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Kähönen E, Kähönen E, Pälve K, Hulkkonen J, Kähönen M, Raitakari OT, Hutri N, Lehtimäki T, Aatola H. Association of childhood socioeconomic status with adulthood maximal exercise blood pressure: the Cardiovascular Risk in Young Finns Study. Blood Press 2024; 33:2323987. [PMID: 38465629 DOI: 10.1080/08037051.2024.2323987] [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: 01/03/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Socioeconomic status has been related to resting blood pressure (BP) levels at different stages of life. However, the association of childhood socioeconomic status (SES) and adulthood exercise BP is largely unknown. Therefore, we studied the association of childhood SES with adulthood maximal exercise BP. MATERIALS AND METHODS This investigation consisted of 373 individuals (53% women) participating in the Cardiovascular Risk in Young Finns Study who had data concerning family SES in childhood (baseline in 1980, at age of 6-18 years) and exercise BP response data in adulthood (follow-up in adulthood in 27-29 years since baseline). A maximal cardiopulmonary exercise test with BP measurements was performed by participants, and peak exercise BP was measured. RESULTS In stepwise multivariable analysis including childhood risk factors and lifestyle factors (body mass index, systolic BP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, fruit consumption, vegetable consumption, and physical activity), lower family SES in childhood was associated with higher maximal exercise BP in adulthood (β value ± SE, 1.63 ± 0.77, p = 0.035). The association remained significant after further adjustment with participants SES in adulthood (β value ± SE, 1.68 ± 0.65, p = 0.011) and after further adjustment with adulthood body-mass index, systolic BP, maximal exercise capacity, and peak heart rate in exercise (β value ± SE, 1.25 ± 0.56, p = 0.027). CONCLUSIONS These findings suggest that lower childhood family SES is associated with higher maximal exercise BP in adulthood.
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Affiliation(s)
- Erika Kähönen
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Emilia Kähönen
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kristiina Pälve
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - Mika Kähönen
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri
- Tampere Centre for Skills Training and Simulation, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Heikki Aatola
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
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Dougherty CM, Cordoza M, Wang D, Alsoyan AH, Stein PK, Burr RL. Aerobic Exercise Improves Heart Rate Variability After an Implantable Cardioverter Defibrillator (ICD). Biol Res Nurs 2024; 26:584-596. [PMID: 38881252 DOI: 10.1177/10998004241261273] [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] [Indexed: 06/18/2024]
Abstract
CLINICAL TRIAL REGISTRATION Clinicaltrials.gov: NCT00522340.
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Affiliation(s)
- Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Makayla Cordoza
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Di Wang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Afnan Hamad Alsoyan
- Critical Care Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Phyllis K Stein
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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Bhammar DM, Nusekabel CW, Wilhite DP, Daulat S, Liu Y, Glover RIS, Babb TG. Effects of Obesity and Sex on Ventilatory Constraints during a Cardiopulmonary Exercise Test in Children. Med Sci Sports Exerc 2024; 56:2039-2048. [PMID: 38768025 PMCID: PMC11402596 DOI: 10.1249/mss.0000000000003481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE Ventilatory constraints are common during exercise in children, but the effects of obesity and sex are unclear. The purpose of this study was to investigate the effects of obesity and sex on ventilatory constraints (i.e., expiratory flow limitation (EFL) and dynamic hyperinflation) during a maximal exercise test in children. METHODS Thirty-four 8- to 12-yr-old children without obesity (18 females) and 54 with obesity (23 females) completed pulmonary function testing and maximal cardiopulmonary exercise tests. EFL was calculated as the overlap between tidal flow-volume loops during exercise and maximal expiratory flow-volume loops. Dynamic hyperinflation was calculated as the change in inspiratory capacity from rest to exercise. RESULTS Maximal minute ventilation was not different between children with and without obesity. Average end-inspiratory lung volumes (EILV) and end-expiratory lung volumes (EELV) were significantly lower during exercise in children with obesity (EILV: 68.8% ± 0.7% TLC; EELV: 41.2% ± 0.5% TLC) compared with children without obesity (EILV: 73.7% ± 0.8% TLC; EELV: 44.8% ± 0.6% TLC; P < 0.001). Throughout exercise, children with obesity experienced more EFL and dynamic hyperinflation compared with those without obesity ( P < 0.001). Also, males experienced more EFL and dynamic hyperinflation throughout exercise compared with females ( P < 0.001). At maximal exercise, the prevalence of EFL was similar in males with and without obesity; however, the prevalence of EFL in females was significantly different, with 57% of females with obesity experiencing EFL compared with 17% of females without obesity ( P < 0.05). At maximal exercise, 44% of children with obesity experienced dynamic hyperinflation compared with 12% of children without obesity ( P = 0.002). CONCLUSIONS Obesity in children increases the risk of developing mechanical ventilatory constraints such as dynamic hyperinflation and EFL. Sex differences were apparent with males experiencing more ventilatory constraints compared with females.
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Affiliation(s)
- Dharini M Bhammar
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Celia W Nusekabel
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | | - Shilpa Daulat
- Department of Internal Medicine, Rush University, Chicago, IL
| | - Yulun Liu
- School of Public Health, UT Southwestern Medical Center and Simmons Comprehensive Cancer Center, Dallas, TX
| | - Rae I S Glover
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and UT Southwestern Medical Center, Dallas, TX
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Visser S, Lawler C, Fermoyle CC, Spencer LM, McAnulty AJ, Alison JA, Webster S, Troy L, Jo H, Hayen A, Corte TJ. The 1-min sit-to-stand test as a screening tool to assess exercise-induced oxygen desaturation in normoxemic people with interstitial lung disease. Respir Med 2024; 232:107748. [PMID: 39074595 DOI: 10.1016/j.rmed.2024.107748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND In patients with interstitial lung disease (ILD), exercise-induced desaturation during the 6-min walk test (6MWT), specifically nadir oxygen saturation (nSpO2) of ≤88 % is a negative prognostic marker. As the 6MWT is often impractical for ILD patients, the aim of this study is to compare the 1-min sit-to-stand test (1minSTS) with the 6MWT to detect exercise-induced desaturation. METHODS Participants were recruited from a tertiary referral clinic with both tests performed on the same day. Utilising Bland-Altman analysis, the relationship between nSpO2 on 1minSTS and 6MWT was determined. An area under the receiver operating characteristic curve (AUC) determined the ability of nSpO2 on 1minSTS test to predict SpO2 ≤88 % on 6MWT. RESULTS Fifty participants completed the study (idiopathic pulmonary fibrosis n = 24, 48 %; connective tissue disease associated ILD n = 20, 40 %; other ILD n = 6, 12 %). Mean (SD) FVC%pred was 73 ± 16 %, mean DLCO%pred 57 ± 16 % and resting SpO2 99 ± 1 %. The 1minSTS resulted in less exercise-induced oxygen desaturation, with a median IQR nSpO2 of 95 % (89-98) and 93 % (85-96) respectively (p < 0.001). Moderate agreement was determined between the nSpO2 on both tests, with a mean difference of 3.2 % [-14 to +3.0 %]. The 1minSTS test accurately identified participants with nSpO2 ≤88 % on 6MWT (AUC 0.96). Oxygen desaturation ≤94 % during the 1minSTS test provided 100 % sensitivity and 87 % specificity for oxygen desaturation ≤88 % at 6MWT. CONCLUSION This study demonstrates that exercise-induced oxygen desaturation during the 1minSTS test correlates with oxygen desaturation on 6MWT. The 1minSTS may be a practical screening tool for ILD patients who would benefit from further exercise testing.
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Affiliation(s)
- Simone Visser
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia.
| | - Chloe Lawler
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Caitlin C Fermoyle
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Lissa M Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Amanda J McAnulty
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jennifer A Alison
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Allied Health, Sydney Local Health District, Sydney, Australia
| | - Susanne Webster
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lauren Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Helen Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
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Fukui M, Matsunaga T, Hattori A, Takamochi K, Tomita H, Nojiri S, Suzuki K. Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer. J Thorac Cardiovasc Surg 2024; 168:1289-1296.e4. [PMID: 38218531 DOI: 10.1016/j.jtcvs.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To investigate the influence of simple preoperative exercise tests as prognostic factors for early-stage lung cancer. METHODS This single-institution retrospective study included consecutive patients who underwent pulmonary resection for stage 0 to I lung cancer between April 2017 and December 2019. Before surgery, 7 metabolic equivalents of task in the double Master 2-step test were loaded into the exercise echocardiogram. The relationship between prognosis and exercise stress test results in terms of availability, symptoms, and saturation of percutaneous oxygen was investigated. RESULTS This study included 862 patients with pathological stage 0 to I lung cancer. Among the 862 patients, 673 patients (78.1%) who were able to complete 7 metabolic equivalents of task exercise for 3 minutes without assistance were classified into the complete group. The 5-year survival of the complete group was significantly better than that of the incomplete group. Multivariable analysis revealed that age (hazard ratio, 1.06; P = .008), male sex (hazard ratio, 2.23; P = .011), carcinoembryonic antigen level >5 ng/mL (hazard ratio, 2.33; P = .011), and inability to complete 7 metabolic equivalents of task exercise (hazard ratio, 3.90; P < .001) were the prognostic factors. Patients in the older group who had the ability to complete exercise had a better prognosis than those in the younger group without the ability (P = .003). CONCLUSIONS Preoperative exercise ability is a prognostic factor for early-stage lung cancer. Patients who can tolerate an exercise load of 7 metabolic equivalents of task, even if they are aged 70 years or older, have a better prognosis than patients younger than age 70 years without exercise tolerance.
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Affiliation(s)
- Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisashi Tomita
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Tackney MS, Carpenter JR, Villar SS. Unleashing the full potential of digital outcome measures in clinical trials: eight questions that need attention. BMC Med 2024; 22:413. [PMID: 39334286 DOI: 10.1186/s12916-024-03590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
The use of digital health technologies to measure outcomes in clinical trials opens new opportunities as well as methodological challenges. Digital outcome measures may provide more sensitive and higher-frequency measurements but pose vital statistical challenges around how such outcomes should be defined and validated and how trials incorporating digital outcome measures should be designed and analysed. This article presents eight methodological questions, exploring issues such as the length of measurement period, choice of summary statistic and definition and handling of missing data as well as the potential for new estimands and new analyses to leverage the time series data from digital devices. The impact of key issues highlighted by the eight questions on a primary analysis of a trial are illustrated through a simulation study based on the 2019 Bellerophon INOPulse trial which had time spent in MVPA as a digital outcome measure. These eight questions present broad areas where methodological guidance is needed to enable wider uptake of digital outcome measures in trials.
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Affiliation(s)
- Mia S Tackney
- MRC-Biostatistics Unit, University of Cambridge, East Forvie Building, Forvie, Robinson Way, Cambridge, CB2 0SR, UK.
| | - James R Carpenter
- MRC Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, 90 High Holborn, London, WC1V 6LJ, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Sofía S Villar
- MRC-Biostatistics Unit, University of Cambridge, East Forvie Building, Forvie, Robinson Way, Cambridge, CB2 0SR, UK
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Çerezci-Duygu S, Erbahçeci F, Durutürk N, Ümit-Yemişçi O. The effects of spinal stabilization exercises on functional exercise capacity in individuals with transtibial amputation: A randomized trial. Prosthet Orthot Int 2024:00006479-990000000-00263. [PMID: 39259574 DOI: 10.1097/pxr.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/29/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Optimization of mobility activities with spinal stabilization exercises and reducing spinal loads in individuals with transtibial amputation are recommended by researchers; however, the effect of spinal stabilization exercises on functional exercise capacity has not been investigated. OBJECTIVE This study aims to investigate the effect of spinal stabilisation exercises on functional exercise capacity in individuals with transtibial amputation. STUDY DESIGN Randomized controlled trial with concealed allocation, assessor blinding. METHODS Eighteen individuals with transtibial amputation were included. Conventional physiotherapy program was applied to individuals in control group, and spinal stabilization exercise training was applied to individuals in intervention group together with conventional physiotherapy program for 8 weeks. The primary outcome was maximal oxygen uptake during 6-Minute Stepper Test. The secondary outcomes were maximal energy expenditure, step count and fatigue during 6-Minute Stepper Test, perceived mobility level with prosthesis, and stabilization strength of deep spinal muscles. RESULTS In the within-group comparisons, the change in the functional exercise capacity, step count, and stabilization strength of deep spinal muscles were found to be statistically significant in both groups. In the between-group comparison, the changes in the functional exercise capacity, perceived mobility level, and stabilization strength of deep spinal muscles were found to be significant in favor of the group in which spinal stabilization exercises were applied. CONCLUSIONS Along with improvement in proximal control of movement, improvements were observed in some parameters that are indicative of physical capacity. Considering the described developments, exercise programs focused on spinal stabilization in individuals with amputation are becoming a serious alternative in clinical practice.
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Affiliation(s)
- Senay Çerezci-Duygu
- Department of Orthotics and Prosthetics, Gülhane Faculty of Health Sciences, University of Health Sciences, Ankara, Türkiye
| | - Fatih Erbahçeci
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Neslihan Durutürk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Başkent University, Ankara, Türkiye
| | - Oya Ümit-Yemişçi
- Department of Physical and Rehabilitation Medicine, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
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Ripollés-Melchor J, Monge García MI, Ruiz-Escobar A, Sáez-Ruiz E, Algar-Yañez B, Abad-Motos A, Abad-Gurumeta A. Validity of estimated aortic pulse wave velocity measured during the 6-min walk test to predict anaerobic fitness before major non-cardiac surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00126-4. [PMID: 39245143 DOI: 10.1016/j.redare.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND This study aimed to assess the efficacy of estimated preoperative aortic pulse wave velocity (AoPWV) to discriminate between low and high 6 min walk test (6MWT) distance in patients awaiting major non-cardiac surgery. METHODS Prospective observational study in 133 patients undergoing non cardiac surgery. AoPWV and the distance walked during a 6MWT were assessed. Receiver operating characteristic (ROC) curve analysis was used to determine two different AoPWV cut-points for predicting a distance of 427 m in the 6MWT. We also calculated lower and upper AoPWV cut-points (probability ≥ 0.75) for predicting a distance of < 427 m, ≥427 m, and also 563 m in the 6MWT. RESULTS The ROC curve analysis for the < 427 m distance revealed an area under the curve (AUC) of 0.68 (95% confidence interval 0.56-0.79) and an AUC of 0.72 (95% confidence interval 0.61-0.83) for >563 m. Patients with AoPWV > 10.97 m/s should be considered high risk, while those with <9.42 m/s can be considered low risk. CONCLUSIONS AoPWV is a simple, non-invasive, useful clinical tool for identifying and stratifying patients awaiting major non-cardiac surgery. In situations of clinical uncertainty, additional measures should be taken to assess the risk.
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Affiliation(s)
- J Ripollés-Melchor
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - M I Monge García
- Departamento de Cuidados Intensivos, Hospital Universitario SAS de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - A Ruiz-Escobar
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - E Sáez-Ruiz
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - B Algar-Yañez
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - A Abad-Motos
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
| | - A Abad-Gurumeta
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
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Fiore L, Mazzaracchio V, Antinucci A, Ferrara R, Sciarra T, Lista F, Shen AQ, Arduini F. Wearable electrochemical device based on butterfly-like paper-based microfluidics for pH and Na + monitoring in sweat. Mikrochim Acta 2024; 191:580. [PMID: 39243287 PMCID: PMC11380643 DOI: 10.1007/s00604-024-06564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/10/2024] [Indexed: 09/09/2024]
Abstract
A wearable potentiometric device is reported based on an innovative butterfly-like paper-based microfluidic system, allowing for continuous monitoring of pH and Na+ levels in sweat during physical activity. Specifically, the use of the butterfly-like configuration avoids evaporation phenomena and memory effects, enabling precise and timely biomarker determination in sweat. Two ad hoc modified screen-printed electrodes were embedded in the butterfly-like paper-based microfluidics, and the sensing device was further integrated with a portable and miniaturized potentiostat, leveraging Bluetooth technology for efficient data transmission. First, the paper-based microfluidic configuration was tested for optimal fluidic management to obtain optimized performance of the device. Subsequently, the two electrodes were individually tested to detect the two biomarkers, namely pH and Na+. The results demonstrated highly promising near-Nernstian (0.056 ± 0.002 V/dec) and super-Nernstian (- 0.080 ± 0.003 V/pH) responses, for Na+ and pH detection, respectively. Additionally, several important parameters such as storage stability, interferents, and memory effect by hysteresis study were also investigated. Finally, the butterfly-like paper-based microfluidic wearable device was tested for Na+ and pH monitoring during the physical activity of three volunteers engaged in different exercises, obtaining a good correlation between Na+ increase and dehydration phenomena. Furthermore, one volunteer was tested through a cardiopulmonary test, demonstrating a correlation between sodium Na+ increase and the energetic effort by the volunteer. Our wearable device highlights the high potential to enable early evaluation of dehydration and open up new opportunities in sports activity monitoring.
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Affiliation(s)
- Luca Fiore
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy
- SENSE4MED, Via Bitonto 139, 00133, Rome, Italy
| | - Vincenzo Mazzaracchio
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy
| | - Arianna Antinucci
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy
- SENSE4MED, Via Bitonto 139, 00133, Rome, Italy
| | - Roberto Ferrara
- Physical Medicine and Rehabilitation Unit, Italian Army Medical Hospital, 00184, Rome, Italy
| | - Tommaso Sciarra
- Physical Medicine and Rehabilitation Unit, Italian Army Medical Hospital, 00184, Rome, Italy
- Defence Institute for Biomedical Sciences, Rome, Italy
| | | | - Amy Q Shen
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna-Son, Okinawa, 904-0495, Japan
| | - Fabiana Arduini
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy.
- SENSE4MED, Via Bitonto 139, 00133, Rome, Italy.
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Insel M, El Aini T, Woodhead G, Wig R, Kubba S, Claessen G, Howden E, Rischard F. Post-Pulmonary Embolism Phenotypes Described by Invasive Cardiopulmonary Exercise Testing. Chest 2024:S0012-3692(24)05134-1. [PMID: 39236998 DOI: 10.1016/j.chest.2024.08.040] [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: 02/04/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Post-pulmonary embolism (PE) dyspnea is common. Existing noninvasive studies have demonstrated that post-PE dyspnea is associated with elevations in right ventricular (RV) afterload, dead space ventilation, and deconditioning. We aimed to use invasive cardiopulmonary exercise testing (iCPET) parameters in patients with post-PE dyspnea to identify unique physiologic phenotypes. RESEARCH QUESTION Do distinct post-PE dyspnea physiologic phenotypes exist that are described with iCPET? STUDY DESIGN AND METHODS Patients were enrolled at the time of acute PE and through our pulmonary hypertension (PH) and dyspnea clinic. iCPET was performed if high suspicion existed for PH or if unexplained dyspnea was present. A hierarchical cluster analysis was performed to identify dyspnea phenotypes. iCPET parameters assessing pulmonary hemodynamics, ventilation, and peripheral oxygen use then were compared within and across each cluster and with iCPET control participants against peak oxygen consumed per minute (VO2). RESULTS One hundred seventy-three patients were enrolled. Sixty-seven patients underwent iCPET. All patients showed reductions in peak VO2 and peak cardiac index relative to control participants. Three clusters were identified. Cluster 1 was defined by having elevated RV afterload and impaired ventilatory efficiency. Cluster 2 was defined by elevated RV afterload with reductions in respiratory mechanics. Cluster 3 was defined by mild derangement in RV afterload with mild reductions in peak cardiac output. INTERPRETATION iCPET revealed significant heterogeneity in post-PE dyspnea. Three phenotypes are characterized by differences in RV afterload: ventilatory efficiency, respiratory mechanics, and peripheral oxygen use.
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Affiliation(s)
- Michael Insel
- Division of Pulmonary Allergy Sleep and Critical Care, University of Arizona, Tucson, AZ.
| | - Tammer El Aini
- Division of Pulmonary Allergy Sleep and Critical Care, University of Arizona, Tucson, AZ
| | | | - Rebecca Wig
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Saad Kubba
- Division of Cardiology, University of Arizona, Tucson, AZ
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Erin Howden
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Franz Rischard
- Division of Pulmonary Allergy Sleep and Critical Care, University of Arizona, Tucson, AZ
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Piamonti D, Panza L, Flore R, Baccolini V, Pellegrino D, Sanna A, Lecci A, Lo Muzio G, Angelone D, Mirabelli FM, Morviducci M, Onorati P, Messina E, Panebianco V, Catalano C, Bonini M, Palange P. Ventilatory efficiency in long-term dyspnoeic patients following COVID-19 pneumonia. Respir Physiol Neurobiol 2024; 327:104285. [PMID: 38825094 DOI: 10.1016/j.resp.2024.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Long COVID is defined as persistency of symptoms, such as exertional dyspnea, twelve weeks after recovery from SARS-CoV-2 infection. OBJECTIVES To investigate ventilatory efficiency by the use of cardiopulmonary exercise testing (CPET) in patients with exertional dyspnea despite normal basal spirometry after 18 (T18) and 36 months (T36) from COVID-19 pneumonia. METHODS One hundred patients with moderate-critical COVID-19 were prospectively enrolled in our Long COVID program. Medical history, physical examination and lung high-resolution computed tomography (HRCT) were obtained at hospitalization (T0), 3 (T3) and 15 months (T15). All HRCTs were revised using a semi-quantitative CT severity score (CSS). Pulmonary function tests were obtained at T3 and T15. CPET was performed in a subset of patients with residual dyspnea (mMRC ≥ 1), at T18 and at T36. RESULTS Remarkably, at CPET, ventilatory efficiency was reduced both at T18 (V'E/V'CO2 slope = 31.4±3.9 SD) and T36 (V'E/V'CO2 slope = 31.28±3.70 SD). Furthermore, we identified positive correlations between V'E/V'CO2 slope at T18 and T36 and both percentage of involvement and CSS at HRCT at T0, T3 and T15. Also, negative linear correlations were found between V'E/V'CO2 slope at T18 and T36 and DLCO at T3 and T15. CONCLUSIONS At eighteen months from COVID-19 pneumonia, 20 % of subjects still complains of exertional dyspnea. At CPET this may be explained by persistently reduced ventilatory efficiency, possibly related to the degree of lung parenchymal involvement in the acute phase of infection, likely reflecting a damage in the pulmonary circulation.
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Affiliation(s)
- Daniel Piamonti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
| | - Luigi Panza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Roberto Flore
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Daniela Pellegrino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Arianna Sanna
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Altea Lecci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Giulia Lo Muzio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Dario Angelone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | - Matteo Morviducci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Paolo Onorati
- Alghero City Hospital, Pulmonology and Respiratory Pathophysiology Service, Alghero, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Matteo Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Harvey A, Curnier D, Dodin P, Jacquemet V, Caru M. The Effects of Cycle Ergometer Versus Treadmill Exercise Stress Testing on QTc Interval Prolongation in Patients With Long QT Syndrome: A Systematic Review and Meta-analysis. Clin J Sport Med 2024; 34:474-502. [PMID: 39012267 DOI: 10.1097/jsm.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/16/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The safest and most effective exercise stress tests (EST) modalities for long QT syndrome (LQTS) are currently unknown. The main objective was to explore the effects of EST on the corrected QT interval (QTc) in patients with LQTS, and to compare the effects of different EST modalities (cycle ergometer vs treadmill). DATA SOURCES Systematic searches were performed in September 2022 in accordance with the PRISMA statement through PubMed, Medline, EBM Reviews, Embase, and Web of Science. MAIN RESULTS A total of 1728 patients with LQTS, whether congenital or acquired, without any age restrictions (pediatric age ≤18 years and adult age >19 years), and 2437 control subjects were included in the 49 studies. The QT interval data were available for 15 studies. Our analyses showed that the QT interval prolonged in a similar manner using either a cycle ergometer or a treadmill (standardized mean difference [SMD] = 1.89 [95% CI, 1.07-2.71] vs SMD = 1.46 [95% CI, 0.78-2.14], respectively). Therefore, it seems that either modality may be used to evaluate patients with LQTS. CONCLUSIONS The methodology for the measurement of the QT interval was very heterogeneous between studies, which inevitably influenced the quality of the analyses. Hence, researchers should proceed with caution when exploring and interpreting data in the field of exercise and LQTS.
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Affiliation(s)
- Audrey Harvey
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Philippe Dodin
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada ; and
| | - Maxime Caru
- Department of Pediatrics and Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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13
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Shlomi D, Beck T, Reuveny R, Segel MJ. Prediction of exercise respiratory limitation from pulmonary function tests. Pulmonology 2024; 30:452-458. [PMID: 36717291 DOI: 10.1016/j.pulmoe.2022.12.003] [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: 05/28/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Evaluation of unexplained exercise intolerance is best resolved by cardiopulmonary exercise testing (CPET) which enables the determination of the exercise limiting system in most cases. Traditionally, pulmonary function tests (PFTs) at rest are not used for the prediction of a respiratory limitation on CPET. OBJECTIVE We sought cut-off values on PFTs that might, a priori, rule-in or rule-out a respiratory limitation in CPET. METHODS Patients who underwent CPET in our institute were divided into two groups according to spirometry: obstructive and non-obstructive. Each group was randomly divided 2:1 into derivation and validation cohorts respectively. We analyzed selected PFTs parameters in the derivation groups in order to establish maximal and minimal cut-off values for which a respiratory limitation could be ruled-in or ruled-out. We then validated these values in the validation cohorts. RESULTS Of 593 patients who underwent a CPET, 126 were in the obstructive and 467 in the non-obstructive group. In patients with obstructive lung disease, forced expiratory volume in 1 second (FEV1) ≥ 61% predicted could rule out a respiratory limitation, while FEV1 ≤ 33% predicted was always associated with a respiratory limitation. For patients with non-obstructive spirometry, FEV1 of ≥ 73% predicted could rule-out a respiratory limitation. Application of this algorithm might have saved up to 47% and 71% of CPETs in our obstructive and non-obstructive groups, respectively. CONCLUSION Presence or absence of a respiratory limitation on CPET can be predicted in some cases based on a PFTs performed at rest.
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Affiliation(s)
- D Shlomi
- Adelson School of Medicine, Ariel University, Ariel, Israel; Pulmonary Clinic, Dan-Petah-Tiqwa District, Clalit Health Services - Community Division, Ramat-Gan, Israel.
| | - T Beck
- Department of Surgical Oncology (Surgery C), Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Reuveny
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pulmonary Institute, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel; Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - M J Segel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pulmonary Institute, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
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14
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Jones LW, Moskowitz CS, Lee CP, Fickera GA, Chun SS, Michalski MG, Stoeckel K, Underwood WP, Lavery JA, Bhanot U, Linkov I, Dang CT, Ehdaie B, Laudone VP, Eastham JA, Collins A, Sheerin PT, Liu LY, Eng SE, Boutros PC. Neoadjuvant Exercise Therapy in Prostate Cancer: A Phase 1, Decentralized Nonrandomized ControlledTrial. JAMA Oncol 2024; 10:1187-1194. [PMID: 39023900 PMCID: PMC11258635 DOI: 10.1001/jamaoncol.2024.2156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/22/2024] [Indexed: 07/20/2024]
Abstract
Importance Observational data have shown that postdiagnosis exercise is associated with reduced risk of prostate cancer death. The feasibility and tumor biological activity of exercise therapy is not known. Objective To identify recommended phase 2 dose of exercise therapy for patients with prostate cancer. Design, Setting, and Participants This single-center, phase 1a dose-finding trial was conducted at a tertiary cancer center using a patientcentric, decentralized platform and included 53 inactive men with treatment-naive localized prostate cancer scheduled to undergo surgical resection between June 2019 and January 2023. Data were analyzed in June 2024. Intervention Six escalated exercise therapy dose levels ranging from 90 to 450 minutes per week of individualized, moderate-intensity treadmill walking, allocated using adaptive continual reassessment. All exercise therapy sessions were conducted remotely with real-time monitoring. Main Outcomes and Measures Feasibility was evaluated by relative exercise dose intensity (REDI). A dose level was considered feasible if 70% or more of patients achieved an REDI of 75% or greater. Activity end points were changes in tumor cell proliferation (Ki67) and plasma prostate-specific antigen levels between pretreatment and postintervention. Safety and changes in patient physiology were also assessed. Results A total of 53 men were enrolled (median [IQR] age, 61 [56-66] years). All dose levels were feasible (≥75% REDI). The mean (95% CI) changes in Ki67 were 5.0% (-4.3% to 14.0%) for 90 minutes per week, 2.4% (-1.3% to 6.2%) for 150 minutes per week, -1.3% (-5.8% to 3.3%) for 225 minutes per week, -0.2% (-4.0% to 3.7%) for 300 minutes per week, -2.6% (-9.2% to 4.1%) for 375 minutes per week, and 2.2% (-0.8% to 5.1%) for 450 minutes per week. Changes in prostate-specific antigen levels were 1.0 ng/mL (-1.8 to 3.8) for 90 minutes per week, 0.2 ng/mL (-1.1 to 1.5) for 150 minutes per week, -0.5 ng/mL (-1.2 to 0.3) for 225 minutes per week, -0.2 (-1.7 to 1.3) for 300 minutes per week, -0.7 ng/mL (-1.7 to 0.4) for 375 minutes per week, and -0.9 ng/mL (-2.4 to 0.7) for 450 minutes per week. No serious adverse events were observed. Overall, 225 minutes per week (approximately 45 minutes per treatment at 5 times weekly) was selected as the recommended phase 2 dose. Conclusions and Relevance The results of this nonrandomized clinical trial suggest that neoadjuvant exercise therapy is feasible and safe with promising activity in localized prostate cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03813615.
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Affiliation(s)
- Lee W. Jones
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | | | | | | | - Su S. Chun
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | - Umeshkumar Bhanot
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Irina Linkov
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chau T. Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Vincent P. Laudone
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - James A. Eastham
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Anne Collins
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lydia Y. Liu
- Institute for Precision Health, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
- Department of Urology, University of California, Los Angeles
| | - Stefan E. Eng
- Institute for Precision Health, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
- Department of Urology, University of California, Los Angeles
| | - Paul C. Boutros
- Institute for Precision Health, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
- Department of Urology, University of California, Los Angeles
- Department of Human Genetics, University of California, Los Angeles
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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15
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Pathare N, MacPhail D. Physical therapy management of an individual with post-COVID fatigue considering emotional health in an outpatient setting: A case report. Physiother Theory Pract 2024; 40:2160-2170. [PMID: 37323003 DOI: 10.1080/09593985.2023.2225185] [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: 01/13/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this case report is to provide a plan of care with an emphasis on patient education and consideration of emotional health for a patient with post-COVID fatigue in an outpatient setting. CASE DESCRIPTION A 50-year-old woman, ten-weeks post-COVID syndrome, participated in an examination that revealed deficits in exercise capacity, strength, breathing pattern, mild depression, emotional breakdown, and mild anxiety accompanied by "brain fog" with activity. Her primary complaint was fatigue with ordinary activities around her home that impeded her from returning to work. On examination, scores included six-minute walk test distance (6MWD): 79.5 m, UCSD Shortness of Breath Questionnaire (SOBQ): 72/120, and Patient Health Questionnaire (PHQ-9): 6/27. The patient participated in 20 biweekly sessions with a focus on patient education, supporting emotional health, aerobic training, strengthening exercises, breathing exercises, and home exercise program. OUTCOMES At discharge, the patient's exercise capacity, muscle strength, dyspnea, and depression improved, beyond the MCID/MID values, 6MWD: 335 m, SOBQ: 34/120; and PHQ-9 :1/27. The patient had no anxiety with activity and reported confidence to resume activities, allowing her to return to work safely. CONCLUSION Following an intervention that addressed emotional needs with physical symptoms, our patient with post-COVID fatigue showed substantial improvements in exercise capacity, muscle strength, dyspnea, and depression. This highlights the consideration of psychosocial well-being in our plan of care for this population.
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Affiliation(s)
- Neeti Pathare
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, USA
| | - Dylan MacPhail
- Department of Physical Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
- Department of Physical Therapy, Russell Sage College, Troy, NY, USA
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16
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Dores H, Mendes M, Abreu A, Durazzo A, Rodrigues C, Vilela E, Cunha G, Gomes Pereira J, Bento L, Moreno L, Dinis P, Amorim S, Clemente S, Santos M. Cardiopulmonary exercise testing in clinical practice: Principles, applications, and basic interpretation. Rev Port Cardiol 2024; 43:525-536. [PMID: 38583860 DOI: 10.1016/j.repc.2024.01.005] [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: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024] Open
Abstract
Cardiopulmonary exercise testing (CPET) provides a noninvasive and integrated assessment of the response of the respiratory, cardiovascular, and musculoskeletal systems to exercise. This information improves the diagnosis, risk stratification, and therapeutic management of several clinical conditions. Additionally, CPET is the gold standard test for cardiorespiratory fitness quantification and exercise prescription, both in patients with cardiopulmonary disease undergoing cardiac or pulmonary rehabilitation programs and in healthy individuals, such as high-level athletes. In this setting, the relevance of practical knowledge about this exam is useful and of interest to several medical specialties other than cardiology. However, despite its multiple established advantages, CPET remains underused. This article aims to increase awareness of the value of CPET in clinical practice and to inform clinicians about its main indications, applications, and basic interpretation.
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Affiliation(s)
- Hélder Dores
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal; CHRC, NOVA Medical School, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
| | - Miguel Mendes
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Abreu
- Cardiovascular Rehabilitation Center, Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, CHULN/Faculdade de Medicina da Universidade de Lisboa, FMUL/CRECUL, Lisbon, Portugal; Ergometry Department, Department of Cardiology, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Saúde Ambiental, ISAMB, FMUL/Laboratório Associado Terra, Lisbon, Portugal; Instituto de Medicina Preventiva e Saúde Pública, IMPSP, FMUL, Lisbon, Portugal; Instituto de Medicina Nuclear, IMN, FMUL, Lisbon, Portugal; Cardiovascular Center, Universidade de Lisboa, CCUL, Centro Académico de Medicina da Universidade de Lisboa, CAML, Lisbon, Portugal
| | - Anaí Durazzo
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Cidália Rodrigues
- Department of Pulmonology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo Vilela
- Department of Cardiology, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Gonçalo Cunha
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - José Gomes Pereira
- Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal; Comité Olímpico de Portugal, Lisbon, Portugal; Desporsano - Sports Clinic, Lisbon, Portugal
| | | | - Luís Moreno
- Regimento de Comandos, Exército Português, Belas, Portugal; Hospital CUF Tejo, Lisbon, Portugal
| | - Paulo Dinis
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centro de Saúde Militar de Coimbra, Exército Português, Coimbra, Portugal
| | - Sandra Amorim
- Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Susana Clemente
- Department of Pulmonology, Hospital da Luz, Lisbon, Portugal; Department of Pulmonology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Mário Santos
- Department of Cardiology, Pulmonary Vascular Disease Unit, Centro Hospitalar Universitário de Santo António, Porto, Portugal; CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Porto, Portugal; Department of Immuno-Physiology and Pharmacology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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17
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Vecchiato M, Aghi A, Nerini R, Borasio N, Gasperetti A, Quinto G, Battista F, Bettini S, DI Vincenzo A, Ermolao A, Busetto L, Neunhaeuserer D. Comparison of Cardiorespiratory Fitness Prediction Equations and Generation of New Predictive Model for Patients with Obesity. Med Sci Sports Exerc 2024; 56:1732-1739. [PMID: 38768055 DOI: 10.1249/mss.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) is a critical marker of overall health and a key predictor of morbidity and mortality, but the existing prediction equations for CRF are primarily derived from general populations and may not be suitable for patients with obesity. METHODS Predicted CRF from different non-exercise prediction equations was compared with measured CRF of patients with obesity who underwent maximal cardiopulmonary exercise testing (CPET). Multiple linear regression was used to develop a population-specific nonexercise CRF prediction model for treadmill exercise including age, sex, weight, height, and physical activity level as determinants. RESULTS Six hundred sixty patients underwent CPET during the study period. Within the entire cohort, R2 values had a range of 0.24 to 0.46. Predicted CRF was statistically different from measured CRF for 19 of the 21 included equations. Only 50% of patients were correctly classified into the measured CRF categories according to predicted CRF. A multiple model for CRF prediction (mL·min -1 ) was generated ( R2 = 0.78) and validated using two cross-validation methods. CONCLUSIONS Most used equations provide inaccurate estimates of CRF in patients with obesity, particularly in cases of severe obesity and low CRF. Therefore, a new prediction equation was developed and validated specifically for patients with obesity, offering a more precise tool for clinical CPET interpretation and risk stratification in this population.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | | | - Raffaele Nerini
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Nicola Borasio
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Angelo DI Vincenzo
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Padova, ITALY
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, ITALY
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18
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Hijleh AA, Berton DC, Neder-Serafini I, James M, Vincent S, Domnik N, Phillips D, O'Donnell DE, Neder JA. Sex- and age-adjusted reference values for dynamic inspiratory constraints during incremental cycle ergometry. Respir Physiol Neurobiol 2024; 327:104297. [PMID: 38871042 DOI: 10.1016/j.resp.2024.104297] [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: 04/08/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 06/15/2024]
Abstract
Activity-related dyspnea in chronic lung disease is centrally related to dynamic (dyn) inspiratory constraints to tidal volume expansion. Lack of reference values for exertional inspiratory reserve (IR) has limited the yield of cardiopulmonary exercise testing in exposing the underpinnings of this disabling symptom. One hundred fifty apparently healthy subjects (82 males) aged 40-85 underwent incremental cycle ergometry. Based on exercise inspiratory capacity (ICdyn), we generated centile-based reference values for the following metrics of IR as a function of absolute ventilation: IRdyn1 ([1-(tidal volume/ICdyn)] x 100) and IRdyn2 ([1-(end-inspiratory lung volume/total lung capacity] x 100). IRdyn1 and IRdyn2 standards were typically lower in females and older subjects (p<0.05 for sex and age versus ventilation interactions). Low IRdyn1 and IRdyn2 significantly predicted the burden of exertional dyspnea in both sexes (p<0.01). Using these sex and age-adjusted limits of reference, the clinician can adequately judge the presence and severity of abnormally low inspiratory reserves in dyspneic subjects undergoing cardiopulmonary exercise testing.
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Affiliation(s)
- Abed A Hijleh
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Danilo C Berton
- Pulmonary Function Tests Laboratory, Federal University of Rio Grande to Sul, Rua Ramiro Barcelos, 2350 Bloco A, Av. Protásio Alves, 211 - Bloco B e C - Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Igor Neder-Serafini
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Matthew James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Sandra Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Nicolle Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Devin Phillips
- School of Kinesiology and Health Science, Faculty of Health, York University, Norman Bethune College, 170 Campus Walk Room 341, Toronto, ON M3J 1P3, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada.
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19
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Harvey-Dunstan TC, Baldwin MM, Tal-Singer R, Allinder M, Polkey MI, Hamilton A, Richardson M, Edwards SA, Steiner MC, Morgan MD, Singh SJ. The Responsiveness of Exercise Tests in COPD: A Randomized Controlled Trial. Chest 2024:S0012-3692(24)04900-6. [PMID: 39173827 DOI: 10.1016/j.chest.2024.05.051] [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: 12/20/2023] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests commonly are used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings. RESEARCH QUESTION What exercise test possesses the greatest sensitivity to change from before to after intervention in patients with COPD? STUDY DESIGN AND METHODS One hundred fifty-four patients with symptomatic COPD were recruited and randomized (2:1:1) to 6 weeks of long-acting muscarinic antagonist (LAMA), pulmonary rehabilitation (PR), or usual care. Before and after intervention, participants performed a ramp-incremental cycle exercise test (ICET) and constant work rate cycle test (CWRCT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT), 6-min walk test (6MWT), and 4-m gait speed test. RESULTS One hundred three participants (mean ± SD age, 67 ± 8 years; 75 male participants [73%]; FEV1, 50.6 ± 16.8% predicted) completed the study. Significant improvements in the ICET, CWRCT, ISWT, ESWT, and 6MWT results were observed after PR (P < .05), with the greatest improvements seen in the constant work rate protocols (percentages change: CWRCT, 42%; ESWT, 41%). INTERPRETATION The ESWT and CWRCT seemed to be the most responsive exercise test protocols to LAMA and PR therapy. The magnitude of change was much greater after a program of rehabilitation compared with bronchodilator therapy. TRIAL REGISTRY ISRCTN; No. 64759523.
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Affiliation(s)
- Theresa C Harvey-Dunstan
- Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England; Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, England.
| | - M M Baldwin
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, England
| | | | | | - M I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, England
| | - A Hamilton
- Boehringer Ingelheim (Canada) Ltd., Burlington, Canada
| | - M Richardson
- Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England
| | - S A Edwards
- Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England
| | - M C Steiner
- Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, England
| | - M D Morgan
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, England
| | - S J Singh
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, England
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20
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Lu Z, Yang J, Tao K, Li X, Xu H, Qiu J. Combined Impact of Heart Rate Sensor Placements with Respiratory Rate and Minute Ventilation on Oxygen Uptake Prediction. SENSORS (BASEL, SWITZERLAND) 2024; 24:5412. [PMID: 39205108 PMCID: PMC11360153 DOI: 10.3390/s24165412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Oxygen uptake (V˙O2) is an essential metric for evaluating cardiopulmonary health and athletic performance, which can barely be directly measured. Heart rate (HR) is a prominent physiological indicator correlated with V˙O2 and is often used for indirect V˙O2 prediction. This study investigates the impact of HR placement on V˙O2 prediction accuracy by analyzing HR data combined with the respiratory rate (RESP) and minute ventilation (V˙E) from three anatomical locations: the chest; arm; and wrist. Twenty-eight healthy adults participated in incremental and constant workload cycling tests at various intensities. Data on V˙O2, RESP, V˙E, and HR were collected and used to develop a neural network model for V˙O2 prediction. The influence of HR position on prediction accuracy was assessed via Bland-Altman plots, and model performance was evaluated by mean absolute error (MAE), coefficient of determination (R2), and mean absolute percentage error (MAPE). Our findings indicate that HR combined with RESP and V˙E (V˙O2HR+RESP+V˙E) produces the most accurate V˙O2 predictions (MAE: 165 mL/min, R2: 0.87, MAPE: 15.91%). Notably, as exercise intensity increases, the accuracy of V˙O2 prediction decreases, particularly within high-intensity exercise. The substitution of HR with different anatomical sites significantly impacts V˙O2 prediction accuracy, with wrist placement showing a more profound effect compared to arm placement. In conclusion, this study underscores the importance of considering HR placement in V˙O2 prediction models, with RESP and V˙E serving as effective compensatory factors. These findings contribute to refining indirect V˙O2 estimation methods, enhancing their predictive capabilities across different exercise intensities and anatomical placements.
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Affiliation(s)
- Zhihui Lu
- School of China Football Sports, Beijing Sport University, Beijing 100084, China;
| | - Junchao Yang
- Exercise Science School, Beijing Sport University, Beijing 100084, China; (J.Y.); (X.L.); (H.X.)
| | - Kuan Tao
- School of Sports Engineering, Beijing Sport University, Beijing 100084, China;
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing Sport University, Beijing 100084, China
| | - Xiangxin Li
- Exercise Science School, Beijing Sport University, Beijing 100084, China; (J.Y.); (X.L.); (H.X.)
| | - Haoqi Xu
- Exercise Science School, Beijing Sport University, Beijing 100084, China; (J.Y.); (X.L.); (H.X.)
| | - Junqiang Qiu
- Exercise Science School, Beijing Sport University, Beijing 100084, China; (J.Y.); (X.L.); (H.X.)
- Beijing Sports Nutrition Engineering Research Center, Beijing 100084, China
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21
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Fukuta H, Goto T, Kamiya T. Effects of calcium channel blockers in patients with heart failure with preserved ejection fraction: A protocol for systematic review and meta-analysis. PLoS One 2024; 19:e0307258. [PMID: 39159218 PMCID: PMC11332996 DOI: 10.1371/journal.pone.0307258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/01/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. Patients with HFpEF are often elderly and their primary chronic symptom is severe exercise intolerance. Due to the frequent coexistence of hypertension in HFpEF patients, the use of anti-hypertensive medications is common in their treatment. While many cohort studies and several randomized controlled trials (RCTs) have examined the effectiveness of various anti-hypertensive drugs such as beta-blockers and renin-angiotensin system inhibitors in HFpEF, the role of calcium channel blockers (CCBs) remains uncertain. Despite several RCTs and cohort studies exploring the effects of CCBs on prognosis and exercise capacity in HFpEF patients, the findings have been inconsistent, likely due to limited statistical power and/or variations in study design. Therefore, our aim is to conduct a systematic review and meta-analysis of studies on the effects of CCBs in these patients. METHODS This meta-analysis will include RCTs and cohort studies on the effect of CCBs in HFpEF patients. Information of studies will be collected from PubMed, Web of Science, and Scopus. The primary outcome of interest will be prognosis. The secondary outcome of interest will be exercise capacity. DISCUSSION Synthesizing our meta-analytical results with expert consensus could contribute to the formulation of updated clinical guidelines. Our systematic review and meta-analysis will provide directions for future research on the use of CCBs in HFpEF patients. SYSTEMATIC REVIEW REGISTRATION INPLASY202430097.
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Affiliation(s)
- Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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22
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Terol C, Hagen J, Rammeloo L, Kuipers IM, Blom NA, ten Harkel ADJ. Prognostic value of cardiopulmonary exercise test in children with congenital heart defects. Open Heart 2024; 11:e002820. [PMID: 39160087 PMCID: PMC11337671 DOI: 10.1136/openhrt-2024-002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) has an important prognostic value in adults with different congenital heart defects (CHDs) and is a useful tool for risk stratification and clinical decision-making. In this retrospective study, we studied the prognostic value of CPET in paediatric patients with CHD. METHODS 411 CPET performed by paediatric patients with different CHDs were evaluated in this retrospective study. Medical records were reviewed to determine the presence of cardiac events. Participants were classified using the 2018 AHA/ACC guideline for the management of adults with CHD that combines anatomical complexity and current physiological stage. RESULTS 411 patients with a median age at test of 12 years, 51 patients with simple CHD, 170 patients with moderate complexity CHD and 190 with high complexity CHD underwent CPET. Overall, CPET parameters were lower than the reference values (%predicted VO2peak=75% and %predicted oxygen uptake efficiency slope (OUES)=79%), showing worst exercise capacity in the most complex types of CHD (Group III: %predicted VO2peak=72% and %predicted OUES=75%). Seventy-one patients presented with cardiac events at a median time from CPET to first event of 28 months. Patients with cardiac events had lower exercise performance as compared with patients without cardiac events as determined by the submaximal variables (%predicted OUES: HR=2.6 (1.5-4.4), p<0.001 and VE/VCO2: HR=2.2 (1.4-3.5), p=0.001). CONCLUSION Reduced exercise capacity at young age is related to a higher probability of future cardiovascular events in paediatric patients with CHD. Submaximal exercise variables can be used instead when maximal exercise cannot be achieved.
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Affiliation(s)
- Covadonga Terol
- Department of Paediatrics, Division of Paediatric Cardiology, LUMC, Leiden, The Netherlands
| | - Juliette Hagen
- Department of Paediatrics, Division of Paediatric Cardiology, LUMC, Leiden, The Netherlands
| | - Lukas Rammeloo
- Department of Paediatrics, Division of Paediatric Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Department of Paediatrics, Division of Paediatric Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nicolaas A Blom
- Department of Paediatrics, Division of Paediatric Cardiology, LUMC, Leiden, The Netherlands
- Department of Paediatrics, Division of Paediatric Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Arend DJ ten Harkel
- Department of Paediatrics, Division of Paediatric Cardiology, LUMC, Leiden, The Netherlands
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23
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Fransplass Storli M, Steiro Fimland M, Engan HK, Sandmæl JA. Validity of the Ekblom-Bak Cycle Ergometer Test in Patients with Cardiovascular Disease. J Rehabil Med 2024; 56:jrm39901. [PMID: 39136289 PMCID: PMC11334349 DOI: 10.2340/jrm.v56.39901] [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: 01/17/2024] [Accepted: 07/04/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE To assess the validity of the Ekblom-Bak cycle ergometer test in patients with cardiovascular disease admitted to cardiac rehabilitation. METHODS Estimated peak oxygen consumption from the Ekblom-Bak test was compared with directly measured peak oxygen consumption from a treadmill cardiopulmonary exercise test. Patients completed the cardiopulmonary exercise test first, followed by the Ekblom-Bak test after 24 h rest. Pearson's correlation coefficient (r) was used to establish the correlation between estimated and measured peak oxygen consumption, and Bland-Altman plots with limits of agreement were used to determine the bias between the 2 tests. RESULTS Twenty-six patients were included in the final analysis. The Ekblom-Bak test significantly overestimated peak oxygen consumption. Agreement between estimated and measured peak oxygen consumption was: bias = 4.3 mL/kg/min (limits of agreement: -4.0-12.6 mL/kg/min). CONCLUSION The Ekblom-Bak test overestimated peak oxygen consumption to such an extent that it cannot accurately assess cardiorespiratory fitness in patients with cardiovascular disease. Thus, the cardiopulmonary exercise test remains the test of choice.
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Affiliation(s)
- Magnus Fransplass Storli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway; Unicare Helsefort Rehabilitation Centre, Rissa, Norway
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24
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Şahin E, Ayaz T, Saglam M. Acute effects of blood flow restricted aerobic exercise in type 2 diabetes mellitus. Medicine (Baltimore) 2024; 103:e39031. [PMID: 39093729 PMCID: PMC11296424 DOI: 10.1097/md.0000000000039031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND This study aimed to compare the acute effects of aerobic exercise performed with blood flow restriction (BFR), a novel method to increase exercise gains, with blood free flow (BFF) conditions in type 2 diabetes mellitus (T2DM). METHODS Fifteen individuals with T2DM performed BFF and BFR (40% of arterial occlusion pressure) cycling exercises 48 hours apart, at equal intensity (45% heart rate reserve) and duration (38 minutes). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), blood glucose, heart rate, and muscle oxygen saturation (SmO2) were assessed before-after and during exercise sessions. RESULTS SBP, DBP, and MAP in the overload phase were higher in the BFR group than in the BFF group (P = .009, 0.031, and 0.013, respectively). Changes in blood pressure (∆SBP and ∆DBP) were similar between the BFF and BFR groups (P > .05), whereas ∆MAP differed (P = .016). Changes in blood glucose levels and heart rates were not significantly different between the groups. Although SmO2baseline was lower in the BFR group (P = .049), SmO2min and SmO2max did not differ significantly between the BFF and BFR groups. CONCLUSION The similar decrease in blood glucose levels between the groups suggests that BFR exercise is favorable in terms of hypoglycemia. The higher blood pressure observed during the BFR exercise remained within safe limits. These results suggest that people with T2DM can safely perform BFR aerobic exercises; however, further studies are required.
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Affiliation(s)
- Elif Şahin
- Güneysu Physical Therapy and Rehabilitation College, Recep Tayyip Erdogan University, Rize, Turkey
| | - Teslime Ayaz
- Department of Internal Medicine, Faculty of Medicine, Bakircay University, Izmir, Turkey
| | - Melda Saglam
- Faculty Of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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25
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Zeder K, Brittain E, Kovacs G, Maron BA. The Management of Mild Pulmonary Hypertension in Clinical Practice. Ann Am Thorac Soc 2024; 21:1115-1123. [PMID: 38747696 PMCID: PMC11298986 DOI: 10.1513/annalsats.202312-1079fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 08/02/2024] Open
Abstract
The definition of pulmonary hypertension (PH) has been revised recently, with the mean pulmonary artery pressure (mPAP) threshold (assessed by right heart catheterization) reduced from ⩾25 mm Hg to >20 mm Hg. This change reflects the mPAP upper limit of normal and a lower limit that is independently associated with adverse outcomes. To improve the specificity of diagnosing pathogenic increases in mPAP, however, a diagnosis of precapillary PH now also includes pulmonary vascular resistance >2.0 Wood units (WU) (lowered from >3.0 WU). These changes are positioned to capture approximately 55% more patients with PH. Because all clinical trials showing a benefit of pulmonary vasodilator therapy in precapillary PH used the classical hemodynamic definition, the approach to the diagnosis and management of patients with mild PH (i.e., mPAP 21-24 mm Hg and pulmonary vascular resistance 2-3 WU) requires particular consideration. Here, we use a question/answer format to discuss key areas in the management of mild PH, including practical information tailored to clinicians without training in PH.
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Affiliation(s)
- Katarina Zeder
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
- The University of Maryland-Institute for Health Computing, Bethesda, Maryland
| | - Evan Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gabor Kovacs
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bradley A. Maron
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
- The University of Maryland-Institute for Health Computing, Bethesda, Maryland
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26
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Cohen RA, Go LHT, Friedman L, Zell-Baran LM, Rose CS, Almberg KS. Resting diffusing capacity and severity of radiographic disease predict gas exchange abnormalities with exercise in former US coal miners. Am J Ind Med 2024; 67:732-740. [PMID: 38830640 DOI: 10.1002/ajim.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The US Department of Labor (DOL) does not fund diffusing capacity (DLCO) or metabolic measurements from cardiopulmonary exercise testing (CPET) for coal miners' disability evaluations. Although exercise arterial blood gas testing is covered, many miners are unable to perform maximal tests, and sampling at peak exercise can be challenging. We explored the relationship between resting DLCO, radiographic disease severity, and CPET abnormalities in former US coal miners. METHODS We analyzed data from miners evaluated between 2005 and 2015. Multivariable linear and logistic regression analyses were used to examine relationships between percent predicted (pp) forced expiratory volume in 1 s (FEV1pp), DLCOpp, VO2maxpp, A-a oxygen gradient (A-a)pp, dead space fraction (Vd/Vt), disabling oxygen tension (PO2), and radiographic findings of pneumoconiosis. RESULTS Data from 2015 male coal miners was analyzed. Mean tenure was 28 years (SD 8.6). Thirty-twopercent had an abnormal A-a gradient (>150 pp), 20% had elevated Vd/Vt (>0.33), and 34% a VO2max < 60 pp. DLCOpp strongly predicted a disabling PO2, with an odds ratio (OR) of 2.33 [2.09-2.60], compared to 1.18 [1.08-1.29] for FEV1. Each increase in subcategory of small opacity (simple) pneumoconiosis increased the odds of a disabling PO2 by 42% [1.29-1.57], controlling for age, body mass index, pack-years of tobacco smoke exposure, and years of coal mine employment. CONCLUSIONS DLCO is the best resting pulmonary function test predictor of CPET abnormalities. Radiographic severity of pneumoconiosis was also associated with CPET abnormalities. These findings support funding DLCO testing for impairment and suggest the term "small opacity" should replace "simple" pneumoconiosis to reflect significant associations with impairment.
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Affiliation(s)
- Robert A Cohen
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Leonard H T Go
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lee Friedman
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Kirsten S Almberg
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
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Dos Anjos Souza VR, Vivan L, Seffrin A, Vallini L, de Paula Domingos F, de Lira CAB, Vancini RL, Weiss K, Rosemann T, Knechtle B, Andrade MS. Impact of aging on maximal oxygen uptake in female runners and sedentary controls. Exp Gerontol 2024; 193:112476. [PMID: 38830478 DOI: 10.1016/j.exger.2024.112476] [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: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
The present study aimed to compare V̇O2max (absolute, adjusted to total body mass, and adjusted to lean mass) in recreational runners and sedentary women < and > 50 yr and verify the effect of aging and physical activity level on the three types of V̇O2 max expression. The study included 147 women:85 runners (45.7 ± 14.1 yr) and 62 sedentary controls (48.8 ± 9.8 yr). They were subjected to cardiopulmonary exercise testing for V̇O2 max measurement and a body composition test by dual-emission X-ray absorptiometry system. V̇O2max were expressed as absolute values (L/min), relative to total body mass values (mL/kg/min), and relative to lean mass values (mL/kgLM/min). The two-way analysis of variance revealed a significant interaction [F(2,131) = 4.43, p < 0.001] and effects of age group [F(2,131) = 32.79, p < 0.001] and physical activity group [F(2,131) = 55.64, p < 0.001] on V̇O2max (mL/min). V̇O2max (mL/kg/min) and V̇O2 max (mL/kgLM/min) were significantly influenced by age and physical activity levels. The multiple regression model explains 76.2 % of the dependent variable V̇O2max (mL/kg/min), age (β = -0.335, t = -7.841, p < 0.001), and physical activity group (β = -0.784, t = -18.351, p < 0.001). In conclusion, female runners had higher V̇O2 max values than sedentary women at all ages, even though aging has a greater impact on V̇O2 max in the runners group. In addition to cardiorespiratory fitness, women's metabolic lean mass function, as measured by V̇O2max adjusted by lean mass, is significantly influenced by aging. Finally, physical activity has a greater impact on V̇O2 max levels than aging.
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Affiliation(s)
| | - Lavínia Vivan
- Postgraduate Program in Translation Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Aldo Seffrin
- Postgraduate Program in Translation Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Lucca Vallini
- Postgraduate Program in Translation Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio de Paula Domingos
- Postgraduate Program in Translation Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Claudio Andre Barbosa de Lira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rodrigo Luiz Vancini
- Center for Physical Education and Sports, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland; Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland.
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28
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Wang X, Li J, Zhou J, Gao M, Wang B, Tong Y, Cao Y, Chen W. Based on Cardiopulmonary Exercise Testing to Construct and Validate Nomogram of Long-Term Prognosis Within 12 Months for NSCLC. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13806. [PMID: 39118279 PMCID: PMC11310092 DOI: 10.1111/crj.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/08/2023] [Accepted: 06/28/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Construction nomogram was to effectively predict long-term prognosis in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The nomogram is developed by a retrospective study of 347 patients with NSCLC who underwent cardiopulmonary exercise testing (CPET) before surgery from May 2019 to February 2022. Cross-validation divided the data into a training cohort and validation cohort. The discrimination and accuracy ability of the nomogram were proofed by concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, the area under the curve (AUC), and time-dependent ROC in validation cohort. RESULTS Age, intraoperative blood loss, VO2 peak, and VE/VCO2 slope were included in the model of nomogram. The model demonstrated good discrimination and accuracy with C-index of 0.770 (95% CI: 0.712-0.822). AUC of 6 (AUC: 0.789, 95% CI: 0.726-0.851) and 12 months (AUC: 0.787, 95% CI: 0.724-0.850) were shown in ROC. Time-independent ROC maintains a good effect within 12 months. CONCLUSION We developed a nomogram based on CPET. This model has a good ability of discrimination and accuracy. It could help clinicians to make treatment decision in clinical decision.
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Affiliation(s)
- Xinyu Wang
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
| | - Jin Li
- Department of Rehabilitation Medicine, Xuzhou Central HospitalThe Xuzhou Clinical College of Xuzhou Medical UniversityXuzhouChina
| | - Jingjie Zhou
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
| | - Min Gao
- Department of Rehabilitation Medicine, Xuzhou Central HospitalThe Xuzhou Clinical College of Xuzhou Medical UniversityXuzhouChina
| | - Bin Wang
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
| | - Yiman Tong
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
| | - Yuhan Cao
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
| | - Wei Chen
- Department of Rehabilitation MedicineXuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical UniversityXuzhouChina
- Department of Rehabilitation Medicine, Xuzhou Central HospitalThe Xuzhou Clinical College of Xuzhou Medical UniversityXuzhouChina
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29
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Baldi F, De Rose C, Mariani F, Morello R, Raffaelli F, Valentini P, Buonsenso D. Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-controlled Study. Pediatr Infect Dis J 2024; 43:795-802. [PMID: 38713816 PMCID: PMC11250093 DOI: 10.1097/inf.0000000000004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a noninvasive and nonexpensive diagnostic tool, that provides a comprehensive evaluation of the pulmonary, cardiovascular, and skeletal muscle systems' integrated reactions to exercise. CPET has been extensively used in adults with Long COVID (LC), while the evidence about its role in children with this condition is scarce. METHODS Prospective, case-controlled observational study. Children with LC and a control group of healthy children underwent CPET. CPET findings were compared within the 2 groups, and within the LC groups according to main clusters of persisting symptoms. RESULTS Sixty-one children with LC and 29 healthy controls were included. Overall, 90.2% of LC patients (55 of 61) had a pathologic test vs 10.3% (3/29) of the healthy control. Children with LC presented a statistically significant higher probability of having abnormal values of peak VO2 ( P = 0.001), AT% pred ( P <0.001), VO2/HR % ( P = 0.03), VO2 work slope ( P = 0.002), VE/VCO2 slope ( P = 0.01). The mean VO2 peak was 30.17 (±6.85) in LC and 34.37 (±6.55) in healthy patients ( P = 0.007). CONCLUSIONS Compared with healthy controls, children with LC have objective impaired functional capacity (expressed by a low VO2 peak), signs of deconditioning and cardiogenic inefficiency when assessed with CPET. As such, CPET should be routinely used in clinical practice to objectify and phenotype the functional limitations of children with LC, and to follow-up them.
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Affiliation(s)
- Fabiana Baldi
- From the Pulmonary Medicine Unit, Department of Medical and Surgical Sciences
| | | | | | - Rosa Morello
- Department of Woman and Child Health and Public Health
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
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30
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Molinger J, Kittipibul V, Gray JM, Rao VN, Barth S, Swavely A, Coyne B, Coburn A, Bakker J, Wischmeyer PE, Green CL, MacLeod D, Patel M, Fudim M. Feasibility of a Novel Augmented 6-Minute Incremental Step Test: A Simplified Cardiorespiratory Fitness Assessment Tool. JACC. ADVANCES 2024; 3:101079. [PMID: 39099774 PMCID: PMC11294698 DOI: 10.1016/j.jacadv.2024.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 08/06/2024]
Abstract
Background The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing cardiorespiratory fitness (CRF) but has limited accessibility due to competency requirements and cost. Incorporating portable sensor devices into a simple bedside test of CRF could improve diagnostic and prognostic value. Objectives The authors sought to evaluate the association of an augmented 6-minute incremental step test (6MIST) with standard CPET. Methods We enrolled patients undergoing clinically indicated supine cycle ergometry CPET with invasive hemodynamics (iCPET) for the same-day 6MIST. CRF-related variables were simultaneously recorded using a signal morphology-based impedance cardiograph (PhysioFlow Enduro) and a portable metabolic analyzer (VO2 Master Pro) during incremental pace stationary stepping. The correlation between CPET and hemodynamic parameters from both tests was assessed using the intraclass correlation coefficient (ICC). Results Fifteen patients (mean age 60 ± 14 years, 40% female, 27% Black) were included. All patients who agreed to undergo 6MIST completed the study without any test-related adverse events. We observed good to excellent correlation between iCPET- and 6MIST-measured CPET parameters: peak heart rate (ICC = 0.60; 95% CI: 0.15-0.85), absolute peak O2 consumption (VO2) (ICC = 0.77; 95% CI: 0.44-0.92), relative peak VO2 (ICC = 0.64; 95% CI: 0.20-0.86), maximum ventilation (ICC = 0.59; 95% CI: 0.13-0.84), O2 pulse (ICC = 0.71; 95% CI: 0.33-0.89), and cardiorespiratory optimal point (ICC = 0.82; 95% CI: 0.52-0.94). No significant correlation was determined between iCPET and 6MIST in measuring cardiac index at rest (ICC = 0.19; 95% CI: -0.34 to 0.63) or at peak exercise (ICC = 0.36; 95% CI: -0.17 to 0.73). Conclusions We demonstrate the feasibility of a novel augmented 6MIST with wearable devices for simultaneous CPET and hemodynamic assessment. 6MIST-measured CPET parameters were strongly correlated with the iCPET-derived measurements. Additional studies are needed to confirm the validity of the 6MIST compared to standard upright CPET.
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Affiliation(s)
- Jeroen Molinger
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Veraprapas Kittipibul
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - J. Matthew Gray
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vishal N. Rao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Stratton Barth
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley Swavely
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Coyne
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Aubrie Coburn
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jan Bakker
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Paul E. Wischmeyer
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - David MacLeod
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Manesh Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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31
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Begrambekova YL, Arutynov GP, Glezer MG, Karanadze NA, Kolesnikova EA, Lelyavina TA, Lishuta AS, Orlova YA, Belenkov YN. [Evaluation of the Functional Reserve and Exercise Tolerance in Patients with CHF in Clinical Trials (Consent Document of the Editorial board of the Journal of Cardiology, the Board of the Society of Specialists in Heart Failure (SSHF) and Working Group "Non-drug treatment methods" of SSHF)]. KARDIOLOGIIA 2024; 64:4-26. [PMID: 39102569 DOI: 10.18087/cardio.2024.7.n2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 08/07/2024]
Abstract
Assessing the functional capacity and exercise tolerance is an important and widely used research tool in patients with heart failure. It is used not only in cardiac rehabilitation and physical therapy, but also for inclusion criteria and outcome measures in studies of drug interventions. This document outlines the scope, guidelines for the implementation and interpretation, and limitations of the methods for assessing the functional capacity and exercise tolerance in clinical trials in patients with heart failure.
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Affiliation(s)
- Yu L Begrambekova
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - G P Arutynov
- Pirogov Russian National Research Medical University
| | - M G Glezer
- Vladimirsky Moscow Regional Research Clinical Institute; Sechenov First Moscow State Medical University
| | - N A Karanadze
- Medical Research and Educational Center, Lomonosov Moscow State University
| | | | | | - A S Lishuta
- Sechenov First Moscow State Medical University
| | - Ya A Orlova
- Medical Research and Educational Center, Lomonosov Moscow State University
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32
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Deng Z, Wu F, Wan Q, Dai C, Lu L, Peng J, Zhou K, Wu X, Tang G, Huang S, Cai G, Huang P, Wang Z, Zheng Y, Yang H, Zhao N, Xiao S, Wen X, Sun R, Yang C, Huang Y, Chen R, Zhou Y, Ran P. Clinical features and associated factors of impaired ventilatory efficiency: findings from the ECOPD study in China. BMJ Open Respir Res 2024; 11:e002320. [PMID: 39032939 PMCID: PMC11261676 DOI: 10.1136/bmjresp-2024-002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Impaired ventilatory efficiency during exercise is a predictor of mortality in chronic obstructive pulmonary disease. However, little is known about the clinical features and associated factors of impaired ventilatory efficiency in China. METHODS We conducted a cross-sectional community-based study in China and collected demographic and clinical information, cardiopulmonary exercise testing, spirometry, and CT data. Impaired ventilatory efficiency was defined by a nadir ventilatory equivalent for CO2 production above the upper limit of normal. Multivariable linear and logistic regression models were used to explore the clinical features and associated factors of impaired ventilatory efficiency. RESULTS The final analyses included 941 subjects, 702 (74.6%) of whom had normal ventilatory efficiency and 239 (25.4%) had impaired ventilatory efficiency. Participants with impaired ventilatory efficiency had more chronic respiratory symptoms, poorer lung function and exercise capacity, and more severe emphysema (natural logarithm transformation of the low-attenuation area of the lung with attenuation values below -950 Hounsfield units, logLAA-950: 0.19±0.65 vs -0.28±0.63, p<0.001) and air trapping (logLAA-856: 1.03±0.65 vs 0.68±0.70, p<0.001) than those with normal ventilatory efficiency. Older age (60-69 years, OR 3.10 (95% CI 1.33 to 7.21), p=0.009 and 70-80 years, OR 6.48 (95% CI 2.56 to 16.43), p<0.001 vs 40-49 years) and smoking (former, OR 3.19 (95% CI 1.29 to 7.86), p=0.012; current, OR 4.27 (95% CI 1.78 to 10.24), p=0.001 vs never) were identified as high risk factors of impaired ventilatory efficiency. CONCLUSIONS Impaired ventilatory efficiency was associated with poorer respiratory characteristics. Longitudinal studies are warranted to explore the progression of individuals with impaired ventilatory efficiency.
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Affiliation(s)
- Zhishan Deng
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Fan Wu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
| | - Qi Wan
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cuiqiong Dai
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lifei Lu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jieqi Peng
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
| | - Kunning Zhou
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaohui Wu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
| | - Gaoying Tang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Suyin Huang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
| | - Guannan Cai
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Peiyu Huang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Youlan Zheng
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huajing Yang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ningning Zhao
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shan Xiao
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiang Wen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruiting Sun
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Changli Yang
- Department of Pulmonary and Critical Care Medicine, Wengyuan County People’s Hospital, Shaoguan, Guangdong, China
| | - Yongqing Huang
- Lianping County People’s Hospital, Heyuan, Guangdong, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, Guangzhou, Guangdong, China
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Marco E, Pérez-Sáez MJ, Muñoz-Redondo E, Curbelo YG, Ramírez-Fuentes C, Meza-Valderrama D, Acuña-Pardo C, Muns MD, Vázquez-Ibar O, Chamoun BO, Faura-Vendrell A, Bach A, Crespo M, Pascual J. Phase Angle as Surrogate Marker of Muscle Weakness in Kidney Transplant Candidates Referred to Prehabilitation. Nutrients 2024; 16:2245. [PMID: 39064689 PMCID: PMC11280164 DOI: 10.3390/nu16142245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Phase angle (PhA), a marker of nutritional status obtained by bioelectrical impedance analysis (BIA), is associated with the integrity of cell membranes. Damage to muscle fiber membranes can impact muscle strength, which is related to adverse outcomes in adults with advanced chronic kidney disease (CKD). The main objective of this study was to determine the usefulness of the PhA in identifying muscle weakness in candidates for kidney transplants (KTs). Secondly, it aimed to examine the associations of PhA with other parameters of body composition, exercise performance, and muscle structure. Sensitivity, specificity, and area under the receiver operating characteristics curve were used to evaluate the PhA (index test) as a biomarker of muscle weakness. Muscle strength was estimated with maximal voluntary isometric contraction of the quadriceps (MVCI-Q) of the dominant side. Muscle weakness was defined as MVIC-Q < 40% of body weight. A total of 119 patients were evaluated (mean age 63.7 years, 75.6% men). A phase angle cut-off of 5.1° was identified to classify men with a higher likelihood of having low muscle strength in upper limbs (MVIC-Q 40% of their body weight). Male KT candidates with PhA < 5.1° had poorer exercise capacity, lower muscle strength, less muscle mass, and smaller muscle size. A PhA < 5.1° was significantly associated with an eight-fold higher muscle weakness risk (OR = 8.2, 95%CI 2.3-29.2) in a binary regression model adjusted by age, frailty, and hydration status. Remarkably, PhA is an easily obtainable objective parameter in CKD patients, requiring no volitional effort from the individual. The associations of PhA with aerobic capacity, physical activity, muscle mass, and muscle size underscore its clinical relevance and potential utility in the comprehensive evaluation of these patients.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr. Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Yulibeth G. Curbelo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Cindry Ramírez-Fuentes
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Panama City 0819, Panama
| | - Carolina Acuña-Pardo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
| | - Mª Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain;
| | - Olga Vázquez-Ibar
- Department of Geriatrics, Centre-Fòrum Hospital del Mar, 08019 Barcelona, Spain;
| | - Betty Odette Chamoun
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Faura-Vendrell
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Bach
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Julio Pascual
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
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Camkiran V, Yurtseven E, Aslan G, Ozyigit T. The relationship between aerobic capacity and left atrial size in healthy young males: An observational study. Medicine (Baltimore) 2024; 103:e38931. [PMID: 38996121 PMCID: PMC11245229 DOI: 10.1097/md.0000000000038931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Aerobic capacity, defined as peak oxygen uptake (peakVO2), is a marker for aerobic fitness and is associated with left ventricular (LV) systolic and diastolic function. The aim of the study was to explore the relation between left atrial (LA) volume index (LAVI) and aerobic capacity in healthy young male adults. One hundred three healthy young male subjects (mean age: 34.2 ± 5.5years) were consecutively included in the study. All subjects underwent echocardiography to assess LAVI, LV systolic and diastolic functions. Aerobic capacity was assessed by cardiopulmonary exercise testing. All patients had normal left ventricular ejection fraction (LVEF). One hundred one subjects had normal LAVI (≤34 mL/m2) while 2 subjects had mildly increased LAVI (35-41 mL/m2). Mean peakVO2 predicted was 82.2 ± 14.4%. 64subjects (62.1%) had a peakVO2 < 85% of age-predicted and sex-predicted values and they had higher LAVI compared to those who had a peakVO2 higher than 85% of age-predicted and sex-predicted values (22.0 ± 4.8 mL/m2 vs 20.3 ± 4.1 mL/m2, P = .055). Notably, only LAVI showed a significant correlation with peakVO2 and predicted breathing reserve (BR), while anaerobic threshold correlated with both LAVI and LVEF. Age was also a significant factor, negatively impacting peakVO2 (r = -0.265, P = .007) and predicted BR (r = -0.282, P = .004). Multivariate analysis revealed that both LAVI and age were independent predictors of peakVO2 and predicted BR. This study suggests that LAVI can be a valuable indicator of aerobic capacity in apparently healthy young males.
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Affiliation(s)
- Volkan Camkiran
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Ece Yurtseven
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Gamze Aslan
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Tolga Ozyigit
- Department of Cardiology, American Hospital, Istanbul, Turkey
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35
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Kasiak P, Kowalski T, Rębiś K, Klusiewicz A, Sadowska D, Wilk A, Wiecha S, Barylski M, Poliwczak AR, Wierzbiński P, Mamcarz A, Śliż D. Oxygen uptake efficiency plateau is unaffected by fitness level - the NOODLE study. BMC Sports Sci Med Rehabil 2024; 16:151. [PMID: 38987830 PMCID: PMC11234747 DOI: 10.1186/s13102-024-00939-w] [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: 03/07/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Endurance athletes (EA) are an emerging population of focus for cardiovascular health. The oxygen uptake efficiency plateau (OUEP) is the levelling-off period of ratio between oxygen uptake (VO2) and ventilation (VE). In the cohort of EA, we externally validated prediction models for OUEP and derived with internal validation a new equation. METHODS 140 EA underwent a medical assessment and maximal cycling cardiopulmonary exercise test. Participants were 55% male (N = 77, age = 21.4 ± 4.8 years, BMI = 22.6 ± 1.7 kg·m- 2, peak VO2 = 4.40 ± 0.64 L·min- 1) and 45% female (N = 63, age = 23.4 ± 4.3 years, BMI = 22.1 ± 1.6 kg·m- 2, peak VO2 = 3.21 ± 0.48 L·min- 1). OUEP was defined as the highest 90-second continuous value of the ratio between VO2 and VE. We used the multivariable stepwise linear regression to develop a new prediction equation for OUEP. RESULTS OUEP was 44.2 ± 4.2 mL·L- 1 and 41.0 ± 4.8 mL·L- 1 for males and females, respectively. In external validation, OUEP was comparable to directly measured and did not differ significantly. The prediction error for males was - 0.42 mL·L- 1 (0.94%, p = 0.39), and for females was + 0.33 mL·L- 1 (0.81%, p = 0.59). The developed new prediction equation was: 61.37-0.12·height (in cm) + 5.08 (for males). The developed model outperformed the previous. However, the equation explained up to 12.9% of the variance (R = 0.377, R2 = 0.129, RMSE = 4.39 mL·L- 1). CONCLUSION OUEP is a stable and transferable cardiorespiratory index. OUEP is minimally affected by fitness level and demographic factors. The predicted OUEP provided promising but limited accuracy among EA. The derived new model is tailored for EA. OUEP could be used to stratify the cardiorespiratory response to exercise and guide training.
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Affiliation(s)
- Przemysław Kasiak
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
- Doctoral School, Medical University of Warsaw, Warsaw, Poland.
| | - Tomasz Kowalski
- Department of Physiology, Institute of Sport - National Research Institute, Warsaw, Poland
| | - Kinga Rębiś
- Department of Physiology, Institute of Sport - National Research Institute, Warsaw, Poland
| | - Andrzej Klusiewicz
- Faculty of Physical Education and Health, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Biała Podlaska, Poland
| | - Dorota Sadowska
- Department of Physiology, Institute of Sport - National Research Institute, Warsaw, Poland
| | - Adrian Wilk
- Department of Physiology, Institute of Sport - National Research Institute, Warsaw, Poland
| | - Szczepan Wiecha
- Faculty of Physical Education and Health, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Biała Podlaska, Poland
| | - Marcin Barylski
- Department of Internal Medicine, Rehabilitation and Physical Medicine, Medical University of Lodz, Łódź, Poland
| | - Adam Rafał Poliwczak
- Department of Internal Medicine, Rehabilitation and Physical Medicine, Medical University of Lodz, Łódź, Poland
| | - Piotr Wierzbiński
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Fleurent-Grégoire C, Burgess N, Denehy L, Edbrooke L, Engel D, Testa GD, Fiore JF, McIsaac DI, Chevalier S, Moore J, Grocott MP, Copeland R, Levett D, Scheede-Bergdahl C, Gillis C. Outcomes reported in randomised trials of surgical prehabilitation: a scoping review. Br J Anaesth 2024; 133:42-57. [PMID: 38570300 PMCID: PMC11213997 DOI: 10.1016/j.bja.2024.01.046] [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: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Heterogeneity of reported outcomes can impact the certainty of evidence for prehabilitation. The objective of this scoping review was to systematically map outcomes and assessment tools used in trials of surgical prehabilitation. METHODS MEDLINE, EMBASE, PsychInfo, Web of Science, CINAHL, and Cochrane were searched in February 2023. Randomised controlled trials of unimodal or multimodal prehabilitation interventions (nutrition, exercise, psychological support) lasting at least 7 days in adults undergoing elective surgery were included. Reported outcomes were classified according to the International Society for Pharmacoeconomics and Outcomes Research framework. RESULTS We included 76 trials, mostly focused on abdominal or orthopaedic surgeries. A total of 50 different outcomes were identified, measured using 184 outcome assessment tools. Observer-reported outcomes were collected in 86% of trials (n=65), with hospital length of stay being most common. Performance outcomes were reported in 80% of trials (n=61), most commonly as exercise capacity assessed by cardiopulmonary exercise testing. Clinician-reported outcomes were included in 78% (n=59) of trials and most frequently included postoperative complications with Clavien-Dindo classification. Patient-reported outcomes were reported in 76% (n=58) of trials, with health-related quality of life using the 36- or 12-Item Short Form Survey being most prevalent. Biomarker outcomes were reported in 16% of trials (n=12) most commonly using inflammatory markers assessed with C-reactive protein. CONCLUSIONS There is substantial heterogeneity in the reporting of outcomes and assessment tools across surgical prehabilitation trials. Identification of meaningful outcomes, and agreement on appropriate assessment tools, could inform the development of a prehabilitation core outcomes set to harmonise outcome reporting and facilitate meta-analyses.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill Research, Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada.
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Barbosa RCC, Silva RA, Lunardi AC, Silva STC, Corso SD, Fonseca AJ, Stelmach R, Carvalho CRF. Reproducibility, validity, and reliability of the incremental step test for subjects with moderate to severe asthma. Pulmonology 2024; 30:344-351. [PMID: 35221263 DOI: 10.1016/j.pulmoe.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE We investigated the measurement properties of the incremental step test in subjects with moderate to severe asthma. METHODS Subjects with moderate to severe persistent asthma were recruited from a tertiary university hospital specializing in treating severe asthma. All subjects performed one cardiopulmonary exercise test (CPET) and two incremental step tests (IST) in random sequences. Pulmonary gas exchange was measured during all exercise tests. The measurement properties investigated were reliability by intraclass correlation coefficient (ICC), measurement error by the standard error of measurement and minimum detectable difference, construct validity by Pearson's correlation, and interpretability by the ceiling and floor effects. RESULTS Fifty subjects (38 females, mean [SD], age 43.7 [11.6] yr, % FEV1 70 [14.3], BMI 28.5 [5.3] kg/m2) completed the study. The peak oxygen uptake (peak VO2) for the CPET was 27.6 [±6.8] ml/kg/min, for the first IST was 22.3 [±5.3] ml/kg/min and for the second IST was 23.3 [±5.3] ml/kg/min. The IST presented excellent reliability (ICC=0.93, CI95% 0.88-0.96), very good measurement error (2.5%), and construct validity for peak VO2 measurement compared to the CPET (r = 0.85; p < 0.001) to assess exercise capacity in subjects with moderate to severe asthma, with appropriate ceiling (10%) and floor (0%) effects. CONCLUSION The IST presented excellent reliability and very good measurement error and validity to assess exercise capacity in subjects with moderate to severe asthma, without ceiling or floor effects.
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Affiliation(s)
- R C C Barbosa
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - R A Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - A C Lunardi
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - S T C Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - S D Corso
- Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - A J Fonseca
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - C R F Carvalho
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
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Wohlgemuth KJ, Jesko A, Frost V, Conner MJ, Mota JA. Characteristics of slow and fast performers on a firefighter air consumption test. APPLIED ERGONOMICS 2024; 118:104262. [PMID: 38430846 DOI: 10.1016/j.apergo.2024.104262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
An air consumption test (ACT) is a physical ability test used in the fire service. The purpose of this study was to compare demographics and physiological differences between slow versus fast performers on an ACT. 160 career firefighters had air consumption, total task time, body mass index (BMI), peak heart rate (HRpeak), body fat percentage (BF%), and oxygen consumption (VO2peak) measured. K-means clustering was used to dichotomize between slow and fast groups during an ACT. Independent samples t-tests and Cohen's d measures of effect size were used to examine differences between groups. There were no significant differences in groups for age (t = -1.05, p = 0.30, d = 0.17), BMI (t = -1.85, p = 0.07, d = 0.32), or HRpeak (t = 0.99, p = 0.32, d = 0.16). There were significant differences between groups for BF% (t = -3.35, p < 0.01, d = 0.57), relative (t = 3.52, p < 0.01, d = 0.58) and absolute VO2peak (t = 4.29, p < 0.01, d = 0.68), air consumption (t = -4.87, p < 0.01, d = 0.81), and total task time (t = -15.04, p < 0.01, d = 2.58).
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Affiliation(s)
- Kealey J Wohlgemuth
- Neuromuscular and Occupational Performance Laboratory, Texas Tech University, Lubbock, TX, USA
| | - Alex Jesko
- Front Line Mobile Health, Georgetown, TX, USA
| | - Vanessa Frost
- Travis County Emergency Services, District #2, Pflugerville, TX, USA
| | | | - Jacob A Mota
- Neuromuscular and Occupational Performance Laboratory, Texas Tech University, Lubbock, TX, USA.
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Staes M, Gyselinck I, Goetschalckx K, Troosters T, Janssens W. Identifying limitations to exercise with incremental cardiopulmonary exercise testing: a scoping review. Eur Respir Rev 2024; 33:240010. [PMID: 39231595 PMCID: PMC11372471 DOI: 10.1183/16000617.0010-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/28/2024] [Indexed: 09/06/2024] Open
Abstract
Cardiopulmonary exercise testing (CPET) is a comprehensive and invaluable assessment used to identify the mechanisms that limit exercise capacity. However, its interpretation remains poorly standardised. This scoping review aims to investigate which limitations to exercise are differentiated by the use of incremental CPET in literature and which criteria are used to identify them. We performed a systematic, electronic literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science and Scopus. All types of publications that reported identification criteria for at least one limitation to exercise based on clinical parameters and CPET variables were eligible for inclusion. 86 publications were included, of which 57 were primary literature and 29 were secondary literature. In general, at the level of the cardiovascular system, a distinction was often made between a normal physiological limitation and a pathological one. Within the respiratory system, ventilatory limitation, commonly identified by a low breathing reserve, and gas exchange limitation, mostly identified by a high minute ventilation/carbon dioxide production slope and/or oxygen desaturation, were often described. Multiple terms were used to describe a limitation in the peripheral muscle, but all variables used to identify this limitation lacked specificity. Deconditioning was a frequently mentioned exercise limiting factor, but there was no consensus on how to identify it through CPET. There is large heterogeneity in the terminology, the classification and the identification criteria of limitations to exercise that are distinguished using incremental CPET. Standardising the interpretation of CPET is essential to establish an objective and consistent framework.
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Affiliation(s)
- Michaël Staes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Iwein Gyselinck
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Research Unit Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Clinical Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Jensen D. Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiologic Responses in Chronic Airflow Limitation. Chest 2024; 166:81-94. [PMID: 38423279 DOI: 10.1016/j.chest.2024.02.034] [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: 10/15/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. RESEARCH QUESTION How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? STUDY DESIGN AND METHODS An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy people; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. RESULTS We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40-89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak rate of oxygen uptake < lower limit of normal) was present in 26%. Relative to peak power output, rate of oxygen uptake, and minute ventilation, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiologic abnormalities during CPET. INTERPRETATION Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness.
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Affiliation(s)
- Magnus Ekström
- Division of Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada
| | - Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jean Bourbeau
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
| | - Wan C Tan
- Department of Medicine, University of British Columbia Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
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Quadflieg K, Higgins R, Arents E, Demeyer H, Criel M, Daenen M, Ruttens D, Thomeer M, Stevens D, Maiorana A, Spruit MA, Cavalheri V, Burtin C. Prognostic value of the 1-min sit-to-stand test to predict post-operative complications in patients with lung cancer elected for lung resection. ERJ Open Res 2024; 10:00765-2023. [PMID: 38957165 PMCID: PMC11215763 DOI: 10.1183/23120541.00765-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 07/04/2024] Open
Abstract
Patients with nonsmall cell lung cancer achieving ≤22 repetitions during a 1-min sit-to-stand test are at increased risk of post-operative complications https://bit.ly/3T7pnS9.
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Affiliation(s)
- Kirsten Quadflieg
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Rachael Higgins
- Physiotherapy Department, Fiona Stanley Fremantle Hospitals Group, Perth, Australia
| | - Eva Arents
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Maarten Criel
- Department Lung diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Marc Daenen
- Department Lung diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Ruttens
- Department Lung diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Michiel Thomeer
- Department Lung diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Dieter Stevens
- Department of Pulmonary Medicine, Ghent University Hospital, Ghent, Belgium
| | - Andrew Maiorana
- Curtin School of Allied Health and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
| | - Martijn A. Spruit
- CIRO, Center of Expertise for Chronic Organ Failure, Department of Research and Education, Horn, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vinicius Cavalheri
- Curtin School of Allied Health and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Chris Burtin
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Bass A, Géphine S, Martin M, Belley M, Robic M, Fabre C, Grosbois JM, Dion G, Saey D, Chambellan A, Maltais F. Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study. JMIR Res Protoc 2024; 13:e57404. [PMID: 38941132 PMCID: PMC11245655 DOI: 10.2196/57404] [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: 02/16/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a "stepper" for 6 minutes. OBJECTIVE This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. METHODS Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec in Québec, Groupement des Hôpitaux de l'Institut Catholique de Lille in France, and FormAction Santé in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Québec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Québec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives. RESULTS Ethical approval was received for this project (October 12, 2023, in Québec and September 25, 2023, in France) and the first participant was recruited in February 2024. CONCLUSIONS This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). TRIAL REGISTRATION ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57404.
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Affiliation(s)
- Alec Bass
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
| | - Sarah Géphine
- FormAction Santé, Pérenchies, France
- Université of Lille, Université de Artois, Université du Littoral Cote d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Mickaël Martin
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
| | - Marianne Belley
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
| | - Manon Robic
- Université of Lille, Université de Artois, Université du Littoral Cote d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Claudine Fabre
- Université of Lille, Université de Artois, Université du Littoral Cote d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | | | - Geneviève Dion
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
| | - Didier Saey
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
| | - Arnaud Chambellan
- Service de Pneumologie, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - François Maltais
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Université Laval, Québec, QC, Canada
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Montoliu Nebot J, Iradi Casal A, Cepeda Madrigal S, Rissi G, Sanz Saz S, Molés Gimeno JD, Miravet Sorribes LM. [Physiological assessment and management of post-COVID patients with normal cardiopulmonary imaging and functional tests]. Semergen 2024; 50:102282. [PMID: 38936100 DOI: 10.1016/j.semerg.2024.102282] [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: 02/29/2024] [Accepted: 03/24/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Contributing to elucidate the pathophysiology of dyspnoea and exertion intolerance in post-COVID syndrome patients with normal cardiopulmonary imaging and functional tests at rest, while determining their fitness and level of endurance in order to individualize working parameters for physical rehabilitation. MATERIAL AND METHODS After an anamnesis and clinical examination at rest, 27 subjects (50±11.9 years) (14 women) with post-COVID syndrome of more than 6 months of evolution performed a continuous maximal-incremental graded cardiopulmonary exercise test (CPET) with breath-by-breath gas-exchange monitoring and continuous ECG registration, on an electromagnetically braked cycle ergometer. The values obtained were compared with those of reference, gender or controls, using the Chi-square, t-Student or ANOVA test. RESULTS The clinical examination at rest and the CPET were clinically normal and without adverse events. Reasons for stopping exercise were leg discomfort. It is only worth noting a BMI=29.9±5.8kg/m2 and a basal lactate concentration of 2.1±0.7mmol/L. The physiological assessment of endurance showed the following results relative to predicted VO2máx: 1)peakVO2=80.5±18.6%; 2)VO2 at ventilatory threshold1 (VO2VT1): 46.0±12.9%; 3)VO2VT2: 57.2±16.4%; 4)working time in acidosis: 5.6±3,0minutes; and 5)maximum lactate concentration: 5.1±2.2mmol/L. CONCLUSIONS The CPET identified limited aerobic metabolism and early increase in glycolytic metabolism as causes of dyspnoea and exercise intolerance, determined fitness for physical rehabilitation, and individualized it based on the level of endurance.
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Affiliation(s)
- J Montoliu Nebot
- Unidad de Medicina Deportiva, Servicio de Rehabilitación, Consorcio Hospitalario Provincial de Castellón, Castellón, España
| | - A Iradi Casal
- Departamento de Fisiología, Universitat de València, Valencia, España
| | - S Cepeda Madrigal
- Sección de Neumología, Hospital Universitari de La Plana, Vila-real, Castellón, España
| | - G Rissi
- Sección de Neumología, Hospital Universitari de La Plana, Vila-real, Castellón, España
| | - S Sanz Saz
- Unidad de Medicina Deportiva, Servicio de Rehabilitación, Consorcio Hospitalario Provincial de Castellón, Castellón, España
| | - J D Molés Gimeno
- Unidad de Medicina Deportiva, Servicio de Rehabilitación, Consorcio Hospitalario Provincial de Castellón, Castellón, España
| | - L M Miravet Sorribes
- Sección de Neumología, Hospital Universitari de La Plana, Vila-real, Castellón, España.
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Yano Y, Suematsu Y, Matsuda T, Tsukahara K, Shirosaki M, Matsuo S, Fujimi K, Miura SI. Usefulness of the cardiopulmonary exercise test up to the anaerobic threshold for pati-ents aged ≥ 80 years with cardiovascular disease on cardiac rehabilitation. J Rehabil Med 2024; 56:jrm19453. [PMID: 38898677 PMCID: PMC11210489 DOI: 10.2340/jrm.v56.19453] [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: 09/15/2023] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE A cardiopulmonary exercise test provides information regarding appropriate exercise intensity, but there have been few reports on its use in patients over 80 years of age. DESIGN Retrospective observational study. PATIENTS A total of 511 cardiovascular disease patients who performed a cardiopulmonary exercise test from February 2011 to January 2020 were investigated. METHODS Patients were stratified according to age: < 70 years, 70-79 years, and ≥ 80 years, and the results of the cardiopulmonary exercise test up to anaerobic threshold were compared. RESULTS Patients in the < 70 age bracket showed higher oxygen consumption, carbon dioxide output, and ventilatory volume and lower ventilation equivalents per oxygen consumption and carbon dioxide output in all time periods. However, there were no significant differences in these parameters or the work rate (70-79 years of age: 41.4 ± 11.7 watts, vs ≥ 80 years: 42.2 ± 10.9 watts, p = 0.95) or oxygen consumption per body weight at anaerobic threshold (12.2 ± 0.2 ml/min/kg, vs 12.1 ± 0.4 ml/min/kg, p = 0.97) between the 70-79 year age bracket and the ≥ 80 year age bracket. CONCLUSION Even for cardiovascular disease patients age ≥ 80 years, a cardiopulmonary exercise test up to anaerobic threshold can supply useful information for guiding cardiac rehabilitation.
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Affiliation(s)
- Yuiko Yano
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Miyase Clinic, Fukuoka, Japan (Present affiliation)
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kai Tsukahara
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Hinoki Clinic, Fukuoka, Japan (Present affiliation)
| | - Miki Shirosaki
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Sakiko Matsuo
- Department of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka, Japan; Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
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45
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Knöpfel G, Baty F, Uhl F, Kern L, Brutsche M. Quantification of breathing irregularity for the diagnosis of dysfunctional breathing using proportional tidal volume variation: a cross-sectional, retrospective real-world study. BMJ Open 2024; 14:e083401. [PMID: 38885986 PMCID: PMC11184190 DOI: 10.1136/bmjopen-2023-083401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To develop a statistical approach that provides a quantitative index measuring the magnitude of the irregularity of the breathing response to exercise for the diagnosis of dysfunctional breathing. DESIGN Cross-sectional, retrospective, real-world study. SETTING Single-centre study. PARTICIPANTS A population of 209 patients investigated with cardiopulmonary exercise testing in our institution for unexplained or disproportionate exertional dyspnoea between January and July 2022. PRIMARY AND SECONDARY OUTCOME MEASURES A novel statistical approach providing a quantitative index-proportional tidal volume variation (PTVV)-was developed to measure the magnitude of the irregularity of the breathing response to exercise. RESULTS PTVV provided a reliable statistical readout for the objective assessment of DB with a prediction accuracy of 78% (95% CI: 72 to 83%). The prevalence of DB in the investigated population was high with more than half of the patients affected by moderate-to-severe DB. CONCLUSIONS PTVV can easily be implemented in the clinical routine. Our study suggests a possible further simplification for the diagnosis of DB with two objective criteria including PTVV and one single criterion for hyperventilation.
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Affiliation(s)
- Georg Knöpfel
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Florent Baty
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
- University of Basel, Basel, Switzerland
| | - Friedrich Uhl
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Lukas Kern
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Martin Brutsche
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
- University of Basel, Basel, Switzerland
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46
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Alfaro E, Díaz-García E, García-Tovar S, Galera R, Casitas R, Torres-Vargas M, López-Fernández C, Añón JM, García-Río F, Cubillos-Zapata C. Endothelial dysfunction and persistent inflammation in severe post-COVID-19 patients: implications for gas exchange. BMC Med 2024; 22:242. [PMID: 38867241 PMCID: PMC11170912 DOI: 10.1186/s12916-024-03461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Understanding the enduring respiratory consequences of severe COVID-19 is crucial for comprehensive patient care. This study aims to evaluate the impact of post-COVID conditions on respiratory sequelae of severe acute respiratory distress syndrome (ARDS). METHODS We examined 88 survivors of COVID-19-associated severe ARDS six months post-intensive care unit (ICU) discharge. Assessments included clinical and functional evaluation as well as plasma biomarkers of endothelial dysfunction, inflammation, and viral response. Additionally, an in vitro model using human umbilical vein endothelial cells (HUVECs) explored the direct impact of post-COVID plasma on endothelial function. RESULTS Post-COVID patients with impaired gas exchange demonstrated persistent endothelial inflammation marked by elevated ICAM-1, IL-8, CCL-2, and ET-1 plasma levels. Concurrently, systemic inflammation, evidenced by NLRP3 overexpression and elevated levels of IL-6, sCD40-L, and C-reactive protein, was associated with endothelial dysfunction biomarkers and increased in post-COVID patients with impaired gas exchange. T-cell activation, reflected in CD69 expression, and persistently elevated levels of interferon-β (IFN-β) further contributed to sustained inflammation. The in vitro model confirmed that patient plasma, with altered levels of sCD40-L and IFN-β proteins, has the capacity to alter endothelial function. CONCLUSIONS Six months post-ICU discharge, survivors of COVID-19-associated ARDS exhibited sustained elevation in endothelial dysfunction biomarkers, correlating with the severity of impaired gas exchange. NLRP3 inflammasome activity and persistent T-cell activation indicate on going inflammation contributing to persistent endothelial dysfunction, potentially intensified by sustained viral immune response.
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Affiliation(s)
- Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sara García-Tovar
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Raúl Galera
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Raquel Casitas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - María Torres-Vargas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - José M Añón
- Department of Intensive Medicine, La Paz University Hospital, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
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47
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V. S. O. N. Cavalcante A, Fonseca JD, Araujo Cruz HR, Nascimento VF, Santana Silva JP, Lins CA, Bernardes Neto SCG, Lima ÍND. Neural respiratory drive during maximal voluntary ventilation in individuals with hypertension: A case-control study. PLoS One 2024; 19:e0305044. [PMID: 38861578 PMCID: PMC11166319 DOI: 10.1371/journal.pone.0305044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
Neural respiratory drive (NRD) is measured using a non-invasive recording of respiratory electromyographic signal. The parasternal intercostal muscle can assess the imbalance between the load and capacity of respiratory muscles and presents a similar pattern to diaphragmatic activity. We aimed to analyze the neural respiratory drive in seventeen individuals with hypertension during quite breathing and maximal voluntary ventilation (MVV) (103.9 ± 5.89 vs. 122.6 ± 5 l/min) in comparison with seventeen healthy subjects (46.5 ± 2.5 vs. 46.4 ± 2.4 years), respectively. The study protocol was composed of quite breathing during five minutes, maximum inspiratory pressure followed by maximal ventilatory ventilation (MVV) was recorded once for 15 seconds. Anthropometric measurements were collected, weight, height, waist, hip, and calf circumferences, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), BMI, and conicity index (CI). Differences between groups were analyzed using the unpaired t-test or Mann-Whitney test to determine the difference between groups and moments. A significance level of 5% (p<0,05) was adopted for all statistical analyses. The group of individuals with hypertension presented higher values when compared to the healthy group for neural respiratory drive (EMGpara% 17.9±1.3 vs. 13.1±0.8, p = 0.0006) and neural respiratory drive index (NRDi (AU) 320±25 vs. 205.7±15,p = 0.0004) during quiet breathing and maximal ventilatory ventilation (EMGpara% 29.3±2.7 vs. 18.3±0.8, p = 0.000, NRDi (AU) 3140±259.4 vs. 1886±73.1,p<0.0001), respectively. In conclusion, individuals with hypertension presented higher NRD during quiet breathing and maximal ventilatory ventilation when compared to healthy individuals.
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Affiliation(s)
- Andressa V. S. O. N. Cavalcante
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Jéssica Danielle Fonseca
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Helen Rainara Araujo Cruz
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - Viviane Fabrícia Nascimento
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - João Pedro Santana Silva
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - Caio Alano Lins
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Saint-Clair Gomes Bernardes Neto
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Íllia Nadinne Dantas Lima
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
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Costa ACGD, Martins TF, da Silva VZM, Leite CF, Castro SSD, Cipriano G, Cipriano GFB. Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome. Disabil Rehabil 2024:1-13. [PMID: 38835177 DOI: 10.1080/09638288.2024.2358897] [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: 11/21/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories. MATERIALS AND METHODS Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams. RESULTS The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes. CONCLUSION The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.
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Affiliation(s)
| | | | - Vinicius Zacarias Maldaner da Silva
- Physiotherapy department, University of Brasília, Brazil
- Postgraduate Program in Human Moviment and Rehabilitation, UniEVANGÉLICA, Anápolis, Brazil
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Brazil
| | | | - Gerson Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brazil
- Postgraduate Program in Rehabilitation Science, University of Brasília, Brazil
- Physiotherapy department, University of Brasília, Brazil
- Postgraduate Program in Human Moviment and Rehabilitation, UniEVANGÉLICA, Anápolis, Brazil
| | - Graziella França Bernardelli Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brazil
- Postgraduate Program in Rehabilitation Science, University of Brasília, Brazil
- Physiotherapy department, University of Brasília, Brazil
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49
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Guo M, Diaz‐Canestro C, Pugliese NR, Paneni F, Montero D. Lean body mass and the cardiorespiratory phenotype: An ethnic-specific relationship in Hans Chinese women and men. J Cachexia Sarcopenia Muscle 2024; 15:963-974. [PMID: 38632694 PMCID: PMC11154775 DOI: 10.1002/jcsm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Lean body mass (LBM) and the functional capacity of cardiovascular (CV) and respiratory systems constitute a female-specific relationship in European-American individuals. Whether this recent finding be extrapolated to the world's largest ethnic group, that is, Hans Chinese (HC, a population characterized by low LBM), is unknown. METHODS Healthy HC adults (n = 144, 50% ♀) closely matched by sex, age and physical activity were included. Total and regional (leg, arm and trunk) LBM and body composition were measured via dual-energy X-ray absorptiometry. Cardiac structure, stiffness, central/peripheral haemodynamics and peak O2 consumption (VO2peak) were assessed via transthoracic echocardiography and pulmonary gas analyses at rest and during exercise up to peak effort. Regression analyses determined the sex-specific relationship of LBM with cardiac and aerobic phenotypes. RESULTS Total and regional LBM were lower and body fat percentage higher in women compared with men (P < 0.001). In both sexes, total LBM positively associated with left ventricular (LV) mass and peak volumes (r ≥ 0.33, P ≤ 0.005) and negatively with LV end-systolic and central arterial stiffness (r ≥ -0.34, P ≤ 0.004). Total LBM strongly associated with VO2peak (r ≥ 0.60, P < 0.001) and peak cardiac output (r ≥ 0.40, P < 0.001) in women and men. Among regional LBM, leg LBM prominently associated with the arterio-venous O2 difference at peak exercise in both sexes (r ≥ 0.43, P < 0.001). Adjustment by adiposity or CV risk factors did not modify the results. CONCLUSIONS LBM independently determines internal cardiac dimensions, ventricular mass, distensibility and the capacity to deliver and consume O2 in HC adults irrespective of sex.
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Affiliation(s)
- Meihan Guo
- Faculty of MedicineHong Kong UniversityHong Kong
| | - Candela Diaz‐Canestro
- Faculty of MedicineHong Kong UniversityHong Kong
- Department of Medicine, School of Clinical MedicineHong Kong UniversityHong Kong
| | | | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Zurich University HospitalUniversity of ZurichZurichSwitzerland
- University Heart Center, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - David Montero
- Faculty of MedicineHong Kong UniversityHong Kong
- Department of Medicine, School of Clinical MedicineHong Kong UniversityHong Kong
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50
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Braga F, Milani M, Fachetti A, Espinosa G, Moraes G, Milani JGPO, Mourilhe-Rocha R. Peak oxygen uptake after the 80s as a survival predictor. Eur Geriatr Med 2024; 15:807-815. [PMID: 38421586 DOI: 10.1007/s41999-024-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Peak oxygen uptake (VO2peak) is a crucial health marker, extensively studied in adults for its prognostic value. However, its significance in the older persons, especially octogenarians, remains underexplored due to limited representation in research. This study aims to assess the predictive power of VO2peak for survival in individuals aged 80 and above. METHODS We included individuals aged 80 or older who underwent cardiopulmonary exercise tests at a single center. Mortality rates were compared based on VO2peak relative to 80% of predicted values (%VO2peak). We employed three multivariate Cox regression models: Model 1 (unadjusted), Model 2 (adjusted for age) and Model 3 (adjusted for age and stroke). RESULTS Among 188 participants (mean age 83.3 ± 3 years, 68.9% male), 22 (11.7%) passed away during a median follow-up of 494 days. Non-survivors tended to be older with lower VO2peak and %VO2peak. All models demonstrated associations between %VO2peak ≤ 80% and mortality: HR = 3.19 (95% CI: 1.30-7.86, p = 0.011) for M1; HR = 3.12 (95% CI: 1.26-7.74, p = 0.013) for M2 and HR = 2.80 (95% CI: 1.11-7.06, p = 0.028) for M3. CONCLUSION In the context of an aging population, this study underscores the enduring significance of VO2peak as a survival predictor among the older person, including octogenarians. These findings carry profound implications for tailoring healthcare strategies to address the evolving demographic landscape.
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Affiliation(s)
- Fabricio Braga
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil.
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Science, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Ana Fachetti
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Instituto Nacional de Cardiologia de Laranjeira, Rio de Janeiro, RJ, Brazil
| | - Gabriel Espinosa
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Gabriel Moraes
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Goulart Prata Oliveira Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Science, Hasselt University, Hasselt, Belgium
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Complexo Hospitalar Américas-Vitória and Samaratino Barra, Rio de Janeiro, RJ, Brazil
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