Total body recumbent stepping vs treadmill walking in supervised exercise therapy: A pilot study

Background: Treadmill walking is the most commonly recommended exercise modality in supervised exercise therapy (SET) for peripheral artery disease (PAD); however, other modalities may be equally effective and more tolerable for patients. The primary aim of this single-blind, randomized pilot study was to compare the feasibility, safety, and preliminary efficacy of a treadmill walking (TM) versus a total body recumbent stepping (TBRS) exercise program for treatment of PAD. Methods: Participants ( n = 19) enrolled in a 12-week SET program and were randomized to either a TM ( n = 9) or TBRS ( n = 10) exercise group that followed current SET exercise guidelines. Feasibility, safety, and efficacy outcomes were assessed. Results: SET attendance was 86% and 71%, respectively, for TBRS and TM groups ( p = 0.07). Session exercise dose (metabolic equivalents of task [MET] minutes) (mean [SD]) for TM was 117.6 [27.4] compared to 144.7 [28.7] in the TBRS group ( p = 0.08). Study-related adverse events were nine in 236 training hours and three in 180 training hours for the TBRS and TM groups, respectively. There were no significant differences between groups for improvement in 6-minute walk distance (mean [SD]) (TM: 133.2 ft [53.5] vs TBRS: 154.8 ft [49.8]; p = 0.77) after adjusting for baseline 6-minute walk distance. Conclusion: This is the first randomized study comparing TBRS to TM exercise in SET using current SET guidelines. This pilot study showed that TBRS is a feasible and safe exercise modality in SET. This study provides preliminary efficacy of the use of TBRS exercise in SET programs following current guidelines. Larger studies should be conducted to confirm these findings.

Development of reference equations for the six-minute walk distance of school-aged Nigerian children

BACKGROUND: The six-minute walk test (6MWT), a simple, reliable and valid test that uses the distance walked in six minutes (six-minute walk distance, 6MWD) to quantify functional exercise capacity, is widely used in chronic cardiopulmonary and non-cardiopulmonary disorders. However, th absence of reference standards for Nigerian school-aged children limits its utility in this age group OBJECTIVES: To develop normative values and equations for the 6MWT of school-aged Nigerian children METHODS: In a cross-sectional study, healthy Nigerian children aged 6-11 years in Lagos completed 6MWT on 20-meter straight outdoor courses in their schools following standardized guidelines. Potential predictors: demographic (age, sex), anthropometric (height, weight, chest circumference, leg length) and physiological data [pre-walk, immediate post-walk and 5th-minute post-walk heart rate (HR), oxygen saturation (SpO2), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rating of perceived exertion (RPE)] and the difference between pre-walk and post-walk HR (HR change), SpO2 (SpO2 change), SBP (SBP change), DBP (DBP change) and RPE (RPE change). Primary outcomes:six-minute walk distance (6MWD) in meters. RESULTS: Overall, 627 pupils (52.1% girls) walked 504.6 (66.6) m (95% CI: 499.4, 509.8), ranging from 326.6 to 673.0 m; boys walking 16 m longer (p=0.002). Stepwise linear regression yielded 6MWD=347.9+14(Age in years)+1.6(HR change)+17.6(sex; male=1, female=0)+1.2(SBP change);R square=0.25.Previously published reference equations mostly over-estimated Nigerian children's 6MWD. CONCLUSION: The reference values and equations, after validation in other Nigerian geographic populations, may be useful for the functional evaluation of Nigerian children aged 6-11 years with chronic childhood disorders.

Impact of Outpatient-Based Exercise Prescription on Stable Rheumatic Heart Disease and Post Coronavirus Infection Individual- A Case Report

The outcome of covid-19 patients with co-morbidities has reported to be poor. Post covid exercise-based rehabilitation may have a major role in improving exercise tolerance and quality of life in post-covid-19 patients with co-morbidities. This case report discusses the clinical scenario of a 35-year-old person who is a known case of stable rheumatic heart disease since 29 years and recently diagnosed with covid-19 moderate pneumonia. He was referred to post covid outpatient department for post-covid physiotherapy rehabilitation. After one month of structured exercise-based rehabilitation, improvement recorded in his SF-12 and 6-minute walk distance. COVID-19 patients with co-morbidities seemed to have a poor prognosis, according to various studies. Post covid exercise-based rehabilitation may have a major role in improving exercise tolerance and quality of life in post-covid-19 patients with co-morbidities. There is no structured rehabilitative protocol designed for such unusual combination as of now hence our study focuses on this lacunae. This case report discusses the clinical scenario of a 35-year-old person who is a known case of stable Rheumatic heart disease in the last 29 years and recently diagnosed with COVID-19 moderate pneumonia. He was referred to post covid outpatient department for post-covid physiotherapy rehabilitation. The individual followed a structured exercise-based rehabilitation protocol for one month 6 times/week and improvement recorded in his SF-12 and 6-minute walk distance. There was improvement in six-minute walk distance by 150 meters and rate of perceived exertion was also improved from 9 score to 7 in 6-20 borg scale post one month. In comparison to pre-Rehabilitation, SF-12 improved the quality of life in both physical and mental sore. This case report concluded that there was a definite improvement in the walking distance and quality of life of the patient after post COVID physiotherapy rehabilitation.

Аналіз наявних інструментів оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона

Резюме. Правильний і обґрунтований вибір інструментальних методів оцінювання функціо-нального стану пацієнта є обов’язковою умовою адекватної фізичної терапії. Особливе місце цей аспект займає в системі нейрореабілітації пацієнтів з хворобою Паркінсона в Україні, оскільки на сьогодні кількість осіб, що потребують систематичної фізичної терапії, сягає 23 900 тис. Наростаюча маніфестація моторних і немоторних симптомів при хворобі Паркін-сона, від яких часто вирішальною мірою залежить тяжкість стану пацієнта, негативно впливає на якість його життя. Наявні функціональні порушення, які є самостійними проявами хвороби Паркінсона, вимагають специфічного підходу до комплексного інструментального досліджен-ня цих порушень для визначення диференційно-діагностичних критеріїв та оцінювання впливу фізіотерапевтичного втручання. Мета. Проаналізувати наявні інструменти оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона. Методи. Теоретичний аналіз та узагальнення зарубіжних даних спеціальної науково-методичної літератури з питань застосування інстру-ментів оцінювання при хворобі Паркінсона та їх інформативності і надійності у фізичній терапії. Результати. Представлені дані свідчать, що ефективність запроваджених заходів фізичної терапії при хворобі Паркінсона залежить від правильно підібраних інструментів оцінювання, які дозволяють оцінити моторні і немоторні проблеми через призму життєдіяльності і якості життя пацієнта. Основним інструментом оцінювання для вирішення цього питання вважаєть-ся Уніфікована рейтингова шкала хвороби Паркінсона MDS-UPDRS, яка дозволяє об’єктивно оцінити моторні і немоторні аспекти життя пацієнта і його рухову активність. Оскільки наявні моторні й аксіальні рухові порушення негативно впливають на повсякденну функціональну активність пацієнта, для верифікації цих порушень пропонують використовувати тест для оці-нювання часу підйому і ходьби (Timed Up and Go (TUG)); тест з подвійним завданням (Dual-Task TUG (TUG-DT)) та шкалу рівноваги Берга (Berg Balance Scale (BBS)). Але виходячи з того, що ці тести недостатньо чутливі до невеликих змін у рухливості при хворобі Паркінсона, особливо на середніх і пізніх стадіях захворювання, їх доцільно поєднувати з одним із кількісних тестів для оцінювання ходьби: 10-метровим тестом ходьби (10 Meter Walk Test (10MW)) та 6-хвилинним тестом ходьби (Six Minute Walk Distance (6MWT)). Поняття «життєдіяльність» включає в себе не тільки переміщення, її оцінювання має бути доповнено аналізом ступеня впливу наявних по-рушень на повсякденну діяльність, тобто на якість життя пацієнта. Найбільш інформативними інструментами для проведення цього аналізу є універсальні і специфічні при хворобі Паркінсо-на опитувальники з метою оцінювання стану здоров’я SF-36, EuroQOL (EQ-5D) і PDQ-39 (The Parkinson’s Disease Questionnaire). Результати аналізу та узагальнення даних науково-мето-дичної літератури дають підставу встановити, що маніфестація порушень та їх варіабельність при хворобі Паркінсона стають серйозною проблемою у досягненні кінцевого результату за-проваджених заходів фізичної терапії на всіх стадіях захворювання. Використання в комплексі стандартної експертно-реабілітаційної діагностики спеціальних інструментів оцінювання дозволяє об’єктивізувати оцінювання клінічної інформації та стимулює розроблення особисто-орієнтованих реабілітаційних стратегій із застосуванням заходів фізичної терапії, спрямованих на покращення якості життя пацієнтів з хворобою Паркінсона. Ключові слова: хвороба Паркінсона, фізична терапія, якість життя, інструменти оцінювання, достовірність, надійність, валідність.

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6‐minute walk distance, 10‐meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post‐stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta‐regression analyses adjusted for study baseline mean values (pre‐post comparisons) or baseline mean values and baseline control‐intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre‐post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6‐minute walk distance (36.3 meters; 95% CI, 14.2–58.5), comfortable 10‐meter walk time (0.13 m/s; 95% CI, 0.06–0.19) and fast 10‐meter walk time (0.16 m/s; 95% CI, 0.03–0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41–5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6‐minute walk distance (baseline‐adjusted 27.3 meters; 95% CI, 6.1–48.5; fully adjusted, 24.9 meters; 95% CI, 0.82–49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6–50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial

Background Supervised lifestyle interventions have the potential to significantly improve physical activity and fitness in patients with chronic kidney disease (CKD). Methods To assess the efficacy of a lifestyle intervention in patients with CKD to improve cardiorespiratory fitness and exercise capacity over 36 months, we conducted a randomized clinical trial, enrolling 160 patients with stage 3-4 CKD, with 81 randomized to usual care and 79 to 3-year lifestyle intervention. The lifestyle intervention comprised care from a multidisciplinary team, including a nephrologist, nurse practitioner, exercise physiologist, dietitian, diabetes educator, psychologist, and social worker. The exercise training component consisted of an 8-week individualized and supervised gym-based exercise intervention followed by 34 months of a predominantly home-based program. Self-reported physical activity (metabolic equivalent of tasks [METs] min/wk), cardiorespiratory fitness (peak O2 consumption [VO2peak]), exercise capacity (maximum METs and 6-minute walk distance) and neuromuscular fitness (grip strength and get-up-and-go time) were evaluated at 12, 24, and 36 months. Results The intervention increased the percentage of patients meeting physical activity guideline targets of 500 MET min/wk from 29% at baseline to 63% at 3 years. At 12 months, both VO2peak and METs increased significantly in the intervention group by 9.7% and 30%, respectively, without change in the usual care group. Thereafter, VO2peak declined to near baseline levels, whereas METs remained elevated in the intervention group at 24 and 36 months. After 3 years, the intervention had increased the 6-minute walk distance and blunted declines in the get-up-and-go test. Conclusions A 3-year lifestyle intervention doubled the percentage of CKD patients meeting physical activity guidelines, improved exercise capacity, and ameliorated losses in neuromuscular and cardiorespiratory fitness.

The First Evaluation of a Geroscience Biomarker Index (TAME-BI) in a Trial of Caloric Restriction and Exercise

We leveraged the WF OAIC biorepository to measure a consensus-derived panel of blood-based biomarkers of aging and constructed a geroscience-guided biomarker index (TAME-BI), testing it for the first time in a clinical trial. We measured IL-6, TNF-α-receptor-I, growth differentiating factor-15, cystatin C, and N-terminal pro-B-type natriuretic peptide in a 20-week randomized trial of caloric restriction (CR), aerobic exercise (EX), CR+EX, or attention-control in 88 patients (67±5years) with heart failure with preserved ejection fraction (HFpEF). We calculated TAME-BI (analyte levels ranked, binned by quintile, and summed) and found a time×treatment interaction for improved TAME-BI with intervention (p≤0.05) and detected associations between change in TAME-BI and change in six-minute walk distance (r= -0.24), usual walk speed (r= -0.23), and left ventricular relative wall thickness (r= 0.31). In sum, CR+EX intervention improved TAME-BI and changes in TAME-BI were associated with changes in key functional measures in older HFpEF patients.

Combined Effect of Walking and Vitamin D Intake on Patients with Heart Failure

Objective: Patients with heart failure may benefit from vitamin D treatment, according to new research (Congestive Heart Failure). Methods: In our current nonrandomized clinical research, 43 individuals with dilated cardiomyopathy who did not exhibit substantial gains in physical functioning with optimum heart failure therapy were included. Twelve weeks of weekly vitamin D supplements (200,000 IU) were added to the heart failure therapy to help improve the patient's condition. On the other hand, researchers looked at how it affected the 6-minute walk distance and pro-BNP levels. To analyses the data, we utilized SPSS version 19. Accordingly, we utilized random samples t-tests to assess the substantial role of vitamin D supplementation on pre-intervention vitamin D level, 6-minute walk distance, and pro-BNP level, respectively. Significance was defined as an alpha value less than 0.01. Results: Individuals in NYHA class II (66%) were the majority, while those in NYHA classes I, III and IV were represented by 18%, 8% and 5%, accordingly. Following 14 weeks of vitamin D treatment, the group's mean vitamin D level was increased from 17.596.57ng/ml at baseline to 32.974.65ng/ml (p0.0006). Pre-intervention mean distance travelled was 806382ft, however after the intervention it rose to 945392ft (p-value 0.07). While before the intervention, the mean per-BNP level of research participant was 1025-636, and after intervention, it had enhanced to 160-80--a statistically significant improvement (p=0.005). Conclusion: According to a decline in blood pro-BNP characterized by an increase in six-minute walk distance, vitamin D administration decreases the intensity of heart failure.

TO EVALUATE THE RESPIRATORY FUNCTIONS OF COVID-19 PNEUMONIA SURVIVORS THREE MONTHS AFTER RECOVERY AT TERTIARY CARE CENTRE.

BACKGROUND: In this study we provide a suggested structure for the respiratory follow up of patients with clinicoradiological conrmation of COVID 19 pneumonia three months after recovery. OBJECTIVES: 1.To evaluate the respiratory function and functional disability of COVID – 19 Survivors 3 months after recovery.. MATERIALS AND METHODS: This was a retrospective study done on 70patients, who were attending the OPD/ IP of Thanjavur medical college three months after recovery from COVID PNEUMONIA.These patients were enrolled consecutively from August 2020 to January 2021 .Datas during admission had been collected from patient records.Spirometry, 6-minute walk distance, pulse oximetry ,CT chest scan, psychological assessment were performed 3 months after discharge.Statistical Analysis was done by SPSS trial version 20. RESULTS:,Amongthe 70 studypopulations ,Age rangedfrom24 to74 yearswithmeanage 56.9 yearsofageandSD-11.45,mostof them were male (80%).Nearly 75% of the patients had sp02 80-90% during admission and after recovery nearly 95% of the patient had more than 90% spo2.On admission more than half of the patients had moderate CT severity score ,after recovery more than 70%ofthepatientshad mildCTseverity score .Afterrecovery more than70%ofthepatientsdoesnotrequire oxygen. Onspirometry nearly70%ofthepatientswiththeagegroupof 41-60yearsofagehadmildrestrictionsafterrecovery. CONCLUSION: Three months after SARS CoV-2 infection shows signicant improvement in functional and radiological abnormalities on careful monitoring. A systematic follow-up for survivors needs to be evaluated to optimise care for patients recovering from COVID-19.

Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction

Background Obesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity. Methods and Results Patients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m 2 were offered enrollment in an established 15‐week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6‐minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m 2 ), 74% of whom lost >5% of their baseline body weight following the 15‐week program. At 15 weeks, mean 6‐minute walk distance increased from 223 to 281 m ( P =0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks ( P <0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score ( r =0.452; P =0.000) and 6‐minute walk distance ( r =−0.388; P <0.001). Conclusions In a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15‐week program. This is associated with significant improvements in quality of life and exercise capacity. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02911337.