On the functional capacity and quality of life of patients with acromegaly: are they candidates for rehabilitation programs?

Muscle function, exercise capacity, physical activity level and cardiovascular disease risk factor knowledge in patients with prolactinoma

OBJECTIVE

Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls.

METHODS

Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36).

RESULTS

Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05).

CONCLUSIONS

Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation.

CLINICAL TRIAL REGISTRATION

This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).

Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors

Patients with pituitary tumors may experience persistent fatigue and reduced physical activity, based on subjective measures after treatment. These symptoms may persist despite gross total resection of their tumors and biochemical normalization of pituitary function. While reduced quality of life has been commonly acknowledged in pituitary tumor patients, there is a lack of studies on what interventions may be best implemented to ameliorate these issues, particularly when hormonal levels have otherwise normalized. Aerobic exercise programs have been previously described to ameliorate symptoms of chronic fatigue and reduced physical capacity across a variety of pathologies in the literature. As such, a prescribed aerobic exercise program may be an underrecognized but potentially impactful intervention to address quality of life in pituitary tumor patients. This review seeks to summarize the existing literature on aerobic exercise interventions in patients with pituitary tumors. In addition, future areas of study are discussed, including tailoring exercise programs to the hormonal status of the patient and incorporating more objective measures in monitoring response to interventions.

Osteosarcopenia in acromegaly: reduced muscle quality and increased vertebral fat deposition

PURPOSE

Musculoskeletal disorders are among the most disabling comorbidities in patients with acromegaly. This study examined muscle and bone quality in patients with acromegaly.

METHODS

Thirty-three patients with acromegaly and nineteen age- and body mass index-matched healthy controls were included in the study. Body composition was determined using dual-energy X-ray absorptiometry. The participants underwent abdominal magnetic resonance imaging (MRI) for cross-sectional evaluation of muscle area and vertebral MRI proton density fat fraction (MRI-PDFF). Muscular strength was measured using hand grip strength (HGS). Skeletal muscle quality (SMQ) was classified as weak, low, or normal, according to HGS/ASM (appendicular skeletal muscle mass) ratio.

RESULTS

Groups had similar lean tissues, total body fat ratios, and total abdominal muscle areas. Acromegalic patients had lower pelvic BMD (p = 0.012) and higher vertebral MRI-PDFF (p = 0.014), while total and spine bone mineral densities (BMD) were similar between the groups. The SMQ score rate was normal only 57.5% in the acromegaly group, and 94.7% of the controls had a normal SMQ score (p = 0.01). Subgroup analysis showed that patients with active acromegaly (AA) had higher lean tissue and lower body fat ratios than controlled acromegaly (CA) and control groups. Vertebral MRI-PDFF was higher in the CA group than that in the AA and control groups (p = 0.022 and p = 0.001, respectively). The proportion of participants with normal SMQ was lower in the AA and CA groups than that in the control group (p = 0.012 and p = 0.013, respectively).

CONCLUSION

Acromegalic patients had reduced SMQ and pelvic BMD, but greater vertebral MRI-PDFF. Although lean tissue increases in AA, this does not affect SMQ. Therefore, increased vertebral MRI-PDFF in controlled acromegalic patients may be due to ectopic adiposity.

The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life

BACKGROUND

Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T).

OBJECTIVES

To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life.

METHODS

The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test.

RESULTS

Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively).

CONCLUSIONS

Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.

The impact of functional exercise on the reversal of acromegaly induced frailty: a case report

BACKGROUND

Acromegaly is an endocrine disease caused by the excess secretion of growth hormone and is responsible for the development of multiple comorbidities that can reduce physiologic reserve. The hypersecretion of growth hormone (GH) affects virtually every organ in the body and can predispose an individual to frailty; a state of vulnerability resulting from cumulative decline across multiple systems. Frailty results in a loss of physiologic reserve and vulnerability to adverse outcomes such as morbidity and mortality. Case Description: The patient was a 73-year-old male with acromegaly who declined into a cycle of frailty following coronary artery bypass graft (CABG) and aortic valve replacement surgery. Prolonged hospitalization and lack of adequate physical stress led to the depletion of reserve in the cardiopulmonary, cognitive, musculoskeletal, and neuromuscular systems, leaving a previously independent adult fully dependent for mobility. Outcomes: The patient participated in a twelve-week multicomponent physical therapy program in a skilled nursing facility. The exercise program was designed and administered to impact multiple systems and provide the necessary overload for adaptation. The patient demonstrated significant improvement in the Berg Balance Scale (BBS), Tinetti (POMA), Functional Outcome Scale (FOS), and returned to independent community ambulation.. Discussion: The case illustrates the effectiveness of a multicomponent functional-based exercise program to improve markers of frailty and reverse functional decline in a frail older adult with acromegaly.

Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study

OBJECTIVE

Although the focus of acromegaly treatment is the hormonal control of the disease, a new perspective must be given to the functional rehabilitation of these patients, especially when considering the recent increase in survival. The aim of this study was to evaluate the effects of therapist-oriented home rehabilitation (TOHR) on patients with acromegaly.

PATIENTS AND METHODS

Seventeen adults with acromegaly followed an exercise programme from a booklet with instructions for each exercise prescribed, for 2 months, and were reassessed after 1 month of washout. At each of the 3 timepoints (before and after the intervention and at the 1-month follow-up), the participants were subjected to the following assessments: body composition through bioimpedance, health-related quality of life (HRQoL) using the Acromegaly Quality of Life (AcroQoL) questionnaire, general fatigue through the Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength, lower extremity functionality using isometric dynamometry and the Lower Extremity Functional Scale (LEFS), body balance through stabilometry, and functional capacity through 6-minute walking distance (6MWD).

RESULTS

After performing TOHR, improvements in general fatigue, quadriceps muscle strength, LEFS, 6MWD, balance control and all AcroQoL dimensions were observed (all P < 0.05). After 1 month of washout, however, these gains were lost for all parameters, except the LEFS and balance control.

CONCLUSIONS

In acromegaly, TOHR results in improvements in muscle function, functional capacity, general fatigue, body balance, and HRQoL. Large randomized controlled trials are needed to replicate these benefits and to recommend rehabilitation, especially for those with long-term illness.

Static and dynamic balances of patients with acromegaly and impact of exercise on balance

PURPOSE

Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly.

METHODS

This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device.

RESULTS

The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A.

CONCLUSIONS

Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.

Assessment of static and dynamic plantar data of patients with acromegaly

PURPOSE

To determine both static and dynamic plantar data of acromegalic subjects while barefoot.

METHODS

Seventy acromegalic patients and 48 age-, sex-, weight- and height-matched healthy controls were included. Plantar variables were measured using the footscan gait system. The data included the width and length of each foot, relative force distribution in each quadrant, mean force applied to each foot and maximum pressure while walking. Maximum pressure data were obtained from ten parts of the foot. Injury risk assessments of five different regions were performed. To analyze balance, center of pressure (CoP) measurements were performed. The patients with acromegaly were compared with the controls. Furthermore, a comparison of patients with active and controlled acromegaly was performed.

RESULTS

The foot was wider in acromegalic patients. The mean force on each foot was higher in cases of acromegaly (acromegaly: 1027 ± 180 N, control: 908 ± 180 N, p = 0.001). In the acromegalic individuals, the maximum pressure in the midfoot was higher, while the medial heel maximum pressure was lower (midfoot maximum pressure acromegaly: 11.3 ± 3.5 N/cm², control: 8.9 ± 3.7 N/cm², p = < 0.001). Injury risk was similar. CoP measurements elicited intact balance. In terms of static and dynamic plantar data, there was no difference between patients with active and controlled acromegaly.

CONCLUSIONS

This is the first study to demonstrate that compared with healthy controls, patients with acromegaly experience great force on their feet while standing and high pressure in the midfoot during walking. Podiatric evaluation, custom molded orthotics and individualized rehabilitation programs for acromegalic patients may provide better force and pressure distribution throughout the foot and improve gait and skeletal symptoms.

Clinical and functional variables can predict general fatigue in patients with acromegaly: an explanatory model approach

OBJECTIVE

To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot.

RESULTS

The mean ± SD values for the participants' age, MFIS, PWV, AC, IR1,2, DYN, and the distance in the 6MWT were 49.4 ± 11.2 years, 31.2 ± 18.9 score, 10.19 ± 2.34 m/s, 1.08 ± 0.46 x106 cm5/din, 85.3 ± 29.7%, 33.9 ± 9.3 kgf, and 603.0 ± 106.1 m, respectively. The best predictive model (R2 = 0.378, R2 adjusted = 0.280, standard error = 16.1, and P = 0.026) comprised the following regression equation: MFIS = 48.85 - (7.913 × IGF-I) + (1.483 × AC) - (23.281 × DYN).

CONCLUSION

Hormonal, vascular, and functional variables can predict general fatigue in patients with acromegaly.

The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study

BACKGROUND

Acromegaly causes numerous functional limitations that negatively impact patients' performance of activities of daily living (ADLs) and contribute to the deterioration of health-related quality of life (HRQoL). Thus, the purpose of the present case study was to evaluate the effect of therapist-oriented home rehabilitation (TOHR) for a patient with acromegaly.

CASE DESCRIPTION

We report the case of a 53-year-old man who was diagnosed with primary acromegaly 17 years ago. He complained of difficulties performing tasks that involved his hands, pain in the lower limbs, and fatigue when he climbed a few flights of stairs. Although he performed ADLs independently, he reported some difficulties or discomfort when performing them.

INTERVENTION AND OUTCOME

The patient underwent a booklet-guided physical exercise program that lasted two months (three times per week, 60 minutes per session). The activities included overall stretching, muscle strengthening, and endurance exercises, along with aerobic conditioning through functional circuit training. After two months of exercise, he reported improved HRQoL as assessed with the Acromegaly Quality of Life Questionnaire, with increases in quadriceps muscle strength and 6-min walking distance. However, none of these benefits remained when the patient was assessed after a 1-month washout period.

CONCLUSION

This study showed that patients with acromegaly may benefit markedly from TOHR, which could provide a novel therapeutic approach as an adjunct to hormone control therapy.

An explanatory model of functional exercise capacity in patients with systemic sclerosis: considerations for rehabilitation programs

[Purpose] This study aimed to evaluate the impact of lung function and peripheral muscle function on the six-minute walking distance (6MWD) in systemic sclerosis (SS) patients and, thereby, to develop an explanatory model of functional exercise capacity for these individuals. [Methods] In a cross-sectional study, 31 SS patients underwent pulmonary function testing (including spirometry, diffusing capacity for carbon monoxide [DLCO], and respiratory muscle strength), isometric dynamometry with surface electromyography, and the 6MWD. [Results] There was a significant correlation between the 6MWD (% predicted, 6MWD%) and the following parameters: height (r = 0.427) and DLCO (r = 0.404). In contrast, no other independent variable showed a significant correlation with the 6MWD% (r ≤ 0.257). The final prediction model for 6MWD% (adjusted R(2) = 0.456, SE of bias=12%) was 6MWD% Gibbons = -131.3 + 1.16 × heightcm + 0.33 × DLCO% predicted. [Conclusion] In SS patients, body height and pulmonary diffusion are the main determinants of the 6MWD. Our results justify further investigation of the performance of SS patients during exercise, which may increase the understanding of the pathophysiological mechanisms involved in the disease. The impact of these findings in SS patients may be useful for evaluating the effects of rehabilitation programs.

The prosthesis evaluation questionnaire: reliability and cross-validation of the Turkish version

[Purpose] Currently, there are a limited number of amputee-specific instruments for measuring prosthesis-related quality of life with good psychometric properties in Turkey. This study translated the Prosthetic Evaluation Questionnaire to Turkish and analyzed as well as discussed its construct validity and internal consistency. [Subjects and Methods] The Prosthetic Evaluation Questionnaire was adapted for use in Turkish by forward/backward translation. The final Turkish version of this questionnaire was administered to 90 unilateral amputee patients. Second evaluation was possible in 83 participants within a median 28 day time period. [Results] Point estimates for the intraclass correlation coefficient ranged from 0.69 to 0.89 for all 9 Prosthetic Evaluation Questionnaire scales, indicating good correlation. Overall Cronbach's alpha coefficients ranged from 0.64 to 0.92, except for the perceived response subscale of 0.39. The ambulation subscale was correlated with the physical functioning subscales of Short Form-36 (SF-36) (r=0.48). The social burden subscale score of the Prosthetic Evaluation Questionnaire was correlated with social functioning subscales of SF-36 (r= 0.63). [Conclusion] The Turkish version of the Prosthetic Evaluation Questionnaire is a valid and reliable tool for implementation in the Turkish unilateral amputee population.

Physical and cardiovascular performance in cases with acromegaly after regular short-term exercise

OBJECTIVE

Impaired physical performance is a disturbing complication of acromegaly. We aimed to evaluate the role of regular exercise in amelioration of the impaired physical performance in acromegaly.

METHODS

Patients with acromegaly were divided into two groups according to their participation in a prescheduled programme of exercise. Participants in the study group were exercised 3 days a week for 3 consecutive months. Exercise tolerance was evaluated by maximal oxygen consumption (VO2 max) and time (T) taken to complete the Bruce protocol, muscle flexibility by the sit and reach test (SRT) and muscle strength by the hand grip strength test (HGST). Concomitantly, anthropometric assessment was performed using body mass index (BMI), waist-to-hip ratio (WHR), skinfold measurements from 8 points, percentage body fat (PBF), fat mass (FM) and lean body mass (LBM).

RESULTS

After 3 months of exercise, VO2 max and T were higher in cases that exercised than in cases that did not (P = 0.004 and P = 0.001). Over 3 months, within the exercise group, VO2 max and T of the Bruce protocol increased (P = 0.003 and P = 0.004) and heart rate during warming decreased (P = 0.04). SRT increased within the exercise group after 3 months (P = 0.004). HGSRT did not change significantly (right P = 0.06 and left P = 0.2). The sum of skinfolds, BMI, WHR and LBM remained stable over the study period (P = 0.1, P = 0.08, P = 0.3 and P = 0.09). PBF decreased slightly and FM decreased significantly over 3 months (P = 0.05 and P = 0.03).

CONCLUSION

Even short-term exercise may improve impaired physical performance, muscle activity and disturbed body fat composition in acromegaly.

What is the effect of peripheral muscle fatigue, pulmonary function, and body composition on functional exercise capacity in acromegalic patients?

[Purpose] The six-minute walk test (6MWT) is increasingly being used as an important tool for analyzing functional capacity in patients with multisystem disorders. The aim of this study was to evaluate the effect of body composition, peripheral muscle function, and pulmonary function on the six-minute walk distance (6MWD) in acromegalic patients. [Subjects and Methods] Thirty-two patients with active acromegaly, with a mean age of 48.6 ± 12.1 years, underwent an evaluation of body composition using electrical bioimpedance, isometric dynamometry with surface electromyography, tests of pulmonary function, and the 6MWT. [Results] The mean ± SD values for the 6MWD, fat-free mass (FFM), and maximal expiratory pressure (MEP) were 65.5 ± 11.7% predicted, 55.1 ± 10.6 kg, and 55.2 ± 16.8% predicted, respectively. There was a significant correlation between the 6MWD and the following parameters: the angle of the linear regression line obtained using the values of the median frequency electromyography signal over time during the fatigability test for the vastus medialis muscle (MDF, r=0.65), FFM (r=0.62), MEP (r=0.60), height⁽²⁾/resistance index (r=0.52), resistance (r=−0.50), and forced expiratory volume in 1 second (r=0.50). Multivariate analysis showed that MDF, FFM, and MEP were independent predictors of the 6MWD (R²=0.52). [Conclusion] The fatigability of the peripheral muscles, FFM, and MEP are the primary determinants of the 6MWD in acromegalics.