Cardiac Rehabilitation in Saudi Arabia: Current Status and Future Directions.

PURPOSE OF REVIEW: Cardiovascular diseases (CVDs) are the leading cause of mortality in Saudi Arabia. Cardiac rehabilitation (CR) is one of the well-known interventions to control and minimize the burden of CVDs. Despite recommendations, CR utilization remains suboptimal in Saudi Arabia due to many reasons, including limited awareness, logistical barriers, shortage of specialized facilities and trained professionals, and perceptions about CVDs illness. This review is to evaluate the current status, effectiveness, accessibility, and challenges of CR utilization in Saudi Arabia, and to explore potential future directions for improving these services. The review addresses key questions regarding the incidence of CVDs, the characteristics of existing CR programs, barriers to CR access, and stakeholder perspectives. RECENT FINDINGS: Recent studies demonstrate that the effectiveness of CR, particularly exercise training, in improving outcomes for post-coronary artery bypass grafting (CABG) patients is well-documented, though data on its impact on other cardiac conditions is limited. There are significant barriers to CR utilization in Saudi Arabia, including limited awareness, logistical challenges, a shortage of specialized facilities and trained professionals, and cultural perceptions about CVD. Stakeholder perspectives highlight the necessity for culturally sensitive and inclusive approaches, particularly in addressing gender-specific needs and enhancing patient-provider communication. The Saudi Vision 2030 presents opportunities to expand and enhance CR services in alignment with international standards. This review found that while CR is a crucial intervention for managing CVDs, its utilization in Saudi Arabia is suboptimal due to various barriers. To improve CR access and effectiveness, future strategies should focus on increasing public and professional awareness, developing infrastructure, training healthcare professionals, and fostering public-private partnerships. These measures are essential to making CR more accessible and tailored to the diverse needs of the Saudi population, ultimately enhancing the quality of cardiovascular care and patient outcomes in the region.

The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: a placebo-controlled randomized clinical investigation.

OBJECTIVE: Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA. METHODS: This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for ∼35 min, thrice/week over 12 weeks. The maximal inspiratory (IPmax) and expiratory (EPmax) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index], and asthma control test (ACT) were assessed before and after the intervention. RESULTS: The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (P=.031 and P=.009 respectively) or the In-MT (P=.029 and P=.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (P=.001, P=.004, and P=.0005 respectively) or In-MT (P=.038, P=.037, and P=.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (P<.001) or In-MT (P=.002) training. CONCLUSION: This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA.

The relationship between smartphone usage duration (using smartphone's ability to monitor screen time) with hand-grip and pinch-grip strength among young people: an observational study.

BACKGROUND: The use of smartphones has become widely popular, especially among young people, for multiple purposes other than communication, including gaming and internet browsing. The hand and wrist weakness is one of the main complications associated with the increased use of smartphones. This weakness occurs due to the repetitive flexion and extension of the wrist, thumb, and fingers, leading to a significant musculoskeletal pathology. Little is known about the relationship between smartphone usage duration (using the phones ability to monitor screen time) and hand-grip, pinch-grip strength. Therefore, the study was aimed to investigate the association between smartphone usage duration and hand-grip, pinch-grip strength among young people. METHODS: One hundred young males volunteered to participate in the study. Participants were briefly examined for height and weight using a portable stadiometer and a digital scale. Hand-grip, pinch-grip strength measurement was performed using a hand-held dynamometer. Smartphones usage duration was obtained from the daily average screen time reported in the last seven days. RESULTS: Mean daily usage of smartphone among the participants was 7.8 ± 2.2. There was a weak significant inverse relationship between smartphone usage duration and hand-grip strength (r=-.22, p = .03) and pinch-grip strength (r=-.28, p = .004). Linear regression revealed that 18.8 % of the variance in hand-grip strength and 20.4 % of the variance in pinch-grip strength was explained by age, and smartphone usage duration, with the addition of BMI only to hand-grip strength (p's < 0.00). CONCLUSIONS: Prolonged use of smartphones was related to weaker hand-grip and pinch-grip. Despite the weak relationship, the study showed that smartphone usage duration might contribute as a factor along with age to hand muscles' strength.

Incidence of stroke among Saudi population: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Stroke is a leading cause of death and disability worldwide. However, our knowledge of the incidence of stroke for Saudi Arabian population is not known. Thus, we aimed to determine the pooled annual incidence of stroke in Saudi Arabia. We conducted a comprehensive literature search of PubMed, Web of Science, and SCOPUS, without language or publication year limits. Outcomes of interest were stroke incidence rate for both first and recurrent. A total of five studies met the inclusion criteria for this review. The pooled annual incidence of stroke in Saudi Arabia was 0.029% (95% CI: 0.015 to 0.047) equivalent of 29 strokes per 100,000 people annually (95% CI: 15 to 47). CONCLUSION: The findings indicate that there are 29 stroke cases for every 100,000 people annually for individuals residing Saudi Arabia. Our values were lower than those of other high-income countries. Establishing a nationwide stroke registry is warranted for monitoring and improving healthcare services provided to stroke survivors.

Sleep quality and ventilatory efficiency in elderly heart failure patients: a pilot study on the short-term effect of 4-week low-intensity aerobic exercise.

Background Sleep disturbance and ventilator inefficiency are considered two of the most critical complications for general human wellbeing, particularly in elderly heart failure (HF) patients. Studies examining the effect of low-intensity aerobic exercise in the treatment of sleep disturbance and ventilatory inefficiency in this population of patients are limited.Objective The purpose of the current pilot study was to check the effect of low-intensity aerobic exercise on the quality of sleep and ventilatory efficiency in elderly HF patients.Materials and methods Design: pilot study. SETTING: outpatient physical therapy clinic within Cairo University regional hospital. PARTICIPANTS: eight elderly HF patients (6 men, 2 women) with a mean age of 69.4±4.2 years. INTERVENTION: participants were recruited for a low-intensity exercise program (40 to 50% of maximum heart rate for 30-40 minutes), five sessions weekly for four weeks. Exercise intensity was monitored during the sessions using heart rate. OUTCOME MEASURE: sleep quality was assessed pre- and post- four weeks of exercise program usingthe Pittsburgh sleep quality index (PSQI) and ventilatory efficiency was assessed using cardiopulmonary exercise test.Results HF patients (II-III NYHA), mean age 69.4±4.2 years, body mass index 23.7±2.7 kg/m2, ejection fraction 32.7±4.5 %, VO2peak 16.27±4.2 ml/kg/min, VE/VCO2 30.81±12.7. The mean of global PSQI score ranged between 8.2 to 11.4 with a mean of 9.7±3.4 which indicates that the participants experienced sleep disturbance. The post-exercise assessment showed that patients have reported a significant improvement of all PSQI domains compared with baseline assessment (p<0.05). VO2peak significantly increased from 16.27±4.2 pre-intervention to 20.03±2.6 ml/kg/min post-intervention (p=0.049) whereas VE/VCO2 slightly decreased with a non-significant difference at the end of the study program (p=0.594) indicating animprovement of ventilator efficiencyand overall cardiorespiratory fitness.Conclusion Short-term application of low-intensity aerobic exercise (4 weeks) may improve the quality of sleep and ventilator efficiency in elderly HF patients. The study findings encourage elderly HF patients with sleep disturbance to adhere to the exercise training program. Also, cardiac rehabilitation programs with low intensity of aerobic exercise should be proposed to these patients by their health care provider.

Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study.

BACKGROUND: Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. METHODS: Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. RESULTS: Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. CONCLUSION: Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA. TRIAL REGISTRATION: [Exercise, cardiovascular disease and rheumatoid arthritis, ISRCTN04121489 ].

Effectiveness of a dose-graded aerobic exercise regimen on cardiopulmonary fitness and physical performance in pediatric survivors of acute lymphoblastic leukemia: a randomized clinical trial.

PURPOSE: To determine whether a 12-week supervised dose-graded aerobic exercise (D-GAE) training, when implemented in conjunction with traditional rehabilitation, could help pediatric survivors of acute lymphoblastic leukemia (ALL) enhance their cardiopulmonary capacity and improve their physical performance. METHODS: Fifty-eight pediatric survivors of ALL (age 13.78 ± 2.47 years; boys 60.34%) were assigned at random to either undergo the D-GAE in addition to the traditional physical rehabilitation (D-GAE group; n = 29) or the traditional physical rehabilitation solely (control group; n = 29). The cardiopulmonary fitness (peak oxygen uptake (VO2peak), ventilatory equivalent (VEq/VO2), minute ventilation (VE, L/min), oxygen pulse (O2P), maximum heart rate (HRmax), 1-min heart rate recovery (HRR1), and respiratory exchange ratio (RER)) and physical performance (6-min walk test (6-MWT), timed up and down stairs (TUDS), and 4 × 10-m shuttle run test (4 × 10mSRT)) were assessed on the pre- and post-intervention occasions. RESULTS: The mixed-model ANOVA revealed a meaningful increase of VO2peak (P = .002), VE (P = .026), O2P (P = .0009), HRmax (P = .004), and HRR1 (P = .011), and reduction of VEq/VO2 (P = .003) and RER (P = .003) in the D-GAE group compared with the control group. Besides, the analysis detected a favorable increase in the physical performance for the D-GAE group (6-MWT (P = .007), TUDS (P < .001), 4 × 10mSRT (P = .009)). CONCLUSION: A 12-week D-GAE program in conjunction with traditional rehabilitation holds promise in enhancing cardiopulmonary fitness and improving the physical performance of pediatric survivors of ALL. Clinicians and physical rehabilitation professionals can, therefore, integrate the D-GAE into the traditional rehabilitation protocols for such a patient population to optimize their cardiopulmonary fitness and physical function, while also facilitating a gradual transition to practice and adaption. IMPLICATIONS FOR CANCER SURVIVORS: The favorable outcomes of this study bolster the inclusion of D-GAE as a crucial element in the care and rehabilitation of pediatric survivors of ALL. By embracing these findings, healthcare professionals and oncologists can contribute to mitigating the long-term cardiopulmonary and physical complications associated with cancer treatments and fostering a state of enhanced well-being and increased physical activity among survivors.

Cardiopulmonary response during incremental shuttle walking test in a hallway versus on treadmill in Phase IV cardiac rehabilitation: a cross-sectional study.

There is widespread use of incremental shuttle walking test (ISWT) to measure functional capacity in cardiac rehabilitation patients. Due to occasional physical space limitations, an incremental shuttle walking test on a treadmill (ISWT-T) was suggested as an alternative. Knowledge about the cardiopulmonary response between the two tests and the factors associated with the distance achieved in Phase IV cardiac rehabilitation is limited. Thus, the study aims to compare the cardiopulmonary response between ISWT and ISWT-T and investigate the factors associated with distance achieved in both tests. Thirteen participants (66.3 ± 7.3 years, 84.6% males) attending phase IV cardiac rehabilitation participated in repeated measures counterbalanced trials. Each participant performed one ISWT and one ISWT-T separated by seven days. Main outcome measures included peak heart rate (HR), systolic and diastolic blood pressure post-test, distance achieved, respiratory frequency, tidal volume (VT), minute ventilation, respiratory exchange ratio, peak oxygen uptake (VO2PEAK), and secondary outcome measures included height, weight, waist circumference (WC) leg length (LL). There were no significant differences in the cardiopulmonary responses between ISWT and ISWT-T except for VO2PEAK (25.4 ± 5.8 vs 23.7 ± 5.1, p = 0.05, respectively). Age and height were significantly correlated with distance achieved during ISWT, and ISWT-T [age (r = - 0.72, vs. r = - 0.73, p ≤ 0.05, respectively)], [height (r = 0.68, vs. r = 0.68, p ≤ 0.05, respectively)]. LL was only correlated with distance achieved on ISWT-T (r = 0.59, p ≤ 0.05). These findings suggest a similar cardiopulmonary response between the two tests, but doing ISWT in the hallway evoked a higher metabolic demand than doing it on a treadmill. Additionally, distance achieved on both tests was related to height and inversely to age.

Chronotropic Response and Risk Factors for Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Cross-Sectional Study.

BACKGROUND: Individuals with rheumatoid arthritis (RA) are at a high risk of cardiovascular diseases (CVD). A reduced chronotropic response (CR), which produces exercise intolerance, is known to be a contributing factor to CVD and mortality. Studies have shown that patients with RA have a reduced CR. However, knowledge of CR-related factors in patients with RA is limited. This study aimed to explore CR-related factors, including CVD risk factors, inflammatory markers, and cardiorespiratory fitness (VO2PEAK). METHODS: A total of 106 RA patients underwent a treadmill test, heart rate monitoring, and various assessments, including serological CVD risk factors, inflammatory markers, and VO2PEAK. RESULTS: A total of 34% of participants demonstrated a reduced CR (≤80%). Body mass index, HOMA, hsCRP, and fibrinogen were inversely related to CR, while HDL, QUICKi, VO2PEAK, and RER exhibited a positive association. HDL and VO2PEAK emerged as independent CR-related factors in regression analysis. CONCLUSIONS: The current findings suggest that reduced CR in RA is associated with several CVD risk factors, inflammatory markers, and cardiorespiratory fitness. Future studies should investigate the effects of controlling these associated variables on CR in patients with RA.

Beyond the Acute Phase: Understanding Relationships Among Cardiorespiratory Response to Exercises, Physical Activity Levels, and Quality of Life in Children After Burn Injuries.

The long-term cardiorespiratory function in burn-injured children can be jeopardized due to complications brought on by the injury. This study sought to assess the cardiorespiratory responses to maximal exercise in children who sustained a burn injury and explore the relationships among cardiorespiratory response, physical activity levels (PALs), and health-related quality of life (HRQL). Forty-five burn-injured children (age: 13.89 ± 2.43 years; duration since burn injury: 3.13 ± 0.93 years) and 52 age- and gender-matched healthy children (14.15 ± 2.27 years) participated in this study. Both cohorts were evaluated for the maximal exercise capacity (defined by peak oxygen uptake [VO2peak], maximum heart rate [HRmax], minute ventilation [VE], ventilatory equivalent [VEq], respiratory rate [RR], and respiratory exchange ratio [RER]), PALs, and HRQL. The burn-injured children had significantly lower VO2peak (P = .0001) and VE (P = .003) and higher VEq (P < .0001) and RR (P = .007) than their healthy controls, indicating less-efficient cardiorespiratory capacity. However, the HRmax (P = .092) and RER (P = .251) were similar. The burn-injured children reported significantly lower PALs (P = .014) and HRQL (P < .0001). The PALs (r [95% CI] = .411 [0.132-0.624]; P = .005) and HRQL (r [95% CI] = .536 [0.284-0.712]; P = .0001) were significantly correlated with the cardiorespiratory capacity represented by VO2peak in burn-injured group. The variations in VO2peak explained ~17% and 28.7% of the variations in PALs and HRQL, respectively. In conclusion, the cardiorespiratory efficiency of the burn-injured children may remain limited, even up to a few years following the injury. The limited cardiorespiratory capacity accounts in part for the reduced PALs and HRQL.

Graded aerobic exercise (GAEx): An effective exercise regimen to improve cardio-respiratory fitness and physical and psychosocial functioning in children with burn sequelae of the chest.

PURPOSE: The cardio-respiratory function is compromised in children recovering from burns, particularly, those who sustain a burn injury across the chest, which leads to further prejudicial effects on physical and psychosocial health. This study endeavored to explore the efficacy of 12 weeks of graded aerobic exercise (GAEx) on the cardiorespiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. METHODS: Thirty-six burn-injured children aged 10-18 years (%TBSA: 24.2 ± 4.9, and 38.8 ± 12.9 months since injury) were randomly assigned to GAEx group (n = 18; undergone a 12-week intensity- and time-graded aerobic exercise program plus standard rehabilitation) or control group (n = 18; received the standard rehabilitation only). The cardio-respiratory fitness [marked by the peak oxygen uptake (VO2peak), minute ventilation (VE), ventilatory equivalent of inhaled oxygen (VEq/VO2), oxygen pulse (O2P), respiratory exchange ratio (RER), maximum heart rate (HRmax), and the heart rate recovery at one minute (HRR1)] and physical and psychosocial functioning were assessed pre- and post-intervention. RESULTS: Children in the GAEx group showed significant increases in VO2peak (P = 0.013), VE (P = 0.026), O2P (P = 0.034), HRmax (P = 0.035), and HRR1 (P = 0.04) and declines in VEq/VO2 (P = 0.009) and RER (P = 0.011) as compared to the control group. Additionally, the GAEx group reported higher physical (P = 0.029) and psychosocial (P = 0.012) functioning. CONCLUSION: Twelve weeks of GAEx has salutary effects on cardio-respiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. These findings suggest that adding GAEx as a complementary therapy to the long-term rehabilitation protocol for this patient population is worthwhile.

Optimization of pulmonary function, functional capacity, and quality of life in adolescents with thoracic burns after a 2-month arm cycling exercise programme: A randomized controlled study.

BACKGROUND: Burns to the thorax are at high risk for long-term pulmonary complications due to chest muscle contractures and chronic inflammation in both adolescents and young adults. Few studies have investigated the effects of arm cycling exercise in those individuals. For that reason, this study examined pulmonary function, functional capacity, and quality of life (QOL) in adolescents with thoracic burns subsequent to 2-month arm cycling exercise programme. METHODS: A single-blinded, two-month randomized prospective controlled study was carried out between July 2019 and March 2020 on thirty adolescents with chest burns aged 11-17 years. They were randomized into two equal groups (n = 15), traditional physiotherapy programme (control group), and arm cycling exercise plus traditonal physiotherapy (arm cycling exercise group) for 2 consecutive months. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), six-minute walk test (6MWT), and Pediatric Quality of Life Inventory (PedsQL) were measured in both groups at baseline and after 2-month after intervention. RESULTS: No statistical significance was detected at baseline between control and arm cycling exercise groups (FVC, p = 0.903, FEV1, p = 0.835, 6MWT, p = 0.817, and PedsQL, p = 0.612). 2 months after intervention showed statistical improvements in the arm cycling exercise group in all measures (FVC, p = 0.001, FEV1, p < 0.0001, 6MWT, p = 0.001, and PedsQL, p = 0.001) however, the control group showed statistical improvements in FVC, p = 0.044 and FEV1, p = 0.024 with non-statistically significant changes in 6MWT, p = 0.145 and PedsQL, p = 0.067. The arm cycling exercise group showed greater improvements than control group in the outcome measures (FVC, p = 0.034, FEV1, p < 0.017, 6MWT, p = 0.037, and PedsQL, p = 0.021). CONCLUSIONS: This prospective study clearly demonstrated positive and beneficial influences of two-month arm cycling exercise in the optimization of pulmonary functions, functional performance, and QOL in adolescents suffering from chest burns and thereby eliminating post-burn complications.

Cardiovascular autonomic neuropathy in people with type 2 diabetes mellitus; investigation of its association with classical cardiovascular risk factors using cardiovascular autonomic reflex tests: a cross-sectional study.

BACKGROUND: People with type 2 diabetes mellitus (DM) are at increased risk of cardiovascular disease (CVD). Cardiovascular autonomic neuropathy (CAN) is an underdiagnosed risk factor for CVD, which is prevalent among people with 2DM and can lead to CVD and CVD-related mortality. Little is known about the risk factors associated with CAN in type 2DM. Thus, the study was aimed to assess CAN using five cardiovascular autonomic reflex tests (represented by Ewing's score) and explore the factors associated with CAN in people with type 2DM. The studied factors include traditional and serological CVD risk factors obtained from a fasting blood sample and cardiorespiratory fitness (CRF) obtained via attainment of the highest peak of volumes of O2 (VO2Peak). RESULTS: Univariate analysis revealed a significant positive correlation between resting systolic blood pressure (SBP) and Ewing's score (r=0.47, p=.02) and an inverse correlation between VO2Peak and Ewing's score (r=-0.64, p=.001). Multivariate linear regression revealed that a significant model that included resting SBP and VO2Peak explained 93.8% of Ewing's score variance. CONCLUSION: CAN was associated with two CVD parameters, including resting SBP and CRF, which may indicate the importance of controlling these two factors to prevent or reduce CAN in people with type 2DM.

Instrument assisted soft tissue mobilization (IASTM) versus stretching: A comparison in effectiveness on hip active range of motion, muscle torque and power in people with hamstring tightness.

BACKGROUND: Instrument-assisted soft tissue mobilization (IASTM) is a new technique that has been known to be effective in reducing muscle tightness in athletics. However, little is known about its effect on the range of motion, muscle power, and torque compared to manual stretching among non-athletics. Thus, the study was aimed to compare the effectiveness between IASTM and manual stretching in improving hip flexion active range of motion (ROM), muscle torque and power on hamstring muscle complex (HMC) tightness in one session. METHOD: Twenty-three young male college students with unilateral hamstring tightness measured via straight leg raising (SLR) test (<65°) were randomly assigned to one of two groups. Twelve participants received the application of IASTM (group 1), and eleven received manual stretching (group 2). Hip flexion active ROM was measured via goniometer, the torque & power of the hamstring muscle were measured using Humac isokinetic dynamometer, before and after both interventions. (ISRCTN17693345). RESULTS: There was no significant difference in the improvement of hip flexion active ROM (69.6 ± 6.6 vs 72.5 ± 7.9, p = .34), HMC torque (63.7 ± 14.5 vs 53.2 ± 16.3, p = .14), and HMC power (47.8 ± 11.8 vs 40.9 ± 16.3, p = .34) between group 1 and group 2 respectively. When a comparison was made within each group, significant improvements in hip active flexion ROM was found in both groups (p's < .001), and HMC power was significantly improved in group 1 (p = .04) but not in group 2. CONCLUSION: The current study findings demonstrate that IASTM was as effective as manual stretching in improving hip flexion active ROM, muscle torque and power among non-athletic people with HMC tightness.

The Association between Cardiorespiratory Fitness and Reported Physical Activity with Sleep Quality in Apparently Healthy Adults: A Cross-Sectional Study.

BACKGROUND: Recently, poor cardiorespiratory fitness (CRF) has been postulated as an adverse health outcome related to poor sleep quality. However, studies investigating the relationship between CRF and a subjective sleep quality index are scarce. Thus, the current study aimed to investigate the association between CRF and the Pittsburgh Sleep Quality Index (PSQI) in apparently healthy people. The secondary aim was to investigate the association between reported physical activity (PA) and PSQI. METHODS: Thirty-three healthy male participants volunteered to participate. CRF (VO2PEAK) was measured via cardiopulmonary exercise testing on a treadmill. A short form of the International Physical Activity Questionnaire (IPAQ) was used to measure PA, and PSQI was used for the sleep quality index. RESULTS: There was no correlation between CRF and PSQI total score or any component of the PSQI. There was a significant inverse correlation between IPAQ and PSQI total score (r = -0.36, p = 0.04). Categorical data analysis of the two questionnaires revealed that 42.4% of the participants who reported low physical activity also had poor sleep quality. CONCLUSIONS: The current study showed no association between CRF and the subjective sleep quality index but demonstrated a moderate inverse association between reported PA and subjective sleep quality index. The findings suggest that the more reported PA, the better the overall sleep quality.

Falls and potential therapeutic interventions among elderly and older adult patients with cancer: a systematic review.

Objectives: The aim of this study was to perform a systematic review for previous publications that have assessed the incidence, risk factors, and favorable procedures to prevent and manage falls among cancer survivors of elderly and older adults. Materials: This systematic review was undertook using PubMed, SCOPUS, Web of Science, Medline, and Cochrane Database of clinical studies and systematic reviews to determine the incidence, risk factors, favorable inpatient and outpatient management, and non-pharmacological interventions for falls among elderly and older adult patients with cancer from 2010 to October, 2020. Results: After the comprehensive screening, clinical studies, meta-analysis, systematic reviews, and established guidelines were included in this review. Only 5 clinical studies (3 randomized and 2 single-arm studies), 5 systematic reviews, and 6 established guidelines were considered eligible. The five systematic reviews provide risk factors of falls and the 6 guidelines provide assessment & prevention modalities of falls, however, the 6 clinical studies provide the non-pharmacological intervention for falling among cancer survivors. Many factors associated are demonstrated among wide range of elderly individuals. Earlier falls were reliably listed as an important risk factor of falls in the two inpatient and outpatient environments including both general older people and geriatric cancer populations. Conclusions: This review concludes that the assessment of falls among older individuals with cancer is the most important way for determining who could need additional observation and treatment program. Health professions involving physical therapy and occupational therapy have an important function for promoting health well-being in elderly and older adults with cancer.

Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis.

BACKGROUND: Coronary artery bypass grafting (CABG) is a common surgical procedure for the restoration of blood flow into stenotic or blocked coronary arteries. Cardiac rehabilitation has been implemented to some extent worldwide for the management of postoperative CABG. However, studies about the effect of exercise training on hemodynamic responses of the heart using the Incremental Shuttle Walking (ISWT) test are limited in Saudi Arabia. OBJECTIVES: To investigate the effect of exercise-based cardiac rehabilitation (Phase 3, hospital-based) on some hemodynamic responses including blood pressure, heart rate (HR) and heart rate recovery (HRR), and rate pressure product (RPP) using ISWT on post-CABG patients. METHODS: Fifteen CABG (51.4 ± 6.4 years, 14 male, 1 female) patients without altering their medication were enrolled in a hospital-based cardiac rehabilitation program (Phase 3) between 2011 and 2012 for supervised individual exercise training sessions (three times per week for 8 weeks; 60-minute session at a moderate intensity). Patients performed two tests (ISWT1 and ISWT2) and one before exercise training program and one after, during which resting systolic blood pressure (SBP) and diastolic blood pressure (DBP), post-ISWT SBP and DBP, resting HR, peak HR, HRR (which was defined as the absolute change from peak HR to 1-minute post peak HR), and RPP at rest and at the end of the ISWT were measured. Exercise training sessions included both aerobic and resistance exercises, which were preceded by a cooling down period and followed by a recovery period. RESULTS: Paired t-test showed a significant reduction in both resting SBP (p = 0.04) and DBP (p = 0.03), and a significant increase in post-ISWT2 SBP (p = 0.004), peak HR (p = 0.003), HRR (p = 0.03), and RPP at maximum (p = 0.002) after 8 weeks of supervised exercise training. In addition, there was a significant increase in the speed and distance achieved on ISWT2 (p < 0.001) after the training program. CONCLUSION: Supervised exercise training (cardiac rehabilitation) for 8 weeks was effective in improving hemodynamic responses and functional exercise capacity in CABG patients. Cardiac rehabilitation should be implemented more frequently and health-care providers should be aware of its importance. Further research is needed in this area to confirm these findings in the region.