Which sit-to-stand test best differentiates functional capacity in older people?

ABSTRACT: The Sit-to-Stand (STS) test provides insight into age-related functional capacity; however, there are various variants of STS, and we do not know which of these better discriminates against age-related functional capacity. Our study aimed to compare the age-related functional capacity in older people by evaluating STS power variants, using young individuals as a reference. A cross-sectional study was conducted in 102 adults (57 women) aged 60-80 and 105 adults (54 women) aged 20-30. Participants performed five times STS (5-STS), 30-seconds STS (30s-STS), and 1-minute STS (1min-STS). Z-scores were obtained for each STS variant using power (W), relative (W/kg), and allometric (W/m2) normalization methods. A mixed repeated-measures ANOVA assessed the interactions among the STS variants, normalization methods, sex, physical activity, and tobacco history. A significant interaction between STS variants, normalization methods, and sex (p=0.002) was found. The mean effect of STS variants revealed that the 1-minSTS had the lowest Z-score (p<0.05). Significant variations were observed between STS variants in all normalization methods for women (p<0.001). However, in men, only the difference between 5-STS and 1min-STS remained consistent across normalization methods (p<0.05). Our findings highlight the efficacy of 1min-STS in distinguishing age-related functional capacity over the other STS tests, especially in women.

Reliability of maximal respiratory nasal pressure tests in healthy young adults.

INTRODUCTION: Sniff nasal inspiratory (SNIP) and expiratory pressure (SNEP) may complement the assessment of respiratory muscle strength. Thus, specifying their reliability is relevant to improving the clinical consistency of both tests. OBJECTIVE: To assess the reliability of SNIP and SNEP in healthy young adults. METHODS: This cross-sectional study included self-reported healthy aged 18 to 29 years. SNIP was performed using a plug to occlude one nostril, while SNEP was conducted using a facemask. Participants performed 20 SNIP and SNEP maneuvers with 30-second intervals in between. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) assessed the reliability of SNIP and SNEP. Analyses were conducted between the highest peak pressure and the first reproducible maneuver in men and women. RESULTS: The total sample comprised 32 participants: 16 men and 16 women. The ICC, SEM, and MDC for SNIP maneuvers were 0.994 (95%CI 0.988 to 0.997), 1.820 cmH2O, and 5.043 cmH2O, respectively. For SNEP, these parameters were 0.950 (95%CI 0.897 to 0.976), 6.03 cmH2O, and 16.716 cmH2O. The SNIP and SNEP in men showed ICC of 0.992 (95%CI 0.977 to 0.997) and 0.877 (95%CI 0.648 to 0.957), SEM of 2.07 and 7.66 cmH2O, and MDC of 5.74 and 21.23 cmH2O. In women, SNIP and SNEP presented ICC of 0.992 (95%CI 0.977 to 0.997) and 0.957 (95%CI 0.878 to 0.985), SEM of 1.15 and 6.11 cmH2O, and MDC of 3.19 and 16.95 cmH2O. Also, 60% of the highest SNIPs occurred among the 11th and 20th maneuvers in men and women. In men, 55% of the highest SNEPs occurred among the 11th and 20th maneuvers; this value was 50% in women. CONCLUSION: SNIP and SNEP showed excellent reliability. The reliability of SNIP and SNEP in men was good and excellent, respectively, whereas both tests had excellent reliability in women. Also, women reached the highest peak pressure faster than men in both tests.

Effects on Sleep Quality of Physical Exercise Programs in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the beneficial effects of exercise in different populations and the close relationship between healthy ageing and sleep quality, our objective was to determine if physical exercise delivered through a structured program improves sleep quality in older adults. METHODS: Embase, PubMed/MEDLINE, Web of Science, and Cochrane Register of Clinical Trials (CENTRAL) were searched to 15 January 2023. Studies that applied physical exercise programs in older adults were reviewed. Two independent reviewers analysed the studies, extracted the data, and assessed the quality of evidence. RESULTS: Of the 2599 reports returned by the initial search, 13 articles reporting on 2612 patients were included in the data synthesis. The articles used interventions based on yoga (n = 5), multicomponent exercise (n = 3), walking (n = 2), cycling (n = 1), pilates (n = 1), elastic bands (n = 1), and healthy beat acupunch (n = 1). In the intervention group, we found significant improvement in Pittsburgh sleep quality index of -2.49 points (95% CI -3.84 to -1.14) in comparison to the control group (p = 0.0003) and sleep efficiency measured with objective instruments (MD 1.18%, 95% CI 0.86 to 1.50%, p < 0.0001). CONCLUSION: Our results found that physical exercise programs in older adults improve sleep quality and efficiency measured with objective instruments.

Effects of Exercise in Patients with Obstructive Sleep Apnoea.

Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.

Maximal Voluntary Ventilation Should Not Be Estimated From the Forced Expiratory Volume in the First Second in Healthy People and COPD Patients.

PURPOSE: To evaluate the concordance between the value of the actual maximum voluntary ventilation (MVV) and the estimated value by multiplying the forced expiratory volume in the first second (FEV1) and a different value established in the literature. METHODS: A retrospective study was conducted with healthy subjects and patients with stable chronic obstructive pulmonary disease (COPD). Five prediction formulas MVV were used for the comparison with the MVV values. Agreement between MVV measured and MVV obtained from five prediction equations were studied. FEV1 values were used to estimate MVV. Correlation and agreement analysis of the values was performed in two groups using the Pearson test and the Bland-Altman method; these groups were one group with 207 healthy subjects and the second group with 83 patients diagnosed with COPD, respectively. RESULTS: We recruited 207 healthy subjects (105 women, age 47 ± 17 years) and 83 COPD patients (age 66 ± 6 years; 29 GOLD II, 30 GOLD III, and 24 GOLD IV) for the study. All prediction equations presented a significant correlation with the MVV value (from 0.38 to 0.86, p < 0.05) except for the GOLD II subgroup, which had a poor agreement with measured MVV. In healthy subjects, the mean difference of the value of bias (and limits of agreement) varied between -3.9% (-32.8 to 24.9%), and 27% (-1.4 to 55.3%). In COPD patients, the mean difference of value of bias (and limits of agreement) varied between -4.4% (-49.4 to 40.6%), and 26.3% (-18.3 to 70.9%). The results were similar in the subgroup analysis. CONCLUSION: The equations to estimate the value of MVV present a good degree of correlation with the real value of MVV, but they also show a poor concordance. For this reason, we should not use the estimated results as a replacement for the real value of MVV.

Agreement between clinical and non-clinical digital manometer for assessing maximal respiratory pressures in healthy subjects.

Measurement of respiratory muscles strength such as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are used to detect, diagnose and treat respiratory weakness. However, devices used for these measurements are not widely available and are costly. Currently, the use of a digital manometer is recommended. In industry, several inexpensive devices are available, but these have not been validated for clinical use. Our objective was to determine the agreement between maximal respiratory pressures obtained with a clinical digital manometer and that with a non-clinical digital manometer in healthy volunteers. We assessed the height, weight, lung function, MIP, and MEP of healthy volunteers. To compare pressures obtained by each type of digital manometer, a parallel approach configuration was used. The agreement was measured with the Intraclass Coefficient Correlation (ICC) and the Bland-Altman plot. Twenty-seven participants (14 men) were recruited with a median age of 22 (range: 21-23) years. Each participant underwent three measurements to give a total of 81 measurements. The mean MIPs were 90.8 ± 26.4 (SEM 2.9) and 91.1 ± 26.4 (SEM 2.9) cmH2O for the clinical and non-clinical digital manometers, respectively. The mean MEPs were 113.8 ± 40.4 (SEM 4.5) and 114.5 ± 40.5 (SEM 4.5) cmH2O for the clinical and non-clinical digital manometers, respectively. We obtained an ICC of 0.998 (IC 0.997-0.999) for MIP and 0.999 (IC 0.998-0.999) for MEP. There is a high agreement in the values obtained for MIP and MEP between clinical and non-clinical digital manometers in healthy volunteers. Further validation at lower pressures and safety profiling among human subjects is needed.

[Obstructive sleep apnea-hypopnea and stroke]. / Síndrome de apneas-hipopneas obstructivas del sueño y accidente cerebrovascular.

Stroke, one of the main causes of disability and death worldwide, is frequently associated to the obstructive sleep apnea-hypopnea syndrome. This sleep disorder has been demonstrated to be an independent risk factor for stroke, and therefore its investigation and treatment has been recommended for patients with stroke. Mechanisms relating these two clinical disorders include: oxidative stress, cerebral blood flow alterations, autonomic dysfunction, and hypercoagulability, as well as patent foramen ovale, blood pressure, and heart rhythm disorders. Increasing amount of evidence supports continuous airway positive pressure therapy in patients with stroke, but further randomized clinical trials are needed to obtain solid conclusions. This work reviews the literature on epidemiology, pathophysiology, clinical assessment, and treatment of apnea-hypopnea syndrome in patients with stroke.

Síndrome de apneas-hipopneas obstructivas del sueño y accidente cerebrovascular / Obstructive sleep apnea-hypopnea and stroke

El accidente cerebrovascular, una de las principales causas de discapacidad y muerte a nivel global, se asocia con frecuencia al síndrome de apneas-hipopneas obstructivas del sueño. Se ha demostrado que este trastorno del sueño es un factor de riesgo independiente de accidente cerebrovascular, por lo que se ha recomendado su estudio y tratamiento. Entre los mecanismos que relacionan estos dos cuadros clínicos se destacan: el estrés oxidativo, las alteraciones del flujo sanguíneo cerebral, la disfunción autonómica y la hipercoagulabilidad, como también la persistencia del foramen oval, la hipertensión arterial y los trastornos del ritmo cardiaco. Evidencias incipientes tienden a respaldar el tratamiento del accidente cerebrovascular con presión positiva continua en la vía aérea, pero aún son necesarios más ensayos clínicos aleatorizados para avalar ese tratamiento. Este trabajo presenta una revisión de la literatura sobre epidemiología, fisiopatología, clínica y tratamiento del síndrome de apneas-hipopneas asociado al accidente cerebrovascular.

Stroke, one of the main causes of disability and death worldwide, is frequently associated to the obstructive sleep apnea-hypopnea syndrome. This sleep disorder has been demonstrated to be an independent risk factor for stroke, and therefore its investigation and treatment has been recommended for patients with stroke. Mechanisms relating these two clinical disorders include: oxidative stress, cerebral blood flow alterations, autonomic dysfunction, and hypercoagulability, as well as patent foramen ovale, blood pressure, and heart rhythm disorders. Increasing amount of evidence supports continuous airway positive pressure therapy in patients with stroke, but further randomized clinical trials are needed to obtain solid conclusions. This work reviews the literature on epidemiology, pathophysiology, clinical assessment, and treatment of apnea-hypopnea syndrome in patients with stroke.

Guí­as de rehabilitación respiratoria en niños con enfermedades respiratorias crónicas: actualización 2016 / Pulmonary rehabilitation guidelines in children with chronic respiratory diseases: 2016 update

Pulmonary rehabilitation (PR) is an essential tool in the management of chronic respiratory diseases in childhood. PR improve symptoms, physical performance, quality of life and social integration in children who have limitations in their daily activities. Health professionals have a key role in identifying those children who are candidates for pulmonary rehabilitation programs, in the initial evaluation and in the implementation of therapeutic strategies for training and education. This document is intended as a reference guide for all those professionals who are dedicated to the care of children with chronic respiratory diseases.

La rehabilitación respiratoria (RR) es un componente esencial en el manejo de las enfermedades respiratorias crónicas en la infancia. La RR ha demostrado mejorar los síntomas, el rendimiento físico, la calidad de vida y su participación social en aquellos niños que tienen limitaciones en el desarrollo de sus actividades de la vida diaria. Los profesionales de la salud tienen un rol fundamental en identificar aquellos niños que son candidatos para los programas de rehabilitación respiratoria, en la evaluación inicial y en la implementación de estrategias terapéuticas de entrenamiento y de educación. Este documento pretende ser una guía de consulta para todos aquellos profesionales que se dedican a la atención de niños con enfermedades respiratorias crónicas.