1
|
Buran MM, Savci S, Tanriverdi A, Kahraman BO, Gunduz D, Sevinc C. Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis. J Bras Pneumol 2024; 50:e20230230. [PMID: 38422338 PMCID: PMC11095920 DOI: 10.36416/1806-3756/e20230230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases. METHODS Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George's Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer. RESULTS The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R2 = 0.67, AR2 = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05). CONCLUSIONS Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.
Collapse
Affiliation(s)
- Melike Mese Buran
- . Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Sema Savci
- . Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Aylin Tanriverdi
- . Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Turkey
| | - Buse Ozcan Kahraman
- . Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Damla Gunduz
- . Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Can Sevinc
- . Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| |
Collapse
|
2
|
Acar Y, İlçin N, Sarı IS, Önen F. Functional exercise capacity in patients with ankylosing spondylitis. Physiother Theory Pract 2023:1-7. [PMID: 37776295 DOI: 10.1080/09593985.2023.2263778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test. METHODS This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed. RESULTS The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040). CONCLUSION The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance.
Collapse
Affiliation(s)
- Yasemin Acar
- Graduate School of Health Sciences, Physical Therapy and Rehabilitation Department, Dokuz Eylül University, Izmir, Turkey
| | - Nursen İlçin
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - I Smail Sarı
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Balcova, Izmir, Turkey
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Balcova, Izmir, Turkey
| |
Collapse
|
3
|
Luppo A, de Camargo CO, Birring SS, Lunardi AC, Rached SZ, Athanazio RA, Stelmach R, Corso SD. A study of the psychometric properties of the Brazilian...Portuguese version of Bronchiectasis Health Questionnaire. Pulmonology 2023; 29:42-49. [PMID: 33386281 DOI: 10.1016/j.pulmoe.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The Bronchiectasis Health Questionnaire (BHQ) is a simple, repeatable, and self-reporting health status questionnaire for bronchiectasis. This study aims to cross-culturally adapt the BHQ into Brazilian Portuguese and evaluate its measurement properties. METHODS The participants answered the Saint George...s Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) scale for dyspnea. The Brazilian-Portuguese version of the Bronchiectasis Health Questionnaire (BHQ-Brazil) was used at baseline (test) and after 14 days (retest). The psychometric analyses included internal consistency, test-retest reliability, and construct validity: factorial validity, convergent validity, and discriminative validity, agreement, and ceiling and floor effects. RESULTS The BHQ-Brazil demonstrated adequate internal consistency (Cronbach...s alpha...=...0.92) and substantial reliability (intraclass correlation coefficient...=...0.86; 95%CI: 0.79...0.90). The exploratory factorial analysis was considered suitable. All items presented a factorial load >0.40. The convergent validity of the BHQ-Brazil with mMRC was moderate (r...=......0.53, p...<...0.001), while concurrent validity with the SGRQ was strong (symptoms: r...=......0.72, activities: r...=......0.60, impact: r...=......0.60, total score: r...=......0.75, all p...<...0.001). The standard error of measurement was 4.81 points. The discriminative validity demonstrated that individuals with more pulmonary exacerbations, colonization by Pseudomonas aeruginosa, worst dyspnea, and a higher number of affected lung lobes presented the lowest quality of life. No floor or ceiling effects were observed. CONCLUSION The BHQ-Brazil presents adequate measurement properties to evaluate the impact of bronchiectasis on health-related quality of life, and can be used in clinical and research settings.
Collapse
Affiliation(s)
- A Luppo
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho ... UNINOVE, Rua Vergueiro, 235/249 ... 2.. Subsolo, 01504-001, S.·o Paulo, Brazil.
| | - C O de Camargo
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho ... UNINOVE, Rua Vergueiro, 235/249 ... 2.. Subsolo, 01504-001, S.·o Paulo, Brazil
| | - S S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, United Kingdom, Denmark Hill, London, SE9 5RS, UK
| | - A C Lunardi
- Master and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, S.·o Paulo, SP, Brazil; Department of Physical Therapy, School of Medicine, University of Sao Paulo, Av. Dr. Arnaldo, 455, 01246903, S.·o Paulo, SP, Brazil
| | - S Z Rached
- Pulmonary Division, Heart Institute (InCor), Hospital das Cl.ínicas da Faculdade de Medicina da Universidade de S.·o Paulo, Av. Dr. En..as Carvalho Aguiar, 44, 05403-000, S.·o Paulo, Brazil
| | - R A Athanazio
- Pulmonary Division, Heart Institute (InCor), Hospital das Cl.ínicas da Faculdade de Medicina da Universidade de S.·o Paulo, Av. Dr. En..as Carvalho Aguiar, 44, 05403-000, S.·o Paulo, Brazil
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Cl.ínicas da Faculdade de Medicina da Universidade de S.·o Paulo, Av. Dr. En..as Carvalho Aguiar, 44, 05403-000, S.·o Paulo, Brazil
| | - S D Corso
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho ... UNINOVE, Rua Vergueiro, 235/249 ... 2.. Subsolo, 01504-001, S.·o Paulo, Brazil
| |
Collapse
|
4
|
Respiratory and Peripheral Muscle Weakness and Body Composition Abnormalities in Non-Cystic Fibrosis Bronchiectasis Patients: Gender Differences. Biomedicines 2022; 10:biomedicines10020334. [PMID: 35203543 PMCID: PMC8961780 DOI: 10.3390/biomedicines10020334] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
As demonstrated in COPD, bronchiectasis patients may experience respiratory and peripheral muscle dysfunction. We hypothesized that respiratory and peripheral (upper and lower limbs) muscle function and nutritional status may be more significantly altered in female than in males for identical age and disease severity. In mild-to-moderate bronchiectasis patients (n = 150, 114 females) and 37 controls (n = 37, 21 females), radiological extension, maximal inspiratory and expiratory pressures (MIP and MEP), sniff nasal inspiratory pressure (SNIP), hand grip and quadriceps muscle strengths, body composition, and blood analytical biomarkers were explored. Compared to the controls, in all bronchiectasis patients (males and females), BMI, fat-free mass index (FFMI), fat tissue, upper and lower limb muscle strength, and respiratory muscle strength significantly declined, and FFMI, fat tissue, and quadriceps muscle function were significantly lower in female than male patients. In patients with mild-to-moderate bronchiectasis, respiratory and peripheral muscle function is significantly impaired and only partly related to lung disease status. Quadriceps muscle strength was particularly weakened in the female patients and was negatively associated with their exercise tolerance. Muscle weakness should be therapeutically targeted in bronchiectasis patients. Body composition and peripheral muscle function determination should be part of the comprehensive clinical assessment of these patients.
Collapse
|
5
|
Ora J, Prendi E, Ritondo BL, Pata X, Spada F, Rogliani P. Pulmonary Rehabilitation in Noncystic Fibrosis Bronchiectasis. Respiration 2021; 101:97-105. [PMID: 34352795 DOI: 10.1159/000517527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current guidelines for the treatment of noncystic fibrosis bronchiectasis (NCFB) recommend pulmonary rehabilitation (PR), but to date, there are few studies that have proven its effectiveness. OBJECTIVE The main objective of this study was to examine the effect of PR on pulmonary function tests and exercise capacity. METHOD The aim of this study was to systematically review the effects of PR in NCFB on (1) forced expiratory volume in the first second (FEV1) and (2) exercise capacity evaluated by the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT). This meta-analysis was undertaken according to PRISMA recommendations. RESULTS This pair-wise meta-analysis included data obtained from studies that enrolled 529 NCFB patients. The FEV1 assessment after PR between the active and control group did not show any significant increase (FEV1 difference 0.084 mL; CI: -0.064, +0.233; p = 0.264), and there was an increasing trend (188 mL; CI: -0 to 0.009, +0.384) at the limits of statistical significance (p = 0.061). Walked distance showed a significant increase in the PR group compared to the control group (ISWT distance difference 070.0 m; CI: 55.2, 84.8; p < 0.001), and this finding was confirmed before and after PR both by the ISWT (68.85 m greater than baseline; CI: 40.52, 97.18; p < 0.001) and by the 6MWT (37.7 m greater than baseline; CI: 20.22, 55.25; p < 0.001). CONCLUSIONS PR improves exercise tolerance in NCFB patients, but it has a modest impact on respiratory function.
Collapse
Affiliation(s)
- Josuel Ora
- Division of Respiratory Medicine, Department of Emergency Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Emanuela Prendi
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Xhesika Pata
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Florian Spada
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Paola Rogliani
- Division of Respiratory Medicine, Department of Emergency Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| |
Collapse
|
6
|
Queiroz DS, da Silva CCBM, Amaral AF, Oliveira MR, Moriya HT, Carvalho CRR, Baldi BG, Carvalho CRF. Desaturation-Distance Ratio During Submaximal and Maximal Exercise Tests and Its Association With Lung Function Parameters in Patients With Lymphangioleiomyomatosis. Front Med (Lausanne) 2021; 8:659416. [PMID: 34395465 PMCID: PMC8358109 DOI: 10.3389/fmed.2021.659416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The desaturation-distance ratio (DDR), the ratio of the desaturation area to the distance walked, is a promising, reliable, and simple physiologic tool for functional evaluation in subjects with interstitial lung diseases. Lymphangioleiomyomatosis (LAM) is a rare neoplastic condition frequently associated with exercise impairment. However, DDR has rarely been evaluated in patients with LAM. Objectives: To assess DDR during maximal and submaximal exercises and evaluate whether DDR can be predicted using lung function parameters. Methods: A cross-sectional study was conducted in a cohort of women with LAM. The 6-min walking test (6MWT) and the incremental shuttle walking test (ISWT) were performed, and DDR was obtained from both tests. The functional parameters were assessed at rest using spirometry and body plethysmography. The pulmonary function variables predictive of DDR were also assessed. Results: Forty patients were included in this study. The mean age was 46 ± 10 years. Airway obstruction, reduced DLCO, and air trapping were found in 60, 57, and 15% of patients, respectively. The distance walked and the DDR for the 6MWT and ISWT were, respectively, 517 ± 65 and 443 ± 127 m; and 6.6 (3.8-10.9) and 8.3 (6.2-12.7). FEV1 (airway obstruction) and reduced DLCO and RV/TLC (air trapping) were independent variables predictive of DDR during exercises field tests [DDR6MWT = 18.66-(0.06 × FEV1%pred)-(0.10 × DLCO%pred) + (1.54 × air trapping),R adjust 2 = 0.43] and maximal [DDRISWT = 18.84-(0.09 × FEV1%pred)-(0.05 × DLCO%pred) + (3.10 × air trapping),R adjust 2 = 0.33]. Conclusion: Our results demonstrated that DDR is a useful tool for functional evaluation during maximal and submaximal exercises in patients with LAM, and it can be predicted using airway obstruction, reduced DLCO, and air trapping.
Collapse
Affiliation(s)
- Douglas Silva Queiroz
- Departament of Physical Therapy, School of Medicine, University of Sáo Paulo, Sáo Paulo, Brazil
- Hospital Israelita Albert Einstein, Sáo Paulo, Brazil
| | | | - Alexandre Franco Amaral
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Martina Rodrigues Oliveira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politécnica, Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Bruno Guedes Baldi
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Celso R. F. Carvalho
- Departament of Physical Therapy, School of Medicine, University of Sáo Paulo, Sáo Paulo, Brazil
| |
Collapse
|
7
|
Kuroyama Y, Tabusadani M, Omatsu S, Shiraishi Y, Senjyu H. Incremental Shuttle Walk Distance as an Indicator for Functional Exercise Capacity of Pre-Surgical Patients with Nontuberculous Mycobacterial Lung Disease. TOHOKU J EXP MED 2020; 250:43-48. [PMID: 31996491 DOI: 10.1620/tjem.250.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of nontuberculous mycobacterial lung disease (NTMLD) is increasing worldwide, the number of lung surgeries is increasing accordingly. The disease is progressive and is characterized by exertional intolerance, respiratory dysfunctions, and impaired health-related quality of life (HRQOL). Treatment comprises multidrug antibiotic treatment combined with lung resection. The incremental shuttle walk distance (ISWD) is a standard tool for assessing the patients' tolerance to lung resection. The exertional tolerance, physical functions and HRQOL among pre-surgical patients with NTMLD are clinically important, but not fully studied yet from the viewpoint of physiotherapy. The purpose of this study was to explore the clinical significance of ISWD for assessing the exercise capacity of pre-surgical patients with NTMLD. For peripheral muscle evaluation, the strength of the quadriceps femoris muscle was measured. HRQOL was evaluated using scores of the St. George's Respiratory Questionnaire (SGRQ). Thirty-three patients (mean age 54.9 ± 13 years) were enrolled. The mean ISWD was 505 ± 134 m, shorter than the reference values (ISWD %predicted: 96 ± 27%). Regression analysis showed significant associations between ISWD and percent-predicted vital capacity (r = 0.38, p = 0.03) and percent quadriceps force/body weight (r = 0.54, p = 0.001). HRQOL assessed by SGRQ scores was correlated with ISWD (r < -0.4, p < 0.05). Multiple regression analysis showed that ISWD was significantly associated with leg muscle strength and with HRQOL. In conclusion, ISWD is useful to evaluate the exercise capacity among pre-surgical patients with NTMLD.
Collapse
Affiliation(s)
- Yuki Kuroyama
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences.,Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Mitsuru Tabusadani
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Shunya Omatsu
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Yuji Shiraishi
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences.,Section of Chest Surgery, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Hideaki Senjyu
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences.,Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| |
Collapse
|
8
|
Chang AB, Grimwood K. Contemporary Concise Review 2018: Bronchiectasis. Respirology 2019; 24:382-389. [PMID: 30743310 DOI: 10.1111/resp.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, QLD, Australia.,Department of Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| |
Collapse
|