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1.
PLoS One ; 15(10): e0239203, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33112909

RESUMO

BACKGROUND: There currently is no field test available for measuring maximal exercise capacity in people with stroke. OBJECTIVE: To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. DESIGN: Longitudinal study design. SETTING: Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. SUBJECTS: People with subacute or chronic stroke. INTERVENTIONS: A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). MAIN MEASURES: Number of shuttles completed, 1stVentilatory Threshold (1stVT). RESULTS: The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). CONCLUSIONS: The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.


Assuntos
Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Limiar Anaeróbio , Teste de Esforço/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Consumo de Oxigênio , Reprodutibilidade dos Testes , Reabilitação do Acidente Vascular Cerebral , Caminhada/fisiologia
2.
Health Qual Life Outcomes ; 18(1): 300, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891156

RESUMO

BACKGROUND: Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR). METHODS: Correlations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR. RESULTS: Overall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George's Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: - 0.36; p<0.001). CONCLUSIONS: PROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program. TRIAL REGISTRATION: Netherlands Trial Register ( NL3263 /NTR3416). Registered 2 May 2012.


Assuntos
Teste de Esforço/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos
3.
Mayo Clin Proc ; 95(6): 1184-1194, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32498774

RESUMO

OBJECTIVE: To relate cardiorespiratory fitness (CRF) and hemodynamic responses to exercise to the incidence of chronic kidney disease (CKD). METHODS: We evaluated 2715 Framingham Offspring Study participants followed up (mean, 24.8 years) after their second examination (1979-1983) until the end of their ninth examination (2011-2014). Participants (mean age, 43 years; 1397 women [51.5%]) without prevalent CKD or cardiovascular disease at baseline were included. We examined the associations of CRF and hemodynamic response to exercise with incident CKD using multivariable Cox proportional hazards regression with discrete intervals. RESULTS: Compared with low CRF (first tertile), participants with moderate (second tertile) or high (third tertile) CRF had a lower risk of CKD (hazard ratios [95% CIs]: 0.74 [0.61-0.91] and 0.73 [0.59-0.91], respectively). Participants with chronotropic incompetence (hazard ratio, 1.38 [95% CI, 1.06 to 1.79]), higher exercise systolic blood pressure (hazard ratio per SD, 1.20 [95% CI, 1.07 to 1.34]), and impaired heart rate recovery (hazard ratio, 1.51 [95% CI, 1.08 to 2.10]) had a higher risk of CKD compared with those with chronotropic competence, lower exercise systolic blood pressure, and normal heart rate recovery, respectively. These associations remained robust when the exercise variables were mutually adjusted for. The third tertile of a standardized exercise test score comprising the statistically significant variables was associated with a higher risk of CKD compared with the first tertile (hazard ratio, 1.85; 95% CI, 1.45 to 2.36). CONCLUSION: Higher CRF and favorable hemodynamic responses to submaximal exercise in young adulthood may be markers of lower risk of CKD in later life.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Teste de Esforço/métodos , Insuficiência Renal Crônica/epidemiologia , Adulto , Pressão Sanguínea/fisiologia , Teste de Esforço/estatística & dados numéricos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco
4.
J Strength Cond Res ; 34(7): 2093-2103, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32287090

RESUMO

Fyock-Martin, MB, Erickson, EK, Hautz, AH, Sell, KM, Turnbaugh, BL, Caswell, SV, and Martin, JR. What do firefighting ability tests tell us about firefighter physical fitness? A systematic review of the current evidence. J Strength Cond Res 34(7): 2093-2103, 2020-The firefighting profession is a physiologically demanding occupation. Currently, sudden cardiac deaths account for 40-50% of firefighter job-related deaths, for which, inadequate aerobic fitness (AF) and obesity are established as risk factors. Departments have instituted firefighting physical ability tests (FPATs) as a method of quantifying readiness for occupational-related demands. A systematic review of the current literature examining the correlation between field fitness test performance and FPAT completion times was performed. The search identified 5 studies that met the eligibility criteria. The total number of subjects in the 5 studies was 265 (259 men and 6 women), including 200 professional firefighters (75.5%), 40 volunteer (15.1%), 20 officers (7.5%), and 5 recruits (1.9%). Upper-body strength (UBs) and upper-body endurance (UBe) had the strongest correlation to FPATs (r = -0.31 to -0.66; R = 0.10 to 0.44 and r = -0.27 to -0.61; R = 0.07 to 0.37; p < 0.05, respectively). Two studies suggested that AF has a weak-to-moderate relationship with FPATs (r = 0.38 and r = -0.62). Two studies showed that anaerobic capacity had weak-to-strong correlations with FPATs (r = -0.40 and r = 0.79; R = 0.16 to 0.62; p < 0.05). No studies found a statistically significant correlation between lower-body strength and FPAT performance. Further research is needed to better understand the role of field-based fitness test results on FPAT performance. An annual department-driven multicomponent fitness assessment measuring UBs, UBe, anaerobic capacity, and AF is recommended based on the evidence reviewed.


Assuntos
Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Bombeiros , Aptidão Física/fisiologia , Aptidão Cardiorrespiratória/fisiologia , Humanos , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Resistência Física/fisiologia , Fatores de Risco
5.
PLoS One ; 15(4): e0227185, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271758

RESUMO

Standardized physical fitness monitoring provides a more accurate proxy for youth health when compared with physical activity. Little is known about the utilization of broad-scale individual-level youth physical fitness testing to explore health disparities. We examined longitudinal trends in population-level fitness for 4th-12th grade New York City youth during 2006/7-2016/17 (average n = 510,293 per year). Analyses were performed in 2019. The primary outcome was whether or not youth achieved sex-/age-specific performance levels (called the Healthy Fitness Zone) on the aerobic capacity, muscular strength and muscular endurance tests using the NYC FITNESSGRAM. The Cooper Institute's most recent Healthy Fitness Zone criteria were applied to all tests and years. Prevalence estimates were weighted, accounted for school clustering, adjusted for student-level sociodemographics, and run by sociodemographic subgroups and year. The overall prevalence for meeting 3 Healthy Fitness Zones increased from 15.5% (95%CI: 13.9%-17.0%) in 2006/7 to 23.3% (95%CI: 22.2%-24.4%) in 2016/17 for students in grades 4-12. Fitness for all student groups increased over time, although Hispanic and non-Hispanic black girls consistently had the lowest prevalence of meeting 3 Healthy Fitness Zones as compared to all other race/sex subgroups. Also, 9th-12th graders had a lower prevalence of meeting 3 Healthy Fitness Zones as compared to 4th-8th graders. Given forecasted sharp increases in cardiovascular disease prevalence, routine youth fitness surveillance using standardized, criterion referenced methods can identify important fitness disparities and inform interventions.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Disparidades nos Níveis de Saúde , Aptidão Física/fisiologia , Estudantes/estatística & dados numéricos , Adolescente , Fatores Etários , Doenças Cardiovasculares/fisiopatologia , Criança , Teste de Esforço/normas , Teste de Esforço/estatística & dados numéricos , Teste de Esforço/tendências , Feminino , Humanos , Estudos Longitudinais , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Fatores Sexuais , Adulto Jovem
6.
Circ Cardiovasc Imaging ; 13(4): e009986, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32268807

RESUMO

BACKGROUND: Inconclusive noninvasive tests complicate the care of patients with suspected coronary artery disease, but their prevalence and impact on management, outcomes, and costs are not well described. METHODS: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) patients were randomized to stress testing (n=4533) or computed tomographic angiography (CTA; n=4677). We assessed relationships between inconclusive results, subsequent testing, a composite outcome (death, myocardial infarction, or hospitalization for unstable angina), and healthcare expenditures. RESULTS: Overall, 8.0% of tests were inconclusive (9.7% stress, 6.4% CTA). Compared with negative tests, inconclusive tests were more often referred to a second noninvasive test (stress: 14.6% versus 8.5%, odds ratio [OR], 1.91; CTA: 36.5% versus 8.4%, OR, 5.95; P<0.001) and catheterization (stress: 5.5% versus 2.4%, OR, 2.36; CTA: 23.4% versus 4.1%, OR, 6.49; P<0.001), and composite outcomes were higher for both inconclusive tests (stress: 3.7% versus 2.0%, hazard ratio, 1.81, P=0.034; CTA: 5.0% versus 2.2%, hazard ratio, 1.85; P=0.044) and positive tests (stress: 8.3% versus 2.0%, hazard ratio, 3.50; CTA: 9.2% versus 2.2%, hazard ratio, 3.66; P<0.001). Twenty-four-month costs were higher for inconclusive tests than negative tests by $2905 (stress) and $4030 (CTA). CONCLUSIONS: Among patients with stable chest pain undergoing a noninvasive test, inconclusive results occurred in 6% of CTA and 10% of stress tests. Compared with those with conclusive negative tests, individuals with inconclusive results more often underwent subsequent testing, had increased medical costs, and experienced worse outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01174550.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Teste de Esforço/métodos , Idoso , Angiografia por Tomografia Computadorizada/economia , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Angiografia Coronária/economia , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Teste de Esforço/economia , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
Phys Ther ; 100(3): 447-456, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32031221

RESUMO

BACKGROUND: Cancer-related fatigue is a symptom commonly reported in survivors of breast cancer and is the most variable symptom. Besides questionnaires like PIPER to assess cancer-related fatigue, there is a need to objectively measure fatigue. OBJECTIVE: The aim of this study was to assess the physiological dimension of fatigue based on acceleration during a 30-second maximal sit-to-stand test. DESIGN: This was a cross-sectional study. METHODS: Linear acceleration from a smartphone placed on the sternum was recorded in 70 survivors of breast cancer. Fourth-degree polynomial adjustment from the acceleration signal to the vertical and anterior-posterior axis was calculated. The fatigue temporal cut-off point was detected as a change in the curve slope of the first maximum point of acceleration. RESULTS: Women were aged 51.8 (8.9) years with a body mass index of 25.4 (5.1) Kg/m2. They performed 23.6 (6.57) number of repetitions. The mean fatigue cut-off point from the total sample was 10.2 (3.1) seconds. LIMITATIONS: Further research should employ time-prolonged tests to study acceleration behavior beyond 30 seconds as well as include a physiological criterion that justifies the nonlinear saturation of the acceleration-based criterion. CONCLUSIONS: This study assessed fatigue through a low-cost and easy-to-use methodology during a functional and widely used test such as 30-second maximal sit-to-stand. This would allow clinicians to assess fatigue in a short-effort exercise to individualize exercise prescription dose, measure changes during intervention, and track fatigue objectively throughout survivorship.


Assuntos
Aceleração , Neoplasias da Mama/fisiopatologia , Sobreviventes de Câncer , Teste de Esforço/instrumentação , Fadiga/diagnóstico , Smartphone/instrumentação , Adulto , Idoso , Neoplasias da Mama/terapia , Estudos Transversais , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Fadiga/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Fenômenos Físicos , Postura Sentada , Posição Ortostática , Fatores de Tempo
8.
Medicina (Kaunas) ; 56(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32075328

RESUMO

Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual's aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = -8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = -4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/normas , Teste de Esforço/métodos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Estudos Prospectivos
9.
Mayo Clin Proc ; 95(1): 44-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902428

RESUMO

OBJECTIVE: To analyze the association between cardiorespiratory fitness (CRF) and global and local brain volumes. PARTICIPANTS AND METHODS: We studied 2103 adults (21-84 years old) from 2 independent population-based cohorts (Study of Health in Pomerania, examinations from June 25, 2008, through September 30, 2012). Cardiorespiratory fitness was measured using peak oxygen uptake (VO2peak), oxygen uptake at the anaerobic threshold (VO2@AT), and maximal power output from cardiopulmonary exercise testing on a bicycle ergometer. Magnetic resonance imaging brain data were analyzed by voxel-based morphometry using regression models with adjustment for age, sex, education, smoking, body weight, systolic blood pressure, glycated hemoglobin level, and intracranial volume. RESULTS: Volumetric analyses revealed associations of CRF with gray matter (GM) volume and total brain volume. After multivariable adjustment, a 1-standard deviation increase in VO2peak was related to a 5.31 cm³ (95% CI, 3.27 to 7.35 cm³) higher GM volume. Whole-brain voxel-based morphometry analyses revealed significant positive relations between CRF and local GM volumes. The VO2peak was strongly associated with GM volume of the left middle temporal gyrus (228 voxels), the right hippocampal gyrus (146 voxels), the left orbitofrontal cortex (348 voxels), and the bilateral cingulate cortex (68 and 43 voxels). CONCLUSION: Cardiorespiratory fitness was positively associated with GM volume, total brain volume, and specific GM and white matter clusters in brain areas not primarily involved in movement processing. These results, from a representative population sample, suggest that CRF might contribute to improved brain health and might, therefore, decelerate pathology-specific GM decrease.


Assuntos
Limiar Anaeróbio , Encéfalo , Aptidão Cardiorrespiratória/fisiologia , Substância Cinzenta , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Correlação de Dados , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
10.
Med Sci Sports Exerc ; 52(6): 1248-1255, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31977641

RESUMO

PURPOSE: Cardiopulmonary exercise testing of peak oxygen uptake (V˙O2peak) is the gold standard to measure cardiorespiratory fitness (CRF). For resource-intensive evaluation, equations estimating CRF (eCRF) may be used. The purpose was to investigate if an eCRF equation from a healthy population is useful in persons with rheumatoid arthritis (RA), and if necessary, develop new equations for eCRF in this group. METHODS: V˙O2peak results from 93 persons with RA were compared with eCRF calculated by an established equation for healthy individuals including age, sex, physical activity (PA index), resting HR (RHR), and waist circumference. Because of deviation from the observed V˙O2peak, new equations for eCRF in persons with RA were developed from regression analysis of variables associated with observed V˙O2peak. RESULTS: The established equation overestimated CRF (R = 0.48, root mean square error [RMSE] = 7.07). The new RA equation more accurately estimated CRF (R = 0.81, RMSE = 4.44) (female = 0, male = 1; never smoked = 0, ever smoked = 1): eCRF = 77.961 + (sex × 28.791) - (age × 0.358) - (age-sex interaction × 0.326) - (body mass index [BMI] × 0.700) - (RHR × 0.125) - (smoking × 1.854) + (PA index × 0.211) - (patient global RA assessment × 0.071). Alternative new RA equation (R = 0.79, RMSE = 4.63): eCRF = 77.851 + (sex × 25.460) - (age × 0.381) - (age-sex interaction × 0.254) - (BMI × 0.743) - (RHR × 0.115) - (smoking × 2.154) + (PA index × 0.209). CONCLUSIONS: The new RA equations better predicted CRF in individuals with RA, preventing overestimation in low-fit persons. The new equation should be preferred when estimating CRF in individuals with RA. The alternative equation, without patient global assessment, is useful for individuals with RA in population-based studies.


Assuntos
Artrite Reumatoide/fisiopatologia , Aptidão Cardiorrespiratória , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Fatores Etários , Idoso , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Fatores Sexuais , Fumar/fisiopatologia , Circunferência da Cintura
11.
Am J Med ; 133(8): 976-985, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31987803

RESUMO

BACKGROUND: Compared with troponin T/I test, the introduction of a high-sensitive (hs) troponin test may result in a higher proportion of positive test results in patients with chest pain and over-testing in patients without acute coronary syndrome. We assessed the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an emergency department. METHODS: Retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011). RESULTS: Data from 1274 patients (standard 597 [46.9%], hs-troponin 677 [53.1%]) were analyzed. The proportion of patients with non-ST-segment elevation myocardial infarction increased (hs-troponin 14.9%, compared with 9.7%); the proportion in unstable angina (1.5% to 4.0%) and other cardiac illnesses (8.1% to 11.7%) decreased. Although the proportion of noncardiac chest pain illnesses (67%) remained unchanged, the proportion of positive hs-troponin was higher (6.1% vs 2.0%). The average number of additional tests/person decreased in troponin-positive patients (2.0 to 1.7 test per patient; P = .02) and troponin-negative patients (3.1 to 2.8 tests; P < .0001). CONCLUSION: Although the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with noncardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an emergency department, indicating an increased confidence of clinicians in their diagnosis.


Assuntos
Síndrome Coronariana Aguda/sangue , Angina Instável/sangue , Análise Química do Sangue/métodos , Dor no Peito/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Troponina T/sangue , Síndrome Coronariana Aguda/diagnóstico , Adulto , Idoso , Angina Instável/diagnóstico , Dor no Peito/etiologia , Angiografia Coronária/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Serviço Hospitalar de Emergência , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Estudos Retrospectivos , Suíça , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
12.
Int J Sports Physiol Perform ; 15(5): 690-695, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32000136

RESUMO

BACKGROUND: Half-marathon races have become increasingly more popular with many recreational athletes all around the world. New and recreational runners are likely to have the greatest need for training advice to set running paces during long-distance races. PURPOSE: To develop a simple equation to estimate half-marathon time from the Cooper test and verify its validity. METHODS: One hundred ninety-eight recreational runners (177 men and 21 women, 40 [6.8] years and 33.7 [8] years, respectively) participated in this study. All runners completed the Cooper test 7 to 10 days prior to races. A stepwise multiple regression analysis was performed to select the main predictors of half-marathon time. RESULTS: Simple correlation analysis showed that Cooper test performance (distance) was a good construct to estimate half-marathon time (r = -.906; 95% confidence interval, -0.927 to -0.877; P < .0001). The authors also derived an equation with a high predictive validity (R2 = .82; standard error of estimation = 5.19 min) and low systematic bias (mean differences between the predicted value and the criterion of 0.48 [5.2] min). Finally, the concordance coefficient of correlation (.9038) and proportional bias analysis (Kendall τ = -.0799; 95% confidence interval, -0.184 to 0.00453; P = .09) confirmed a good concurrent validity. CONCLUSION: In this study, the authors derived an equation from the Cooper test data with a high predictive and concurrent validity and low bias.


Assuntos
Teste de Esforço/estatística & dados numéricos , Resistência Física/fisiologia , Análise de Regressão , Corrida/fisiologia , Adulto , Feminino , Frequência Cardíaca , Humanos , Masculino , Modelos Estatísticos , Percepção/fisiologia , Esforço Físico/fisiologia , Reprodutibilidade dos Testes , Fatores de Tempo
13.
Eur Heart J Acute Cardiovasc Care ; 9(1): 52-61, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29543035

RESUMO

BACKGROUND: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. METHODS: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society. RESULTS: Median time from symptom onset to first medical contact was 2 h in patients with ST-elevation myocardial infarction (STEMI) and 4 h in patients with unstable angina and non-STEMI (NSTEMI). In patients with STEMI, median time from hospital admission to percutaneous coronary intervention (PCI) was 40 min and median time from first medical contact to PCI was 1 h 35 min. Primary PCI was performed in 94.7% of patients with STEMI, 70.0% of patients with NSTEMI and 37.4% of patients with unstable angina. PCI was performed during the first 24 h in 79.5% of patients with NSTEMI and the first 72 h in 89.0% of patients with unstable angina. Electrocardiograms were performed in 99.5% after a median of 6 min after admission and obtained within 10 min in 71%. Interestingly, 56.1% of patients were found to have non-ACS diagnoses, underlining the importance of access to additional diagnostic modalities including echocardiography, stress testing or computed tomography. CONCLUSIONS: Guideline-adherence regarding critical time intervals and primary PCI rates is good in German Chest Pain Units. More than half of patients admitted with suspected ACS had non-ACS diagnoses. Improvements in pre-hospital time delays through public awareness programmes are warranted.


Assuntos
Dor no Peito/diagnóstico , Fidelidade a Diretrizes/ética , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Idoso , Angina Instável/diagnóstico , Angina Instável/cirurgia , Eletrocardiografia/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/estatística & dados numéricos , Estudos Prospectivos , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X/estatística & dados numéricos
14.
Clin Physiol Funct Imaging ; 40(2): 83-90, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31697026

RESUMO

INTRODUCTION: A new grading of exercise capacity during bicycle stress testing has been proposed in Sweden based on the new reference material ('the Kalmar material'), which has not been validated. We aimed to examine the prognostic information of the new grading of exercise capacity during exercise stress testing. METHODS: Data on all bicycle exercise tests performed at the Department of Clinical Physiology in Kalmar between May 2005 and October 2016 were cross-linked with the Causes of Death Register (until 30 April 2019) and the National Patient Register (until 12 December 2017). Exercise capacity was graded based on predicted exercise capacity: ≥120% (good), 75 to <120% (normal), 70 to <75% (mildly reduced), 50 to <70% (moderately reduced) and <50% (severely reduced). Associations with all-cause mortality, cardiovascular mortality and hospitalization for ischaemic heart disease (IHD) and heart failure were analysed using Cox regression. RESULTS: A total of 13 887 patients were followed a median of 7·7 years (interquartile range 5·0-10·8); 1809 patients died (546 from cardiovascular disease). Compared to normal exercise capacity, reduction of exercise capacity was strongly associated with increased all-cause mortality [(hazard ratio; 95% confidence interval): mild (3·0; 2·6-3·5); moderate (4·4; 3·9-4·9); and severe reduction (8·5; 7·2-10·0)]. Reduced exercise capacity was also associated with increased risks of cardiovascular hospitalization and mortality. CONCLUSION: Reduced exercise capacity is associated with increased all-cause and cardiovascular mortality, as well as increased risk of future IHD and heart failure diagnosis and hospitalization. In patients with reduced exercise capacity, mortality is progressively increased with worsening grade of exercise capacity.


Assuntos
Ciclismo , Doenças Cardiovasculares/diagnóstico , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Tolerância ao Exercício , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Suécia
15.
J Ren Care ; 46(1): 25-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845535

RESUMO

BACKGROUND: It is important to determine relative and absolute reliability values in outcome measures that are used in clinical practice so as to discriminate between true changes following exercise interventions for patients with chronic kidney disease (CKD). OBJECTIVE: The study aimed to assess test-retest reliability of the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 seconds (STS-60), timed up and go (TUAG), Duke's activity status index (DASI) and hospital anxiety and depression scale (HAD) in patients with CKD. STUDY DESIGN: This study was a pragmatic non-randomised controlled trial. METHODS: Forty people attended two study visits within a 16-day window involving the ISWT, STS-60, TUAG, DASI and HAD tests. Relative reliability was assessed using intraclass correlation coefficient (ICC) and absolute reliability using the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS: Good test-retest reliability was found for the entire sample size across all outcome measures, with TUAG having the highest (ICC = 0.96) and HAD the lowest (ICC = 0.71). The MDC scores at 90% confidence interval (CI) were: 79.6 m for the ISWT, 2.9 seconds for the TUAG, 7.0 repetitions for the STS-60, 8.4 for the DASI, 3.8 for the anxiety HAD subscale and 4.4 for the depression HAD subscale. CONCLUSIONS: This study demonstrated good test-retest reliability for all outcome measures across the CKD trajectory but caution needs to be taken when interpreting the findings for each CKD sub-group separately. The MDC scores at 90% CI can support therapists in determining a true improvement in CKD patients' physical or mental performance.


Assuntos
Teste de Esforço/normas , Caminhada/fisiologia , Adulto , Idoso , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Caminhada/estatística & dados numéricos
16.
Medicina (Kaunas) ; 55(11)2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31766291

RESUMO

Background and objectives: Maximal heart rate (HRmax) is an important training and testing tool, especially in the context of evaluating intensity in exercise prescription; however, few studies have examined the validity of prediction equations of HRmax in physically active female adolescents and the role of maturation level. Therefore, the aim of the present study was to examine the differences between measured and predicted HRmax in a sample of physically active female adolescents. Materials and Methods: Seventy-one selected volleyball players (age 13.3 ± 0.7 years, body mass 62.0 ± 7.2 kg, height 1.72 ± 0.06 m) performed a 20 m shuttle run endurance test, and the actual HRmax was compared with Tanaka HRmax ('208 - 0.7 × age') and Fox HRmax ('220 - age'). Results: A large main effect of assessment method on HRmax was found (p < 0.001, η2 = 0.486) with Fox overestimating actual HRmax by 6.8 bpm (95% confidence intervals, CI; 4.2, 9.3) and Tanaka underestimating actual HRmax by -2.6 bpm (95% CI; -5.1, -0.1). The more matured participants had similar actual HRmax (mean difference -2.4 bpm; 95% CI; -6.5, 1.7; p = 0.242, d = -0.28), difference Fox - actual HRmax (1.5 bpm; 95% CI; -2.6, 5.6, p = 0.466, d = 0.17), and difference Tanaka - actual HRmax (1.7 bpm; 95% CI; -2.4, 5.8; p = 0.414, d = 0.19) to the less matured participants. Conclusions: These findings suggest that age-based prediction equations of HRmax developed in adult populations should be applied with caution in physically active female adolescents, and Tanaka should be preferred instead of the Fox equation.


Assuntos
Envelhecimento/fisiologia , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Adolescente , Índice de Massa Corporal , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos
17.
Medicina (Kaunas) ; 55(11)2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31731714

RESUMO

Background and objectives: Wheelchair basketball players are classified into four functional classes according to the player's "volume of action", characterized by trunk movement and stability. As this classification is based on a kinematic point of view, test items might be differentially affected by the functional classification level. We aimed to clarify field-based skill test items closely related to the functional classification level. Materials and Methods: Twenty-six female wheelchair basketball athletes (Japan National Team candidates) completed seven field-based skill tests (20 m sprint, agility T-test, figure-eight with a ball test, the Yo-Yo 10 m recovery test, and three types of maximal passes), and anthropometric measurements were applied. Results: Significant differences among the classification levels were found for one-hand maximal passes (baseball and hook passes) and the figure-eight with a ball test. Furthermore, performance in the 20 m sprint and 10 m Yo-Yo recovery tests significantly differed between classes 1 and 4. Conclusions: The test items most influenced by the classification levels were one-hand passes, which require trunk stability and balance not only in the horizontal plane, but also in the sagittal and frontal planes. Coaches should consider which test items are strongly affected by the functional classification level when assessing a player's performance.


Assuntos
Basquetebol/classificação , Destreza Motora/classificação , Paratletas/classificação , Adulto , Análise de Variância , Basquetebol/estatística & dados numéricos , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Japão , Paratletas/estatística & dados numéricos , Cadeiras de Rodas
18.
J Athl Train ; 54(10): 1095-1104, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31633414

RESUMO

CONTEXT: Gymnastics trains fundamental movement skills but has high rates of early sport specialization. Early specialization is associated with increased injury risk. Gymnasts devote time to developing technical skill, but whether specialization status influences performance is unknown. OBJECTIVE: To describe the participation and specialization characteristics of youth club gymnastics participants and determine whether the level of specialization is associated with fitness and functional task performance. DESIGN: Retrospective cross-sectional study. SETTING: A single gymnastics facility. PATIENTS OR OTHER PARTICIPANTS: Data on youth gymnasts (n = 131; 84 females, 47 males; age = 10.9 ± 2.9 years, height = 142.14 ± 16.23 cm, mass = 38.15 ± 12.93 kg) were reviewed. MAIN OUTCOME MEASURE(S): Specialization was assessed using a 3-tiered classification. Fitness measurements consisted of the Gymnastics Functional Measurement Tool, Men's Gymnastics Functional Measurement Tool, and core strength. Functional tasks evaluated hop performance, dynamic balance, and jump-landing technique. Separate analyses of covariance, covaried by age, hours of training, and years of gymnastics participation, were used to identify differences in fitness and functional performance among specialization groups. Pearson product correlations were calculated to evaluate the relationships between training hours per week and years in gymnastics with fitness and functional performance. RESULTS: Most gymnasts were classified as moderately (50.4%, n = 66) or highly (35.1%, n = 46) specialized. Only 14.5% (n = 19) were classified as having a low level of specialization. Weak to moderate correlations were present between years in gymnastics and most fitness tasks. Moderate to strong correlations were noted between training hours per week and most fitness tasks. Low-specialization gymnasts scored lower on right lower extremity Y-balance (P = .004), upper left extremity Y-balance (P = .033), and right hop performance (P = .039) tests. CONCLUSIONS: Gymnasts reported high proportions of moderate to high specialization, and many exceeded guidelines for hours participating in gymnastics per week. We did not observe clinically meaningful group differences among specialization status and fitness or functional movement tasks, indicating no clear benefit of gymnastics training to the exclusion of other sports for increased performance.


Assuntos
Teste de Esforço/métodos , Ginástica/fisiologia , Desempenho Físico Funcional , Especialização , Adolescente , Criança , Estudos Transversais , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Destreza Motora , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
19.
JAMA Netw Open ; 2(10): e1913070, 2019 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-31603486

RESUMO

Importance: Owing to a rapid increase in rates of diagnostic cardiovascular testing in the 1990s and early 2000s, the Centers for Medicare & Medicaid Services implemented a series of payment changes intended to reduce overall spending on fee-for-service testing. Whether guideline-concordant testing has been subsequently affected is unknown to date. Objective: To determine whether changes in overall rates of use of diagnostic cardiovascular tests were associated with changes in high-value testing recommended by guidelines and low-value testing that is expected to provide minimal benefits. Design, Setting, and Participants: This retrospective cohort study assessed a national 5% random sample of Medicare fee-for-service beneficiaries aged 65 to 95 years from January 1, 1999, through December 31, 2016. Data were analyzed from February 15, 2018, through August 15, 2019. Exposures: Eligibility to receive high-value testing (assessment of left ventricular systolic function among patients hospitalized with acute myocardial infarction or heart failure) and low-value testing (stress testing before low-risk noncardiac surgery and routine stress testing within 2 years of coronary revascularization not associated with acute care visits). Main Outcomes and Measures: Age- and sex-adjusted annual rates of overall, high-value, and low-value diagnostic cardiovascular testing. Results: Mean (SD) age was similar over time (75.57 [7.32] years in 2000-2003; 74.82 [7.79] years in 2012-2016); the proportion of women slightly declined over time (63.23% in 2000 to 2003; 57.27% in 2012 to 2016). The rate of overall diagnostic cardiovascular testing per 1000 patient-years among the 5% sample of Medicare beneficiaries increased from 275 in 2000 to 359 in 2008 (P < .001) and then declined to 316 in 2016 (P < .001). High-value testing increased steadily over the entire study period for patients with acute myocardial infarction (85.7% to 89.5%; P < .001) and heart failure (72.6% to 80.1%; P < .001). Low-value testing among patients undergoing low-risk surgery increased from 2.4% in 2000 to 3.8% in 2008 (P < .001) but then declined to 2.5% in 2016 (P < .001). Low-value testing within 2 years of coronary revascularization slightly increased from 47.4% in 2000 to 49.2% in 2003 (P = .03) but then declined to 30.8% in 2014 (P < .001). Conclusions and Relevance: Rates of overall and low-value diagnostic cardiovascular testing appear to have declined considerably and rates of high-value testing have increased slightly. Payment changes intended to reduce spending on overall testing may not have adversely affected testing recommended by guidelines.


Assuntos
Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Testes de Função Cardíaca/estatística & dados numéricos , Testes de Função Cardíaca/tendências , Medicare/estatística & dados numéricos , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/estatística & dados numéricos , Cateterismo Cardíaco/tendências , Angiografia por Tomografia Computadorizada , Ponte de Artéria Coronária/estatística & dados numéricos , Ecocardiografia/normas , Ecocardiografia/tendências , Teste de Esforço/estatística & dados numéricos , Teste de Esforço/tendências , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Intervenção Coronária Percutânea/estatística & dados numéricos , Tomografia por Emissão de Pósitrons , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Tomografia Computadorizada de Emissão de Fóton Único/tendências , Estados Unidos , Disfunção Ventricular Esquerda/fisiopatologia
20.
Mil Med Res ; 6(1): 30, 2019 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-31543076

RESUMO

BACKGROUND: The U.S. Air Force physical fitness assessment (PFA) is used to determine the overall fitness of their personnel. It is currently unknown to what extent the PFA scores of Reserve Officers' Training Corps (ROTC) cadets are affected by mandatory physical training. The purpose of this investigation was to longitudinally examine the PFAs of ROTC cadets over a four-year period, evaluate the results across class ranks, and evaluate the sensitivity of the classification of the tests. METHODS: Air Force ROTC cadets performed the PFAs (abdominal circumference, 1-min pushups, 1-min sit-ups, and a 1.5-mile run) in both the spring (n = 26) and fall (n = 22) semesters. PFAs were compiled over a four-year period (Spring 2014 - Fall 2017) and were performed in accordance with Air Force Instruction 36-2905. A one-way repeated measures ANOVA was performed separately for the fall and spring groups for each dependent variable across the 4 years. Additionally, a one-way between groups ANOVA was performed for each dependent variable during the time point (fall 2015; N = 46) with the most recorded cadets for each class rank. RESULTS: Longitudinal assessments revealed a main effect of time (P = 0.010) on abdominal circumference; cadets had a smaller abdominal circumference in their freshman year than in their senior year. A main effect of time (P = 0.006) was also observed on sit-up quantity; cadets performed more sit-ups in their junior year than in their freshman year. Examining between class ranks during the same year (between-subjects ANOVA) revealed a main effect of class rank on sit-up quantity (P = 0.003); the freshmen completed fewer repetitions than the sophomores (P = 0.018) and the juniors did (P = 0.001). CONCLUSION: The results indicated that only the sit-up component showed differences between class ranks. These findings suggest that the Air Force PFA may not be sensitive enough to detect changes in physical fitness or distinguish between class ranks regarding physical performance, even after years of training. This limitation may be in part due to the limited duration of training incorporated by the ROTC program (2 h per week), which provided a maintenance effect rather than improvement in physical performance. We recommend that more attention be directed to the efficacy of physical training, the sensitivity of measures included in the PFA, or both.


Assuntos
Teste de Esforço/estatística & dados numéricos , Militares/estatística & dados numéricos , Aptidão Física , Composição Corporal , Índice de Massa Corporal , Humanos , Estudos Longitudinais , Masculino , Estados Unidos , Adulto Jovem
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