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A shuttle walk test for assessment of functional capacity in chronic heart failure.

BACKGROUND: Peak oxygen uptake (peak VO(2)) is a reference parameter in the assessment of functional capacity of patients with chronic heart failure, but the procedure for cardiopulmonary exercise testing with expired gas analysis is complex and expensive, so more simple and available methods are desirable. METHODS: We compared the usefulness of a time-limited walk test, the 6-minute walk test (6-MT), with that of a symptom-limited walk test, the shuttle walk test (SWT), in the evaluation of patients with moderate to severe chronic heart failure. We prospectively studied 46 clinically stable patients in New York Heart Association class II to IV heart failure with left ventricular ejection fraction <40% (aged 53 +/- 10 years, ejection fraction 23% +/- 8%, New York Heart Association functional class 2.8 +/- 0.7). Each patient performed two 6-MT, two SWT and a cardiopulmonary exercise testing within 2 weeks. RESULTS: We found a close correlation between distance walked in SWT and peak VO(2 ) (r = 0.83, P <.001) and a moderate correlation between distance in 6-MT and peak VO(2) (r = 0.69, P <.001). Both walk tests showed to be reproducible after just one practice walk. All patients who walked > 450 m in SWT had a peak VO(2) >14 mL/kg/min. The overall discriminatory accuracy for SWT distance was greater than that for 6-MT distance for predicting a peak VO(2 ) <14 mL/kg/min (area under receiver operator characteristic curves 0.97 and 0.83 respectively, P =.02). Stepwise multivariate regression analysis, including clinical, exercise testing, echocardiographic, radionuclide-angiographic, and rest hemodynamic data, showed that distance walked in SWT was the only independent predictor of peak VO(2) (P <.001) and the strongest predictor of percent achieved of age- and sex-predicted peak VO(2) (%PVO(2)) (P <.001), with only age offering additional information (P =.02). CONCLUSIONS: The SWT shows to be a feasible and safe method to evaluate patients with chronic heart failure that strongly and independently predicts peak VO(2) and %PVO(2.) This symptom-limited walk test seems to be more useful than 6-MT in the assessment of functional capacity in these patients.

Adult↗

[Assessment of the functional capacity in arterial occlusive disease of the extremities].

In this paper are explained the principles essential for the judgement of the functional capacity in the arterial obturative disease of the extremities. On the basis of tables and figures the diagnostic and prognostic significance of quantitative measurements of blood supply by means of differentiated methods of occlusion plethysmography of the veins in disturbances of the peripheral arterial blood supply are demonstrated. In these cases the importance of the inclusion of all clinico-angiological findings, especially of the functional capacity of the heart and of the therapy of hypertension in the general judgment is emphasized.

Arterial Occlusive Diseases↗

[Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life--a controlled study].

We conducted a three-week randomized trial comparing the improvement of functional capacity by exercise training in chronic heart failure by the steady-state (EF 27.3%, n = 20) and the interval modus (EF 29.3%, n = 20) with a control group (EF = 26.6%, n = 10). Minimal EF was 10%, the lowest maximal oxygen consumption was 9.3 ml/kg/min and the lowest cardiac output was 1.9 l/min; 9 patients had been evaluated for HTX. VO2 at the anaerobic threshold and at maximal exercise increased in the continuous exercise group by 1.4 or 1.6 ml/kg/min, respectively, corresponding to an increase of 13.7% (p < 0.05) and 9.3% (p < 0.05). In the interval training group the increase was 1.3 and 1.5 ml/kg/min corresponding to 14% (p < 0.05) and 8.1% (p < 0.05). Continuous short-term exercise had no impact to central hemodynamics as pulmonary artery pressure (PA), capillary wedge pressure (pc), cardiac index (CI) or stroke volume index (SVI), whereas after interval training a significant increase at maximal exercise could be seen in CI (p < 0.05) and SVI (p < 0.01) with a concomitant drop in systemic peripheral resistance (p < 0.05) compared to the steady-state modus. Interval training was further characterized by a higher short-term but lower mean work load with a significantly smaller increase in lactate. Quality of life was improved according to the SF-36 questionnaire in both training groups but the psychologic sum factor was three times as high, increasing to 24.2% in the steady-state exercise group. It can be concluded that clinically stable patients with heart failure and even those already having been evaluated for cardiac transplantation profit from short-term physical training. Both training modalities seem equally suited to improve functional capacity. However interval training leads to more pronounced improvement in hemodynamics compared to the steady-state exercise, whereas the later had a greater impact on psychological well-being and quality of life. Patients with heart failure and severe peripheral deconditioning tolerate higher workloads with more peripheral stress by an interval training modus. Long-term training modalities need to be established to further improve and stabilize functional status.

Activities of Daily Living↗

Demonstration of the neutrophil granulocyte functional capacity in silicosis, using the NBT test.

The functional capacity of neutrophils was studied using the NBT test in 68 patients with silicosis in various evolutive stages, comparatively with a group of 35 controls. The NBT test showed an initial increase of nonspecific cellular reactivity which decreased as the disease evolved. The results in the control group showed 9 +/- 5% NBT positive neutrophils. The highest proportion of NBT positive neutrophils (17.6 +/- 2.3, p < or = 0.05) was found in stage I of the disease and then decreased gradually with the evolution of the disease. The proportion of NBT positive neutrophils may be considered as a biochemical marker of neutrophil functionality.

Biomarkers↗

Quantitative evaluation of functional capacity during isoniazid therapy in Huntington's disease.

Eleven patients with Huntington's disease were treated with high doses of isoniazid. In addition to clinical assessment, the functional capacity was evaluated quantitatively. The symptoms of four of the patients showed a marked improvement and their functional capacity increased. The condition of one patient with the rigid form (Westphal's variant) deteriorated, and the remaining six patients showed no change. Patients with prominent mental disturbances appeared to respond best to isoniazid therapy.

Adult↗

Occupation, impaired health, and the functional capacity of men to continue working.

Whether the functional capacity of older men to remain at work differs by occupational assignment is an important consideration in judging policies designed to advance the age of retirement. A continuous-time Markov model of retirement disability, and death is used to test hypotheses about the influence of physically demanding work and impaired health on the ability to delay retirement. The model is estimated with panel data on a nationally representative sample of older American males. Physical job requirements and health conditions are found to affect the likelihood of retiring in a disabled state. However, cohort projections of the fractions of workers in physically demanding and sedentary job categories retiring nondisabled are very similar. Special policy consideration of workers in physically demanding occupations may therefore be questioned.

Aged↗

Changes in knee extension and flexion force, EMG and functional capacity during strength training in older females with fibromyalgia and healthy controls.

OBJECTIVE: To investigate the effects of strength training on neuromuscular functions in elderly females with fibromyalgia (FM). METHODS: Thirteen females with fibromyalgia [group FMt; mean age (s.d.) 60.2 (2.5) years] and 11 healthy controls [group HCt; 64.2 (2.7) yr] carried out supervised strength training twice a week for 21 weeks. Thirteen FM patients [group FMc; 59.1 (3.5) yr] served as non-training controls. Maximal isometric force and electromyographic (EMG) activity of the right quadriceps femoris in knee extension and flexion actions, maximal 10-m walking speed, and 10-step stair-climbing time were measured. Tender points were assessed by palpation, subjectively perceived symptoms with a visual analogue scale, and the self-reported physical function capacity by Health Assessment Questionnaire (HAQ). RESULTS: The mean (s.d.) increases in maximal extension force during the training period in groups FMt and in HCt were 32 (33)% (P < 0.001) and 24 (12)% (P < 0.001) respectively and those of flexion were 13 (20)% (P < 0.05) and 24 (17)% (P < 0.01). Explosive force of the extensors increased in both FMt and in HCt. The integrated EMGs of the vastus lateralis and medialis muscles increased in both FMt and HCt. Muscle forces and EMGs in group FMc remained at the basal level. Walking speed, stair-climbing time and the HAQ index improved in group FMt. The changes in the number of tender points and in perceived symptoms were in favour of the training group FMt. CONCLUSIONS: The data support the hypothesis that elderly female FM patients have normal neuromuscular function. Supervised strength training also suits elderly FM patients, has positive effects on perceived symptoms and improves functional capacity without complications.

Aged↗

Functional capacity evaluation reports for clients with personal injury claims: A content analysis.

Functional capacity evaluations (FCEs) for personal injury claimants are rigorously scrutinized by the stakeholders because of their financial implications. This study examined 51 medico-legal FCE reports for clients all of whom suffered with spinal pain attributed to a motor vehicle accident. The FCEs were completed by 14 occupational therapists. Content analysis of the FCE reports identified categories and sub-categories of objective and subjective information on which occupational therapists reported. They included employment, activities of daily living, pain, functional physical capacities and job demands. Recommendations included the suitability of current and future jobs. However, the reasoning behind occupational therapists' recommendations in the FCE reports was frequently not stated. This content analysis demonstrated that these detailed FCE reports had a consistent focus on work capacity; further, the researchers suggest refinements to FCE reporting practices so that findings, recommendations and predictions about work outcomes for clients are interpreted clearly and realistically.

Adolescent↗

Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain.

Back muscles are important to the stability of the lumbar spine. Muscle fiber composition may give some indication of the functional capacity of these muscles. This review explores the relationship between muscle fiber composition and functional capacity of back muscles. The reference values for the type and size of the muscle fibers found in the back musculature of healthy subjects and patients with back pain are also presented. A high percentage of type I fibers, which are larger in size than type II fibers, has been found in back muscles at the thoracic and lumbar levels. This is in accordance with the postural function of these muscles. The diameter of type II fibers is smaller in females than males, which may partly explain the lesser strength and greater endurance capacity of back muscles in females. Due to the limited amount of pertinent data, no conclusive evidence is available regarding age-related changes in muscle fiber composition in the musculature of the back. In patients with lumbar disorders, pathological changes and selective atrophy of type II fibers are seen, and these can be changed with adequate exercises. Further research is suggested to address issues related to gender, age, back pain, and exercise and their effects on the apparent back muscle fiber composition.

Aging↗

Relation of functional capacity with the oxidative stress and antioxidants in chronic heart failure.

Chronic heart failure is a common, disabling disorder with high mortality. Oxidative stress may have both functional and structural effects on the myocardium, leading to myocardial decompensation. In this study, the authors examined the relationship of oxidative stress and functional capacity in patients with varying degrees of heart failure. Fifty-one patients with chronic heart failure and 31 control subjects were studied. The functional capacity of patients was determined. Plasma malondialdehyde, vitamin E, and beta-carotene levels were measured. The malondialdehyde levels were significantly different between control subjects and heart failure patients (p=0.03). There was a positive correlation between patients' malondialdehyde levels and New York Heart Association functional class (r=0.59; p<0.0001). There was a negative correlation between the functional class and vitamin E and beta-carotene levels (r=20.43; p<0.0001 and r=20.25; p<0.01, respectively). These data demonstrate that oxidative stress is increased systemically in patients with chronic heart failure. It seems that this increase correlates with functional class. (c)2001 CHF, Inc.

Journal Article↗

Dental state and functional capacity in 75-year-olds in three Nordic localities.

The aims of the study were to compare dental state in three Nordic 75-year-old populations and to evaluate dental state as a marker of functional ageing. The study is part of a Nordic comparative study of 75-year-olds in Glostrup, Göteborg and Jyväskylä. In the dental studies, 411 subjects in Denmark, 308 in Sweden and 310 in Finland participated. Odontological history was obtained from interviews. Other methods, which are described elsewhere, were used to measure various functional parameters. In Göteborg, 23% of the 75-year-olds reported they were edentulous and 27% that they had more than 20 of their own teeth. The corresponding figures in Glostrup were 45% and 15% and in Jyväskylä 58% and 9%, respectively. In all three localities, economic factors and lifestyle factors, such as tobacco smoking, low physical activity and low social activity, were significant predictors for impaired dental health. The number of teeth was significantly associated with, for example, spirometry parameters, reaction time, body extention and body flexion in males. In females, significant associations were obtained with spirometry parameters, reaction time, handgrip, body extension and body flexion. Internordic differences regarding dental state were obvious. Dental state was associated with functional capacities. We suggest that dental state is a marker of functional capacity in elderly populations.

Aged↗

Neutrophil function capacity to express CD10 is decreased in patients with septic shock.

OBJECTIVE: To evaluate the performance of a newly developed assay to assess neutrophil function capacity. After optimization, the assay was performed on samples derived from patients with septic shock and compared with healthy controls and patients with a systemic viral infection. DESIGN: Prospective evaluation of the performance of a new assay. SETTINGS: Medical intensive care unit, hospital laboratory. PATIENTS: Ten patients with septic shock, ten patients with infectious mononucleosis, and ten healthy controls. MEASUREMENTS AND MAIN RESULTS: We report an assay to assess neutrophil function capacity, in which CD10 membrane expression is measured by FACS before and after in vitro stimulation with Staphylococcus aureus bacteria. This assay evaluates the early activation state of circulating neutrophils and is shown to be of value in diagnosing a sepsis syndrome. First the assay was optimized. As an anticoagulant, sodium-citrate gave the best results. Blood samples must be kept on ice to reduce activation inside the siliconized tube and can be stored in this way for at least 8 hrs without affecting the test results. Kinetic studies showed a maximal expression of CD10 on neutrophils of healthy volunteers after 15 mins of stimulation with S. aureus bacteria. Second, the test was performed on samples derived from ten septic patients and ten patients with infectious mononucleosis. Septic patients had a significantly decreased CD10 expression capacity compared with healthy controls. Patients with infectious mononucleosis have a significantly higher CD10 expression capacity compared with septic patients, but in approximately one-half of them, the expression capacity was below the range found in controls. CONCLUSIONS: These results indicate that in circulating neutrophils, the secretory vesicles have been mobilized completely in patients with septic shock. The assay proves to be of acceptable analytical quality and can be quickly and easily performed. Regarding clinical performance, this assay may be helpful in diagnosing septic shock.

Adolescent↗

Changes in functional capacity after portal branch ligation in rats.

Preoperative portal branch embolization is performed to increase residual liver lobe volume so that posthepatectomy liver insufficiency associated with major hepatic resection can be prevented. Although it is essential to evaluate functional liver capacity after portal branch embolization. the timing of hepatectomy from this viewpoint remains unelucidated. The aim of this study was to clarify the optimal timing of hepatectomy after portal branch embolization. We evaluated the functional capacity of the liver after portal branch ligation (PBL) in rats, and studied the correlation between morphological and functional changes. Morphological changes were evaluated on the basis of the liver lobe weight ratio, and the proliferating cell nuclear antigen labeling index. Functional changes were evaluated by the indocyanine green disappearance rate and serum aminopyrine clearance as functional capacity. Although the total liver weight ratio remained unchanged after PBL, the unembolized lobe ratio increased significantly. Although functional capacity was minimal 2 days after PBL, it had recovered to the preoperative value by 8 days after PBL. The functional capacity of the liver after PBL was minimal around the cellular proliferative period but recovered thereafter. These findings suggest that major hepatectomy after portal branch embolization should be perfomed following the cellular proliferative period of the unembolized lobe.

Animals↗

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review.

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland-Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Activities of Daily Living↗

Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity.

Forty-one patients suffering subarachnoid hemorrhage (SAH) of unknown etiology were re-investigated at an average of 91 months after the bleed to determine functional capacity. Nineteen patients were performing at their previous level of work, five were employed part-time, and four could not work due to the SAH. Five patients showed a moderate disability in activities of daily living but were not dependent on help, one patient was severely disabled, and two had died. There was one rebleed. Early prognosis of an unfavorable outcome was possible on the basis of three clinical variables on admission: a history of hypertension, a Hunt and Hess grade of greater than II, and the presence of focal neurological deficits. In addition, the presence of an organic mental syndrome at discharge was identified as a predictive factor for reduced functional capacity later on. Other clinical variables in the acute stage, including sex, age, history of headache, interval between SAH and admission, impaired consciousness, and cognitive deficits, were not related to a limited functional level. Residual neurological deficits and the Glasgow Outcome Scale score on discharge were also not predictive of restrictions in global functions evaluated by means of the Karnofsky Performance Scale status at follow-up review.

Activities of Daily Living↗

The acute effects of in-patient physiotherapy program on functional capacity in type II diabetes mellitus.

PURPOSE: This study was planned to evaluate the acute effects of a short-term in-patient physiotherapy program on functional capacity in hospitalised type II diabetic patients. METHODS: Forty four hospitalised type II diabetic patients in continuing medical care at Dokuz Eylül University Hospital were included in this study. Twenty three of the 44 patients were randomised to an exercise rehabilitation group and 21 to a control group. Patients in the exercise group were assigned to an average 12.0+/-2.4 days low-intensity exercise rehabilitation program during hospitalisation. The control group did not receive any exercise advice. Before and after the exercise rehabilitation program all patients' functional capacity was evaluated by the 6 min walking test. RESULTS: There were no significant differences in the main measured parameters among groups and in the 6 min walking test at baseline. At the end of the rehabilitation program, the resting heart rate (HR) decreased by 4.1% (P<0.05) in the exercise group by and 2.1% in control group. Resting systolic (SBP) and diastolic blood pressure (DBP) decreased (6.2 and 2.6%) significantly in the exercise group but there were no significant changes in the control group (0.9 and 0.7%). The distance walked in the 6 min test increased significantly more in the exercise group than in the control group ( 18.0% versus 10.2%; P<0.05). Estimated VO2 max also increased more (28.6% versus 3.5%, P<0.05). Moreover, the exercise group described the 6 min walk test as easier than before exercise rehabilitation. The Borg scale did not change in the control group. CONCLUSION: Supervised in-patient exercise rehabilitation is a safe and effective intervention in type II diabetic patients, which reduces physical impairment and improves functional ability.

Blood Pressure↗

Effects of stress resulting from short-term restraint on in vitro functional capacity of leukocytes obtained from pigs.

OBJECTIVE: To investigate whether the procedure used to snare and restrain pigs during collection of blood samples would alter in vitro functional capacity of leukocytes in the samples. ANIMALS: 8 gilts. PROCEDURE: Catheters were surgically inserted into the jugular vein of gilts to enable blood sample collection without restraint. After collection of a control sample, gilts were restrained by use of a snare and samples were collected at 0.5, 3.5, and 6.5 minutes after start of restraint (0 minutes). At each time point, plasma beta-endorphin and cortisol concentrations as well as WBC counts were recorded, and functional capacity of leukocytes in cultures of whole blood was assessed by means of mitogen-induced proliferation and interleukin-2 activity, virus-induced interferon-alpha concentration, and phagocytosis of zymosan particles. RESULTS: Concentrations of plasma beta-endorphin and cortisol were increased at 3.5 and 6.5 minutes after start of restraint. At these times, virus-induced interferon-alpha concentration was decreased, whereas proliferative response to Concanavalin A and phytohemagglutinin increased in samples collected at 6.5 minutes. CONCLUSION AND CLINICAL RELEVANCE: It was possible to snare pigs for the purpose of collecting blood samples and restrain them without causing excessive stress that would affect immunologic variables, provided that the collection procedure was completed within a few minutes.

Animals↗