortality for CHF (32.6 vs. 48.3%; p < 0.05), and higher antacid and laxative use (82.7 vs. 24.8%, respectively; p < 0.0001). Patients with higher magnesium showed less probability to survive at a 3-year follow-up than did patients with lower levels (17.32 +/- 15.93 vs. 22.46 +/- 16.16 months; p < 0.05), and this finding remained significant in the multivariate analysis after adjusting for some confounders. Finally hypermagnesemia should also be considered in the absence of pre-existing renal failure clinical evidence because of its negative prognostic value, especially in elderly patients with CHF. The shown relationship between hypermagnesemia and laxative/antacid use should induce physicians to pay more attention to abuse of these drugs.