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1.
Isr Med Assoc J ; 12(21): 773-778, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814338

RESUMO

BACKGROUND: Falls are a common complication in persons with stroke (PwS). Reliable assessment of balance responses to unexpected loss of balance has the potential to identify risk for falls. OBJECTIVES: To examine inter-observer reliability of balance responses to unannounced surface perturbations in PwS and to explore the concurrent validity of a balance recovery assessment protocol. METHODS: Two observers evaluated balance recovery strategies and fall threshold (a fall into a harness system) in 15 PwS and 15 healthy adults who were exposed to forward, backward, right, and left unannounced surface translations in six increasing intensities while standing. RESULTS: Observer agreement was 100% for the fall threshold. Kappa coefficients for step strategies were 0.960-0.988 in PwS and 0.886-0.938 in healthy adults, 0.905-0.988 for arm reactions in PwS and 0.754-0.926 in healthy adults. Significant correlations were found between fall threshold and Berg Balance Scale (r = 0.691), 6-minute walk test (r = 0.599), and fall efficacy scale-international (r= -0.581). CONCLUSIONS: A trained examiner can reliably classify reactive balance responses to surface perturbations. The high frequency of falls observed in PwS highlights the importance of assessing reactive balance responses to different directions and intensities of surface translations.


Assuntos
Acidentes por Quedas/prevenção & controle , Exame Neurológico/métodos , Equilíbrio Postural , Posição Ortostática , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Medição de Risco/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Teste de Caminhada/métodos
4.
NeuroRehabilitation ; 45(2): 239-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498142

RESUMO

BACKGROUND: Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, and therefore seem attractive to estimate the aerobic fitness in people with chronic diseases. OBJECTIVE: To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple Sclerosis (MS), by comparing it with the peak oxygen uptake (VO2peak in mL/kg/min) as measured by Cardiopulmonary Exercise Testing (CPET) on a cycle ergometer. METHODS: The 2 min fast walk test was performed on a marked indoor trajectory, using a static start protocol. Aerobic capacity (VO2peak, in mL/kg/min) was derived from CPET on a cycle ergometer. Criterion validity was tested by means of Pearson's correlation coefficient and should be at least 0.70 for a good criterion validity of the 2 min walk test. Linear regression analysis was applied to more precisely estimate VO2peak. RESULTS: In total 141 people with severe MS-related fatigue (mean age 47.0 years (range 23-68 years), 73% women, median disease duration 7.8 years (range 0.3 - 28.7 years)) performed both tests. The distance walked in two minutes ranged from 52.0 to 290.0 m (mean 175.1 m, sd 44.9 m), while the VO2peak varied between 11.31 and 40.28 mL/kg/min (mean 22.52 mL/kg/min, sd 6.07 mL/kg/min). The correlation between the 2 min walk test and VO2peak was 0.441 (95% CI: 0.309-0.570). The absolute residual error in estimated VO2peak was 5.47 mL/kg/min. CONCLUSIONS: Due to the poor correlation found between the 2 min walk test and VO2peak, the 2-min walk test cannot be recommended as a valid alternative for estimating aerobic capacity in persons with MS.


Assuntos
Esclerose Múltipla/fisiopatologia , Consumo de Oxigênio , Teste de Caminhada/normas , Adulto , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Teste de Caminhada/efeitos adversos , Teste de Caminhada/métodos , Caminhada
5.
Braz J Med Biol Res ; 52(9): e8402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482976

RESUMO

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO2) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m2). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO2 best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO2 measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO2 of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO2 (mL·kg-1·min-1) = 13.341 + 0.138 × total UDS - (0.183 × BMI), with an estimated standard error of 1.3 mL·kg-1·min-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO2 satisfactorily.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Tolerância ao Exercício/fisiologia , Frequência Cardíaca/fisiologia , Obesidade/fisiopatologia , Consumo de Oxigênio/fisiologia , Teste de Caminhada/métodos , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Fatores de Tempo , Adulto Jovem
6.
Braz J Med Biol Res ; 52(8): e8513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365695

RESUMO

Phenotypic differences have been described between patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and SSc-associated pulmonary hypertension, including performance differences in the 6-min walk test (6MWT). Moreover, the correlations between the 6MWT and traditional pulmonary function tests (PFTs) are weak, indicating the need to search for new parameters that explain exercise performance. Thus, our objective was to evaluate the impact of ventilation distribution heterogeneity assessed by the nitrogen single-breath washout (N2SBW) test and peripheral muscle dysfunction on the exercise capacity in patients with SSc-ILD and limited involvement of the pulmonary parenchyma. In this cross-sectional study, 20 women with SSc-ILD and 20 matched controls underwent PFTs (including spirometry, diffusing capacity for carbon monoxide (DLco), and the N2SBW test) and performed the 6MWT and knee isometric dynamometry. The 6-min walking distance (6MWD, % predicted) was strongly correlated with the phase III slope of the single-breath nitrogen washout (phase III slopeN2SBW) (r=-0.753, P<0.0001) and reasonably correlated with the forced vital capacity (FVC) (r=0.466, P=0.008) and DLco (r=0.398, P=0.011). The peripheral oxygen saturation (SpO2) during exercise was not significantly correlated with any of the pulmonary or muscle function parameters. The phase III slopeN2SBW was the only predictive variable for the 6MWD, whereas quadriceps strength and FVC/DLco were predictive variables for SpO2. Ventilation distribution heterogeneity is one factor that contributes to a lower 6MWD in SSc-ILD patients. In addition, muscle dysfunction and abnormal lung diffusion at least partly explain the decreased SpO2 of these patients.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertensão Pulmonar/fisiopatologia , Doenças Pulmonares Intersticiais/fisiopatologia , Pulmão/fisiologia , Testes de Função Respiratória/métodos , Escleroderma Sistêmico/complicações , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/etiologia , Medidas de Volume Pulmonar/métodos , Pessoa de Meia-Idade , Ventilação Pulmonar , Doença de Raynaud/complicações , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia , Teste de Caminhada/métodos
7.
Pediatr Cardiol ; 40(7): 1494-1502, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31367954

RESUMO

This observational study aimed to investigate the relationship between regional cerebral oxygen saturation (rSO2) during the 6-minute walk test (6-MWT) and the demographic/clinical features of patients with pulmonary arterial hypertension (PAH). Cerebral oxygenation was evaluated during the 6-MWT in 20 pediatric patients with PAH aged ≥ 7 years [13 male, 7 female; median age 12.25 (range 7-18) years]. In all patients, regional cerebral oxygen saturation    (rSO2), arterial oxygen saturation (SpO2), and heart rate (HR) were measured using near-infrared spectroscopy (NIRS) for 2 min before the test, during the 6-MWT test, and 2 min after the test. The relationship between the changes in rSO2, heart rate, and SpO2 values and clinical and laboratory features was compared statistically. The mean pulmonary arterial pressure (mPAP) was 77 (range 25-126) mmHg, and the median 6-minute walk distance (6-MWD) was 427.5 (300-570) m. The changes in rSO2 measurements ranged between 3.41 and 21.8%, and 70% of the patients had a greater than 10% decrease in rSO2 during the test compared with baseline. Eight patients showed a decrease in rSO2 without SpO2 changes. The present study demonstrated a significant decrease in cerebral oxygenation in pediatric patients with PAH during the 6-MWT. We hypothesized that using a combination of the 6-MWT and regional cerebral oxygenation monitoring in pediatric patients with PAH in order to evaluate exercise capacity, as a reflection of reduced daily activities, would provide more precise predictive values than the 6-MWT alone.


Assuntos
Hipertensão Pulmonar Primária Familiar/fisiopatologia , Oxigênio/sangue , Oxigênio/metabolismo , Teste de Caminhada/métodos , Adolescente , Adulto , Criança , Feminino , Frequência Cardíaca , Humanos , Masculino , Oximetria/métodos , Espectroscopia de Luz Próxima ao Infravermelho
8.
Respir Res ; 20(1): 151, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299972

RESUMO

BACKGROUND: The combination of chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) is associated with a higher prevalence of comorbidities and increased mortality. The impact of kidney function on patient-centered outcomes in COPD has not been evaluated. METHODS: Patients from the German COPD and Systemic Consequences - Comorbidities Network (COSYCONET) cohort COPD were analysed. CKD was diagnosed if the estimated glomerular filtration rate (eGFR) measurements were < 60 mL/min/1.73m2 at study inclusion and six month later. The effect of CKD, on comorbidities, symptoms [modified British Medical Research Council dyspnoea scale], physical capacity [six-minute walk test, and timed up and go] and St George's Respiratory Questionnaire were analysed. Restricted cubic spline models were used to evaluate a nonlinear relationship between eGFR with patient-centered outcomes, cox survival analysis was applied to evaluate mortality. RESULTS: 2274 patients were analysed, with CKD diagnosed in 161 (7.1%). Spline models adjusted for age, gender, BMI, FEV1 and cardiovascular comorbidities revealed independent associations between eGFR with modified British Medical Research Council dyspnoea scale, St George's Respiratory Questionnaire, (p < 0.001 and p = 0.011), six-minute walk test (p = 0.015) and timed up and go (p < 0.001). CKD was associated with increased mortality, independently from for other cardiovascular comorbidities (hazard ratio 2.3; p < 0.001). CONCLUSION: These data show that CKD is a relevant comorbidity in COPD patients which impacts on patient-centered outcomes and mortality. TRIAL REGISTRATION: NCT01245933.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Testes de Função Respiratória/métodos , Teste de Caminhada/métodos
9.
Clin Respir J ; 13(9): 545-554, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31295761

RESUMO

OBJECTIVE: This study intended to explore the relation between heart rate recovery at 1 minutes (HRR1) during the recovery phase of cardiopulmonary exercise test (CPET) and exercise capacity in female systemic lupus erythematosus associated pulmonary arterial hypertension (SLE-PAH) patients. METHODS: Twenty-one female SLE-PAH patients underwent right heart catheterization (RHC), pulmonary function test (PFT) and CPET. Forty-two healthy subjects matched with SLE-PAH patients in age, sex and BMI were recruited as a control group. The correlations between HRR1 with clinical and CPET parameters were performed. RESULTS: Peak HR, ΔHR, HRR1, Peak HR-warm HR1min , Peak HR-warm HR2min and CR were significantly lower in SLE-PAH than in controls (P < .01). Increased incidence of CRI was seen in SLE-PAH. Except for the Peak PET O2 , which was higher in controls, all other CPET parameters were lower in SLE-PAH. SLE-PAH patients with HRR1 ≥ 16 had longer 6MWD, lower NT-proBNP, better percent of predicted gas transfer index or diffusing capacity for carbon monoxide (DLco% pred) as well as better CO and CI. Peak HR, ΔHR, HRR1, Peak HR-warm HR1min , Peak HR-warm HR2min , CR, Peak Load, Peak VO2 , Peak PET CO2 , OUEP and OUES were lower and duration of exercise was shorter in patients with HRR1 < 16. HRR1 had positive correlation with 6MWD, DLco% pred, CO, CI and some key CPET parameters. CONCLUSIONS: HRR1 is an easily obtained auxiliary parameter in SLE-PAH patients to reflect an altered autonomic tone. SLE-PAH patients with HRR1 < 16 have more severe hemodynamics, worse clinical findings and marked oxygen uptake inefficiency than those with HRR1 ≥ 16.


Assuntos
Frequência Cardíaca/fisiologia , Lúpus Eritematoso Sistêmico/complicações , /fisiopatologia , Adulto , Cateterismo Cardíaco/métodos , Teste de Esforço/métodos , Feminino , Hemodinâmica/fisiologia , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Consumo de Oxigênio/fisiologia , Fragmentos de Peptídeos/sangue , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Teste de Caminhada/métodos
10.
Respir Res ; 20(1): 166, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340825

RESUMO

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit. OBJECTIVES: To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation. METHODS: We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later. RESULTS: Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = - 0.30, p = 0.042) and change in exercise capacity (rho = - 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later. CONCLUSION: Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.


Assuntos
Aorta/fisiopatologia , Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Rigidez Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Análise de Onda de Pulso/métodos , Teste de Caminhada/métodos
11.
Medicina (Kaunas) ; 55(6)2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31213023

RESUMO

: Background: Several studies showed that there is a relationship between vitamin and mineral status and muscle strength. In particular this is the case for handgrip strength (HS) and vitamin D deficiency. In bariatric surgery there is a risk of decrease in muscle strength after surgery and also vitamin and mineral deficiencies are not uncommon. The aim of this study is to assess the effect of low vitamin 25 (OH) cholecalciferol levels, high dose cholecalciferol supplementation regime and protein intake on physical fitness, measured using handgrip strength (HS) and the shuttle walk run test (SWRT). Methods: For this retrospective study, 100 patients who have had bariatric surgery were included. Group A (n = 50) used 800 IU oral cholecalciferol per day. Group B (n = 50) used 800 IU oral cholecalciferol daily and 50,000 IU liquid cholecalciferol monthly lifelong. Both groups were matched on common variables. To measure physical fitness, we used the HS manometer of Jamar and the Shuttle Walk Run Test (SWRT) to assess physical capacity. Results: No significant differences in HS and SWRT outcomes were found between patients with serum 25 (OH) cholecalciferol < 75 nmol/L or >75 nmol/L. The postoperative HS is significantly influenced by protein intake (p = 0.017) and no significant influence was seen in outcomes of the SWRT (p = 0.447). Conclusion: We have found that serum 25 (OH) cholecalciferol and different cholecalciferol supplementation regimes do not have a significant effect on HS and SWRT before, three and 6 months after surgery. It seems that protein intake plays a more important role in maintaining adequate muscle strength.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Colecalciferol/uso terapêutico , Proteínas na Dieta/análise , Adulto , Cirurgia Bariátrica/métodos , Distribuição de Qui-Quadrado , Colecalciferol/análise , Colecalciferol/sangue , Estudos de Coortes , Teste de Esforço/métodos , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas , Teste de Caminhada/métodos
12.
Fisioter. Pesqui. (Online) ; 26(2): 196-201, abr.-jun. 2019. tab
Artigo em Português | LILACS | ID: biblio-1012144

RESUMO

RESUMO O Modified Shuttle Walk Test (MSWT) é um teste de exercício potencialmente máximo que, associado à avaliação da força muscular respiratória (FMR), reflete a condição respiratória e a capacidade de exercício de escolares com fibrose cística (FC). O objetivo desta pesquisa foi investigar a relação entre FMR e distância percorrida (DP) no MSWT realizado por escolares com FC e comparar os dados obtidos com valores preditos na literatura. Trata-se de um estudo observacional transversal que incluiu escolares com FC. Realizou-se avaliação antropométrica, espirometria e FMR, utilizando as pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) por meio da manovacuometria. Dois MSWT foram realizados, com intervalo de 30 minutos entre eles. Verificou-se a distribuição dos dados pelo teste de Shapiro-Wilk e aplicou-se teste t pareado para comparação entre valores das avaliações e predito, bem como para comparação entre gêneros. Aplicou-se teste de Pearson para correlação entre PImáx e PEmáx e DP no MSWT. Aceitou-se significância de 5%. Participaram 28 crianças (9,9±1,9 anos) destas, 57,14% apresentaram PImáx abaixo do predito (15 crianças) e 53,57% da PEmáx (16 crianças). A média da DP foi 730,4±266,1m, abaixo do predito na literatura. Não houve relação entre DP e FMR. Identificou-se correlação moderada entre valores de PImáx e PEmáx (r=0,58 e p=0,01). Não houve relação entre FMR e desempenho no MSWT nos escolares com FC estudados. A FMR, bem como o DP no MSWT, apresentou-se abaixo do predito na literatura.


RESUMEN El Modified Shuttle Walk Test (MSWT) es una prueba de ejercicio potencialmente máxima que, asociada a la evaluación de la fuerza muscular respiratoria (FMR), refleja la condición respiratoria y la capacidad de ejercicio de escolares con fibrosis quística (FQ). El objetivo de esta investigación fue investigar la relación entre FMR y distancia recorrida (DP) en el MSWT realizado por escolares con FQ y comparar los datos obtenidos con valores predichos en la literatura. Se trata de un estudio observacional transversal que incluyó a los escolares con FQ. Se realizó una evaluación antropométrica, espirometría y FMR, utilizando las presiones inspiratoria máxima (PImáx) y espiratoria máxima (PEmáx) por medio de la manovacuometría. Se realizaron dos MSWT, con un intervalo de 30 minutos entre ellos. Se verificó la distribución de los datos por la prueba de Shapiro-Wilk y se aplicó una prueba t pareada para la comparación entre los valores de las evaluaciones y el predicado, así como para la comparación entre los géneros. Se aplicó una prueba de Pearson para la correlación entre PImáx y PEmáx y DP en el MSWT. Se aceptó una significación del 5%. Participaron del estudio 28 niños (9,9±1,9 años); 57,14% presentaron PImáx por debajo del pronóstico (15 niños) y 53,57% por debajo del pronóstico para PEmáx (16 niños). El promedio de la DP fue 730,4±266,1m, por debajo del predicho en la literatura. No hubo relación entre DP y FMR. Se identificó una correlación moderada entre valores de PImáx y PEmáx (r=0,58 y p=0,01). No hubo relación entre FMR y desempeño en el MSWT en los escolares con FC. La FMR, así como la DP en el MSWT, se presentó abajo del predicho en la literatura.


ABSTRACT Modified Shuttle Walk Test (MSWT) is a potentially maximal exercise test that, together with the assessment of respiratory muscle strength (RMS), reflects the respiratory condition and exercise capacity of schoolchildren with cystic fibrosis (CF). This study aimed to investigate the relationship between the RMS and the performance in the MSWT by schoolchildren with CF and to compare the data obtained with the values predicted in the literature. This is a cross-sectional observational study that included schoolchildren with CF. Anthropometric evaluation, spirometry and RMS evaluation were performed, using the maximal inspiratory (MIP) and expiratory (MEP) pressures (Globalmed MVD300® manovacuometer) (ATS/ERS) (2002). Two MSWT were performed, with an interval of 30 minutes between them. The distribution of the data by the Shapiro-Wilk test was applied and paired t-test was used to compare the values of the evaluations with those predicted, as well as for comparison between genders. Pearson test was used for correlation between MIP and MEP and the performance in the MSWT. Significance of 5% was accepted. 28 children (9.9±1.9 years) participated; 57.14% showed MIP below the predicted (15 children) and 53.57% showed MEP below the predicted (16 children). The mean performance was 730.4±266.1m, which is lower than the values predicted in the literature. No relationship between performance and RMS was observed. A moderate correlation was observed between MIP and MEP values (r=0.58, p=0.01). No relationship between the RMS and the MSWT performance was observed in schoolchildren with CF of this study. The RMS and the performance in the MSWT were below the predicted in the literature.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Músculos Respiratórios/fisiopatologia , Fibrose Cística/fisiopatologia , Teste de Caminhada/métodos , Espirometria/métodos , Antropometria , Estudos Transversais , Tolerância ao Exercício , Pressões Respiratórias Máximas/métodos
13.
Sao Paulo Med J ; 137(1): 45-53, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31116270

RESUMO

BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Levobupivacaína/administração & dosagem , Músculo Esquelético/efeitos dos fármacos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada/métodos
14.
Isr Med Assoc J ; 5(21): 326-329, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140224

RESUMO

BACKGROUND: Pulmonary rehabilitation has shown significant benefit for patients with chronic obstructive pulmonary disease (COPD). The effect on non-COPD pulmonary patients is less well established. OBJECTIVES: To determine whether pulmonary rehabilitation is also beneficial for non-COPD pulmonary patients. METHODS: Clinical and demographic data on non-COPD pulmonary patients who participated in our institutional pulmonary rehabilitation program between January 2009 and December 2016 were collected. Participants engaged in a 60-minute, twice-weekly, ambulatory hospital-based program lasting 12 to 24 sessions. Sessions included both endurance and muscle training as well as healthy lifestyle educational activities. The six-minute walk test (6MWT) and the St. George's Respiratory Questionnaire (SGRQ) were conducted before and after the rehabilitation program. RESULTS: We recruited 214 non-COPD patients, of whom 153 completed at least 12 sessions. Of these, 59 presented with interstitial lung disease (ILD), 18 with non-ILD restrictive lung defects, 25 with asthma, 30 with lung cancer, and 21 with other conditions (e.g., pulmonary hypertension, bronchiectasis) The groups demonstrated significant improvement in 6MWT and in SGRQ scores. Non-COPD patients gained a 61.9 meter (19%) improvement in the 6MWT (P < 0.0001) and 8.3 point reduction in their SGRQ score (P < 0.0001). CONCLUSIONS: Pulmonary rehabilitation is effective in non-COPD pulmonary patients. As such, it should be an integral part of the treatment armament provided to the vast majority of those suffering from chronic respiratory disease.


Assuntos
Dispneia , Terapia por Exercício/métodos , Pneumopatias , Qualidade de Vida , Idoso , Dispneia/etiologia , Dispneia/fisiopatologia , Dispneia/psicologia , Dispneia/reabilitação , Treino Aeróbico/métodos , Feminino , Humanos , Pneumopatias/classificação , Pneumopatias/diagnóstico , Pneumopatias/psicologia , Pneumopatias/reabilitação , Masculino , Pessoa de Meia-Idade , Exercícios de Alongamento Muscular/métodos , Inquéritos e Questionários , Resultado do Tratamento , Teste de Caminhada/métodos
15.
Medicina (Kaunas) ; 55(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137581

RESUMO

Background and objective: Six-minute walk test (6-MWT) is a widely used test for assessing exercise performance in chronic obstructive pulmonary (COPD). However, the association between reduced walking distance and balance impairment in COPD has not been directly investigated. Therefore, the aim of this study was to identify exercise performance as a predictor for balance impairment in COPD. Materials and Methods: The cross-sectional study was conducted at a single visit involving stable COPD patients in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. The 6-MWT was measured for in all subjects. The prognostic confounding factors were also collected for all subjects. Balance test was measured using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. A cut-off score of BBS < 46 and/or the TUG ≥ 13.5 s was classified as balance impairment. Multivariable logistic regressions were performed to identify the six-minute walk distance (6-MWD) as a predictor for balance impairment in COPD. Results: Of the 176 COPD subjects assessed for eligibility, 118 COPD patients were enrolled including 86 males (72.9%) with a mean age of 73.5 ± 8.1 years. Thirty-three (28.0%) cases were classified with a balance impairment. The 6-MWD < 300 m was the predictor of balance impairment in COPD with an adjusted risk ratio of 10.10 (95%CI; 2.87, 35.61, p-value < 0.001). Conclusions: The 6-MWT is not only useful for evaluation of exercise performance, but also for prediction of balance impairment in patients with COPD. Our study suggests that the 6-MWD < 300 m is an important risk factor for balance impairment in COPD.


Assuntos
Exercício/fisiologia , Equilíbrio Postural/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida/psicologia , Estatísticas não Paramétricas , Tailândia , Teste de Caminhada/métodos
16.
Arch. bronconeumol. (Ed. impr.) ; 55(5): 239-245, mayo 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-181744

RESUMO

Introduction: Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case–control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. Methods: Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. Results: Peak FEV1 after LTx was similar in both groups [FEV1 (% predicted) 101 ± 25 vs. 101 ± 31, p = 0.96] and BOS diagnosis in cases was established 3.6 ± 2.5 years after LTx. At the final follow-up assessment (6.5 ± 3.2 years after LTx) FEV1 (% predicted) was 86 ± 34 in NON-BOS vs. 44 ± 17 in BOS (p < 0.001). Evolution of 6MWD was different between groups (group by time interaction: p = 0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3 ± 1.7 vs. BOS 5.0 ± 2.2; p = 0.024). Conclusions: We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS


Introducción: El síndrome de bronquiolitis obliterante (BOS) es una enfermedad debilitante con opciones de tratamiento limitadas que amenaza tanto la calidad de vida como la supervivencia a largo plazo de los trasplantados pulmonares (LTx). Este estudio longitudinal retrospectivo de casos-controles se realizó para comparar la evolución functional de los LTx con y sin BOS a largo plazo. Métodos: Se seleccionaron 24 LTx con BOS (BOS = casos) y 24 sin BOS (NON-BOS = controles). Los casos y controles se emparejaron individualmente atendiendo a la edad, el sexo, el diagnóstico y las características del trasplante. Las mediciones incluyeron: la distancia recorrida en la prueba de 6min marcha (6MWD), la disnea (BORG CR-10) y la función pulmonar, antes del LTx y anualmente en el post-LTx. Resultados: El FEV1 pico post-LTx fue similar en ambos grupos (FEV1 [% predicho] 101 ± 25 vs. 101 ± 31; p = 0,96) y el diagnóstico de BOS en los casos se estableció a los 3,6 ± 2,5 años del LTx. En la evaluación del seguimiento final (6,5 ± 3,2 años tras el LTx) el FEV1 (% predicho) fue del 86±34 en los NON-BOS vs. 44 ± 17 en los BOS (p < 0,001). La evolución del 6MWD fue diferente entre grupos (interacción tiempo por grupo: p = 0,002). La puntuación de disnea en la evaluación final también fue diferente significativamente entre grupos (NON-BOS 3,3 ± 1,7 vs. BOS 5,0 ± 2,2; p = 0,024). Conclusiones: Se ha observado una reducción gradual de la capacidad funcional de ejercicio y un incremento de la disnea en los pacientes con BOS tras el LTx. Así pues, parecen pertinentes estudios prospectivos para examinar si la rehabilitación puede mejorar la sintomatología y enlentecer el deterioro de la capacidad de ejercicio en los pacientes que desarrollan el BOS tras el trasplante


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Transplante de Pulmão/reabilitação , Pulmão/fisiologia , Dispneia/patologia , Bronquiolite Obliterante/fisiopatologia , Estudos Longitudinais , Estudos Retrospectivos , Medidas de Volume Pulmonar , Teste de Caminhada/métodos , Exercício/fisiologia
17.
Monaldi Arch Chest Dis ; 89(1)2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30985097

RESUMO

Despite improvements in treatments, the prognosis of heart failure remains poor. Elderly patients with heart failure are burdened with multiple co-morbidities and polypharmacy. Multidisciplinary disease-management programs are recommended as standard care for patients at high risk of hospitalization. Cardiac rehabilitation is defined a coordinated multidimensional intervention that integrates the basic elements in multidisciplinary management programs with a continuing program of physical activity and exercise training. Cardiac rehabilitation services can be provided on an inpatient or outpatient basis according to the clinical characteristics and severity of the disease. Data support the usefulness of inpatient cardiac rehabilitation interventions soon after hospitalization for acute decompensated heart failure as a "transition care service" to overcome the particularly high risk "vulnerable" phase. Although in the elderly, physical activity is conditioned by the general clinical conditions, the presence of comorbidities and frailty, several data underscore the importance of improving exercise capacity in the elderly vulnerable patient.


Assuntos
Reabilitação Cardíaca/métodos , Idoso Fragilizado/estatística & dados numéricos , Insuficiência Cardíaca/reabilitação , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/estatística & dados numéricos , Comorbidade/tendências , Prática Clínica Baseada em Evidências/métodos , Terapia por Exercício/métodos , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Polimedicação , Prevalência , Recuperação de Função Fisiológica/fisiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Teste de Caminhada/métodos , Teste de Caminhada/estatística & dados numéricos
18.
Physiotherapy ; 105(2): 275-282, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954276

RESUMO

OBJECTIVE: To determine the construct validity and test re-test reliability of the Six-minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT) in the sub-acute recovery phase following mild-to-moderate severity stroke. PARTICIPANTS: 40 stroke patients (mean age: 68.27 years, SD: 13.48) of median National Institutes of Health Stroke Scale (NIHSS) score 1.2 (range: 0 to 8) within six months of stroke. METHOD: Each participant completed one Incremental Cycle Test (ICT) followed by two ISWT and two 6MWT in a randomised order. Pearson's Correlation Coefficients were used to determine the validity and Bland Altman plots were used to determine the test re-test reliability. RESULTS: The Incremental Cycle Test (ICT) was positively correlated with the ISWT (r=0.59, 95% confidence intervals 0.35 to 0.76, P=0.001) and the 6MWT (0.55, 0.35 to 0.71, P<0.001). The correlation of the ICT with the ISWT and 6MWT was higher for the 17 patients with no residual (ISWT: r=0.79, P<0.001; 6MWT: 0.826, P<0.001) compared to mild-to-moderate neurological impairment (ISWT: r=0.45, P=0.03; 6MWT: r=0.38, P=0.08). Test-retest reliability for both the ISWT and the 6MWT showed that there was some variability between the first and second tests with a better performance on the second test. CONCLUSION: The ISWT and 6MWT have a significant, modest correlation with the ICT for stroke patients in the sub-acute recovery phase. The ISWT and 6MWT are not strongly correlated with ICT (VO2 peak) in a stroke population that is disabled. The test-retest reliability of the ISWT and 6MWT indicated that two tests may be needed to accurately assess an individual's capabilities.


Assuntos
Acidente Vascular Cerebral/fisiopatologia , Teste de Caminhada/métodos , Idoso , Feminino , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
19.
Minerva Pediatr ; 71(3): 229-234, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017381

RESUMO

BACKGROUND: The 6-minute walk test (6MWT) in children can be performed in the conventional way, or by using a measuring wheel. This study aimed to compare these test modalities and to determine influencing factors. METHODS: The study included 317 healthy children (172 boys) between 6 and 15 years from elementary schools and high schools, who were randomly assigned to perform a 6MWT either with or without a measuring wheel according to the guidelines of the American Thoracic Society. The 6-minute walk distance (6MWD) was compared between the two measuring modalities as well as different school types. RESULTS: The use of a measuring wheel during the 6MWT led to a significantly greater 6MWD compared to conventional walking. Students of sports schools walked substantially farther than those attending general high schools, irrespective of test modality. In multivariate regression analysis height, post-test heart rate, male sex and the measuring wheel itself were all independently associated with greater 6MWD. CONCLUSIONS: The use of a measuring wheel during a 6MWT reflects physical performance in children and adolescents more accurately as it includes the stretch of way around the cones during lap turns. Test modalities and sports background should be taken into account, especially when performing longitudinal monitoring and multicenter studies.


Assuntos
Frequência Cardíaca/fisiologia , Instituições Acadêmicas , Teste de Caminhada/métodos , Caminhada/fisiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores Sexuais
20.
Geriatr Gerontol Int ; 19(5): 409-413, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30884073

RESUMO

AIM: To determine the effect of two neuromuscular electrical stimulation (NMES) periods on quadriceps strength (QS) and functional performance in nursing home residents. METHODS: A total of 53 older adults living in a nursing home were randomized into two groups: NMES with a short stimulation period and NMES with a long stimulation period. The quadriceps muscles were bilaterally stimulated three times a week for 6 weeks in both groups. Strength was measured with a digital handheld dynamometer and 30-s chair stand test. Functional performance was evaluated with the Berg balance scale, Timed Up and Go test and 6-min walking test. RESULTS: Analysis was carried out on 44 older adults, who completed the study protocol. The isometric QS did not change within groups or between groups. Interestingly, the 30-s chair stand test score increased for both groups, but the improvements were similar among groups. The Berg balance scale score, Timed Up and Go test time and 6-min walking test distance also improved in both groups. However, no difference in any of the functional outcome measures was observed between groups. CONCLUSIONS: The present findings showed that both NMES protocols might be an alternative to achieve an improvement in functional strength of the lower extremities and functional performance in nursing home residents, whereas neither of the two protocols seems effective for improving isometric QS. Both methods might contribute to maintaining isometric QS during the aging process. Geriatr Gerontol Int 2019; 19: 409-413.


Assuntos
Terapia por Estimulação Elétrica/métodos , Instituição de Longa Permanência para Idosos , Extremidade Inferior/fisiopatologia , Casas de Saúde , Desempenho Físico Funcional , Músculo Quadríceps , Idoso , Feminino , Humanos , Masculino , Força Muscular , Equilíbrio Postural , Resultado do Tratamento , Teste de Caminhada/métodos
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