Effect of Sleep-Disordered Breathing on Exercise Capacity after Myocardial Infarction - A Cross-Sectional Study.

Background: Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI. Methods: Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients' maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF). Results: A total of 254 patients aged 60.00 (interquartile range 51.00-67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance (p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance (p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( SpO 2 ) during sleep and MET, MHR, and 6MWT distance (p = 0.019, p = 0.006, and p = 0.013), and minimum SpO 2 and MET and MHR (p = 0.040 and p < 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters. Conclusions: SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.

Functional Mobility and Basic Motor Skills in Patients with Multiple Sclerosis and Its Relation to the Anthropometrical Status and Body Composition Parameters.

Background and objectives: Patients with multiple sclerosis (MS) have many potential risk factors (spasticity, immobilization, glucocorticoids use) which can deteriorate the anthropometrical status and body composition and may have a potential negative impact on functional mobility and basic motor skill improvement after physiotherapy. The aim of the study was to assess the functional mobility and basic motor skills in patients with MS and to correlate them with disability and anthropometrical status and body composition parameters. Materials and Methods: Timed Up-and-Go Test (TUG) and six-min walk test (6MWT) were performed in 36 patients with MS before and after 4 weeks of physiotherapy. Body mass index (BMI), waist-to-height ratio (W/HtR), and waist-to-hip ratio (WHR) were assessed in this group. Body composition was evaluated by bioelectrical impedance analysis (BIA) and fat mass (FAT), fat free mass (FFM), total body water (TBW), and predicted muscle mass (PMM) were expressed as percentage of body mass. Clinical status was assessed by Expanded Disability Status Scale (EDSS) and Ambulatory Index (AI) scales. Results: After physiotherapy, there was a significant improvement in functional mobility and basic motor skills assessed by total distance in 6MWT (p < 0.001) and in TUG trials (p < 0.001). Positive significant correlations were found between the results obtained in both tests (either before and after physiotherapy) vs. FFM, TBW, and PMM, whilst worse results in functional mobility and basic motor skills correlated significantly with higher WHtR, WHR, and FAT (p < 0.05). Clinical status (EDSS) was significantly related to the WHtR and body composition parameters with the same manner as the results in the either 6MWT and TUG. However, there were no significant relationships between BMI vs. either clinical status (EDSS, AI) or functional mobility tests results in patients with MS. Conclusions: Functional mobility and basic motor skills may be significantly improved during physiotherapy, but they are related to the anthropometrical status and body composition of MS patients. Moreover, disability status is also significantly related to these parameters. Body composition deterioration seems to be the important target for the therapeutic intervention in MS patients. For proper nutritional status assessment in patients with MS, body composition analysis or WHtR instead BMI should to be used.

[Kinesiophobia in patients with cardiovascular disease].

OBJECTIVE: Introduction: Kinesiophobia - a fear of physical activity - is a common and worsening rehabilitation outcomes phenomenon in patients with cardiovascular diseases. The aim: To assess the level of kinesiophobia in relation to heart's function evaluated using echocardiography and clinical parameters in patients with cardiovascular disease. PATIENTS AND METHODS: Material and methods:101 patients (28 women) aged 61,9±13,56 years and hospitalized for implantation or replacement of a pacemaker or cardioverter-defibrillator were included in the study. Their heart's function and morphology were evaluated echocardiographically. Level of kinesiophobia was evaluated with the Polish version of Tampa Scale of Kinesiophobia Heart (TSK-Heart) questionnaire. RESULTS: Results: The TSK score in these patients was 41,6±5,39. It's value was increasing with age (p=0,0264), was higher in women than in men (43,5±5,36 vs. 40,8±5,27, p=0,0287) and in patients with coronary artery disease (42,3±6,28 vs. 40,9±4,62, p=0,031). In patients with heart failure, it was decreasing with an increase of body mass index (p=0,0185). Severe mitral insufficiency resulted in higher index value in comparison with moderate or mild one (42,7±4,05 vs. 40,9 ± 5,58, p=0,0369). The TSK index increases with a decrease in tricuspid annular plane systolic excursion (p=0,0033). Patients in NYHA IV class exhibited higher TSK value than those in lower classes (p<0,001). An inverse dependency of TSK index value and hemoglobin level were established (p=0,0041). CONCLUSION: Conclusions: In patients with cardiovascular diseases, kinesiophobia has multicausal nature and is higher in NYHA IV patients. The independent predictors of kinesiophobia are right ventricular dysfunction and anemia.

The Usefulness of Questionnaires in Assessing the Risk of Obstructive Sleep Apnea in Patients in the Managed Care after Acute Myocardial Infarction Program-The Results of a Cross-Sectional Study.

Obstructive sleep apnea (OSA) worsens prognosis after myocardial infarction (MI) but often remains undiagnosed. The study aimed to evaluate the usefulness of questionnaires in assessing the risk of OSA in patients participating in managed care after an acute myocardial infarction program. Study group: 438 patients (349 (79.7%) men) aged 59.92 ± 10.92, hospitalized in the day treatment cardiac rehabilitation department 7-28 days after MI. OSA risk assessment: A 4-variable screening tool (4-V), STOP-BANG questionnaire, Epworth sleepiness scale (ESS), and adjusted neck circumference (ANC). The home sleep apnea testing (HSAT) was performed on 275 participants. Based on four scales, a high risk of OSA was found in 283 (64.6%) responders, including 248 (56.6%) based on STOP-BANG, 163 (37.5%) based on ANC, 115 (26.3%) based on 4-V, and 45 (10.3%) based on ESS. OSA was confirmed in 186 (68.0%) participants: mild in 85 (30.9%), moderate in 53 (19.3%), and severe in 48 (17.5%). The questionnaires' sensitivity and specificity in predicting moderate-to-severe OSA were: for STOP-BANG-79.21% (95% confidence interval; CI 70.0-86.6) and 35.67% (95% CI 28.2-43.7); ANC-61.39% (95% CI 51.2-70.9) and 61.15% (95% CI 53.1-68.8); 4-V-45.54% (95% CI 35.6-55.8) and 68.79% (95% CI 60.9-75.9); ESS-16.83% (95% CI 10.1-25.6) and 87.90% (95% CI 81.7-92.6). OSA is common in post-MI patients. The ANC most accurately estimates the risk of OSA eligible for positive airway pressure therapy. The sensitivity of the ESS in the post-MI population is insufficient and limits this scale's usefulness in risk assessment and qualification for treatment.

Assessment of the Reliability of the DoboMed Exercise Method Mastery Evaluation Scale in People with Adolescent Idiopathic Scoliosis.

BACKGROUND: Conservative treatment of lateral idiopathic curvatures of the spine is a difficult and complex therapeutic process that is not always successful. Repeated assessments of the patient's mastery of a given exercise may significantly increase the effectiveness of conservative treatment. The aim of the study was to assess the credibility of an original scale for evaluating DoboMed exercise proficiency in a group of people with adolescent idiopathic scoliosis. MATERIALS AND METHODS: The study was conducted in a group of 41 patients with juvenile idiopathic scoliosis aged 10 to 16 years. In each patient, during a 3-week exercise period, the mastery of the Dobomed exercise method was assessed according to the authors original scale. Four physical therapists conducted this study. RESULTS: The Kendall-Smith concordance coefficient was used in the statistical analysis. On the basis of Kendalls W coefficient, Spearmans R coefficient of similarity was calculated to describe the correlation of all possible pairs of orderings. There was a high level of agreement between the therapists in the assessment of the key elements for mastering the method. CONCLUSION: 1. The original method mastery evaluation scale has clinical value in monitoring the progress of exercises according to the Dobomed method. 2. A high level of agreement between the therapists was noted for those features that are important in mastering the method. 3. Standardisation of our scale for evaluating mastery of DoboMed exercises will allow patients to be monitored with regard to their performance of the exercises also by their parents.

Short-term effects of combination of several physiotherapy methods on the respiratory function - a case report of adolescent idiopathic scoliosis.

UNLABELLED: The aim of the study was to evaluate the positive effects of combination of several physiotherapy methods on the respiratory function on example of a case report. MATERIAL AND METHODS: 14 years old girl with an adolescent idiopathic scoliosis (AIS), right thoracic (primary curve, Cobb angle = 40°, AVR = 12°) and left lumbar (secondary curve, Cobb angle = 33°, AVR = 24°) participated in the study. She was 2 years after menarche. She underwent stationary (in-patient) treatment for 3 weeks with use of standard medical care (DoboMed). Treatment also included manual therapy (OMT Kaltenborn-Evjenth) and Dynamic Brace System (DBC) device, produced by Meditrack. Then she continued exercises at home. Respiratory system function was analyzed with use of SpiroPro electronic spirometer (Jaeger) and the strength of respiratory muscles with use of portable digital pressure meter equipped with the Omega PX 25 ± 35 kPa pressure transducer. Range of movement of the spine was examined with Rippstein V plurimeter, angle of apical trunk rotation (ATR) with the Bunnell scoliometer. Measurement was performed 4 times: before treatment, after one week and 3 weeks after the beginning of the treatment and 3 months after finalization of the treatment period. RESULTS: Examination showed that DoboMed medical care treatment, manual therapy and use of DBC device in period of 3 weeks caused improvement of respiratory parameters (MIP - maximal inspiration pressure by 6.7%; MEP - maximal expiratory pressure by 12.6%, PEF - peak expiratory flow by 16.1%). Spinal range of lateral movement and angle of apical trunk rotation has also improved. CONCLUSION: In short term treatment, the manual therapy aided with DBC system has improved the respiratory parameters and trunk morphology values. Such a composition of various physiotherapy methods can help to conduct further specialized exercises of DoboMed method.

Body Composition in Multiple Sclerosis Patients and Its Relationship to the Disability Level, Disease Duration and Glucocorticoid Therapy.

Background: Patients with multiple sclerosis (MS) have many potential factors (spasticity, immobilization, glucocorticoids use) for the deterioration of body composition. Aim: To assess the nutritional status (by classical anthropometry and by bioelectrical impedance analysis (BIA)) in MS patients and to correlate it with clinical state, MS duration time and the presence of glucocorticoid therapy in anamnesis (ever used). Methods: Anthropometrical (BMI and waist and hip circumferences, waist-to-height ratio (W/HtR), and waist-to-hip ratio (WHR)) and body composition (BIA) data were evaluated in 176 patients with MS. Fat mass (FM), and fat-free mass (FFM) were expressed as kilograms (kg), percentage (%) and indexes (FMI: fat mass index, FFMI: fat-free mass index) expressed in kg/m2. The median Expanded Disability Status Scale score was 4.5. Patients were then divided according to EDSS score as mild (EDSS 1.0−4.0) or moderate (EDSS 4.5−6.5) disability subgroup. Results: Waist c., WHtR, WHR, and FM% were significantly higher in the moderate MS group (p < 0.01; p < 0.001; p < 0.001; and p < 0.05, respectively). Whilst, FFM% was significantly lower (p < 0.05). BMI did not correlate significantly with any disability status score and MS time. Significant correlations were observed between EDSS, ΔEDSS and MS time and Waist c., WHtR, WHR, FM% and FFM%. WHtR had the strongest significance (p < 0.0001 vs. EDSS; p < 0.0001 vs. ΔEDSS; and p < 0.01 vs. MS time, respectively). After the adjustment to the MS time, only FM% was no longer significantly related to both EDSS and ΔEDSS. MS duration time, EDSS, ΔEDSS, WHtR, FM(kg), FM%, and FMI were significantly higher in the patients with a positive history of glucocorticoid therapy (all p < 0.05). Whilst, FFM% was significantly lower in MS patients treated with glucocorticoids (p < 0.01). Conclusions: Greater disability in MS patients is strongly related to lower fat-free mass and higher fat mass, especially with the abdominal distribution, irrespective of the duration time of the disease. Oral glucocorticoid therapy seems to have a negative impact on the body composition of MS patients. However, further prospective multifactorial studies in this field have to be done. For the proper assessment of nutritional status in MS patients, Waist c., WHtR, WHR, or body composition parameters seem to be of greater use than BMI.

Sleep-disordered breathing as a risk factor for unnecessary pacemaker implantation.

BACKGROUND: Sleep-disordered breathing (SDB) is a risk factor for bradyarrhythmia, which is reversible with positive airway pressure therapy. AIMS: The study aims to evaluate the occurrence and number of severe sinus bradycardia and advanced atrioventricular block (AVB) in patients with cardiovascular diseases and SDB risk factors. METHODS: The analysis covered 207 patients with cardiovascular diseases aged 59.4 (standard deviation [SD], 10.49) years, including 177 men (85.51%), hospitalized in the Department of Electro-cardiology and the Day Stay Cardiac Rehabilitation Ward Upper-Silesian Medical Centre in Katowice, Poland. The inclusion criterion was a high risk of SDB, in particular obstructive sleep apnea (OSA), in one of the following questionnaires: the Four-Variable Screening Tool, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale. Both level-3 portable sleep tests and electrocardiogram Holter recordings were made simultaneously. RESULTS: SDB was confirmed in 175 (84.5%) patients, including severe in 74 (35.7%), moderate in 42 (20.3%), and mild in 59 (28.5%) participants. The dominant type of SDB was OSA, which was found in 158 (76.3%) participants. The severe SDB was a predictor of third-degree AVB (odds ratio [OR], 11.61; 95% confidence interval [CI], 1.37-98.60), second-degree AVB type 2 (Mobitz) (OR, 4.51; 95% CI, 1.17-18.08), pauses above 3 seconds (OR, 10.26; 95% CI, 2.18-48.40), and sinus bradycardia below 40 bpm (OR, 3.00; 95% CI, 1.36-6.60) during sleep. CONCLUSIONS: SDB, with particular emphasis on OSA, is a risk factor for sinus bradycardia and advanced AVB during sleep, which may lead to a hasty qualification for pacemaker implantation. The severity of SDB determines the frequency and number of bradyarrhythmic episodes.

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels.

Background: Societal aging - as a global demographic phenomenon - shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60-74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results: Mean study group age was 66.5 ± 4.1 years () and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 µg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53-8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77-0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02-1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

[Exercise capacity of adolescent girls with mild idiopathic scoliosis after direct correction with using of the Cheneau brace. Preliminary study]. / Wydolnosc wysilkowa dziewczat ze skolioza idiopatyczna typu mlodzienczego po zalozeniu gorsetu Cheneau. Doniesienie wstepne.

INTRODUCTION: Idiopathic scoliosis is that kind of structural deformation, for which there was no reasonable cause based on the temporary level of science. The conservative treatment of the idiopathic scoliosis is based on a rigid brace. The aim of the study is to establish if Cheneau brace decreases exercise capacity in adolescent patients with mild idiopathic scoliosis. MATERIAL AND METHODS: The research was done in 31 girls aged 11 to 18 years with diagnosed idiopathic adolescent scoliosis. These patients were qualified to conservative treatment with using Cheneau brace. RESULTS: Exercise test with using cycle ergometer proved hightly statistically significant greater end workload at girls without using Cheneau brace in comparison to girls which used Cheneau brace. The study showed also the statistically significant longer distance of the walking test, which was made by patients without direct correction of Cheneau's brace in comparison to patients with direct correction of Cheneau's brace. CONCLUSIONS: The initially study showed, that Chenau brace essentially diminishes exercice capacity at patients with idiopathic adolescent scoliosis.

Quality of life assessment using EORTC QLQ questionnaires in the prostate cancer population treated with radical prostatectomy: a systematic review.

CONTEXT: In recent years, quality of life has become an increasingly common outcome measure for assessing the effectiveness of treatment and surgical techniques. OBJECTIVE: The aim of our systematic review is to explore changes in health-related quality of life in patients suffering from prostate cancer and treated by means of radical prostatectomy. EVIDENCE ACQUISITION: We focus on studies in which EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires are used because these instruments have shown high internal and external validity in many studies and include questions grouped in cancer-specific scales. Following the application of exclusion and inclusion criteria, we select eight studies for qualitative synthesis. CONCLUSIONS: Our results indicate that most quality of life scales do not present a large decline. However, prospective studies with detailed descriptions of methodology, and in particular descriptions of participants, are still needed before general conclusions can be drawn. Moreover, scoring of results in accordance with questionnaire guidelines is essential for the performance of meta-analysis.

Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients.

Metabolic syndrome (MS) and anxiety disorders are common problems among hemodialysis patients (HD). However, there have been no studies defining the role of physical activity in reducing anxiety in HD patients with MS. This study was aimed to determine the effects on the severity of anxiety of a four-week rehabilitation program for HD patients, with or without metabolic syndrome (MS), planned and adapted to their abilities. The study was single-center, interventional, non-randomized, and prospective. Fifty-eight individuals completed the project (28 HD patients and 30 controls (C) with normal kidney function). Each group was divided into two subgroups with respect to MS. The mean age of the subjects in the HD and C groups was 56.9 ± 13.3 years (x¯ ± SD) and 61.5 ± 8.3 years (x¯ ± SD), respectively. Planned and adapted to the patient's abilities, the rehabilitation program based on physiotherapy was provided to each subject for 4 weeks. Baseline and post-intervention determined anxiety levels using the State-Trait Anxiety Inventory (STAI). The X1 scale tests state anxiety, and the X2 scale tests trait anxiety. Post-intervention, there was no significant difference in the intensity of state anxiety observed in HD patients compared to C with normal renal function, as observed before the program. After four weeks of regular physical activity planned and adapted to the patient's abilities in an inpatient ward, the level of state anxiety (X1) and trait anxiety (X2) lowered considerably in all HD patients (respectively: 35.1 ± 8.0 vs. 29.2 ± 5.0, p = 0.001 for X1 and 41.8 ± 9.1 vs. 38.1 ± 5.9, p = 0.008 for X2). The rehabilitation program significantly reduced the intensity of state anxiety (X1) in HD patients with MS (35.8 ± 7.9 vs. 29.2 ± 5.1; p = 0.01). The rehabilitation program helped to significantly reduce the intensity of trait anxiety (X2) in HD patients without MS (41.9 ± 10.7 vs. 36.9 ± 5.9; p = 0.04). Four-week physical activity planned and adapted to the patient's abilities reduces the intensity of anxiety in HD patients and controls with normal renal function. HD patients with MS benefit more in terms of reducing perceived state anxiety, and HD patients without MS in terms of reducing trait anxiety.

A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

INTRODUCTION: In physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period. MATERIAL AND METHODS: The patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion. RESULTS: At 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05). CONCLUSIONS: Focused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

Ground reaction force analysis for assessing the efficacy of focused and radial shockwaves in the treatment of symptomatic plantar heel spur.

BACKGROUND: Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur. OBJECTIVE: The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur. METHODS: Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment. RESULTS: In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups. CONCLUSIONS: Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.

The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease.

STUDY OBJECTIVES: To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease. METHODS: The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge. RESULTS: Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively. CONCLUSIONS: High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.

Association between Bone Turnover Markers, Leptin, and Nutritional Status in Girls with Adolescent Idiopathic Scoliosis (AIS).

The link between scoliotic deformity and bone metabolism in adolescent idiopathic scoliosis (AIS) has not been well researched. Moreover, the data concerning the cross-talk between fat tissue content/hormonal activity and bone markers in this group of patients are lacking. The aim of the study was to assess whether there exists a significant relationship between the severity of AIS and bone turnover markers and leptin levels. The study group was consisted of 77 AIS girls, aged 14.7 ± 2.17 years. Scoliotic curve severity assessed by Cobb's angle was categorized as mild (10-19°), moderate (20-39°), or severe (≥40°). Corrected height, weight, and waist and hip circumferences were measured and body mass index (BMI), corrected height Z-score, BMI Z-score, and waist/height ratio (WHtR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM), and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. Bone turnover markers (osteocalcin (OC) and amino terminal of collagen cross-links (NTx) and leptin levels were assessed in serum. Multiple regression analysis showed that, OC, NTx (negatively with p < 0.05), and leptin (positively with p < 0.01) were significantly associated with curve severity in AIS girls. Moreover, Cobb's angle was positively correlated with W/HtR (p < 0.01) and FAT (p < 0.05). One-way analysis of variance (ANOVA) revealed significant differences in leptin (p < 0.05 vs. mild only), OC (p < 0.05 vs. mild and moderate), and W/HtR (p < 0.01 and p < 0.05 vs. mild and moderate, respectively) between the three AIS severity subgroups. OC was significantly lower in the severe AIS subgroup, while leptin and W/HtR were significantly higher. Significant correlations between leptin and anthropometrical parameters as BMI z-score and W/HtR were shown. Leptin level correlated also significantly with BMI z score (p < 0.001), W/HtR (p < 0.0001), and body composition parameters (p < 0.000001). Moreover, there was a significant negative correlation between NTx and leptin level (p < 0.05). Bone metabolism in AIS girls seems to be altered and significantly related to the scoliotic curve severity. Leptin may be a crucial link in the cross-talk between bone turnover and body composition in this group of patients. Further studies concerning interrelationship between nutritional status and bone metabolism in patients with AIS are warranted.

Frailty Phenotype: Evidence of Both Physical and Mental Health Components in Community-Dwelling Early-Old Adults.

BACKGROUND: Demographic aging results in increased incidence of old-age disability. Frailty is a major factor contributing to old-age disability. The aim of this study was to investigate the prevalence of the frailty phenotype as defined by Fried et al and to estimate the need for associated preventative interventions in early-old community-dwelling inhabitants of the southern industrial region of Poland, as well as to investigate the defining components of the frailty phenotype. METHODS: The study group consisted of 160 individuals with an average age of 66.8 ± 4.2 years ( ± SD), 71 (44.4%) of study participants were women. The cohort was randomized out of over 843 thousand community-dwelling Upper Silesian inhabitants aged 60-74 years, who agreed to participate in this project. A comprehensive geriatric assessment (CGA), frailty phenotype test (as described by Fried et al) blood tests and bioimpedance body structure analysis was completed for study participants. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale (IADL), Mini-Mental State Examination (MMSE), the Timed Up and Go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA), and Geriatric Depression Scale - Short Form (GDS-SF). RESULTS: Prefrailty was diagnosed in 24.4% of the subjects (95% Confidence Interval (CI) = 17.7-31.0%; 31% in women and 19.1% in men, P=0.082) and frailty in 2.5% subjects (95% CI 0.1-4.9%; more frequently in women: 4.2% versus 1.1% in men, P=0.046). Having one or more positive frailty criteria was positively associated with depression (odds ratio (OR)=2.85, 95% CI=1.08-7.54, P=0.035) and negatively associated with MMSE score (OR=0.72, 95% CI=0.56-0.93, P=0.012) and fat-free mass (OR=0.96, 95% CI=0.92-0.99, P=0.016) in multivariate logistic regression analysis adjusted for age, sex, disease prevalence, number of medications, functional tests (Barthel Index, IADL, MMSE, GDS-SF), BMI, bioimpedance body composition score, and blood tests. CONCLUSION: At least 25% of the early-old community-dwelling population would benefit from a frailty prevention program. The frailty phenotype reflects both physical and mental health in this population.

Predicting Adverse Outcomes in Healthy Aging Community-Dwelling Early-Old Adults with the Timed Up and Go Test.

BACKGROUND: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions. METHODS: The study included 160 community-dwelling individuals aged 60-74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death. RESULTS: Cohort characteristics: age 66.8±4.2 years (mean±SD), 3.81±2.23 diseases, 4.29±3.60 medications or supplements, and good functional status (MMSE 29.0±1.5, Barthel Index 98.1±8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9-27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41-19.1), falls (9.38%; 95% CI=4.86-13.9), death (0.63%; 95% CI=0-1.85) and no institutionalization. A higher probability of CE was associated with age ≥70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤0.8 m/s (P=0.028) and TUG >9 s (P<0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07-1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551-0.766, P=0.004) and Youden's J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643). CONCLUSION: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.

[Identity of the cardiological rehabilitation with patients with implanted cardioverter-defibrillator]. / Odrebnosc rehabilitacji kardiologicznej u pacjentów po implantacji kardiowertera-defibrylatora.

Implantable cardioverter defibrylator - ICD saves people's life and it protections against sudden cardiac death. Myocardial infarction in the past is the most often factor of the sudden cardiac death risk. The controlled physical activity and psychologists therapeuthical sessions are very important in improvement of quality of life for patients who have implanted ICD.