The “Walking Estimated Limitation Stated by History” (WELSH) visual tool is applicable and accurate to determine walking capacity, even in people with low literacy level

Determination of the self-reported walking capacity by interview or standardized questionnaire is important. However, the existing questionnaires require the patient to be able to read and write in a specific language. We recently proposed the WELSH (Walking Estimated Limitation Stated by History) tool to be administrable to illiterate people. The main objective was to assess the applicability of WELSH tool in the community and in a large group. We performed a prospective study in the city of Bobo-Dioulasso in Burkina Faso during June 2020. We recruited 630 interviewers among medical students. They were trained to administer the WELSH, and to conduct a 6-minute walk test. We performed a Pearson’s “r” correlation between the WELSH and maximal walking distance (MWD). Of the 1723 participants available for the analysis, 757 (43.9%: 41.6–46.3) never went to school or attended only elementary school. The percentage of questionnaires with participant filling-in errors corrected by the investigator decreased with the decrease in educational level (p<0.001). The average WELSH score was 53 ± 22 and the average MWD was 383 ±142 meters. The Spearman correlation coefficient between the WELSH score and the MWD was r = 0.567 (p<0.001). Correlations ranged from 0.291 to 0.576 in males and females, (all p values < 0.05) and in different levels of education, with the highest coefficients found in illiterate people. The WELSH is feasible on the community by a wide variety of interviewers. It correlates with the MWD estimated by the 6-minutes’ walk test even for people with little or no schooling.

Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II)

Background We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716

Comparison between 20 and 30 meters in walkway length affecting the 6-minute walk test in patients with chronic obstructive pulmonary disease: A randomized crossover study

Background A 30-m walkway length for the 6-minute walk test (6MWT) is the standard recommendation established by the American Thoracic Society to assess patients with chronic obstructive pulmonary disease (COPD). This study aimed to compare between the distances of 20 and 30 m long corridor affecting 6MWT in COPD patients. Methods A randomized crossover study was conducted with patients. COPD patients were randomized 1:1 to either a 20-m or a 30-m walkway in the first test, then switched to the other in the second test. Physiologic parameters and 6-minute walking distance (6MWD) were recorded. Results Fifty subjects (92% men) were included: age 69.1±7.4 years, body mass index 22.9±5.5 kg/m2, FEV1 63.0±21.3%, and 50% having cardiovascular disease. The 6MWD in a 20-m and a 30-m walkway were 337.82±71.80 m and 359.85±77.25 m, respectively (P<0.001). Mean distance difference was 22.03 m (95% CI -28.29 to -15.76, P<0.001). Patients with a 20-m walkway had more turns than those with a 30-m walkway (mean difference of 4.88 turns, 95% CI 4.48 to 5.28, P<0.001). Also, higher systolic blood pressure was found in patients with a 20-m walkway after 6MWT (4.62 mmHg, P = 0.019). Other parameters and Borg dyspnea scale did not differ. Conclusions The walkway length had significant effect on walking distance in COPD patients. A 30-m walkway length should still be recommended in 6MWT for COPD assessment. Clinical trial registration Clinicaltrials.in.th number: TCTR20200206003.

Effects of Game-Based Task-Oriented Circuit Training on Physical Functions of Stroke Survivors: A Pilot Study in A State Hospital in Kelantan, Malaysia

Despite being increasingly popular and commonly used in rehabilitation, both game-based exercise training and task-oriented circuit training have never been combined to provide a new training experience for stroke survivors undergoing rehabilitation. Past studies have assessed the effectiveness of these exercise approaches separately and reported positive outcomes. Combining the two training programs may create a more enriched environment and yield favorable outcomes. The aim of this study was to determine the effects of game-based task-oriented circuit training on the physical functions of stroke survivors. This research was a pretest-posttest experimental pilot trial involving 30 participants at post-acute and chronic stage post-stroke (mean age and standard deviation = 58.9 ± 6.6 years; mean Montreal Cognitive Assessment scoring = 23.4 ± 7.1) conducted at a state hospital in Kelantan, Malaysia between August 2019 to February 2020. All participants received game-based task-oriented circuit training using a “Checkercise Board” for 45 minutes, twice per week for 8 weeks. The outcome of the training was measured with regard to lower limb strength, functional stability and aerobic capacity, with the use of the 30-second chair rise test, Dynamic Gait Index (DGI) and 6-minute walk test, respectively. Analysis was done by the ‘intention-to-treat’ approach, using paired samples t-test to determine the differences between pre and post-training outcomes scores. All data was analyzed using the Statistics Package for the Social Sciences (SPSS), version 23.0. The significance level was set at p < 0.05 and Cohen’s (d) was used to determine the effect size. Post-training, participants’ mean 30-second chair rise test, DGI and 6-minute walk test scores increased by 9%, 7% and 23% respectively compared to pre-treatment (p < 0.05), with medium effect size of 0.5 to 0.6. Game-based task-oriented circuit training effectively improves lower limb strength, functional stability and aerobic capacity of stroke survivors, and may be used as a therapy option for this population. A future study is needed to confirm these study finding.

Complex approach to assessment of functional status of patients with chronic obstructive pulmonary disease

BACKGROUND: Considering the economic costs of managing patients with chronic obstructive pulmonary disease (COPD), as well as the high mortality and disability rate, it is necessary to improve the diagnosis of the disease, to look for new approaches to assessing the functional status of patients. AIM: Is to study the functional status of patients with COPD. MATERIALS AND METHODS: A comprehensive approach was applied to assess the functional status of patients: the data of the 6-minute walk test (6MWT), heart rate variability (HRV) was studied, ergoreflex was assessed according to HRV data. 64 patients with COPD and 41 male volunteers without respiratory diseases older than 40 years were examined. Statistical processing of the obtained results was carried out using the licensed package of applied statistical programs Excel 2010 and Statistica 10. RESULTS: The group of patients with COPD and the respondents of the control group were comparable in terms of body mass index, heart rate, respiratory rate, index of indicators of activity of regulatory systems (p > 0.05). As expected, during the 6MWT, differences were obtained between the studied groups in terms of the distance covered (p < 0.01). Similarly, the results of the study of the function of external respiration showed a statistically significant difference in all the studied parameters (p < 0.01). The results obtained confirmed the presence of impaired respiratory function in the group of patients with COPD. Analysis of HRV values, when conducting a test with external peripheral vascular occlusion, confirmed ergoreflex hyperactivity in patients with COPD. CONCLUSION: The integration of methods for routine clinical diagnostics of patients condition (spirometry, 6-minute walk test, assessment of autonomic status) and the introduction of the study of ergoreflex activity made it possible to expand the understanding of the functional state of patients with COPD and is of great interest for further research.

The Efficacy of a Commercial Physical Activity Monitor in Longitudinal Tracking of Pulmonary Hypertension Patients

Patients with pulmonary arterial hypertension (PAH) have quality of life (QoL) limitations, decreased exercise capacity, and poor prognosis if left untreated. Standard exercise testing is routinely performed for the evaluation of patients with PAH but may be limited in its ability to monitor activity levels in daily living. We evaluated the validity of the commercial Fitbit Charge HR as a tool to assess real time exercise capacity as compared to standard exercise testing in patients with PAH. Ambulatory pediatric and adult PAH patients were enrolled and given a Fitbit with instructions to continuously wear during waking hours. Subjects underwent a 6-minute walk test (6MWT), cardiopulmonary exercise test (CPET) and an SF-36 QoL survey on the day of enrollment and follow-up. Twenty-seven ambulatory subjects with PH were enrolled and 21 had sufficient data for analyses (median age 25, range 13-59, 14 F) were enrolled. Daily steps measured by the Fitbit had a positive correlation with 6MWT distance (r = 0.72, p = 0.03) and an inverse correlation with WHO functional class. On the QoL survey, 77% reported improvement in energy/fatigue (p = 0.055). At follow up there was a strong correlation between Fitbit steps and role limitations due to physical problems (r = 0.88, p = 0.020) and weaker correlations with less related QoL markers. These findings suggest activity monitors may have potential as a simple/novel method of assessing longitudinal exercise capacity and activity levels in PAH patients. Further study in larger cohorts of patients is warranted to determine the best accelerometric correlates with outcomes.

The Influence of Abdominal Obesity on Hip Pain, Function, and Walking Ability after Three Years of THA: A Prospective Cohort Study

Background: There are many clinical studies about the impact of obesity on postoperative function following THA, but their conclusions are different and even contradictory. Abdominal obesity is closely related to obesity, while its impact on postoperative function following THA remains to be elucidated.Methods: Four hundred and thirteen patients were included in this study. They were divided into an AO group (waist circumference ≥ 90 cm for men and ≥ 85 cm for women) and a non-AO group (waist circumference ≤ 90 cm for men and ≤ 85 cm for women). Preoperative assessments including numerical pain rating, the Oxford Hip Score, and 6-minute walk test were repeated at 1,2, and 3 years postoperatively. Postoperative assessments included the anteversion and inclination of the acetabular prosthesis and satisfaction survey.Results：At a mean follow-up of 48±1.3 months, there was a significant difference in the improvement of the 6-minute walk test (251.22 to 387.46, 410.34, 410.07 vs 207.79 to 362.17, 395.82, 403.36; p < 0.001) at 1, 2 and 3 years and the numerical pain rating scale (6.00 to 0.39 vs 5.76 to 0.80; p < 0.001) at 1 year between the non-AO group and AO group. There was no difference between both groups in inclination, anteversion, OHS, and satisfaction. Conclusion: AO does not increase the complications after THA, nor does it have a significant impact on the function after THA, but it seems to have a negative effect on the improvement of walking ability and the relief of hip pain.

COMPLEX ESTIMATE OF THE TEST OF A 6-MINUTE WALK IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE

Одним из важных проявлений большинства хронических легочных заболеваний является одышка, которая, в свою очередь, становится основной причиной ограничения переносимости физических нагрузок. Снижение физической толерантности у больных, страдающих хроническими легочными заболеваниями, обусловлено неспособностью организма обеспечивать необходимое поступление кислорода во время нагрузки, а в клиническом отношении - с невозможностью для пациента выполнять ту физическую работу, которую мог выполнять ранее. Среди методов оценки переносимости физических нагрузок используют кардиопульмонарное тестирование на велоэргометре, тредмиле, которое требует обязательного присутствия врача, что не всегда возможно в амбулаторных условиях. В ряде работ показана достаточная эффективность для диагностики состояния больного и оценки переносимости нагрузки использование для этой цели теста 6-минутный ходьбы. Это тест с ходьбой в произвольном темпе в течение 6 мин. Результатом теста является расстояние, которое больной может быстро пройти по ровной твердой поверхности за 6 мин. Расстояние, пройденное в тесте 6-минутной ходьбы, имеет прогностическое значение при многих заболеваниях, включая ХОБЛ. В данной статье оценивается комплексная оценка модифицированного теста 6-минутной ходьбы у больных ХОБЛ с использованием динамической пульcоксиметрии, которая расширяет диагностические возможности нагрузочного тестирования. Показано, что параллельно нарастанию выраженности одышки у больных снижается сатурация кислорода с постепенным восстановлением в покое. В контрольной группе, несмотря на сопоставимую с больными ХОБЛ одышку, оцениваемую по шкале Борга, насыщение крови кислородом не менялось. Комплексная оценка теста 6-минутной ходьбы поможет объективизировать эффективность проводимых лечебных и профилактических мероприятий у больных с ХОБЛ One of the important manifestations of most chronic pulmonary diseases is a shortness of breath, which, in turn, becomes the main reason for the restability of physical exertion. A decrease in physical tolerance in patients suffering from chronic pulmonary diseases is due to the inability of the body to provide the necessary flow of oxygen during the load, and in the clinical terms - with the impossibility of the patient to carry out that physical work that could be performed earlier. Among the methods for estimating the tolerability of physical loads, cardiopulmonary testing on the bikergometr, tredmil, which requires the mandatory presence of a doctor, which is not always possible in the outpatient conditions. A number of work shows sufficient efficiency for the diagnostic of the patient's condition and the use of load portability to use for this purpose a 6-minute walk. This is a walking speed in an arbitrary pace for 6 minutes. The result of the test is the distance that the patient can quickly go through a smooth solid surface for 6 minutes. The distance traveled in a 6-minute walk test is prognostic in many diseases, including COPD. This article is estimated to be an integrated assessment of a 6-minute walk test using a dynamic pulse oximetry, which expands the diagnostic capabilities of load testing. It has been shown that in parallel increasing the severity of shortness of breath in patients decreases the saturation of oxygen with gradual restoration alone. In the control group, despite comparable with sickness patient with COPD, the oxygen saturation estimated on the Borg scale did not change. A comprehensive test assessment of a 6-minute walk will help to facility the effectiveness of therapeutic and preventive measures to patients with COPD